Integrated Business Statistics Program (IBSP)

Reporting Guide

This guide is designed to assist you as you complete the 2015 Annual Retail Trade Survey. If you need more information, please call the Statistics Canada Help Line at the number below.

Help Line: 1-800-858-7921

Table of contents

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Reporting instructions
Business activity
Reporting period information
Revenue
Expenses
Industry characteristics
Sales by type of client
Distribution of operating revenue by method of sale
E-commerce
Appendix 1 - Gasoline service station guide
Appendix 2 - Beer, wine and liquor chains

Text begins

Reporting instructions

1. Please report all dollar amounts in thousands of Canadian dollars ('000 CAN$).

2. Do not include sales tax.

3. Percentages should be rounded to whole numbers

4. When precise figures are not available, please provide your best estimates.

Business activity

The description on file for this business comes from the North American Industrial Classifications System (NAICS). This database contains a limited number of activity classifications. The classifications on file might be applicable for this business or organization, even if it is not exactly how you would describe this business or organization’s main activity.

By selecting "Yes, this is the main activity.", you indicate that the description is applicable, and it describes the main economic activity which typically generates the most revenue for this business or organization.

By selecting "No, this is secondary activity." you indicate that the description is applicable, but that there is a different economic activity which typically generates more revenue for this business or organization. You will be given a chance to describe this business or organization’s main activity, and select an appropriate classification.

By selecting "No, this description is not applicable." you indicate that this description is not applicable as a main or a secondary activity of this business or organization. You will be given a chance to describe this business or organization’s main activity, and provide an appropriate classification.

If you answer “no”, indicating that your business unit is not a store retailer as defined above, then please call 1-800-858-7921 for further instructions.

Reporting period information

Here are twelve common fiscal periods that fall within the targeted dates:

• May 1, 2014 to April 30, 2015
• June 1, 2014 to May 31, 2015
• July 1, 2014 to June 30, 2015
• August 1, 2014 to July 31, 2015
• September 1, 2014 to August 31, 2015
• October 1, 2014 to September 30, 2015
• November 1, 2014 to October 31, 2015
• December 1, 2014 to November 30, 2015
• January 1, 2015 to December 31, 2015
• February 1, 2015 to January 31, 2016
• March 1, 2015 to February 28, 2016
• April 1, 2015 to March 31, 2016

Here are other examples of fiscal periods that fall within the required dates:

• September 18, 2014 to September 15, 2015 (e.g., floating year-end)
• June 1, 2015 to December 31, 2015 (e.g., a newly opened business)

Revenue

1. Sales of goods and services (e.g., fees, admissions, services revenue)

Sales of products and services are defined as amounts derived from the sale of products and services (cash or credit), falling within a business’s ordinary activities. Sales should be reported net of trade discount, value added tax and other taxes based on sales.

Include: Sales from Canadian locations (domestic and export sales); Transfers to other business units or a head office of your firm.
Exclude: Transfers into inventory and consignment sales; Federal, provincial and territorial sales taxes and excise duties and taxes; intracompany sales in consolidated financial statements.

2. Rental and leasing

Include: Rental or leasing of apartments, commercial buildings, land, office space, residential housing, investments in co-tenancies and co-ownerships, hotel or motel rooms, long and short term vehicle leasing, machinery or equipment, storage lockers, etc.

3. Commissions

Include: Commissions earned on the sale of products or services by businesses such as advertising agencies, brokers, insurance agents, lottery ticket sales, sales representatives, and travel agencies – (Compensation could also be reported under this item (for example, compensation for collecting sales tax)).

4. Subsidies (including grants, donations and fundraising)

Include: Non-repayable grants, contributions and subsidies from all levels of government; Revenue from private sector (corporate and individual) sponsorships, donations and fundraising.

5. Royalties, rights, licensing and franchise fees

A royalty is defined as a payment received by the holder of a copyright, trademark or patent.

Include: Revenue received from the sale or use of all intellectual property rights of copyrighted materials such as musical, literary, artistic or dramatic works, sound recordings or the broadcasting of communication signals.

6. Dividends

Include: Dividend income; Dividends from Canadian sources; Dividends from foreign sources; Patronage dividends.
Exclude: Equity income from investments in subsidiaries or affiliates.

7. Interest

Include: Investment revenue; Interest from foreign sources; Interest from Canadian bonds and debentures; Interest from Canadian mortgage loans; Interest from other Canadian sources.
Exclude: Equity income from investments in subsidiaries or affiliates.

8. Other revenue (please specify)

Include: Amounts not included in questions (1) to (7)

9. Total revenue

The sum of questions (1) to (8).

Expenses

1. Cost of goods sold

Many business units distinguish their costs of materials from their other business expenses (selling, general and administrative). This item is included to allow you to easily record your costs/expenses according to your normal accounting practices.

Include: Cost of raw materials and/or goods purchased for re-sale – net of discounts earned on purchases; Freight in and duty.

2. Employment costs and expenses

1. Salaries, wages and commissions

Please report all salaries and wages (including taxable allowances and employment commissions as defined on the T4 – Statement of Remuneration Paid) before deductions for this reporting period.

Include: Vacation pay; Bonuses (including profit sharing); Employee commissions; Taxable allowances (e.g., room and board, vehicle allowances, gifts such as airline tickets for holidays); Severance pay.
Exclude: All payments and expenses associated with casual labour and outside contract workers (report these amounts at question 3 - Subcontracts).

2. Employee benefits

Include contributions to: Health plans; Insurance plans; Employment insurance; Pension plans; Workers’ compensation; Association dues; Contributions to any other employee benefits such as child care and supplementary unemployment  benefit (SUB) plans; Contributions to provincial and territorial health and education payroll taxes.

3. Subcontracts

Subcontract expense refers to the purchasing of services from outside of the company rather than providing them in-house.

Include: Hired casual labour and outside contract workers; Custom work and contract work; Subcontract and outside labour; Hired labour.

4. Research and development fees

Expenses from activities conducted with the intention of making a discovery that could either lead to the development of new products or procedures, or to the improvement of existing products or procedures.

5. Professional and business fees 

Include: Legal services; Accounting and auditing fees; Consulting fees; Education and training fees; Appraisal fees; Management and administration fees; Property management fees; Information technology (IT) consulting and service fees (purchased); Architectural fees; Engineering fees; Scientific and technical service fees; Other consulting fees (management, technical and scientific); Veterinary fees; Fees for human health services; Payroll preparation fees; All other professional and business service fees.
Exclude: Service fees paid to Head Office (report at question 21 - All other costs and expenses).

6. Utilities 

Utility expenses related to operating your business unit such as water, electricity, gas, heating and hydro.

Include: Diesel, wood, natural gas, oil and propane; Sewage. 
Exclude: Energy expenses covered in your rental and leasing contracts; Telephone, Internet and other telecommunications (report this amount at question 8 - Telephone, Internet and other telecommunication expenses); Vehicle fuel (report at question 21 - All other costs and expenses).

7. Office and computer related expenses

Include: Office stationery and supplies, paper and other supplies for photocopiers, printers and fax machines; Postage and courier (used in the day to day office business activity); Diskettes and computer upgrade expenses; Data processing.
Exclude: Telephone, Internet and other telecommunication expenses (report this amount at question 8 - Telephone, Internet and other telecommunication expenses).

8. Telephone, Internet and other telecommunications

Include: Internet; Telephone and telecommunications; Cellular telephone; Fax machine; Pager.

9. Business taxes, licenses and permits

Include: Property taxes paid directly and property transfer taxes; Vehicle license fees; Beverage taxes and business taxes; Trade license fees; Membership fees and professional license fees; Provincial capital tax.

10. Royalties, franchise fees and memberships

Include: Amounts paid to holders of patents, copyrights, performing rights and trademarks; Gross overriding royalty expenses and direct royalty costs; Resident and non-resident royalty expenses; Franchise fees.
Exclude: Crown royalties

11. Crown charges

Federal or Provincial royalty, tax, lease or rental payments made in relation to the acquisition, development or ownership of Canadian resource properties.  

Include: Crown royalties; Crown leases and rentals; Oil sand leases; Stumpage fees.

12. Rental and leasing

Include: Lease rental expenses, real estate rental expenses, condominium fees and equipment rental expenses; Motor vehicle rental and leasing expenses; Studio lighting and scaffolding; Machinery and equipment rental expenses; Storage expenses; Road and construction equipment rental; Fuel and other utility costs covered in your rental and leasing contracts.

13. Repair and maintenance

Include: Buildings and structures; Machinery and equipment; Security equipment; Vehicles; Costs related to materials, parts and external labour associated with these expenses; Janitorial and cleaning services and garbage removal.

14. Amortization and depreciation

Include: Direct cost depreciation of tangible assets and amortization of leasehold improvements; Amortization of intangible assets (e.g., amortization of goodwill, patents, franchises, copyrights, trademarks, deferred charges, organizational costs).

15. Insurance

Insurance recovery income should be deducted from insurance expenses.

Include: Professional and other liability insurance; Motor vehicle and property insurance; Executive life insurance; Bonding, business interruption insurance and fire insurance.

16. Advertising, marketing, promotion, meals and entertainment

Include: Newspaper advertising and media expenses; Catalogues, presentations and displays; Tickets for theatre, concerts and sporting events for business promotion; Fundraising expenses; Meals, entertainment and hospitality purchases for clients.

17. Travel, meetings and conventions

Include: Travel expenses; Meeting and convention expenses, seminars; Passenger transportation (e.g., airfare, bus, train, etc.); Accommodations; Travel allowance and meals while travelling; Other travel expenses.

18. Financial services 

Include: Explicit service charges for financial services; Credit and debit card commissions and charges; Collection expenses and transfer fees; Registrar and transfer agent fees; Security and exchange commission fees; Other financial service fees.
Exclude: Interest expenses (report at question 19 - Interest expense).

19. Interest expense

Report the cost of servicing your company’s debt.

Include: Interest; Bank charges; Finance charges; Interest payments on capital leases; Amortization of bond discounts; Interest on short-term and long-term debt, mortgages, bonds and debentures.

20. Other non-production-related costs and expenses

Include: Charitable donations and political contributions; Bad Debt expense; Loan losses; Provisions for loan losses (minus Bad debt recoveries); Inventory adjustments

21. All other costs and expenses (including intracompany expenses)

Include:
Production costs; Pipeline operations, drilling, site restoration; Gross overriding royalty; Other producing property rentals; Well operating, fuel and equipment; Other lease rentals; Other direct costs; Equipment hire and operation; Log yard expense, forestry costs, logging road costs; Freight in and duty; Overhead expenses allocated to costs of sales; Other expenses; Cash over/short (negative expense); Reimbursement of parent company expense; Warranty expense; Recruiting expenses; General and administrative expenses; Interdivisional expenses; Interfund transfer (minus expense recoveries); Exploration and Development (including prospect/geological, well abandonment & dry holes, exploration expenses, development expenses); Amounts not included in questions 1 to 20 above.

22. Total expenses

The sum of lines 1 to 21

Industry Characteristics

All revenue reported should exclude sales taxes (GST/HST, PST and TVQ) and be net of returns, discounts, sales allowances, and charges for outward transportation by common or contract carriers. Do not deduct the value of trade-ins.

1. Sales of all goods purchased for resale, net of returns and discounts

Include:

• Excise taxes (such as those on gasoline, liquor, and tobacco) and other taxes that are levied on the manufacturer/importer and included in the cost of products purchased by this business unit;
• Sales of all goods purchased for resale; please report gross sales of new and used goods less returns and discounts;
• Parts used in generating repair and maintenance revenue; report the labour portion of repair and maintenance at question 3.

Do not deduct the value of trade-ins.

Exclude:

• Taxes collected directly from customers and paid directly by this operating unit to provincial and federal tax agencies;
• Sales and revenue from concessions.

2. Sales of goods manufactured as a secondary activity by this retailing business unit

Report revenue from sales of goods of own manufacture.

3. Labour revenue from repair and maintenance

Include:

• Labour revenue from installations, warranty and repair work;
• Parts used in generating installation, repair and maintenance revenue are to be included at question 1.

4. Revenue from rental and leasing of goods and equipment

Include:

• Video/computer game rental;
• Rug shampoo equipment rental;
• Tool rental.

5. Revenue from rental of real estate

Include:

• Revenue received from renting out or leasing property owned by this business unit.

Sales by type of client

This section is designed to measure which sector of the economy purchases your services.
Please provide a percentage breakdown of your sales by type of client.
Please ensure that the sum of percentages reported in this section equals 100%.

1. Clients in Canada

a. Individuals and households
Please report the percentage of sales to individuals and households who do not represent the business or government sector.

b. Businesses
Percentage of sales sold to the business sector should be reported here.
Include:
• Sales to Crown corporations.

c. Governments, not-for-profit organizations and public institutions (e.g., hospitals, schools)
Percentage of sales to federal, provincial, territorial and municipal governments should be reported here.
Include:
• Sales to hospitals, schools, universities and public utilities.

2. Clients outside Canada

Please report the percentage of total sales to customers or clients located outside Canada including foreign businesses, foreign individuals, foreign institutions and/or governments.
Include:
• Sales to foreign subsidiaries and affiliates.

Distribution of operating revenue by method of sale

1. In-store sales

Please report total operating revenue of goods and services which are purchased in a fixed point-of-sale location accessible to the public.

Include: sales at pumps for gasoline stations.

2. E-commerce

Please report total operating revenue of goods and services conducted over the Internet with or without online payment.

Include: all revenue where the order is received and the commitment to purchase is made via the Internet, although payment can be made by other means, orders made in web pages, extranet, mobile devices or Electronic Data Interchange (EDI).

Exclude: orders made by telephone calls, facsimile or e-mail.

3. Catalogue and mail-order or telephone

Please report total operating revenue of goods and services generated from customer ordering their goods from catalogues and mail order flyers.

Include: sales purchased via telephone and fax.

4. All other methods

Please report total operating revenue of goods and services generated from all other methods.

Include: sales at trade shows, special events, in-home sales and card lock.

E-commerce

Mobile app

Include sales through any app, or application, that is downloaded and designed to run on a handheld device such as a smartphone or tablet (for example, places where a user may download these apps include Apple’s App Store, Google Play or Blackberry App World).

Company website

Include sales through a browser-based website where your organization maintains control of the content.

Third-party website

Include sales through a browser-based website where a third-party maintains the structure of the website and control of the look and feel while your company only provides the product to be sold (for example, Amazon, Expedia, Etsy).

Electronic Data Interchange (EDI)

A standard format for exchanging business data. EDI is based on the use of message standards, ensuring that all participants use a common language.

APPENDIX 1 - GASOLINE SERVICE STATION GUIDE

I - Independent retail dealer

An independent retail dealer purchases gasoline for resale from a supplier (e.g., an oil refinery or wholesaler), i.e., owns the inventories.

An independent dealership is a typical retail operation and should report all data as requested on the questionnaire.

A franchisee is usually an independent retail dealer.

Reporting instructions:

Section - Revenue

Exclude:

• provincial sales taxes (PST and TVQ);
• goods and services tax (GST) or harmonized sales tax (HST).

Include:

• excise taxes;
• revenue from repairs, rentals, car washes and other services.

II - Retail commissioned agent

A retail commissioned agent sells petroleum products on consignment and does not own the inventory of gasoline; may also purchase and carry inventories of other merchandise for resale.

A retail commissioned agent also receives a commission or flat fee from supplier of products sold on consignment.

Reporting instructions:

Section - Revenue

Please report only the commissions or fees received for consignment sales, plus excise taxes, and total sales of other merchandise not on consignment, as well as revenue from repairs, rentals, car washes and other services.

Exclude:

• provincial sales taxes (PST and TVQ);
• goods and services tax (GST), or harmonized sales tax (HST).

Section - Expenses, questions 1 a), b), c) and d) (Cost of goods sold)

Exclude:

• inventories and purchases of goods held on consignment.

Include:

• all other merchandise, preferably valued at cost price.

Section - Expenses, questions 2 a) and b) (Employment costs and expenses)

Report as requested on questionnaire.

III - Lessee

For purposes of the survey, a lessee can be either an independent dealer or a retail commissioned agent.

If a lessee purchases gasoline for resale, i.e., he owns the inventories, he should report as an independent dealer.

If a lessee sells gasoline on consignment, i.e., he does not own the inventories, he should report as a retail commissioned agent.

IV - Oil refinery or other wholesale supplier

An oil-producing company, refinery or other wholesale supplier involved in gasoline retailing through:

a) company owned-and-operated gasoline service stations;
or
b) retail commissioned agents or lessees who sell company-owned gasoline on consignment.

Reporting instructions:

Report for each location, depending upon its type, i.e.:

a) company-owned;
or
b) retail commissioned agent or lessee.

Section - Revenue

a) Company owned-and-operated stations

Include:

• total retail sales of petroleum products;
• sales of all other merchandise;
• receipts from repairs, rentals, car washes and other services;
• excise taxes.

Exclude:

• provincial sales taxes (PST and TVQ);
• goods and services tax (GST) or harmonized sales tax (HST).

b) Retail commissioned agents or lessees who sell on consignment

Include:

• only the value of retail sales of petroleum products sold on consignment, including excise taxes.

Exclude:

• commissions or fees paid to agents or lessees;
• provincial sales taxes (PST and TVQ);
• goods and services tax (GST) or harmonized sales tax (HST).

Section - Expenses, questions 1 a), b), c) and d) (Cost of goods sold)

Report total inventories of petroleum products held at retail locations (both company owned-and-operated and retail commissioned agents or lessees), as well as at any other locations where the inventories are segregated pending sale on consignment or through company owned-and-operated outlets.

Inventories should be reported at transfer or wholesale value.

For company owned-and-operated stations, inventories of other merchandise held for resale (e.g., food, auto parts, etc.) should also be reported.

Section - Expenses, question 1 b) (Purchases)

Report the transfer or wholesale value of all petroleum products sold on consignment or through company owned-and-operated stations.

Purchases of other merchandise sold through company owned-and-operated outlets should also be included, at cost of goods sold.

Section - Expenses, questions 2 a) and b) (Employment costs and expenses)

Report for all employees of company owned-and-operated stations, plus a portion of the administrative salaries (overhead) applicable to both the company owned-and-operated outlets as well as to the stations operated by retail commissioned agent or lessees who sell on consignment.

Important

If none of the above categories applies to your service station business, please enclose a note with your questionnaire.

APPENDIX 2 - BEER, WINE AND LIQUOR CHAINS

The information in this appendix applies, if and only if, your company is requested to complete the Monthly Survey on Sales and Inventory of Alcoholic Beverages.

If you are not sure whether your company receives the Monthly Survey on Sales and Inventory of Alcoholic Beverages, please call us at 1 800 858 7921 for clarification.

If you are primarily a retailer of beer, wine and/or liquor and your company also receives the Monthly Survey on Sales and Inventory of Alcoholic Beverages, you are requested to complete the entire questionnaire for both your retail and wholesale trade operations.

The definition of store retailers is included in ‘Business activity’ section. Your retail stores should be reported in the section ‘Details on this business’s locations’ of the questionnaire with NAICS code 445310 - Beer, Wine and Liquor Stores.

Your wholesale distribution centers (i.e., distribution outlets that are not retail stores and that sell directly to commercial accounts) should be reported in the section ‘Details on this business’s locations’ of the questionnaire with NAICS code 413220 - Alcoholic Beverage Wholesaler-Distributors.

It is expected that the total operating revenue that you report on this questionnaire will be similar to the total sales, excluding taxes that have been reported for the relevant months on the Survey on Sales and Inventory of Alcoholic Beverages. If there is a substantial difference and you have not provided an explanation in the Comments section, it is likely that Statistics Canada will telephone you in an attempt to understand the reasons for the differences.

2014 to 2015
Clinic Questionnaire

Explanatory notes for this document
Respondent Verification Component
Respondent Verification (RVB)
Name Spelling Confirmation (NSC)
Sex Confirmation (SXC)
Confirmation of Birth Date (DDN)
Language Confirmation (LNG)
Consent Component
Consent (CON)
Report (REP)
Urgent Condition (URG)
Electronic Address (EA)
Urine Collection 1 Component (UC1)
Screening Component
Screening Component Introduction (SCI)
Adherence to Guidelines (ATG)
Physical and Health Conditions (PHC)
Hearing Restriction (HER)
Spirometry Questions (SPQ)
Spirometry Restriction (SPR)
Medications and Product Confirmation (MEDC)
Medication use for Clinic (MEUC)
Confirm Drug Product (CDP)
New Product Information (NPI)
New Product Information – Call block (NPC)
Other Reason for Screening Out (ORS)
Water Analysis Questions Component (WAQ)
Fish and Shellfish Consumption Component
Fish and Shellfish Consumption (FSF)
Detail Fish and Shellfish (DFS)
Noise Exposure Component
Noise Exposure Component Introduction (HCI)
Hearing Ability (HAB)
Noise Exposure (NEX)
Activity Detail (ACD)
Sun Exposure Component (SEB)
Skin Pigmentation Component
Skin Pigmentation Component Introduction (SKI)
Skin Pigmentation Measurement (SKM)
Skin Pigmentation Recording (SKR)
Anthropometric Component
Anthropometric Component Introduction (ACI)
Height and Weight Measurements (HWM)
Blood Pressure Component
Blood Pressure Measurement (BPM)
Blood Pressure Recording (BPR)
Activity Monitor Component (AM)
Indoor Air Sampler Component
Indoor Air Sampler (IAS)
Indoor Air Questions (IAQ)
Spirometry Measurement Component (SPM)
Hearing Component
Otoscopy Measurement (OTM)
Tympanometry Measurement (TYM)
Otoacoustic Emissions Measurement (OAE)
Audiometry Measurement (AUD)
Grip Strength Component
Grip Strength Component Introduction (GSI)
Grip Strength Measurement (GSM)
Phlebotomy Component
Phlebotomy Component Introduction (PHI)
Blood Collection (BDC)
Urine Collection 2 Component (UC2)
Report of Measurements Component (RM)
Exit Component
Exit Component Introduction (ECI)
Exit Consent Questions (ECQ)
Contact (CONT)
Clinic Sign-Out Component (CSO)
Appendix 1
Date Block (APP1)
Address (AD)
Get Contact Name (GCN)
North American Telephone (NATP)
Overseas Telephone (OSTP)

Explanatory notes for this document

1. Question text in bold font is read to the respondent. Text in normal font is not read to the respondent. Instructions to the person asking the questions or taking the measures are prefaced by the word "Instruction", and are not read aloud.
2. Question text in bold font enclosed by brackets () is read to the respondent at the discretion of the person asking the questions.
3. In this text, the use of the masculine is generic and applies to both men and women. Please note that during the actual clinic visit, the questions were personalized to be appropriate to the gender of the respondent.
4. Question text enclosed in square brackets [ ] is dynamic and in most cases will vary depending on the particular circumstances. The symbol ^ indicates that dynamic substitution will take place.
5. In this document, the flow direction from a given response is not provided when it is to the next immediate question.
6. For more detailed information on physical measures protocols, please contact Statistics Canada's National Contact Centre (toll-free 1-800-263-1136; 613-951-8116; infostats@statcan.gc.ca).

Respondent Verification Component

Respondent Verification (RVB)

RVB_BEG

External variables required:

Variables taken from sample file:

• STAND: name of the city/town/village in which the clinic has been set up
• CLINICID: 8 digit respondent identifier
• AWC_AGE: age of respondent
• AWC_YOB: year of birth of respondent
• AWC_MOB: month of birth of respondent
• AWC_DOB: day of birth of respondent
• RespondentName: name of respondent

Variables assigned in Variable Creation:

• CurrentYear: numeric year during which clinic visit is taking place
• CurrentMonth: numeric month during which clinic visit is taking place
• CurrentDay: numeric day during which clinic visit is taking place
• SessionE: English text of when the clinic visit is taking place
• ShortRespName: first 4 letters of LNAME plus first 3 letters of FNAME
• IntLangE: English text of language of application during the household interview (either English or French)
• GenderE: English text for sex of respondent
• SCS_N12: visit type (3= clinic visit; 4= home visit)

RVB_C11

• If SCS_N12 = 4, go to RVB_END.
• Otherwise, go to RVB_N11.

RVB_N11

Instruction: Press <1> to print the Participant's personal information form.

• 1 Print the form
• (DK, RF not allowed)

RVB_D11

Programmer:

• IF SCS_N12 = 4 THEN
  • RVB_D11 = EMPTY
• ELSE
  • IF RVB_N11 = 1 and RVB_D11 = EMPTY,
  • Set RVB_D11 = Current Time (in HH:MM:SS format).
• ENDIF

RVB_R11
Here is the first of several forms we will be asking you to complete. Please read it carefully and provide the information requested.

Instruction: Provide the respondent with the English/French double-sided Participant’s personal information form.

When the respondent returns the form, check to ensure that all requested information has been filled in and is legible.

• Press <1> to continue.

RVB_N12

Instruction: Press <1> to print the label with the respondent's CLINICID as a bar code identifier.

• Stick the first label onto a bracelet
• Attach the bracelet around the wrist of the respondent.

• 1 Print the label
• (DK, RF not allowed)

RVB_END

Name Spelling Confirmation (NSC)

NSC_BEG

External variables required:

Variables taken from sample file:

• STAND: name of the city/town/village in which the clinic has been set up
• CLINICID: 8 digit respondent identifier
• FNAME: first name of respondent
• LNAME: last name of respondent
• AWC_AGE: age of respondent

Variables assigned in Variable Creation:

• CurrentYear: numeric year during which clinic visit is taking place
• CurrentMonth: numeric month during which clinic visit is taking place
• CurrentDay: numeric day during which clinic visit is taking place
• SesscionE: English text of when the clinic visit is taking place
• RespondentName: name of respondent
• GenderE: English text for sex of respondent

NSC_C11

• If RespondentName = "EMPTY", go to NSC_N13.
• Otherwise, go to NSC_N11.

NSC_N11

Instruction: Record whether ^RespondentName's name is spelled correctly.

1. Yes (Go to NSC_D15)
2. No (DK, RF not allowed)

NSC_N12

Instruction: Record whether corrections are to be made to:

1. ...the first name only?
2. ...the last name only? (Go to NSC_N14)
3. ...both names?
   (DK, RF not allowed)

NSC_N13

Instruction: Enter the first name only.

• (25 spaces)
• (DK, RF not allowed)

NSC_C14

• If NSC_N12 = 1 (first name only), go to NSC_D15.
• Otherwise, go to NSC_N14.

NSC_N14

• Instruction: Enter the last name only.
• (25 spaces)
• (DK, RF not allowed)

NSC_D15

Programmer:

• IF NSC_N11 = 1 THEN
  • Set RespondentFirstName = FNAME
  • Set RespondentLastName = LNAME
  • Set RespondentName = FNAME + LNAME
    (separated by one space)
• ELSE IF NSC_N12 = 1 THEN
  • Set RespondentFirstName = NSC_N13
  • Set RespondentLastName = LNAME
  • Set RespondentName = NSC_N13 + LNAME
    (separated by one space)
• ELSE IF NSC_N12 = 2 THEN
  • Set RespondentFirstName = FNAME
  • Set RespondentLastName = NSC_N14
  • Set RespondentName = FNAME + NSC_N14
    (separated by one space)
• ELSE
  • Set RespondentFirstName = NSC_N13
  • Set RespondentLastName = NSC_N14
  • Set RespondentName = NSC_N13 + NSC_N14
    (separated by one space)
• ENDIF

NSC_END

Sex Confirmation (SXC)

SXC_BEG

External variables required:

Variables taken from sample file:

• STAND: name of the city/town/village in which the clinic has been set up
• CLINICID: 8 digit respondent identifier
• AWC_AGE: age of respondent
• SEX_Q01: sex of respondent

Variables assigned in Variable Creation:

• CurrentYear: numeric year during which clinic visit is taking place
• CurrentMonth: numeric month during which clinic visit is taking place
• CurrentDay: numeric day during which clinic visit is taking place
• SessionE: English text of when the clinic visit is taking place
• GenderE: English text for sex of respondent

Variables from previously completed blocks:

• RespondentName: name of respondent

SXC_C11

• If SEX_Q01 = EMPTY, go to SXC_N12.
• Otherwise, go to SXC_N11.

SXC_N11

Instruction: Record whether ^RespondentName's sex is correct.

1. Yes (Go to SXC_D13)
2. No (DK, RF not allowed)

SXC_N12

Instruction: Record ^RespondentName's sex.

1. Male
2. Female
   (DK, RF not allowed)

SXC_D13

Programmer:

• IF SXC_N11 = 1, THEN
  • IF SEX_Q01 = 1 THEN
    • CON_SEX = 1
    • GenderE = "Male"
  • ELSE
    • CON_SEX = 2
    • GenderE = "Female"
  • ENDIF
• ELSE
  • IF SXC_N12 = 1 THEN
    • CON_SEX = 1
    • GenderE = "Male"
  • ELSE
    • CON_SEX = 2
    • GenderE = "Female"
  • ENDIF
• ENDIF

SXC_END

Confirmation of Birth Date (DDN)

DDN_BEG

External variables required:

Variables taken from sample file:

• STAND: name of the city/town/village in which the clinic has been set up
• CLINICID: 8 digit respondent identifier
• AWC_DOB: day of birth of respondent
• AWC_MOB: month of birth of respondent
• AWC_YOB: year of birth of respondent
• AWC_AGE: age of respondent

Variables assigned in Variable Creation:

• CurrentYear: numeric year during which clinic visit is taking place
• CurrentMonth: numeric month during which clinic visit is taking place
• CurrentDay: numeric day during which clinic visit is taking place
• SessionE: English text of when the clinic visit is taking place
• ShortRespName: respondent short name

Variables from previously completed blocks:

• RespondentName: name of respondent
• GenderE: English text for sex of respondent
• CON_SEX: sex of respondent

Programmer:

• "Feedback" data represents information collected during the household interview (e.g., "Feedback date of birth" represents the date of birth provided by the respondent during the household interview).

DDN_C1

• If AWC_DOB, AWC_MOB or AWC_YOB is blank, DK or RF, or AWC_AGE is blank, go to DDN_B2.
• Otherwise, go to DDN_D1.

DDN_D1

• If AWC_MOB = 1, DT_MONTHOFBIRTHE = "January".
• If AWC_MOB = 2, DT_MONTHOFBIRTHE = "February".
• If AWC_MOB = 3, DT_MONTHOFBIRTHE = "March".
• If AWC_MOB = 4, DT_MONTHOFBIRTHE = "April".
• If AWC_MOB = 5, DT_MONTHOFBIRTHE = "May".
• If AWC_MOB = 6, DT_MONTHOFBIRTHE = "June".
• If AWC_MOB = 7, DT_MONTHOFBIRTHE = "July".
• If AWC_MOB = 8, DT_MONTHOFBIRTHE = "August".
• If AWC_MOB = 9, DT_MONTHOFBIRTHE = "September".
• If AWC_MOB = 10, DT_MONTHOFBIRTHE = "October".
• If AWC_MOB = 11, DT_MONTHOFBIRTHE = "November".
• If AWC_MOB = 12, DT_MONTHOFBIRTHE = "December".

DDN_N1

Instruction: Record whether ^RespondentName's date of birth is ^MonthOfBirthE ^AWC_DOB, ^AWC_YOB.

• 1 Yes (Go to DDN_D4)
• 2 No (DK, RF not allowed)

Content type - Note to data users:

• If the DOB is confirmed at DDN_N1, then the DOB values are entered into the DOB fields at DDN_B2 and age is calculated.

DDN_B2

Instruction: Record ^RespondentName's date of birth.

• Call the Date block. See Appendix I.

Content type - Note to data users:

• If Month of birth or Year of birth is not known or refused, respondent is flowed to DDN_N4 where he/she is asked his/her age.
• If Day of birth is not known or refused AND the current month is the same as the month of birth, then respondent is flowed to DDN_N4 where he/she is asked his/her age.
• If entered DOB is not different from the feedback DOB, then go to DDN_N4.
• Mulitple edits assure that the respondent is not less than 3 years of age or greater than 80 years of age.

DDN_Q3
I would like to confirm that your age is ^CalculatedAge.

Instruction: Date of birth is ^MonthOfBirthE ^DDN_B2.DATD, ^DDN_B2.DATY.

1. Yes (Go to DDN_E4)
2. No, return and correct date of birth (Go to DDN_B2)
3. No, collect age
   (DK, RF not allowed)

Programmer:

IF ^CalculatedAge < 3 or ^CalculatedAge > 80 display ^CalculatedAge in red font.

• IF DDN_B2.DATM = 1, THEN
  • MonthOfBirthE = "January"
• ELSE IF DDN_B2.DATM = 2, THEN
  • MonthOfBirthE = "February"
• ELSE IF DDN_B2.DATM = 3, THEN
  • MonthOfBirthE = "March"
• ELSE IF DDN_B2.DATM = 4, THEN
  • MonthOfBirthE = "April"
• ELSE IF DDN_B2.DATM = 5, THEN
  • MonthOfBirthE = "May"
• ELSE IF DDN_B2.DATM = 6, THEN
  • MonthOfBirthE = "June"
• ELSE IF DDN_B2.DATM = 7, THEN
  • MonthOfBirthE = "July"
• ELSE IF DDN_B2.DATM = 8, THEN
  • MonthOfBirthE = "August"
• ELSE IF DDN_B2.DATM = 9, THEN
  • MonthOfBirthE = "September"
• ELSE IF DDN_B2.DATM = 10, THEN
  • MonthOfBirthE = "October"
• ELSE IF DDN_B2.DATM = 11, THEN
  • MonthOfBirthE = "November"
• ELSE IF DDN_B2.DATM = 12, THEN
  • MonthOfBirthE = "December"
• ENDIF

Calculate the age using the entered date of birth, and pre-fill the question text with the result.

DDN_N4

Instruction: Record ^RespondentName's age.

• Age in years
• (MIN: 1)
• (MAX: 85)
• (DK, RF not allowed)

DDN_D4

Content type - Note to data users:

• The respondent's age in years (CON_AGE) and age in days (AGE_DAYS) are calculated using date of birth.

Programmer:

• IF DDN_N1 = 1 THEN
  • CON_DDN = AWC_MOB + AWC_DOB + AWC_YOB
  • CON_AGE = CalculatedAge
• ELSE IF DDN_B2.DATD = RESPONSE AND DDN_B2.DATM = RESPONSE AND DDN_B2.DATY = RESPONSE THEN
  • CON_DDN = DDN_B2.DATM + DDN_B2.DATD + DDN_B2.DATY
• ENDIF
• IF DDN_Q3 = 1 THEN
  • CON_AGE = CalculatedAge
• ELSE IF DDN_N4 = RESPONSE THEN
  • CON_AGE = DDN_N4
• ENDIF
• IF CON_DDN = RESPONSE THEN
  • AGE_DAYS = Age in days based on CON_DDN
• ELSE IF DDN_B2.DATM = RESPONSE AND DDN_B2.DATY = RESPONSE THEN
  • AGE_DAYS = Age in days based on DDN_B2.DATY + DDN_B2.DATM + 15
• ELSE
  • AGE_DAYS = EMPTY
• ENDIF

DDN_D6

Content type - Note to data users:

• The respondent's required minimum urine sample volume(DDN_D6) is calculated based on respondent age and randomly set sampling flags.

Programmer:

• IF CON_AGE <6 THEN
  • IF (BPAFLG = 1 or TRICFLG =1 or ARSCFLG = 1 or ORGPFLG = 1 or PARAFLG = 1) THEN
    • IF (BENZFLG = 1 or  PAHFLG = 1) THEN
      • DDN_D6 = 40.0 ml
    • ELSE
      • DDN_D6 = 30.0 ml
    • ENDIF
  • ELSE
    • IF (BENZFLG = 1 or  PAHFLG = 1) THEN
      • DDN_D6 = 30.0 ml
    • ELSE
      • DDN_D6 = 20.0 ml
    • ENDIF
  • ENDIF
• ELSE
  • IF (BPAFLG = 1 or TRICFLG =1 or ARSCFLG = 1 or ORGPFLG = 1 or PARAFLG = 1) THEN
    • IF (BENZFLG = 1 or  PAHFLG = 1) THEN
      • DDN_D6 = 50.0 ml
    • ELSE
      • DDN_D6 = 40.0 ml
    • ENDIF
  • ELSE
    • IF (BENZFLG = 1 or  PAHFLG = 1) THEN
      • DDN_D6 = 40.0 ml
    • ELSE
      • DDN_D6 = 30.0 ml
    • ENDIF
  • ENDIF
• ENDIF

DDN_N6

Instruction: Press <1> to print the labels with the respondent's short name.

• First label: Stick it onto the respondent's file folder.
• Second label: Staple it to the inside of the respondent's file folder.
• Third label: Stick it onto a urine sample container.

DO NOT give the container to the respondent until the Urine component has been generated (after CONSENT).

• 1 Print the labels
• (DK, RF not allowed)

DDN_END

Language Confirmation (LNG)

LNG_BEG

External variables required:

Variables taken from sample file:

• STAND: name of the city/town/village in which the clinic has been set up
• CLINICID: 8 digit respondent identifier

Variables assigned in Variable Creation:

• CurrentYear: numeric year during which clinic visit is taking place
• CurrentMonth: numeric month during which clinic visit is taking place
• CurrentDay: numeric day during which clinic visit is taking place
• SessionE: English text of when the clinic visit is taking place

Variables from previously completed blocks:

• RespondentName: name of respondent
• GenderE: English text for sex of respondent
• CON_AGE: age of respondent

LNG_N11

Instruction: Record ^RESPONDENTNAME's preferred official language.

• 1 English
• 2 French
• (DK, RF not allowed)

LNG_END
If necessary, change the application language to correspond to the response to LNG_N11.

Consent Component

Consent (CON)

CON_BEG

External variables required:

Variables taken from sample file:

• STAND: name of the city/town/village in which the clinic has been set up
• CLINICID: 8 digit respondent identifier
• STOREBLD: flag for whether storage is available for blood and urine samples
• STOREDNA: flag for whether storage is available for DNA samples

Variables assigned in Variable Creation:

• CurrentYear: numeric year during which clinic visit is taking place
• CurrentMonth: numeric month during which clinic visit is taking place
• CurrentDay: numeric day during which clinic visit is taking place
• DryRun: whether the case is a dry run case (1/2= dryrun; 3= survey respondent)
• SessionE: English text of when the clinic visit is taking place

Variables from previously completed blocks:

• RespondentFirstName: first name of respondent
• RespondentName: name of respondent
• GenderE: English text for sex of respondent
• CON_AGE: age of respondent
• LNG_N11: respondent's preferred official language
• SCS_N12: visit type (3= clinic visit; 4= home visit)

CON_C01

• If SCS_N12 = 4, go to CON_D01.
• Otherwise, go to CON_N01.

CON_N01

Instruction: Press <1> to print the Consent form(s).

• 1 Print the form(s)
• (DK, RF not allowed)

CON_D01

• If CON_AGE < 14, DT_CONINST1E = "the parent or guardian".
• Otherwise, DT_CONINST1E = "the respondent".
• If CON_AGE < 14, DT_CONINST3E = "^RespondentFirstName's".
• Otherwise, DT_CONINST3E = "his/her".

CON_Q11
Before we start the clinic tests, we need to ensure you have reviewed the Information and Consent Booklet that was given to you during the interview at your home. Did you have a chance to read that booklet?

Instruction: Show the respondent the Information and Consent Booklet.

• 1 Yes
• 2 No
• (DK, RF not allowed)

CON_D11

Programmer:

• IF SCS_N12 = 4 THEN
  • CON_D11 = EMPTY
• ELSE
  • IF CON_Q11 = RESPONSE and CON_D11 = EMPTY,
    • Set CON_D11 = Current Time (in HH:MM:SS format)
• ENDIF

CON_C12

• If CON_Q11 = 2, go to CON_R13.
• Otherwise, go to CON_R12

CON_R12
Do you have any questions about any of the information in the booklet or about the clinic portion of the survey?

Instruction: Answer any questions as thoroughly as possible.

• Press <1> to continue.
• Go to CON_R14

CON_R13
Here is a copy of the Information and Consent Booklet. Please take a few minutes to read through it. If you have any questions about the information in the booklet or the clinic tests, I can answer them for you.

Instruction: Hand the Information and Consent Booklet to the respondent and give him/her time to read through it (approximately 5 minutes).

• Press <1> to continue.

CON_R14
Here is the Consent form for participation in the clinic portion of the survey. Please read the form carefully and check either the "Yes" or "No" box for each item.

Instruction: Provide [the parent or guardian/the respondent] with the Consent form.

• Check to ensure that it has been completed correctly.
• Sign the form as the witness.
• Press <1> to continue.

CON_R15
I am now going to enter that information into our computer system. I may have some additional questions about your responses.

Instruction: Press <1> to continue.

CON_C15

• If CON_AGE > 13, go to CON_D16.
• Otherwise, go to CON_N15.

CON_N15

Instruction: Record whether a parent or guardian has consented to the respondent participating in the physical measure tests.

• 1 Yes
• 2 No
• (DK, RF not allowed)

Content type - Note to data users:

• If CON_N15 = 2, the clinic visit will not continue for that respondent.

CON_C16

• If CON_AGE < 6, go to CON_N21.
• Otherwise, go to CON_R16.

CON_R16
Your parent or guardian has said you can take part in the tests today. If you would like to participate we need you to write or print your name on this form.

Instruction: Provide the child with the Assent form.

• Check to ensure that it has been completed correctly.
• Sign the form as the witness.
• Press <1> to continue.

CON_D16

• If CON_AGE > 13, DT_CON16E = "consented".
• Otherwise, DT_CON16E = "assented".

CON_N16

Instruction: Record whether the respondent has [consented/assented] to participating in the physical measure tests.

• 1 Yes
• 2 No
• (DK, RF not allowed)

Content type - Note to data users:

• If CON_N16 = 2, the clinic visit will not continue for that respondent.

CON_N21

Instruction: Record whether [the parent or guardian/the respondent] has consented to receiving reports of [^RespondentFirstName's /his/her] test results.

• 1 Yes
• 2 No
• (DK, RF not allowed)

CON_D23

• If CON_AGE > 13, DT_CON4E = "your".
• Otherwise, DT_CON4E = "^RespondentFirstName's".

• If CON_AGE < 14, DT_CONREPE = "contaminants that might require".
• Otherwise, DT_CONREPE = "diseases and contaminants that might require".

• If CON_AGE < 14, DT_CONREP2E = "contaminants".
• Otherwise, DT_CONREP2E = "diseases and contaminants".

CON_N23

Instruction: Record whether [the parent or guardian/the respondent] has consented to allowing Statistics Canada to test [RespondentFirstName's/ his/her] blood and urine for ^DT_CONREPE mandatory reporting in his/her province of residence, and to contact him/her as well as the appropriate provincial authorities if the results are positive.

• 1 Yes
• 2 No
• (DK, RF not allowed)

CON_C23B

• If CON_N21 = 1 or CON_N23 = 2, go to CON_C23C.
• Otherwise, go to CON_R23.

CON_R23
You have indicated on the Consent form that you do not want to receive reports of [your/RespondentFirstName’s] test results. However, you have agreed that Statistics Canada can test [your/RespondentFirstName’s] blood and urine for reportable [diseases and contaminants that might require/contaminants]. I just want you to be aware that, by agreeing to have these tests done, you will receive the results if they are positive.

Instruction: Answer any questions as thoroughly as possible.

• Press <1> to continue.

CON_C23C

• If DRYRUN in (1,2), go to CON_END.
• Otherwise, go to CON_C24A.

CON_C24A

• If STOREBLD = 2, go to CON_C26.
• Otherwise, go to CON_C24B.

CON_C24B

• If CON_AGE > 13, go to CON_N25.
• Otherwise, go to CON_N24.

CON_N24

Instruction: Record whether a parent or guardian has consented to storage of the respondent's blood and urine for use in future health studies.

• 1 Yes
• 2 No
• (DK, RF not allowed)

Go to CON_END

CON_N25

Instruction: Record whether the respondent has agreed to storage of blood and urine for use in future health studies.

• 1 Yes
• 2 No
• (DK, RF not allowed)

CON_C26

• If CON_AGE < 14 or STOREDNA = 2, go to CON_END.
• Otherwise, go to CON_N26.

CON_N26

Instruction: Record whether the respondent has agreed to storage of DNA for use in future health studies.

• 1 Yes
• 2 No
• (DK, RF not allowed)

CON_END

Report (REP)

REP_BEG

External variables required:

Variables taken from sample file:

• STAND: name of the city/town/village in which the clinic has been set up
• CLINICID: 8 digit respondent identifier
• ERESFLG: Flag indicating if Electronic results is offered to respondents (1 = YES; 2 = NO)

Variables assigned in Variable Creation:

• CurrentYear: numeric year during which clinic visit is taking place
• CurrentMonth: numeric month during which clinic visit is taking place
• CurrentDay: numeric day during which clinic visit is taking place
• SessionE: English text of when the clinic visit is taking place
• MailAddress: mailing address of respondent

Variables from previously completed blocks:

• RespondentFirstName: first name of respondent
• RespondentName: first and last name of respondent
• GenderE: English text for sex of respondent
• CON_AGE: age of respondent
• LNG_N11: respondent's preferred official language
• CON_N15: yes/no indicator of whether a parent or guardian has consented to the respondent participating in the physical measure tests
• CON_N16: yes/no indicator of whether the respondent has consented to participating in the physical measure tests
• CON_N21: yes/no indicator of whether the respondent/parent/guardian has consented to receiving the test results

REP_C11A

• If CON_N15 = 2 or CON_N16 = 2, go to REP_END.
• Otherwise, go to REP_C11B.

REP_C11B

• If CON_N21 = 2, go to REP_C13.
• Otherwise, go to REP_D11.

REP_D11

• If CON_AGE < 14 and CON_SEX = 1, DT_VOSE = "his".
• If CON_AGE < 14 and CON_SEX = 2, DT_VOSE = "her".
• Otherwise, DT_VOSE = "your".

REP_R11
Today, at the end of the clinic visit, you will receive [RespondentFirstName’s/your ] Report of physical measurements containing the results that are immediately available. We will send the final report of [his/her/your ]^DT_VOSE remaining test results in 6 to 7 months.

Instruction: Press <1> to continue.

REP_C13

• If CON_AGE > 13, go to REP_C14.
• Otherwise, go to REP_N13.

REP_N13

Instruction: Record the name of the person who signed the Consent form.

• Enter the person's first and last name.
• (80 spaces)
• (DK, RF not allowed)

REP_C14

• If CON_N21 = 2, go to REP_C21.
• Otherwise, go to REP_C16.

REP_C16

• If ERESFLG=1, go to REP_Q16.
• Otherwise, go to REP_Q20.

Programmer:

• For CHMS cycle 4, the ERESFLG flag will always be set to 2 (electronic results will not be offered).

REP_Q20
We can send you the results by regular mail or by courier. Can we send you the final report by regular mail?

1. Yes (Go to REP_C21)
2. No
   (DK, RF not allowed)

REP_R21
We will send you the final report of test results by courier.

Instruction: Press <1> to continue.

REP_C21

• If no mailing address exists (i.e., the street and city fields are empty), go to REP_B22.
• Otherwise, go to REP_Q21.

REP_Q21
I would like to confirm your mailing address. Is it:
^MailAddress

• 1 Yes
• 2 No
• (DK, RF not allowed)

Programmer:

• If "Yes" is selected, copy the values from the displayed address into the respective REP_B22 address fields and go to REP_END.
• If "No" is selected, copy the values from the displayed address into the respective REP_B22 address fields and allow changes to the displayed address.

REP_B22

• Call the Address block. See Appendix I

Programmer:

• Pass the following parameters:
• DV_QTEXT_E = "What is your mailing address?"
• LISTINGADFLAG = 2 (No)
• NONCANADFLAG = 1 (Yes)

REP_END

Urgent Condition (URG)

URG_BEG

External variables required:

Variables taken from sample file:

• STAND: name of the city/town/village in which the clinic has been set up
• CLINICID: 8 digit respondent identifier
• TelephoneNumber1: First telephone number of the respondent
• TelephoneNumber2: Second telephone number of the respondent
• EMAILADDRESS: E-mail address of respondent or of parent/guardian (if less than 14 years old)

Variables assigned in Variable Creation:

• CurrentYear: numeric year during which clinic visit is taking place
• CurrentMonth: numeric month during which clinic visit is taking place
• CurrentDay: numeric day during which clinic visit is taking place
• SessionE: English text of when the clinic visit is taking place

Variables from previously completed blocks:

• RespondentFirstName: first name of respondent
• RespondentName: first and last name of respondent
• GenderE: English text for sex of respondent
• CON_AGE: age of respondent
• LNG_N11: respondent's preferred official language
• CON_N15: whether a parent or guardian has consented to the respondent participating in the physical measure tests
• CON_N16: whether the respondent has consented to participating in the physical measure tests

URG_C04

• If CON_N15 = 2 or CON_N16 = 2, go to URG_END.
• Otherwise, go to URG_C05.

URG_C05

• If TelephoneNumber1 = EMPTY and TelephoneNumber2 = EMPTY, go to URG_D10.
• Otherwise, go to URG_R06.

URG_R06
I would like to confirm the telephone numbers we have on file.

Instruction: Press <1> to continue.

URG_Q07
Is ^TelephoneNumber1 correct?

• 1 Yes (Go to URG_C08)
• 2 No (DK, RF not allowed)

Programmer:

• If "Yes" is selected, copy the values from the displayed telephone number into the respective URG_B07 phone number fields and go to URG_C08.

URG_B07

• Call the North American Telephone (NATP) block. See Appendix I.

Programmer:

• Pass the following parameters:
• DV_QTEXT_E = "What is the correct phone number?"
• ASKEXT = 2 (No).

URG_C08

• If TelephoneNumber2 = EMPTY, go to URG_D10.
• Otherwise, go to URG_Q09.

URG_Q09
Is ^TelephoneNumber2 correct?

• 1 Yes (Go to URG_C11)
• 2 No
• (DK, RF not allowed)

Programmer:

• If "Yes" is selected, copy the values from the displayed telephone number into the respective URG_B09 phone number fields and go to URG_C11.

URG_B09

• Call the North American Telephone (NATP) block. See Appendix I.

Programmer:

• Pass the following parameters:
• DV_QTEXT_E = "What is the correct phone number?"
• ASKEXT = 2 (No).

URG_C09

• If 1=1, go to URG_C11.
• Otherwise, go to URG_C11.

URG_D10

• If TelephoneNumber1 = EMPTY and TelephoneNumber2 = EMPTY, DT_URG10_TEXTE = "a".
• Otherwise, DT_URG10_TEXTE = "another".

URG_Q10
Is there [a/another] phone number that can be used to reach you?

• 1 Yes
• 2 No (Go to URG_C11)
  DK, RF (Go to URG_C11)

URG_B11
Call the North American Telephone (NATP) block. See Appendix I.

Programmer:

• Pass "What is it?" as parameter.

URG_C11

• If EMAILADDRESS = DK, RF or EMPTY, go to URG_Q11.
• Otherwise, go to URG_B12.

URG_Q11
Can you provide us with an e-mail address?

• 1 Yes
• 2 No (Go to URG_N13)
  DK, RF (Go to URG_N13)

URG_B12

• Call the Electronic Address block (EA)

Programmer:

• SPECRESPNAME = RespondentFirstName
• If CON_SEX = 1 then PROXYSEX = 1.
• If CON_SEX = 2 then PROXYSEX = 2.

URG_N13

Instruction: Is the respondent in a wheelchair?

• 1 Yes
• 2 No
  (DK, RF not allowed)

URG_C14

• If URG_N13 = 1, go to URG_Q14.
• Otherwise, go to URG_D20.

URG_Q14
The laboratories that analyse the urine samples require that these samples are provided without the use of a catheter. For this reason, we need to know if you use a catheter.

Instruction: Record if the respondent is using a catheter.

• 1 Yes
• 2 No
  DK, RF

URG_D20

Content type - Note to data users:

PROXYSEX is the gender of selected respondent and whether the interview is being conducted by proxy. PROXYSEX is set here as follows:

• 1 = male, non-proxy
• 2 = female, non-proxy
• 3 = male, proxy
• 4 = female, proxy

Programmer:

• IF CON_AGE > 11 THEN
  • IF CON_SEX = 1 THEN
    • PROXYSEX = 1
  • ELSE
    • PROXYSEX = 2
  • ENDIF
• ELSE
  • IF CON_SEX = 1 THEN
    • PROXYSEX = 3
  • ELSE
    • PROXYSEX = 4
  • ENDIF
• ENDIF

URG_END

Electronic Address (EA)

EA_BEG
Call block

External variables required:

Variables taken from sample file:

• EMAILADDRESS: specific respondent’s e-mail address (as provided in a previous interview or survey)

Variables from previously completed blocks

• SPECRESPFNAME: first name of selected respondent
• PROXYSEX: gender of selected respondent and whether the interview is being conducted by proxy
  • 1 = male, non-proxy
  • 2 = female, non-proxy
  • 3 = male, proxy
  • 4 = female, proxy

EA_C01

• If EMAILADDRESS = DK, RF or EMPTY, go to EA_Q02.
• Otherwise, go to EA_D01A.

EA_D01A

• Not Applicable

EA_D01B

• Not Applicable

EA_Q01
I would like to confirm your e-mail address.
Is it ^EMAILADDRESS?

Instruction: Read the e-mail address character by character.

1. Yes
2. No
   DK, RF (Go to EA_END)

Programmer:

• Pre-fill the question text with the appropriate respondent name and e-mail address.

EA_D02

Programmer:

• If EA_Q01 = 1, set EA_Q02 = ^EMAILADDRESS

EA_C02

• If EA_Q01 = 1 (Yes), go to EA_END.
• Otherwise, go to EA_Q02.

EA_Q02
What is your e-mail address?

Instruction: Ask about upper and lower case, special characters, etc.

• (80 spaces)
• DK, RF (Go to EA_END)

Help text:

• Email address must follow the format:  name@domain.type

  Name may contain only the following: letters (upper or lower case, no accents), numbers, or ! ' & . - + * $ % ^ _(no blank spaces)

  Domain may contain only:
  (a) sequences of 1-3 numbers with a period (.) between them (e.g. 123.53.233) OR
  (b) sequences of letters (upper or lower case, no accents) or numbers with a period (.) between each sequence; each sequence must contain at least one letter (e.g. statcan.gc)
  Optionally, domain may begin with the character [

  Type may contain only:
  (a) 1-3 numbers OR
  (b) 2-4 letters (e.g. com, org, net, ca)
  Optionally, type may end with the character ]

Programmer:

• Any lower case text characters typed into the field should NOT be converted to upper case text characters after <Enter> is pressed.

EA_Q03
I would like to confirm the e-mail address.
Is it ^EA_Q02?

Instruction: Read the e-mail address character by character.

1. Yes (Go to EA_END)
2. No
   DK, RF (Go to EA_END)

EA_END

Urine Collection 1 Component (UC1)

UC1_BEG

External variables required:

Variables taken from sample file:

• STAND: name of the city/town/village in which the clinic has been set up
• CLINICID: 8 digit respondent identifier

Variables assigned in Variable Creation:

• CurrentYear: numeric year during which clinic visit is taking place
• CurrentMonth: numeric month during which clinic visit is taking place
• CurrentDay: numeric day during which clinic visit is taking place
• SessionE: English text of when the clinic visit is taking place

Variables from previously completed blocks:

• RespondentName: name of respondent
• RespondentFirstName: first name of respondent
• GenderE: English text for sex of respondent
• CON_AGE: age of respondent
• SCS_N12: Visit type (3= clinic visit; 4= home visit)

UC1_D10A

• If CON_AGE < 6, DT_UC110E = "^RespondentFirstName".
• Otherwise, DT_UC110E = "you".

UC1_Q10
Now we would like [^RespondentFirstName/you] to provide a urine sample.

Instruction: Press <1> to continue

• 1 Continue
• (DK is not allowed)
• RF
• Go to UC1_D10B

UC1_D10B

Programmer:

• IF SCS_N12 = 4 THEN
  • UC1_D10B = EMPTY
• ELSE
  • IF (UC1_Q10 = 1 or RF) and UC1_D10B = EMPTY,
    • Set UC1_D10B = Current Time (in HH:MM:SS format)
• ENDIF

UC1_C20A

• If UC1_Q10 = RF, go to UC1_END.
• Otherwise, go to UC1_C20B.

UC1_C20B

• If CON_AGE < 6, go to UC1_R21.
• Otherwise, go to UC1_R20.

UC1_R20
Please use this container to collect the urine sample.

• You will need to remove the lid and place it on the shelf in the washroom with the inside facing up.
• Do not touch the inside of the container.
• Fill the container as full as possible and put the lid back on tightly.
• Once you are finished, please rinse and dry the exterior of the container. Wash your hands, place the container in the paper bag provided and bring it back to me.

Instruction: Demonstrate how to remove the lid using the example container and ensure the respondent understands what is meant by placing the lid on the shelf "with the inside facing up".

• Answer any questions as thoroughly as possible.
• Press <1> to continue.

UC1_C21

• If CON_AGE > 5, go to UC1_C30.
• Otherwise, go to UC1_R21.

UC1_R21
To collect urine samples from young children, we are using a special urine collection device that rests under the toilet seat.

• You will need to lift the toilet seat and install the collection device.
• Ensure it fits snugly in the front of the toilet with the edges resting over the lip of the bowl.
• Lower the toilet seat.

Instruction: Show the example urine collection device to the respondent's parent or guardian and demonstrate which end is the front.

• Instruct the parent or guardian to use the washroom in the reception area (the collection device does not fit the toilet in the second washroom).
• Answer any questions as thoroughly as possible.
• Press <1> to continue.

UC1_R22
To collect the urine, ensure ^RespondentFirstName is sitting on the toilet seat in such a way that the urine stream is collected in the device.

Try to collect as much urine as possible and avoid touching the inside of the collection device.

Instruction: Press <1> to continue.

UC1_R23
Once ^RespondentFirstName no longer requires your assistance:

• Remove the lid of the container and place it on the shelf in the washroom with the inside facing up.
• Over the toilet, pour the urine from the collection device into the container using the 'spout'.
• Fill the container as full as possible and put the lid back on tightly.
• Discard the collection device in the washroom garbage.
• Please rinse and dry the exterior of the container. Wash your hands, place the container in the paper bag provided and bring it back to me.

Instruction: Show the parent or guardian the spout used for pouring the urine.

Demonstrate how to remove the lid and pour the urine using the example container.

Ensure the parent or guardian understands what is meant by placing the lid on the shelf "with the inside facing up".

• Answer any questions as thoroughly as possible.
• Press <1> to continue.

UC1_C30

• If SCS_N12 = 4, go to UC1_N40.
• Otherwise, go to UC1_R30.

UC1_R30
In case you forget any of the collection procedures, there are step by step instructions posted in the washroom.

Instruction: Press <1> to continue.

UC1_N40

Instruction: Record whether the respondent provided a urine sample.

• 1 Yes
• 2 No (Go to UC1_N70)
• (DK, RF not allowed)

UC1_C42

• If SCS_N12 = 4, go to UC1_N42B.
• Otherwise, go to UC1_D42A.

UC1_N42B

Instruction: Enter the urine collection time (Please use a HH:MM format followed by "AM" or "PM").

• (MIN: 1)
• (MAX: 13)
• (DK, RF not allowed)

UC1_D42A

Programmer:

• IF SCS_N12 = 4,
  • Set UC1_D42A = UC1_N42B
• ELSE
  • IF UC1_N40 = 1 and UC1_D42A = EMPTY,
    • Set UC1_D42A = Current Time (in HH:MM:SS format)
• ENDIF

UC1_D42B

Programmer:

• Set UC1_D42B = current date

UC1_Q43
In order to complete an accurate analysis of the sample provided, we would like to know how long ago [^RespondentFirstName/you] urinated prior to providing this sample.

Instruction: Read categories to respondent.

1. Less than 1 hour ago
2. 1 to 2 hours ago
3. More than 2 hours ago
   DK
   (RF is not allowed)

UC1_N50

Instruction: The required urine volume can be found on the urine container label.

Did the respondent provide a urine sample of sufficient volume?

• 1 Yes (Go to UC1_END)
• 2 No (DK, RF not allowed)

UC1_R60
We did not obtain enough urine for the lab to run all the desired tests. I will prepare another urine container so that a second sample can be collected before the end of the clinic visit.

Instruction: Prepare a second urine container using the label stapled to the inside of the respondent's file folder.

• Using a Sharpie, write the number 2 in the upper right hand corner of the label.
• Provide the paper bag containing the second labelled urine container to the respondent.
• Press <1> to continue.
• Go to UC1_END

UC1_N70

Instruction: Record the reason why the respondent did not provide a urine sample.

• 1 Refusal
• 2 Unable to provide
• 3 Other - Specify (Go to UC1_S70)
• (DK, RF not allowed)
• Go to UC1_END

UC1_S70

• (Record the reason why the respondent did not provide a urine sample.)
• Instruction: Specify the reason.
• (80 spaces)
• (DK, RF not allowed)

UC1_END

Screening Component

Screening Component Introduction (SCI)

SCI_BEG

External variables required:

Variables taken from sample file:

• STAND: name of the city/town/village in which the clinic has been set up
• CLINICID: 8 digit respondent identifier

Variables assigned in Variable Creation:

• CurrentYear: numeric year during which clinic visit is taking place
• CurrentMonth: numeric month during which clinic visit is taking place
• CurrentDay: numeric day during which clinic visit is taking place
• SessionE: English text of when the clinic visit is taking place

Variables from previously completed blocks:

• RespondentName: name of respondent
• GenderE: English text for sex of respondent
• CON_AGE: age of respondent
• SCS_N12: Visit Type (3= clinic visit; 4= home visit)

SCI_D1A

• If CON_AGE < 14, DT_SCITEXTE = "Your parent or guardian may need to help you answer some of these questions".
• Otherwise, DT_SCITEXTE = "EMPTY".

SCI_R1
The following questions are asked to ensure that you are given all the tests for which you are eligible. Some questions may have been asked during the home interview, but we need to ensure that our information is up-to-date. We also need to know if any changes have occurred since the home interview.It is important to note that some medications and physical conditions may exclude you from certain tests.

Please answer to the best of your knowledge, as accurate information about you is important. [Your parent or guardian may need to help you answer some of these questions/EMPTY].

Instruction: Press <1> to continue.

SCI_D1B

Programmer:

• IF SCS_N12 = 4 THEN
  • SCI_D1B = EMPTY
• ELSE
  • IF SCI_R1 = 1 and SCI_D1B = EMPTY,
    • Set SCI_D1B = Current Time (in HH:MM:SS format)
• ENDIF

SCI_END

Adherence to Guidelines (ATG)

ATG_BEG

External variables required:

Variables taken from sample file:

• STAND: name of the city/town/village in which the clinic has been set up
• CLINICID: 8 digit respondent identifier
• SELFAST: whether selected to fast for 12 hours (1=fasting, 2=non-fasting)

Variables assigned in Variable Creation:

• CurrentYear: numeric year during which clinic visit is taking place
• CurrentMonth: numeric month during which clinic visit is taking place
• CurrentDay: numeric day during which clinic visit is taking place
• SessionE: English text of when the clinic visit is taking place

Variables from previously completed blocks:

• RespondentName: name of respondent
• GenderE: English text for sex of respondent
• CON_AGE: age of respondent
• SCS_N12: visit type (3= clinic visit; 4= home visit)

ATG_R11
At the time of the home interview, you were given a set of pre-testing guidelines. We will now review those guidelines.

Instruction: Press <1> to continue.

ATG_Q11
When did you last eat or drink anything other than water (e.g., coffee, tea, alcohol, juice or flavoured water)?

Instruction: Probe to determine what and how much the respondent ate or drank.

Enter the time (followed by "AM" or "PM") at which the respondent last ate or drank something that does not meet the phlebotomy fasting requirements.

• (MIN: 1.00)
• (MAX: 12.59)
• (DK, RF not allowed)

Help text: The respondent is still considered fasted if the following have been consumed within the indicated time-frame:

• Black coffee - up until the time of the appointment
• Coffee with milk/cream - up to 2 hours prior to the appointment
• Juice - up to 2 hours prior to the appointment
• Gum and candy are allowed - up until the time of the appointment

The respondent is not considered fasted if the following have been consumed within the past 10 hours.

• Liquids other than those indicated above, including
  • Milkshakes
  • Protein shakes
  • Meal replacements
  • Milk
  • Energy drinks
  • Any other beverages or supplements
• Any food

ATG_N11

Instruction: Confirm the date.

• 1 Yesterday
• 2 Today
• (DK, RF not allowed)

ATG_D11

• If ATG_N11 = 1, DT_ATGN11E = "yesterday".
• ELSE, DT_ATGN11E = "today".

ATG_C11

• If SCS_N12 = 3, go to ATG_D12.
• Otherwise, go to ATG_N12.

ATG_N12

Instruction: Enter the time (followed by "AM" or "PM") the fasting question (ATG_Q11) was asked to the respondent.

• (MIN: 1.00)
• (MAX: 12.59)
• (DK, RF not allowed)

ATG_D12

Content type - Note to data users:

• Fasting status (10 hr) is determined based on the fasting flag (SELFAST) and the responses to ATG_Q11 and ATG_N11 (if clinic visit) along with ATG_N12 (if home visit). ATG_D12=1 (fasted) and ATG_D12=2 (not fasted).

Programmer:

• IF SCS_N12 = 3 THEN
• IF SELFAST = 2 THEN
  • ATG_D12 = 2
• ELSE
  • IF ATG_N11 = 1 and the difference between CurrentDate-1/ATG_Q11 and CurrentDate/CurrentTime is 10 hours or more OR
    • ATG_N11 = 2 and difference between CurrentDate/ATG_Q11 and CurrentDate/CurrentTime is 10 hours or more THEN
    • ATG_D12 = 1
• ELSE
  • ATG_D12 = 2
• ENDIF
• ENDIF
• ELSE
  • IF SCS_N12 = 4 THEN
  • IF SELFAST = 2 THEN
    • ATG_D12 = 2
• ELSE
  • IF ATG_N11 = 1 and the difference between CurrentDate-1/ATG_Q11 and CurrentDate/ATG_N12 is 10 hours or more OR
    • ATG_N11 = 2 and difference between CurrentDate/ATG_Q11 and CurrentDate/ATG_N12 is 10 hours or more THEN
    • ATG_D12 = 1
• ELSE
  • ATG_D12 = 2
• ENDIF
• ENDIF
• ENDIF

ATG_C14A

• If CON_AGE < 6, go to ATG_Q41.
• Otherwise, go to ATG_C21.

ATG_C21

• If CON_AGE < 12, go to ATG_Q22.
• Otherwise, go to ATG_Q21.

ATG_Q21
Have you smoked cigarettes or used other tobacco or nicotine products during the past 2 hours?

• 1 Yes
• 2 No
• (DK, RF not allowed)

ATG_Q22
Have you consumed any caffeinated products (e.g., coffee, pop, energy drinks, tea or chocolate) during the past 2 hours?

• 1 Yes
• 2 No
• (DK, RF not allowed)

ATG_C31

• If CON_AGE < 12, go to ATG_Q41.
• Otherwise, go to ATG_Q31.

ATG_Q31
Have you consumed any alcohol during the past 6 hours?

• 1 Yes
• 2 No
• (DK, RF not allowed)

ATG_Q41
Have you exercised today for at least ten minutes at a time (e.g., running, moderate or vigorous walking, swimming, weight training)?

• 1 Yes
• 2 No (Go to ATG_Q50)
• (DK, RF not allowed)

ATG_Q43
How long has it been since you last exercised?

• 1 1 to less than 30 minutes ago
• 2 30 minutes to less than 1 hour ago
• 3 1 hour to less than 2 hours ago
• 4 More than 2 hours ago
• (DK, RF not allowed)

ATG_Q50
Have you listened to loud music today?

Instruction: Loud music is defined as:

A) A volume above 50% of the maximum volume level for a given audio device; or

B) Volume levels that prevent you from understanding someone speaking in a normal voice an arm's length away.

• 1 Yes
• 2 No
• (DK, RF not allowed)

ATG_Q51
In the past 24 hours, have you been exposed to loud noise without hearing protection? Examples of loud noise include power tools, farm machinery, guns, motorcycle riding at highway speed or any activity where you had to speak in a raised voice to be heard or communicate.

Instruction: A raised voice is defined as volume of speech between a normal voice and shouting.

• 1 Yes
• 2 No
• (DK, RF not allowed)

ATG_END

Physical and Health Conditions (PHC)

PHC_BEG

External variables required:

Variables taken from sample file:

• STAND: name of the city/town/village in which the clinic has been set up
• CLINICID: 8 digit respondent identifier
• PHCFLAG: whether or not the menstrual period questions need to be asked

Variables assigned in Variable Creation:

• CurrentYear: numeric year during which clinic visit is taking place
• CurrentMonth: numeric month during which clinic visit is taking place
• CurrentDay: numeric day during which clinic visit is taking place
• SessionE: English text of when the clinic visit is taking place
• Date2MonthsAgoE: the date two months ago in English
• TwoMonthsAgoDay: the day of the date two months ago
• TwoMonthsAgoMonth: the month of the date two months ago
• TwoMonthsAgoYear: the year of the date two months ago

Variables from previously completed blocks:

• RespondentName: name of respondent
• GenderE: English text for sex of respondent
• CON_SEX: sex of respondent
• CON_AGE: age of respondent

PHC_R11
I am now going to ask you about your current health and physical condition.

Instruction: Press <1> to continue.

PHC_C11A

• If CON_SEX = 1, go to PHC_Q41.
• Otherwise, go to PHC_C11B.

PHC_C11B

• If CON_AGE < 14 or > 59, go to PHC_C13A.
• Otherwise, go to PHC_Q11.

PHC_Q11
Are you currently pregnant?

• 1 Yes (Go to PHC_Q12)
• 2 No
• DK
• (RF is not allowed)

Go to PHC_C13A

PHC_Q12
In what week are you?

• Week
• (MIN: 1)
• (MAX: 45)
• DK, RF

PHC_C13A

• If PHCFLAG = 2, go to PHC_Q41.
• Otherwise, go to PHC_C13B.

Content type - Note to data users:

• For cycle 4 PHCFLAG will always be set to 1 (menstrual cycle questions will be asked).

PHC_C13B

• If (PHC_Q11 = 2 or DK and CON_AGE = 14 to 59) or CON_AGE = 12 or 13, go to PHC_Q13.
• Otherwise, go to PHC_Q41.

PHC_Q13
Have you had a menstrual period in the past 6 months?

• 1 Yes (Go to PHC_Q14)
• 2 No
• DK, RF

Go to PHC_Q41

PHC_Q14
Is your menstrual cycle regular? Here, "regular" is defined as having a menstrual period every 20 to 36 days.

• 1 Yes (Go to PHC_Q15)
• 2 No
• DK, RF

Go to PHC_Q41

PHC_Q15
What is the length of your typical menstrual cycle, that is, from day 1 of the last menstrual period to day 1 of the next?

Instruction: A menstrual cycle represents the number of days between two menstruations. Record the duration of the respondent's typical menstrual cycle in days.

• Days
• (MIN: 1)
• (MAX: 97)
• DK, RF

PHC_B16

• Call the Date block. See Appendix I

Content type - Note to data users:

• Hard edits are in place to ensure that data is not recorded if the respondent does not have regular menstrual periods (20-26 days) or has not had a menstrual period in the past 6 months.

Programmer:

• Pass "When was the first day of your last menstrual period? Instruction: If the respondent is unable to indicate the first day of her last menstrual period but is able to estimate the week in which her last menstrual period occurred, then choose the date as being the Monday of that week." as parameter.

PHC_Q41
Do you have any acute conditions, for example a sprained wrist, flu or other infection? An acute condition develops suddenly and is short-term.

• 1 Yes
• 2 No (Go to PHC_Q43)
• (DK, RF not allowed)

PHC_N41

Instruction: What type(s) of acute condition(s) does the respondent have?

Mark all that apply.

• 1 Bone, joint or muscle problem
• 2 Flu or other infection
• 3 Medical procedure (recovery)
• 4 Other health problem
• 6 Fever
• (DK, RF not allowed)

Go to PHC_N42

PHC_N42

Instruction: From which test(s) should the respondent be excluded because of this condition?

Probe to determine the seriousness of the condition.

Mark all that apply.

• 05 Activity monitor
• 06 Spirometry
• 08 Grip strength
• 12 None
• 14 Hearing
• 15 Skin Pigmentation
• (DK, RF not allowed)

PHC_Q43
Do you have a chronic condition, for example arthritis, heart condition, multiple sclerosis, or colostomy bag that may prevent you from participating in any of the tests today? A chronic condition develops slowly and is long lasting.

Instruction: Show the laminated card with pictures of each test to the respondent.

• 1 Yes
• 2 No (Go to PHC_Q51)
• (DK, RF not allowed)

PHC_N43

Instruction: What type(s) of chronic condition(s) does the respondent have?

Mark all that apply.

1. Bone, joint or muscle problem
2. Cardiovascular condition
3. Respiratory condition
4. Physically impaired
5. Other health problem
6. (DK, RF not allowed)

PHC_N44

Instruction: From which test(s) should the respondent be excluded because of this condition?

Probe to determine the seriousness of the condition.

Mark all that apply.

• 05 Activity monitor
• 06 Spirometry
• 08 Grip strength
• 12 None
• 14 Hearing
• 15 Skin Pigmentation
• (DK, RF not allowed)

PHC_Q51
Do you have a clotting condition such as haemophilia or von Willebrand disease?

• 1 Yes
• 2 No
• (DK, RF not allowed)

PHC_Q52
Have you received chemotherapy in the past four weeks?

• 1 Yes
• 2 No
• (DK, RF not allowed)

PHC_Q53
In the past 2 months, that is, from ^Date2MonthsAgoE to today, did you receive a blood transfusion?

• 1 Yes
• 2 No
• DK, RF

PHC_Q54
In the past 2 months, did you donate blood?

• 1 Yes
• 2 No (Go to PHC_Q56)
• DK, RF (Go to PHC_Q56)

Go to PHC_B55

PHC_B55

• Call the Date block. See Appendix I

Programmer:

• Pass "What was the date when you last donated blood?" as parameter.

PHC_Q56
Have you ever felt dizzy or fainted during a blood draw?

• 1 Yes
• 2 No
• (DK, RF not allowed)

PHC_C57

• If CON_AGE < 19, go to PHC_C57B.
• Otherwise, go to PHC_Q57A.

PHC_Q57A
Have you ever had a mastectomy?

Instruction: A mastectomy involves removal of the breast tissue, the underlying muscle tissue, and lymph nodes of the underarm.

1. Yes
2. No (Go to PHC_Q58)
   (DK, RF not allowed)

PHC_Q57B
On which side?

1. Right
2. Left
3. Both
   (DK, RF not allowed)

PHC_C57B

• If CON_AGE < 6, go to PHC_END.
• Otherwise, go to PHC_Q58.

PHC_Q58
Is your doctor currently prescribing drugs (for example, water pills) for your blood pressure or a heart condition?

1. Yes
2. No (Go to PHC_END)
   (DK, RF not allowed)

PHC_Q59
For which condition(s) are you taking the drugs?

Instruction: Mark all that apply.

• 01 High blood pressure
• 02 Low blood pressure
• 03 Angina
• 04 Previous heart attack
• 05 Aneurysm
• 06 Arrhythmia
• 07 Other heart condition
• 08 Other medical condition
• DK, RF

PHC_C59

• If PHC_Q59 in (7, 8), go to PHC_S59.
• Otherwise, go to PHC_END.

PHC_S59
Instruction: Specify.

• (80 spaces)
• (DK, RF not allowed)

PHC_END

Hearing Restriction (HER)

HER_BEG

External variables required:

Variables taken from sample file:

• STAND: name of the city/town/village in which the clinic has been set up
• CLINICID: 8 digit respondent identifier

Variables assigned in Variable Creation:

• CurrentYear: numeric year during which clinic visit is taking place
• CurrentMonth: numeric month during which clinic visit is taking place
• CurrentDay: numeric day during which clinic visit is taking place
• SessionE: English text of when the clinic visit is taking place

Variables from previously completed blocks:

• RespondentName: name of respondent
• GenderE: English text for sex of respondent
• CON_AGE: age of respondent

HER_R10
The next set of questions concern your hearing health.

Instruction: Press <1> to continue.

HER_Q10
When was the last time you had your hearing tested?

Instruction: A hearing test is conducted to evaluate a person's ability to hear different frequencies of sound, from very high (for example, the highest note on a piano) to very low (for example, the call of an owl). The subject of a hearing test is asked to wear headphones or earphones and then listens to different sounds played in random order. The subject is asked to raise his or her hand or press a button when a sound is played. Depending on surrounding noise levels, a hearing test can be performed in a soundproof booth or in a quiet room.

Read categories to respondent.

1. Less than a year ago
2. 1 to less than 5 years ago
3. 5 to less than 10 years ago
4. 10 or more years ago
5. Never (Go to HER_Q30)
   DK, RF

HER_Q20
Has a health professional ever diagnosed you with a hearing problem?

• 1 Yes
• 2 No
• DK, RF

HER_Q30
Have you had any surgery performed on the inside of your ear in the past three months?

• 1 Yes
• 2 No (Go to HER_Q40)
• (DK, RF not allowed)

HER_Q31
On which ear(s)?

• 1 Right
• 2 Left
• 3 Both
• (DK, RF not allowed)

HER_Q40
Do you currently have an ear infection or pain in your ear(s)?

• 1 Yes
• 2 No (Go to HER_Q50)
• (DK, RF not allowed)

HER_Q41
In which ear(s)?

• 1 Right
• 2 Left
• 3 Both
• (DK, RF not allowed)

HER_Q50
Do you have a cochlear implant?

Instruction: A cochlear implant (bionic ear) is a small, electronic device that is surgically placed (implanted) within the inner ear to help to provide a sense of sound to a person who is profoundly deaf or severely hard-of-hearing.

• 1 Yes
• 2 No (Go to HER_D52)
• (DK, RF not allowed)

HER_Q51
In which ear(s)?

• 1 Right
• 2 Left
• 3 Both
• (DK, RF not allowed)

HER_C52

• If HER_Q51 = 3, go to HER_END.
• Otherwise, go to HER_D52.

HER_D52

• If HER_Q51 = 1, DT_HER52TEXTE = "Do you have a hearing aid for your left ear?".
• If HER_Q51 = 2, DT_HER52TEXTE = "Do you have a hearing aid for your right ear?".
• Otherwise, DT_HER52TEXTE = "Do you have a hearing aid?".

HER_Q52
[Do you have a hearing aid for your left ear?/Do you have a hearing aid for your right ear?/Do you have a hearing aid?]

• 1 Yes
• 2 No (Go to HER_D54)
• (DK, RF not allowed)

HER_C53

• If HER_Q50 = 2, go to HER_Q53.
• Otherwise, go to HER_D54.

HER_Q53
In which ear(s)?

1. Right
2. Left
3. Both
   (DK, RF not allowed)

HER_D54

Programmer:

• IF HER_Q53 = 1,
  • HER_D54 = 1
  • ELSE IF HER_Q53 = 2
    • HER_D54 = 2
  • ELSE IF HER_Q53 = 3
    • HER_D54 = 3
  • ELSE IF (HER_Q51 = 1 AND HER_Q52 = 1)
    • HER_D54 = 2
  • ELSE IF (HER_Q51 = 2 AND HER_Q52 = 1)
    • HER_D54 = 1
• ENDIF

HER_END

Spirometry Questions (SPQ)

SPQ_BEG

External variables required:

Variables taken from sample file:

• STAND: name of the city/town/village in which the clinic has been set up
• CLINICID: 8 digit respondent identifier

Variables assigned in Variable Creation:

• CurrentYear: numeric year during which clinic visit is taking place
• CurrentMonth: numeric month during which clinic visit is taking place
• CurrentDay: numeric day during which clinic visit is taking place
• SessionE: English text of when the clinic visit is taking place

Variables from previously completed blocks:

• RespondentFirstName: first name of respondent
• RespondentName: name of respondent
• GenderE: English text for sex of respondent
• CON_SEX: sex of respondent
• CON_AGE: age of respondent

SPQ_C01

• If CON_AGE < 6, go to SPQ_END.
• Otherwise, go to SPQ_C11.

SPQ_C11

• If CON_AGE > 12, go to SPQ_R21.
• Otherwise, go to SPQ_R11.

SPQ_R11
The next set of questions is related to the health of ^RespondentFirstName's lungs.

Instruction: Ask the questions of the parent or guardian of the respondent.

• Press <1> to continue.

SPQ_Q11
Has your child ever had wheezing or whistling in the chest at any time in the past?

• 1 Yes
• 2 No (Go to SPQ_Q16)
• (DK, RF not allowed)

SPQ_Q12
Has your child had wheezing or whistling in the chest in the last 12 months?

• 1 Yes
• 2 No (Go to SPQ_Q16)
• (DK, RF not allowed)

SPQ_Q13
How many attacks of wheezing has your child had in the last 12 months?

Instruction: Read categories to the parent or guardian of the respondent.

1. 1 to 3 attacks
2. 4 to 12 attacks
3. More than 12 attacks
   (DK, RF not allowed)

SPQ_Q14
In the last 12 months, how often, on average, has your child's sleep been disturbed due to wheezing?

Instruction: Read categories to the parent or guardian of the respondent.

1. Never woken with wheezing
2. Less than one night per week
3. One or more nights per week
   (DK, RF not allowed)

SPQ_Q15
In the last 12 months, has wheezing ever been severe enough to limit your child's speech to only one or two words at a time between breaths?

• 1 Yes
• 2 No
• (DK, RF not allowed)

SPQ_Q16
In the last 12 months, has your child's chest sounded wheezy during or after exercise?

• 1 Yes
• 2 No
• (DK, RF not allowed)

SPQ_Q17
In the last 12 months, has your child had a dry cough at night, apart from a cough associated with a cold or a chest infection?

• 1 Yes
• 2 No
• (DK, RF not allowed)

Go to SPQ_END

SPQ_R21
The next set of questions is related to the health of your lungs.

Instruction: Press <1> to continue.

SPQ_Q21
Do you cough regularly?

• 1 Yes
• 2 No
• (DK, RF not allowed)

SPQ_Q22
Do you cough up phlegm regularly?

• 1 Yes
• 2 No
• (DK, RF not allowed)

SPQ_Q23
Do even simple chores make you short of breath?

• 1 Yes
• 2 No
• (DK, RF not allowed)

SPQ_Q24
Do you wheeze when you exert yourself, or at night?

• 1 Yes
• 2 No
• (DK, RF not allowed)

SPQ_Q25
Do you get frequent colds that persist longer than those of other people you know?

Instruction: Select "yes" only if respondent meets both conditions (i.e., colds are both frequent and persist longer than those of other people).

• 1 Yes
• 2 No
• (DK, RF not allowed)

SPQ_END

Spirometry Restriction (SPR)

SPR_BEG

External variables required:

Variables taken from sample file:

• STAND: name of the city/town/village in which the clinic has been set up
• CLINICID: 8 digit respondent identifier

Variables assigned in Variable Creation:

• CurrentYear: numeric year during which clinic visit is taking place
• CurrentMonth: numeric month during which clinic visit is taking place
• CurrentDay: numeric day during which clinic visit is taking place
• SessionE: English text of when the clinic visit is taking place

Variables from previously completed blocks:

• RespondentName: name of respondent
• GenderE: English text for sex of respondent
• CON_AGE: age of respondent

SPR_C11A

• If CON_AGE < 6, go to SPR_END.
• Otherwise, go to SPR_C11B.

SPR_C11B

• If PHC_Q11 = 1 and PHC_Q12 = RESPONSE and PHC_Q12 > 27, go to SPR_END.
• Otherwise, go to SPR_C11C.

SPR_C11C

• If PHC_N42 = 6, go to SPR_END.
• Otherwise, go to SPR_C11D.

SPR_C11D

• If PHC_N44 = 6, go to SPR_END.
• Otherwise, go to SPR_R11.

SPR_R11
I also need to ask a few health related questions to make sure you are able to do the lung function test today.

Instruction: Press <1> to continue.

SPR_Q11
Have you had a heart attack within the past 3 months?

• 1 Yes (Go to SPR_END)
• 2 No
• (DK, RF not allowed)

SPR_Q12
Have you had major surgery on your chest or abdomen in the past 3 months?

• 1 Yes (Go to SPR_END)
• 2 No
• (DK, RF not allowed)

SPR_Q13
Have you had eye surgery in the past 6 weeks?

• 1 Yes (Go to SPR_END)
• 2 No
• (DK, RF not allowed)

SPR_END

Medications and Product Confirmation (MEDC)

Overview: Up to 45 medications (both prescription and non prescription) entered at the household interview will be confirmed at the clinic in MEDC.

MEDC_BEG

External fields required:

Variables taken from sample file:

• STAND: name of the city/town/village in which the clinic has been set up
• CLINICID: 8 digit respondent identifier
• MEU_B11[i].DV_PIN: Product Identification Number (DIN, DIN-HM, NPN or EN) of the ith prescription medication from the household interview, i = 1 to 45.
• MEU_B11[i].DV_Product_name: Name of the ith prescription medication from the household interview, i = 1 to 45.
• MEU_B11[i].DV_Short_form: Code for the form of ith prescription medication from the household interview, i = 1 to 45 (used to derive dynamic text for take/use).
• 01 = Tablet/pill/capsule
• 02 = Lozenge
• 03 = Chew/gummy
• 04 = Globule
• 05 = Drop
• 06 = Tincture
• 07 = Liquid/solution
• 08 = Suspension
• 09 = Cream/ointment/gel/lotion
• 10 = Packet/sachet
• 11 = Powder
• 12 = Granule
• 13 = Spray/aerosol
• 14 = Patch
• 15 = Kit
• 16 = Suppository
• 50 = Other
• MEU_B11[i].NPI_N05: Indicator of whether there is an ith prescription medication from the household interview, i = 1 to 45.
• If MEU_B11[i].NPI_N05 = 1 or 2, there is an ith prescription medication. Otherwise, there are no more prescription medications
• MEU_B25[j].DV_PIN: Product Identification Number (DIN, DIN-HM, NPN or EN) of the jth over-the-counter or other health product from the household interview, j = 1 to 45.
• MEU_B25[j].DV_Product_name: Name of the jth over-the-counter or health product from the household interview, j = 1 to 45.
• MEU_B25[j].DV_Short_form: Code for the form of the jth over-the-counter or health product from the household interview, j = 1 to 45 (used to derive dynamic text for take/use).
• 01 = Tablet/pill/capsule
• 02 = Lozenge
• 03 = Chew/gummy
• 04 = Globule
• 05 = Drop
• 06 = Tincture
• 07 = Liquid/solution
• 08 = Suspension
• 09 = Cream/ointment/gel/lotion
• 10 = Packet/sachet
• 11 = Powder
• 12 = Granule
• 13 = Spray/aerosol
• 14 = Patch
• 15 = Kit
• 16 = Suppository
• 50 = Other
• MEU_B25[j].NPI_N05: Indicator of whether there is a jth over-the-counter or other health product from the household interview, j = 1 to 45. If MEU_B25[j].NPI_N05 = 1 or 2, there is a jth over-the-counter or other health product. Otherwise, there are no more over-the-counter or other health products

Variables assigned in Variable Creation:

• CurrentYear: numeric year during which clinic visit is taking place
• CurrentMonth: numeric month during which clinic visit is taking place
• CurrentDay: numeric day during which clinic visit is taking place
• SessionE: English text of when the clinic visit is taking place

Variables from previously completed blocks:

• RespondentName: name of respondent
• GenderE: English text for sex of respondent
• CON_AGE: age of respondent
• CON_SEX: sex of respondent
• ProxySex: gender of selected respondent and whether the interview is being conducted by proxy

MEDC_C100A

• If MEU_B11[1].NPI_N05 = 1 or 2 or MEU_B25[1].NPI_N05 = 1 or 2 , go to MEDC_D100A.
• Otherwise, go to MEDC_B300.MEDC_D100ANot Applicable

MEDC_R100
Now I'd like to confirm your use of prescription and over-the-counter medications and other health products, including natural health products.

Instruction: Press <1> to continue.

MEDC_C100B

• If MEU_B11[n].NPI_N05 = 1 or 2, go to MEDC_C100C.
• Otherwise, go to MEDC_C200A.

MEDC_C100C

• If MEU_B11[n].DV_Product_Name = RESPONSE, go to MEDC_D100B.
• Otherwise, go to MEDC_C100B.

MEDC_D100B

Programmer:

• If MEU_B11[n].DV_Short_form = 9, 13,14, 15 or 16 THEN set
  • DT_TAKE1E = "used"
  • DT_TAKE2E = "using"
• ELSE
  • DT_TAKE1E = "took"
  • DT_TAKE2E = "taking"
• ENDIF

MEDC_B101

• Call the Confirm Drug Product (CDP) block

Programmer:

• Pass "DT_QuestionE = During the interview in your home, it was reported that you were ^DT_TAKE2E ^DV_PRODUCT_NAME. When was the last time that you ^DT_TAKE1E this medication?" as parameter for the 1st product and every other multiple of 5.
• Pass "DT_QuestionE = When was the last time that you ^DT_TAKE1E ^DV_PRODUCT_NAME?" as parameter for all other products.

MEDC_C200A

• If MEU_B25[n].NPI_N05 = 1 or 2, go to MEDC_C200B.
• Otherwise, go to MEDC_B300.

MEDC_C200B

• If MEU_B25[n].DV_PRODUCT_NAME = RESPONSE, go to MEDC_D200.
• Otherwise, go to MEDC_C200A.

MEDC_D200

Programmer:

• If MEU_B25[n].DV_Short_form = 9, 13,14, 15 or 16 THEN set
  • DT_TAKE1E = "used"
  • DT_TAKE2E = "using"
• ELSE
  • DT_TAKE1E = "took"
  • DT_TAKE2E = "taking"
• ENDIF

MEDC_B201

• Call the Confirm Drug Product (CDP) block

Programmer:

• Pass "DT_QuestionE = During the interview in your home, it was reported that you were ^DT_TAKE2E ^DV_Product_name. When was the last time that you ^DT_TAKE1E this product? " as parameter for the 1st product and every other multiple of 5.
• Pass "DT_QuestionE = When was the last time that you ^DT_TAKE1E ^DV_Product_name? " as parameter for all other products.

MEDC_B300

• Call the Medication Use for clinic (MEUC) block

MEDC_C411A

• If CON_AGE < 6, go to MEDC_END.
• Otherwise, go to MEDC_C411B.

MEDC_C411B

• If CON_AGE < 14, go to MEDC_C511.
• Otherwise, go to MEDC_R411.

MEDC_R411
Now I am going to ask you a question about your use of other substances such as performance enhancing or recreational drugs. We ask this question because these drugs can affect the results of the physical and biological measures that we will be taking today. You can be assured that anything you say will remain confidential and that your answer will not screen you out of any tests.

Instruction: Press <1> to continue.

MEDC_Q411
In the past week have you used any performance enhancing or recreational drugs such as steroids, marijuana or cocaine?

• 1 Yes
• 2 No
• DK, RF

MEDC_C511

• If MEU_B11[1].NPI_N05 = (EMPTY) and
• MEDC_B300. MEUC_Q02 <> 1 and
• MEU_B25[1].NPI_N05 = (EMPTY) and
• MEDC_B300.MEUC_Q22 <> 1, go to MEDC_END.
• Otherwise, go to MEDC_N611.

MEDC_N611

Instruction: From which tests should the respondent be excluded because of medication use?

• 1 Spirometry
• 6 None
• (DK, RF not allowed)

Programmer:

• Display a list of the confirmed and new prescription drugs immediately below the question header.
• If any drugs are to be displayed, include a title as follows:
• Medications currently being taken

MEDC_END

Confirm Drug Product (CDP)

CDP_BEG

External variables required:

• Proxysex
• DT_QuestionE: English question text
• DT_TAKE1E: English text for "used/took"
• DV_Product_name: Name of product
• DV_PIN: Product Identification Number (DIN, DIN-HM, NPN or EN) from NPI block

CDP_Q1
^DT_QUESTIONE
(The response categories are today, yesterday, within the last week, within the last month or more than one month ago.)

1. Today
2. Yesterday
3. Within the last week
4. Within the last month
5. More than one month ago
6. Never ^DT_TAKE1E the product
7. DK, RF

CDP_END

Medication use for Clinic (MEUC)

MEUC_BEG

External variables required:

Variables from previously completed blocks:

• PROXYSEX: gender of selected respondent and whether the interview is being conducted by proxy
• CON_SEX: sex of respondent
• CON_AGE : age of respondent
• RespondentFirstname: first name of respondent
• DV_PIN: Product Identification Number (DIN, DIN-HM, NPN or EN) from NPI block

Content type - Note to data users:

• Information on up to 15 new prescription, over-the-counter and other health products, taken or used in the past month is collected in MEUC. First, information (collected in the NPI block) on prescription medications is captured, followed by over-the-counter and other health products. Look-up databases are used to identify the products. Products containing ingredients of particular interest have been pre-flagged on these databases (FollowUpFlag = 1). For these products, additional questions are administered to collect information on the quantity and frequency of use. If more that 15 new medications have been taken during the past month, then the respondent is asked to state the number of additional medications he/she takes.

Programmer:

• Set DT_DateLastMonthE = English text of date one month ago.

MEUC_D02A

• If any of MEDC_B101[n].CDP_Q1 = 1, 2, 3, 4 or 5, DT_OTHER1 = "other ".
• Otherwise, DT_OTHER1 = "EMPTY".

MEUC_D02B

• If CON_SEX = 1 and CON_AGE > 13, DT_MEUTEXT2E = "antibiotics and nicotine patches".
• Otherwise, if CON_SEX = 2 and CON_AGE > 13, DT_MEUTEXT2E = "antibiotics, nicotine patches and birth control pills, patches or injections".
• Otherwise, DT_MEUTEXT2E = "antibiotics and asthma medication".

MEUC_Q02
In the past month, that is, from ^DT_DATELASTMONTHE to today, have you taken or used any [other /EMPTY]medications that have been prescribed or administered by a health professional such as a doctor or dentist? This includes such things as insulin, [antibiotics and nicotine patches/antibiotics, nicotine patches and birth control pills, patches or injections/antibiotics and asthma medication].

Instruction: This question applies only to medications taken or used within the past month. Medications that have been prescribed but not taken or used within this period of time (e.g., Epi-pen) should not be captured.

• 1 Yes
• 2 No (Go to MEUC_Q22)
• DK, RF (Go to MEUC_Q22)

MEUC_B11

• Call the New product information (NPI) block

Content type - Note to data users:

• The NPI block is called once for each prescription medication, up to a maximum of 15 times.

MEUC_C11

• If the number of products captured is less than 15, go to MEUC_N11.
• Otherwise, go to MEUC_Q15.

MEUC_N11

Instruction: Do you have another prescription medication to capture?

• 1 Yes (Go to MEUC_B11)
• 2 No
• (DK is not allowed)
• RF (Go to MEUC_Q22)

MEUC_Q12
Have you taken or used any other prescription medications in the past month? Please include any prescription creams, injections or patches.

• 1 Yes (Go to MEUC_B11)
• 2 No
• DK, RF

Go to MEUC_Q22

Content type - Note to data users:

• MEUC_Q15 to MEUC_Q21 are asked only if more than 15 additional prescription medications have been taken or used in the past month.

MEUC_Q15
How many other prescription medications have you taken or used in the past month? Please include any prescription creams, injections or patches.

• (MIN: 0)
• (MAX: 95)
• DK, RF

MEUC_D19

• If any of MEDC_B201[n].CDP_Q1 = 1, 2, 3, 4, or 5 , DT_OTHER2 = "other".
• Otherwise, DT_OTHER2 = "EMPTY".

MEUC_Q20
Have you taken or used any [other/EMPTY]over-the-counter medications or other health products, including natural health products in the past month?

Over-the-counter medications could include such things as pain killers, antacids, allergy pills and hydrocortisone creams. Examples of health products include vitamins, minerals, amino acids, probiotics, fish oils and other oils, herbal remedies and homeopathic preparations.

Instruction: This question applies only to products taken or used within the past month. Products that have not been taken or used within this period of time should not be captured.

• 1 Yes (Go to MEUC_Q21)
• 2 No
• DK, RF

Go to MEUC_END

MEUC_Q21
How many [other/EMPTY]over-the-counter medications or other health products have you taken or used in the past month?

• (MIN: 1)
• (MAX: 95)
• DK, RF

Go to MEUC_END

MEUC_Q22
Have you taken or used any [other/EMPTY] over-the-counter medications or other health products, including natural health products, in the past month, that is, from ^DT_DATELASTMONTHE to today.

Over-the-counter medications could include such things as pain killers, antacids, allergy pills and hydrocortisone creams. Examples of health products include vitamins, minerals, amino acids, probiotics, fish oils and other oils, herbal remedies and homeopathic preparations.

Instruction: Has the respondent taken or used any over-the-counter medications or other health products in the past month?

This question applies only to products taken or used within the past month. Products that have not been taken or used within this period of time should not be captured.

• 1 Yes
• 2 No (Go to MEUC_END)
• DK, RF (Go to MEUC_END)

MEUC_B25

• Call the New Drug Product (NPI) block

Content type - Note to data users:

• The NPI block is called once for each over-the-counter medication or other health product, up to a maximum of 15 products in total (including prescription medications).

MEUC_C26

• If the number of products (combined) captured is less than 15, go to MEUC_N26.
• Otherwise, go to MEUC_Q29.

MEUC_N26

Instruction: Do you have another over-the-counter medication or health product to capture?

• 1 Yes (Go to MEUC_B25)
• 2 No
• (DK is not allowed)
• RF (Go to MEUC_END)

MEUC_Q27
Have you taken or used any other over-the-counter medications or health products in the past month? Please include any solutions, powders, creams or pastes.

• 1 Yes (Go to MEUC_B25)
• 2 No
• DK, RF

Go to MEUC_END

Content type - Note to data users:

• MEUC_Q29 is asked only if more than 15 additional products in total, including prescription medications, over-the-counter medications and other health products, have been taken or used in the past month.

MEUC_Q29
How many other over-the-counter medications or health products have you taken or used in the past month? Please include any solutions, powders, creams or pastes.

• (MIN: 0)
• (MAX: 95)
• DK, RF

MEUC_END

New Product Information (NPI)

NPI_BEG

External variables required:

• MEUC_Q22: whether respondent taken or used any over-the-counter medications or health products
• ProxySex: gender of selected respondent and whether the interview is being conducted by proxy
• FollowUpFlag: 0 or 1
• CON_AGE: age of respondent

NPI_N05

Instruction: Is a product identification number available for the product (e.g., DIN, DIN-HM, NPN, EN)?

• 1 Yes
• 2 No (Go to NPI_N15)
• (DK, RF not allowed)

NPI_N07

Instruction: Record the product identification number from the bottle, tube or box. Include all leading zeros.

• (8 spaces)

Content type - Note to data users:

• A search is performed based on the Product Identification Number. This could be a Drug Identification Number (DIN); Natural Product Number (NPN); Homeopathic Medicine Number (DIN_HM); or Exemption Number (EN).

NPI_C08

• If Blaise search does not find an exact match, go to NPI_N11.
• Otherwise, go to NPI_N08.

NPI_N08

• Instruction: Select the correct product.
• (DK, RF not allowed)

Programmer:

• List records with an exact match on PIN as response categories. The default 'Go to' for these responses should be NPI_D25.
• Please add the response category 'None of the above' as the last response category. The "Go to" for this category should be NPI_N11.
• Don't know and Refusal are not allowed.
• Display the following variables: Pk, product_name, product_strength and form.

NPI_N11

Instruction: Is ^NPI_N07 the correct product identification number?

• 1 Yes (Go to NPI_D18A)
• 2 No (Go to NPI_N05)
• (DK, RF not allowed)

NPI_N15

Instruction: Why is a product identification number not available for the product?

• 1 Container not available
• 2 No product identification number
• (DK, RF not allowed)

NPI_D15

If NPI_N15 = 1 and MEUC_Q22 = EMPTY, DT_NPI15E = "To search for this product I will need some of the following information:

• Product name: for example, Accutane, Alesse 21 or Ventolin.
• Product form: for example, pill, powder, liquid or cream.
• Manufacturer: for example, Roche, Pfizer or GlaxoSmithKline.".

Else If NPI_N15 = 1 and MEUC_Q22 = RESPONSE , DT_NPI15E = "To search for this product, I will need some of the following information:

• Product name: for example, Children's Tylenol^® Cold and Cough Nighttime.
• Product form: for example, pill, powder, liquid or cream.
• Manufacturer: for example, Bayer, Jamieson or Sisu.".

Otherwise, DT_NPI15E = "EMPTY".

Content type - Note to data users:

• If a product identification number is not available, MedSearch can be used to search for the medication.
• The MedSearch tool uses a look-up database to search for prescription medications, over-the-counter medications and other health products based on product name, manufacturer, active ingredients, route of administration, form and/or product strength.

NPI_Q16
^DT_NPIN15E

Instruction: Use the MedSearch tool to find the product.

• Press <1> to continue.
• 1 Continue
• (DK, RF not allowed)

NPI_N17

Instruction: Was an exact product match found?

• 1 Yes
• 2 No (Go to NPI_D18A)
• (DK, RF not allowed)

NPI_Q17A

• Product identification number: ^DV_PIN
• Product name: ^DV_PRODUCT_NAME
• Form: ^DV_FORME
• Strength: ^DT_STRENGTH
• Route of administration: ^DT_ROUTEE

Instruction: Confirm whether the information displayed is correct.

• 1 Yes (Go to NPI_D25)
• 2 No
• (DK, RF not allowed)

NPI_N17B

Instruction: Do you want to search for the product again?

• 1 Yes (Go to NPI_D15)
• 2 No
• (DK, RF not allowed)

NPI_D18A

• If MEUC_Q22 = EMPTY, DT_NAMEEXAMPLEE = "For example, Accutane, Alesse 21 or Ventolin.".
• Otherwise, DT_NAMEEXAMPLEE = "For example, Children's Tylenol^® Cold and Cough Nighttime.".

Content type - Note to data users:

• If a product cannot be found in the database search at NPI_N07 or NPI_N17, information about the product is entered at NPI_Q18 to NPI_Q25.

NPI_Q18
(What is the name of this product? [For example, Accutane, Alesse 21 or Ventolin./For example, Children's Tylenol^® Cold and Cough Nighttime.])

Instruction: Capture the information from the product container, if it is available. Otherwise, ask the respondent to provide the information, as accurately as possible.

• (80 spaces)
• DK, RF (Go to NPI_END)

NPI_C19

• If NPI_N15 = 1, go to NPI_Q20.
• Otherwise, go to NPI_D19.

NPI_D19

• If MEUC_Q22 = EMPTY, DT_COMPANYEXAMPLEE = "For example, Roche, Pfizer, GlaxoSmithKline.".
• Otherwise, DT_COMPANYEXAMPLEE = "For example, Bayer, Jamieson or Sisu.".

NPI_Q19
What company information is found on the product container?
[For example, Roche, Pfizer, GlaxoSmithKline./For example, Bayer, Jamieson or Sisu.]

Instruction: Capture all the company names from the product container. This could include: the manufacturer, the importer and/or the company for which this product was manufactured. If there is no company information on the container, enter <Don't know>.

• (80 spaces)
• DK, RF

NPI_Q20
(What is the form of this product? For example, is it a pill, powder, liquid or cream?)

Instruction: Capture the information from the product container, if it is available. Otherwise, ask the respondent to provide the information, as accurately as possible.

Select the product form.

• 01 Tablet / pill / capsule
• 02 Lozenge
• 03 Chew / gummy
• 04 Globule
• 05 Drop
• 06 Tincture
• 07 Liquid / solution
• 08 Suspension
• 09 Cream / ointment / gel / lotion
• 10 Packet / sachet
• 11 Powder
• 12 Granule
• 13 Spray / aerosol
• 14 Patch
• 15 Kit
• 16 Suppository
• 50 Other - Specify (Go to NPI_S20)
• DK, RF

Go to NPI_D20

NPI_S20
(What is the form of this product? For example, is it a pill, powder, liquid or cream?)

Instruction: Specify.

• (80 spaces)
• (DK, RF not allowed)

NPI_D20

• If NPI_Q20 = 50, DT_FORME = "NPI_S20".
• Otherwise, if NPI_Q20 = DK, RF, DT_FORME = "EMPTY".
• Otherwise, DT_FORME = "English text of category selected at NPI_Q20".

NPI_Q21
(What is the strength of this product, for example, 250mg, 1%, 1000 international units?)

Instruction: Capture the information from the product container, if it is available. Otherwise, ask the respondent to provide the information, as accurately as possible.

• (80 spaces)
• DK, RF

NPI_Q22
(How is this product administered? For example, is it inhaled, swallowed, dissolved beneath the tongue or applied to the skin?)

Instruction: Capture the information from the product container, if it is available. Otherwise, ask the respondent to provide the information as accurately as possible.

Select the route of administration of the product.

• 01 Oral
• 02 Sublingual (under tongue)
• 03 Buccal (inside of cheek)
• 04 Dental (teeth or gums)
• 05 By inhalation
• 06 Nasal (nose)
• 07 Ophthalmic (eyeball)
• 08 Otic (ear)
• 09 Topical (applied to skin)
• 10 Transdermal (absorbed through skin)
• 11 By injection
• 12 Rectal
• 13 Vaginal
• 50 Other - Specify (Go to NPI_S22)
• DK, RF

Go to NPI_D25

NPI_S22
(How is this product administered? For example, is it inhaled, swallowed, dissolved beneath the tongue or applied to the skin?)

Instruction: Specify.

• (80 spaces)
• (DK, RF not allowed)

Go to NPI_D25

NPI_D25

• If DV_Short_form = 9, 13,14, 15 or 16 then set:, DT_TAKE1E = "used".
• Else, DT_TAKE1E = "took".
• If DV_Short_form = 9, 13,14, 15 or 16 then set:, DT_TAKE2E = "using".
• Else, DT_TAKE2E = "taking".
• If DV_Short_form = 9, 13,14, 15 or 16 then set:, DT_TAKE3E = "use".
• Else, DT_TAKE3E = "take".

NPI_Q25
When was the last time that you [used/took] this product?

(The response categories are today, yesterday, within the last week or within the last month.)

1. Today
2. Yesterday
3. Within the last week
4. Within the last month
5. More than one month ago (Go to NPI_END)
6. DK, RF (Go to NPI_END)

NPI_C25

• If FollowUpFlag = 1 (administer follow-up questions), go to NPI_D26.
• Otherwise, go to NPI_END.

Content type - Note to data users:

• The next questions are only asked for products found on the look-up database that contain ingredients of particular interest.

NPI_D26

Content type - Note to data users:

• DT_NPC_TEXT1E is created and passed to NPC. This text string contains examples of possible units of measure based on the form of the product.

NPI_B26

• Call the New Product Information – Call block (NPC).

Programmer:

• Pass DT_NPC_TEXT1E, DT_NPC_TEXT1E and available choices for NPC_N12) as a parameter.

NPI_D59

• If MEUC_Q22 = 1, DT_SPRODE = "this or a similar product".
• Otherwise, DT_SPRODE = "this product".

NPI_D60

• If NPI_Q25 = 1 or 2, DT_NPITEXT5E = "For how long have you been [using/taking] [this or a similar product/this product]? (^DV_PRODUCT_NAME)".
• Otherwise, DT_NPITEXT5E = "For how long did you ^DT_TAKE3E [this or a similar product/this product]? (^DV_PRODUCT_NAME)".

NPI_D62

• If MEUC_Q22 = EMPTY, DT_NPITEXT7E = "Consider a change in prescription (e.g., a change in medication company or dosage) to be a stop in medication use.
• Do not consider a short break in the use of prescribed medication (e.g., temporarily ran out of medication or forgot to take a dose) to be a stop in medication use.
• For prescription medication used on an as-needed basis (e.g., medicated cream for a reoccurring condition), only include the period when it was last used.".
• Otherwise, DT_NPITEXT7E = "A similar product could be a different company name (e.g., Jamieson Vitamin C^® vs. Flintstones Vitamin C^®) or a different form (e.g., tablet vs. liquid).
• Do not consider a short break in the use of a product (e.g., temporarily ran out of a vitamin supplement or forgot to take a dose) to be a stop in product use.
• For over-the-counter medication used on an as-needed basis (e.g., medication for a cold or headache), only include the period when it was last used ".

NPI_Q63
[For how long have you been [using/taking] [this or a similar product/this product]?/For how long did you [use/take] [this or a similar product/this product]?] (^DV_PRODUCT_NAME)

(If you stopped [using/taking] it at some point, only include the most recent period of use.)

Instruction: Enter time only.

• ^DT_NPITEXT7E
• (MIN: 0)
• (MAX: 500)
• DK (Go to NPI_Q65)
• RF (Go to NPI_END)

NPI_N64

Instruction: Select the reporting period.

1. Days
2. Weeks
3. Months
4. Years
5. (DK, RF not allowed)

NPI_Q65
In the past month, on how many days did you [use/take] this product (^DT_PRODUCT_NAME)?

Instruction: Enter number of days.

If the medication was used every day for the past month, enter "31".

• (MIN: 1)
• (MAX: 31)
• DK, RF

NPI_END

New Product Information – Call block (NPC)

NPC_BEG

External variables required:

• DT_NPC_TEXT1E: example text in English
• DV_PRODUCT_NAME: product name
• DT_Take1E: English text fill for "used/took"
• DT_Take3E: English text fill for "use/take"

NPC_Q10
On the days that you [used/took] this product, how many times did you usually [use/take] it in a single day?

Instruction: Record the number of times per day.

• (MIN: 1)
• (MAX: 100)
• DK, RF (Go to NPC_END)

NPC_Q11
How much did you usually [use/take] each time you [used/took] it?

Instruction: Enter the quantity only.

• (MIN: 0.01)
• (MAX: 99,995.00)
• DK, RF (Go to NPC_END)

NPC_D11A

• If NPC_Q10 = 1, DT_TIMESE = "time".
• Otherwise, DT_TIMESE = "times".

NPC_N12

Instruction: Select the unit of measure.

• 01 Tablets / pills / capsules
• 02 Lozenges
• 03 Chews / gummies
• 04 Millilitres (mL)
• 05 Milligrams (mg)
• 06 Grams (g)
• 07 Tablespoons (Tbsp)
• 08 Teaspoons (tsp)
• 09 Capfuls
• 10 Scoops
• 11 Packets / sachets
• 12 Drops
• 13 Sprays
• 14 Doses
• 15 Vials
• 16 Units
• 50 Other - Specify (Go to NPC_S12)
• DK, RF (Go to NPC_END)

Go to NPC_D12

NPC_S12
(Select the unit of measure.)

Instruction: Specify.

• (80 spaces)
• (DK, RF not allowed)

NPC_D12

• If NPC_N12 = 01, DT_UNITE = "tablet(s)".
• If NPC_N12 = 02, DT_UNITE = "lozenge(s)".
• If NPC_N12 = 03, DT_UNITE = "chew(s)".
• If NPC_N12 = 04, DT_UNITE = "millilitre(s)".
• If NPC_N12 = 05, DT_UNITE = "milligram(s)".
• If NPC_N12 = 06, DT_UNITE = "gram(s)".
• If NPC_N12 = 07, DT_UNITE = "tablespoon(s)".
• If NPC_N12 = 08, DT_UNITE = "teaspoon(s)".
• If NPC_N12 = 09, DT_UNITE = "capful(s)".
• If NPC_N12 = 10, DT_UNITE = "scoop(s)".
• If NPC_N12 = 11, DT_UNITE = "packet(s)".
• If NPC_N12 = 12, DT_UNITE = "drop(s)".
• If NPC_N12 = 13, DT_UNITE = "spray(s)".
• If NPC_N12 = 14, DT_UNITE = "dose(s)".
• If NPC_N12 = 15, DT_UNITE = "vial(s)".
• If NPC_N12 = 16, DT_UNITE = "unit(s)".
• If NPC_N12 = 50, DT_UNITE = "^NPC_S12".

NPC_Q14
So you [used/took] ^NPC_Q11 ^DT_UNITE ^NPC_Q10 [time/times] each day you [used/took] this product (^DV_PRODUCT_NAME). Is that correct?

• 1 Yes
• 2 No (Go to NPC_Q10)
• (DK, RF not allowed)

NPC_END

Other Reason for Screening Out (ORS)

ORS_BEG

External variables required:

Variables taken from sample file:

• STAND: name of the city/town/village in which the clinic has been set up
• CLINICID: 8 digit respondent identifier

Variables assigned in Variable Creation:

• CurrentYear: numeric year during which clinic visit is taking place
• CurrentMonth: numeric month during which clinic visit is taking place
• CurrentDay: numeric day during which clinic visit is taking place
• SessionE: English text of when the clinic visit is taking place

Variables from previously completed blocks:

• RespondentName: name of respondent
• GenderE: English text for sex of respondent
• CON_AGE: age of respondent

ORS_Q1
Other than what you have already mentioned, are there any other reasons you should not participate in one or more of the physical tests?

• 1 Yes
• 2 No
• DK, RF

ORS_C1

• If CON_AGE < 6, go to ORS_N7.
• Otherwise, go to ORS_N1.

ORS_N1

Instruction: Is there any other reason why the respondent should not perform the Grip Strength test?

• 1 Yes
• 2 No (Go to ORS_N2)
• (DK, RF not allowed)

ORS_S1

Instruction: Specify the reason.

• (80 spaces)
• (DK, RF not allowed)

ORS_N2

Instruction: Is there any other reason why the respondent should not perform the Spirometry test?

• 1 Yes
• 2 No (Go to ORS_N7)
• (DK, RF not allowed)

ORS_S2

Instruction: Specify the reason.

• (80 spaces)
• (DK, RF not allowed)

ORS_N7

Instruction: Is there any other reason why the respondent should not perform the Hearing tests?

• 1 Yes
• 2 No (Go to ORS_N8)
• (DK, RF not allowed)

ORS_S7

Instruction: Specify the reason.

• (80 spaces)
• (DK, RF not allowed)

ORS_N8

Instruction: Is there any other reason why the respondent should not perform the skin pigmentation measurements?

• 1 Yes
• 2 No (Go to ORS_END)
• (DK, RF not allowed)

ORS_S8

Instruction: Specify the reason.

• (80 spaces)
• (DK, RF not allowed)

ORS_END

Water Analysis Questions Component (WAQ) (ORS)

WAQ_BEG

External variables required:

Variables taken from sample file:

• STAND: name of the city/town/village in which the clinic has been set up
• CLINICID:8 digit respondent identifier

Variables assigned in Variable Creation:

• CurrentYear: numeric year during which clinic visit is taking place
• CurrentMonth: numeric month during which clinic visit is taking place
• CurrentDay: numeric day during which clinic visit is taking place
• SessionE: English text of when the clinic visit is taking place
• RespondentName: name of respondent
• GenderE: English text for sex of respondent

Variables from previously completed blocks:

• BVOCFLG: tap water subsampling flag (blood)
• UFLUFLG: tap water subsampling flag (urine)
• SCS_N12: Visit type (3= clinic visit; 4= home visit)
• RespondentName: name of respondent
• GenderE: English text for sex of respondent
• CON_AGE: age of respondent

WAQ_D01

• If BVOCFLG=1 and UFLUFLG=1, DT_WAQTEXT1E = "blood and urine".
• If BVOCFLG=1 and UFLUFLG=2, DT_WAQTEXT1E = "blood".
• If BVOCFLG=2 and UFLUFLG=1, DT_WAQTEXT1E = "urine".

WAQ_R01
Now I am going to ask you some questions about behaviours and habits to help us better understand your [blood and urine/blood/urine] test results. These questions are related to your household tap water analysis.

Instruction: Press <1> to continue.

Programmer:

• Allow 'DK' as a response category.

WAQ_C01

• If WAQ_R01 = DK, go to WAQ_N60.
• Otherwise, go to WAQ_D02.

WAQ_D02

Programmer:

• IF SCS_N12 = 4 THEN
  • WAQ_D02 = EMPTY
• ELSE
  • IF WAQ_R01 = 1 and WAQ_D02 = EMPTY,
    • Set WAQ_D02 = Current Time (in HH:MM:SS format)
• ENDIF

WAQ_C02

• If BVOCFLG = 1, go to WAQ_Q02.
  Otherwise, go to WAQ_C04A.

WAQ_Q02
When did you last spend time in a swimming pool, in a hot tub, or in a steam room?

Instruction: Include steam rooms but do not include saunas. Steam rooms contain hot mist created by a steam generator, and are made of materials such as ceramic tile that can contain the moisture. The humidity in a steam room can build to almost 100%. Saunas use dry heat (stones placed on some kind of heater) and are usually wood-lined with wood benches. Although steam may be produced by pouring water on the stones, the steam in a sauna quickly dissipates. Saunas are maintained at a much higher temperature than steam rooms.

Read categories to respondent.

1. Less than 6 hours ago
2. 6 to less than 12 hours ago
3. 12 to less than 24 hours ago
4. 24 or more hours ago
   DK, RF

WAQ_Q03
When did you last take a hot shower, for 5 minutes or longer, or a hot bath, for twenty minutes or longer?

Instruction: Include warm baths or showers, but do not include cold baths or showers.

1. Less than 6 hours ago
2. 6 to less than 12 hours ago
3. 12 to less than 24 hours ago
4. 24 or more hours ago
   DK, RF

WAQ_C04A

• If UFLUFLG=1, go to WAQ_C04B.
• Otherwise, go to WAQ_END.

WAQ_C04B

• If CON_AGE < 6, go to WAQ_Q08.
• Otherwise, go to WAQ_Q04.

WAQ_Q04
How often do you drink black, white or green tea? Examples of black tea include Orange Pekoe, Earl Grey and English Breakfast. Please do not include herbal teas.

Instruction: Include decaffeinated tea. Include iced tea if it was made from hot steeped black, white or green tea (in tea bags or in loose leaf form). Do not include pre-prepared powdered, bottled or canned iced tea.

Enter frequency only.

• Times
• (MIN: 0)
• (MAX: 365)
• DK, RF
• Go to WAQ_Q08)

WAQ_C05

• If WAQ_Q04=0, go to WAQ_Q08.
• Otherwise, go to WAQ_N05A.

WAQ_N05A

Instruction: Select the reporting period.

1. Per day
2. Per week
3. Per month
4. Per year
   (DK, RF not allowed)

WAQ_Q06
When you drink black, white or green tea, how much do you usually drink in cups? A cup is equivalent to the size of a measuring cup: 250ml or 8oz.

Instruction: Read categories to respondent.

1. Less than 1 cup
2. 1 to less than 2 cups
3. 2 or more cups
   DK, RF

WAQ_Q07
When did you last drink black, white or green tea?

Instruction: Read categories to respondent.

1. Less than 6 hours ago
2. 6 to less than 12 hours ago
3. 12 to less than 24 hours ago
4. 24 or more hours ago
   DK, RF

WAQ_Q08
When did you last receive fluoride treatments at the dentist?

Instruction: A fluoride treatment may take the form of a rinse, varnish, gel or foam. Varnishes are painted on the teeth; foams are put into a mouth guard, which is applied to the teeth for 1 to 4 minutes; gels can be painted on or applied via a mouth guard. After a fluoride treatment, the patient is asked to refrain from eating, drinking and smoking for 30 minutes.

Read answer categories to respondent.

1. Less than 3 months ago
2. 3 to less than 6 months ago
3. 6 to less than 9 months ago
4. 9 to less than 12 months ago
5. 12 or more months ago
6. Never
   DK, RF

WAQ_Q09
Do you use fluoride-containing products at home, such as toothpaste, mouthwash, or 24-hour fluoride treatment?

• 1 Yes
• 2 No (Go to WAQ_END)
• DK, RF (Go to WAQ_END)

WAQ_Q10
When was the last time you used one of these products?

Instruction: Read categories to respondent.

1. Less than 6 hours ago
2. 6 to less than 12 hours ago
3. 12 to less than 24 hours ago
4. 24 or more hours ago
   DK, RF
   
   Go to WAQ_END

WAQ_N60

Instruction: Why was the component not fully completed?

• 01 Respondent unable to continue for health reasons
• 06 No time
• 20 Other - Specify
• (DK, RF not allowed)

Go to WAQ_END

WAQ_S60
(Why was the component not fully completed?)

Instruction: Specify.

• (80 spaces)
• (DK, RF not allowed)

WAQ_END

Fish and Shellfish Consumption Component

Fish and Shellfish Consumption (FSF)

FSF_BEG

External variables required:

Variables taken from sample file:

• STAND: name of the city/town/village in which the clinic has been set up
• CLINICID: 8 digit respondent identifier

Variables assigned in Variable Creation:

• CurrentYear: numeric year during which clinic visit is taking place
• CurrentMonth: numeric month during which clinic visit is taking place
• CurrentDay: numeric day during which clinic visit is taking place
• SessionE: English text of when the clinic visit is taking place
• DateLastMonthE: English text of month of date one month before the clinic visit

Variables from previously completed blocks:

• RespondentName: name of respondent
• CON_SEX: sex of respondent
• GenderE: English text for sex of respondent
• CON_AGE: age of respondent
• SCS_N12: Visit type (3= clinic visit; 4= home visit)

FSF_R10
Now a few questions about your consumption of shellfish over the past month. Think about all the shellfish you ate, both meals and snacks, at home and away from home. Include fresh, frozen and canned shellfish.

Instruction: Press <1> to continue.

Programmer:

• Allow ‘DK’ as a response category.

FSF_C10

• If FSF_R10 = DK, go to FSF_N70.
• Otherwise, go to FSF_D10.

FSF_D10

Programmer:

• IF SCS_N12 = 4 THEN
  • FSF_D10 = EMPTY
• ELSE
  • IF FSF_R10 = 1 and FSF_D10 = "EMPTY" THEN
    • SET FSF_D10 = Current Time (in HH:MM:SS format)
• ENDIF

FSF_Q10
Have you eaten any of the following shellfish over the past month, that is, from ^DateLastMonthE to today?

Instruction: The term "shellfish" refers to a type of mollusc/crustacean. It does not include "saltwater fish" which are covered in the next question.

Read categories to respondent. Mark all that apply.

• 01 Lobster
• 02 Shrimp
• 03 Mussels
• 04 Scallops
• 05 Oysters
• 06 Squid or calamari
• 07 Clams
• 08 Crab
• 09 Surimi or imitation crab
• 10 Any other shellfish (Go to FSF_S10V)
• 11 No shellfish
• DK
• RF (Go to FSF_END)

Go to FSF_C11

FSF_S10V
What other shellfish did you consume?

Instruction: Enter one shellfish only.

• (80 spaces)
• DK, RF (Go to FSF_C11)

FSF_Q10X
Over the past month, did you consume any other shellfish?

• 1 Yes
• 2 No (Go to FSF_C11) DK, RF (Go to FSF_C11)

FSF_S10X
What other shellfish did you consume?

Instruction: Enter one shellfish only.

• (80 spaces)
• DK, RF (Go to FSF_C11)

FSF_Q10Y
Over the past month, did you consume any other shellfish?

• 1 Yes
• 2 No (Go to FSF_C11)
• DK, RF (Go to FSF_C11)

FSF_S10Y
What other shellfish did you consume?

Instruction: Enter one shellfish only.

• (80 spaces)
• DK, RF

FSF_C11

• If FSF_Q10 = 11 or DK, go to FSF_R24.
• Otherwise, go to FSF_C12.

FSF_C12

• If FSF_Q10 = 1, go to FSF_B12.
• Otherwise, go to FSF_C13.

Content type - Note to data users:

• For each shellfish identified at FSF_Q10, the Detail Fish and Shellfish block is called to quantify the number of times the shellfish was consumed in the past month. This block will also be called up to 3 times for any other shellfish that is specified at FSF_S10V, FSF_S10X, and FSF_S10Y.

FSF_B12

• Call the Detail Fish and Shellfish (DFS) block.

Programmer:

• Pass DT_QuestionE = "lobster" as parameter.

FSF_C13

• If FSF_Q10 = 2, go to FSF_B13.
• Otherwise, go to FSF_C14.

FSF_B13

• Call the Detail Fish and Shellfish (DFS) block.

Programmer:

• Pass DT_QuestionE = "shrimp" as parameter.

FSF_C14

• If FSF_Q10 = 3, go to FSF_B14.
• Otherwise, go to FSF_C15.

FSF_B14

• Call the Detail Fish and Shellfish (DFS) block.

Programmer:

• Pass DT_QuestionE = "mussels" as parameter.

FSF_C15

• If FSF_Q10 = 4, go to FSF_B15.
• Otherwise, go to FSF_C16.

FSF_B15

• Call the Detail Fish and Shellfish (DFS) block.

Programmer:

• Pass DT_QuestionE = "scallops" as parameter.

FSF_C16

• If FSF_Q10 = 5, go to FSF_B16.
• Otherwise, go to FSF_C17.

FSF_B16

• Call the Detail Fish and Shellfish (DFS) block.

Programmer:

• Pass DT_QuestionE = "oysters" as parameter.

FSF_C17

• If FSF_Q10 = 6, go to FSF_B17.
• Otherwise, go to FSF_C18.

FSF_B17

• Call the Detail Fish and Shellfish (DFS) block.

Programmer:

• Pass DT_QuestionE = "squid or calamari" as parameter.

FSF_C18

• If FSF_Q10 = 7, go to FSF_B18.
• Otherwise, go to FSF_C19.

FSF_B18

• Call the Detail Fish and Shellfish (DFS) block.

Programmer:

• Pass DT_QuestionE = "clams" as parameter.

FSF_C19

• If FSF_Q10 = 8, go to FSF_B19.
• Otherwise, go to FSF_C20.

FSF_B19

• Call the Detail Fish and Shellfish (DFS) block.

Programmer:

• Pass DT_QuestionE = "crab" as parameter.

FSF_C20

• If FSF_Q10 = 9, go to FSF_B20.
• Otherwise, go to FSF_C21.

FSF_B20

• Call the Detail Fish and Shellfish (DFS) block.

Programmer:

• Pass DT_QuestionE = "surimi or imitation crab" as parameter.

FSF_C21

• If FSF_S10V = RESPONSE and <> DK, RF, go to FSF_B21.
• Otherwise, go to FSF_C22.

FSF_B21

• Call the Detail Fish and Shellfish (DFS) block.

Programmer:

• Pass DT_QuestionE = "^FSF_S10V" as parameter.

FSF_C22

• If FSF_S10X = RESPONSE and <> DK, RF, go to FSF_B22.
• Otherwise, go to FSF_C23.

FSF_B22

• Call the Detail Fish and Shellfish (DFS) block.

Programmer:

• Pass DT_QuestionE = "^FSF_S10X" as parameter.

FSF_C23

• If FSF_S10Y = RESPONSE and <> DK,RF, go to FSF_B23.
• Otherwise, go to FSF_R24.

FSF_B23

• Call the Detail Fish and Shellfish (DFS) block.

Programmer:

• Pass DT_QuestionE = "^FSF_S10Y" as parameter.

FSF_R24
Now, think about all salt and freshwater fish you ate, both meals and snacks, at home and away from home. Include fresh, frozen and canned fish of all types, as well as the fish in fish and chips.

Instruction: Press <1> to continue.

FSF_Q24
Have you eaten any of the following fish over the past month, that is, from ^DateLastMonthE to today?

Instruction: The term "saltwater fish" does not include "shellfish", which were asked about in the previous question.

If respondent is unsure of the type of cod they have eaten, choose "Atlantic cod".

Read categories to respondent. Mark all that apply.

• 01 Fish Sticks
• 02 Tuna in a can or pouch
• 03 Tuna (fresh or frozen)
• 04 Salmon in a can or pouch
• 05 Salmon - fresh, frozen or smoked
• 06 Smelt
• 07 Shark
• 08 Marlin
• 09 Swordfish
• 10 Halibut
• 11 Rainbow Trout
• 12 Atlantic cod
• 13 Mackerel
• 14 Herring
• 15 Sardines
• 16 Sole, flounder or plaice
• 17 Haddock
• 18 Tilapia
• 19 Any other fish (Go to FSF_S24V)
• 20 No fish
• 21 Sablefish or black cod
• DK, RF

Go to FSF_C24A

FSF_S24V
What other fish did you consume?

Instruction: Enter one type of fish only.

• (80 spaces)
• DK, RF (Go to FSF_C24A)

FSF_Q24X
In the past month, did you consume any other fish?

• 1 Yes
• 2 No (Go to FSF_C24A)
• DK, RF (Go to FSF_C24A)

FSF_S24X
What other fish did you consume?

Instruction: Enter one type of fish only.

• (80 spaces)
• DK, RF (Go to FSF_C24A)

FSF_Q24Y
In the past month, did you consume any other fish?

• 1 Yes
• 2 No (Go to FSF_C24A)
• DK, RF (Go to FSF_C24A)

FSF_S24Y
What other fish did you consume?

Instruction: Enter one type of fish only.

• (80 spaces)
• DK, RF

FSF_C24A

• If FSF_Q24 = 20, DK or RF, go to FSF_END.
• Otherwise, go to FSF_C24.

FSF_C24

• If FSF_Q24 = 1, go to FSF_B24.
• Otherwise, go to FSF_C25A.

Content type - Note to data users:

• For each fish identified at FSF_Q24, the Detail Fish and Shellfish block is called to quantify the number of times the fish was consumed in the past month. This block will also be called up to 3 times for any other fish that is specified at FSF_S24V, FSF_S24X, and FSF_S24Y.

FSF_B24

• Call the Detail Fish and Shellfish (DFS) block.

Programmer:

• Pass DT_QuestionE = "fish sticks" as parameter.

FSF_C25A

• If FSF_Q24 = 2, go to FSF_Q25.
• Otherwise, go to FSF_C26.

FSF_Q25
Over the past month, when you ate tuna in a can or pouch, was it:

Instruction: Read categories to respondent.

1. ...light (flaked or chunk) tuna?
2. ...white (solid) tuna? (Go to FSF_C25B)
3. ...both?
   DK, RF (Go to FSF_C25C)

FSF_B25A

• Call the Detail Fish and Shellfish (DFS) block.

Programmer:

• Pass DT_QuestionE = "light (flaked or chunk) tuna in a can or pouch" as parameter.

FSF_C25B

• If FSF_Q25 = 2 or 3, go to FSF_B25B.
• Otherwise, go to FSF_C25C.

FSF_B25B

• Call the Detail Fish and Shellfish (DFS) block.

Programmer:

• Pass DT_QuestionE = "white (solid) tuna in a can or pouch" as parameter.

FSF_C25C

• If FSF_Q25 = DK or RF, go to FSF_B25C.
• Otherwise, go to FSF_C26.

FSF_B25C

• Call the Detail Fish and Shellfish (DFS) block.

Programmer:

• Pass DT_QuestionE = "tuna in a can or pouch" as parameter.

FSF_C26

• If FSF_Q24 = 3, go to FSF_B26.
• Otherwise, go to FSF_C27.

FSF_B26

• Call the Detail Fish and Shellfish (DFS) block.

Programmer:

• Pass DT_QuestionE = "tuna (fresh or frozen)" as parameter.

FSF_C27

• If FSF_Q24 = 4, go to FSF_B27.
• Otherwise, go to FSF_C28.

FSF_B27

• Call the Detail Fish and Shellfish (DFS) block.

Programmer:

• Pass DT_QuestionE = "salmon in a can or pouch" as parameter.

FSF_C28

• If FSF_Q24 = 5, go to FSF_B28.
• Otherwise, go to FSF_C29.

FSF_B28

• Call the Detail Fish and Shellfish (DFS) block.

Programmer:

• Pass DT_QuestionE = "salmon - fresh, frozen or smoked" as parameter.

FSF_C29

• If FSF_Q24 = 6, go to FSF_B29.
• Otherwise, go to FSF_C30.

FSF_B29

• Call the Detail Fish and Shellfish (DFS) block.

Programmer:

• Pass DT_QuestionE = "smelt" as parameter.

FSF_C30

• If FSF_Q24 = 7, go to FSF_B30.
• Otherwise, go to FSF_C31.

FSF_B30

• Call the Detail Fish and Shellfish (DFS) block.

Programmer:

• Pass DT_QuestionE = "shark" as parameter.

FSF_C31

• If FSF_Q24 = 8, go to FSF_B31.
• Otherwise, go to FSF_C32.

FSF_B31

• Call the Detail Fish and Shellfish (DFS) block.

Programmer:

• Pass DT_QuestionE = "marlin" as parameter.

FSF_C32

• If FSF_Q24 = 9, go to FSF_B32.
• Otherwise, go to FSF_C33.

FSF_B32

• Call the Detail Fish and Shellfish (DFS) block.

Programmer:

• Pass DT_QuestionE = "swordfish" as parameter.

FSF_C33

• If FSF_Q24 = 10, go to FSF_B33.
• Otherwise, go to FSF_C34.

FSF_B33

• Call the Detail Fish and Shellfish (DFS) block.

Programmer:

• Pass DT_QuestionE = "halibut" as parameter.

FSF_C34

• If FSF_Q24 = 11, go to FSF_B34.
• Otherwise, go to FSF_C35.

FSF_B34

• Call the Detail Fish and Shellfish (DFS) block.

Programmer:

• Pass DT_QuestionE = "rainbow trout" as parameter.

FSF_C35

• If FSF_Q24 = 12, go to FSF_B35.
• Otherwise, go to FSF_C36.

FSF_B35

• Call the Detail Fish and Shellfish (DFS) block.

Programmer:

• Pass DT_QuestionE = "Atlantic cod" as parameter.

FSF_C36

• If FSF_Q24 = 13, go to FSF_B36.
• Otherwise, go to FSF_C37.

FSF_B36

• Call the Detail Fish and Shellfish (DFS) block.

Programmer:

• Pass DT_QuestionE = "mackerel" as parameter.

FSF_C37

• If FSF_Q24 = 14, go to FSF_B37.
• Otherwise, go to FSF_C38.

FSF_B37

• Call the Detail Fish and Shellfish (DFS) block.

Programmer:

• Pass DT_QuestionE = "herring" as parameter.

FSF_C38

• If FSF_Q24 = 15, go to FSF_B38.
• Otherwise, go to FSF_C39.

FSF_B38

• Call the Detail Fish and Shellfish (DFS) block.

Programmer:

• Pass DT_QuestionE = "sardines" as parameter.

FSF_C39

• If FSF_Q24 = 16, go to FSF_B39.
• Otherwise, go to FSF_C40.

FSF_B39

• Call the Detail Fish and Shellfish (DFS) block.

Programmer:

• Pass DT_QuestionE = "sole, flounder or plaice" as parameter.

FSF_C40

• If FSF_Q24 = 17, go to FSF_B40.
• Otherwise, go to FSF_C41.

FSF_B40

• Call the Detail Fish and Shellfish (DFS) block.

Programmer:

• Pass DT_QuestionE = "haddock" as parameter.

FSF_C41

• If FSF_Q24 = 18, go to FSF_B41.
• Otherwise, go to FSF_C41B.

FSF_B41

• Call the Detail Fish and Shellfish (DFS) block.

Programmer:

• Pass DT_QuestionE = "tilapia" as parameter.

FSF_C41B

• If FSF_Q24 = 21, go to FSF_B41B.
• Otherwise, go to FSF_C42.

FSF_B41B

• Call the Detail Fish and Shellfish (DFS) block.

Programmer:

• Pass DT_QuestionE = "sablefish or black cod" as parameter.

FSF_C42

• If FSF_S24V = RESPONSE and <> DK,RF, go to FSF_B42.
• Otherwise, go to FSF_C43.

FSF_B42

• Call the Detail Fish and Shellfish (DFS) block.

Programmer:

• Pass DT_QuestionE = "^FSF_S24V" as parameter.

FSF_C43

• If FSF_S24X = RESPONSE and <> DK,RF, go to FSF_B43.
• Otherwise, go to FSF_C44.

FSF_B43

• Call the Detail Fish and Shellfish (DFS) block.

Programmer:

• Pass DT_QuestionE = "^FSF_S24X" as parameter.

FSF_C44

• If FSF_S24Y = RESPONSE and <> DK,RF, go to FSF_B44.
• Otherwise, go to FSF_END.

FSF_B44

• Call the Detail Fish and Shellfish (DFS) block.

Programmer:

• Pass DT_QuestionE = "^FSF_S24Y" as parameter.

FSF_C69

• If 1 = 1, go to FSF_END.
• Otherwise, go to FSF_END.

FSF_N70

Instruction: Why was the component not fully completed?

• 01 Respondent unable to continue for health reasons
• 06 No time
• 20 Other - Specify
• (DK, RF not allowed)

Go to FSF_END

FSF_S70
(Why was the component not fully completed?)

Instruction: Specify the reason.

• (80 spaces)
• (DK, RF not allowed)

FSF_END

Detail Fish and Shellfish (DFS)

DFS_BEG

External variables required:

Variables taken from sample file:

• STAND: name of the city/town/village in which the clinic has been set up
• CLINICID: 8 digit respondent identifier

Variables assigned in Variable Creation:

• CurrentYear: numeric year during which clinic visit is taking place
• CurrentMonth: numeric month during which clinic visit is taking place
• CurrentDay: numeric day during which clinic visit is taking place
• SessionE: English text of when the clinic visit is taking place

Variables from previously completed blocks:

• RespondentName: name of respondent
• CON_SEX: sex of respondent
• GenderE: English text for sex of respondent
• CON_AGE: age of respondent
• DT_QuestionE: English question text

DFS_Q11
Over the past month, how many times did you eat:...
^DT_QUESTIONE?

• Times
• (MIN: 1)
• (MAX: 95)
• DK, RF (Go to DFS_END)

DFS_N11

Instruction: Select the reporting period.

1. Per month
2. Per week
3. Per day
   (DK, RF not allowed)

DFS_END

Noise Exposure Component

Noise Exposure Component Introduction (HCI)

HCI_BEG

List external fields required:

Variables taken from sample file:

• STAND: name of the city/town/village in which the clinic has been set up
• CLINICID:8 digit respondent identifier
• CON_AGE:age of respondent

Variables assigned in Variable Creation:

• CurrentYear: numeric year during which clinic visit is taking place
• CurrentMonth: numeric month during which clinic visit is taking place
• CurrentDay: numeric day during which clinic visit is taking place
• SessionE: English text of when the clinic visit is taking place
• RespondentName: name of respondent
• GenderE: English text for sex of respondent

Variables from previously completed blocks:

• RespondentName: Name of respondent
• CON_AGE: age of respondent
• HER_Q41: Whether respondent has ear infection
• HER_Q51: Whether respondent has cochlear implant
• PHC_N42: Whether the respondent should be excluded from the block because of an acute condition
• PHC_N44: Whether the respondent should be excluded from the block because of an chronic condition
• ORS_N7:Whether the respondent should be excluded from the block for a other reason
• SCS_N12: Visit type (3= clinic visit; 4= home visit)

HCI_D01

• If PHC_N42 = 14 or PHC_N44 = 14 or HER_Q41 = 3 or HER_Q50 = 1 or ORS_N7 = 1 or SCS_N12 = 4, DT_HCITEXT1E = "EMPTY
• Otherwise, DT_HCITEXT1E = "This information will help us better understand the results from your hearing tests".

HCI_R01
Now we are going to ask you questions about your day-to-day hearing health and your exposure to noise. [EMPTY/ This information will help us better understand the results from your hearing tests.]

Instruction: Press <1> to continue.

Programmer:

• Allow 'DK' as a response category.
• If HCI_R01 = DK, go to HCI_END.
• Otherwise, go to HCI_D02.

HCI_D02

Programmer:

• IF SCS_N12 = 4 THEN
  • HCI_D02 = EMPTY
• ELSE
  • IF HCI_R01 = 1 and HCI_D02 = "EMPTY" THEN
    • SET HCI_D02 = Current Time (in HH:MM:SS format)
• ENDIF

HCI_END

Hearing Ability (HAB)

HAB_BEG

List external fields required:

Variables taken from sample file:

• STAND: name of the city/town/village in which the clinic has been set up
• CLINICID:8 digit respondent identifier

Variables assigned in Variable Creation:

• CurrentYear: numeric year during which clinic visit is taking place
• CurrentMonth: numeric month during which clinic visit is taking place
• CurrentDay: numeric day during which clinic visit is taking place
• SessionE: English text of when the clinic visit is taking place

Variables from previously completed blocks:

• RespondentName: name of respondent
• CON_AGE: age of respondent
• CON_SEX: sex of respondent
• GenderE: English text for sex of respondent
• HER_Q52: whether respondent has a hearing aid
• HCI_R01: hearing questionnaire introduction

HAB_C05

• If HCI_R01 = DK, go to HAB_END.
• Otherwise, go to HAB_D07.

HAB_D07

• If HER_Q52 = 1, DT_HETEXT1E = "without a hearing aid".
• Otherwise, DT_HETEXT1E = "EMPTY".

HAB_Q07
Are you usually able to hear what is said in a group conversation with at least 3 other people [without a hearing aid/EMPTY]?

• 1 Yes (Go to HAB_END)
• 2 No
• DK, RF (Go to HAB_END)

HAB_C08

• If HER_Q52=1, go to HAB_Q08.
• Otherwise, go to HAB_Q09.

HAB_Q08
Are you usually able to hear what is said in a group conversation with at least 3 other people with a hearing aid?

• 1 Yes (Go to HAB_Q10)
• 2 No
• DK, RF

HAB_Q09
Are you able to hear at all?

• 1 Yes
• 2 No (Go to HAB_END)
• DK, RF (Go to HAB_END)

HAB_Q10
Are you usually able to hear what is said in a conversation with one other person in a quiet room[ without a hearing aid/EMPTY]?

• 1 Yes (Go to HAB_END)
• 2 No
• DK, RF (Go to HAB_END)

HAB_C11

• If HER_Q52=1, go to HAB_Q11.
• Otherwise, go to HAB_END.

HAB_Q11
Are you usually able to hear what is said in a conversation with one other person in a quiet room with a hearing aid?

• 1 Yes
• 2 No
• DK, RF

HAB_END

Noise Exposure (NEX)

NEX_BEG

List external fields required:

Variables taken from sample file:

• STAND: name of the city/town/village in which the clinic has been set up
• CLINICID: 8 digit respondent identifier

Variables assigned in Variable Creation:

• CurrentYear: numeric year during which clinic visit is taking place
• CurrentMonth: numeric month during which clinic visit is taking place
• CurrentDay: numeric day during which clinic visit is taking place
• SessionE: English text of when the clinic visit is taking place

Variables from previously completed blocks:

• RespondentName: Name of respondent
• GenderE: English text for sex of respondent
• CON_AGE: age of respondent
• CON_SEX: sex of respondent
• HCI_R01: hearing questionnaire introduction

NEX_C01A

• If HCI_R01 = DK, go to NEX_N70.
• Otherwise, go to NEX_C01.

NEX_C01

• If CON_AGE < 16, go to NEX_D07.
• Otherwise, go to NEX_Q01.

NEX_Q01
At any time in your life, have you worked in a noisy environment? By noisy, I mean so loud that you and your co-workers had to speak in a raised voice to be understood by or communicate with someone standing an arm's length away.

Instruction: A raised voice is a volume of speech between a normal voice and shouting. Include unpaid work.

• 1 Yes
• 2 No (Go to NEX_D07)
• DK, RF (Go to NEX_D07)

NEX_Q02
For how long did you work in a noisy environment?

Instruction: Read categories to respondent.

1. Less than 12 months
2. 1 to less than 5 years
3. 5 to less than 10 years
4. 10 or more years
   DK, RF

NEX_Q03
What was the source of the loud noise?

Instruction: Read categories to respondent. Mark all that apply.

1. Machinery such as bulldozers, backhoes or sawmill equipment
2. Modes of transportation such as trains, airplanes, cars or trucks
3. Munitions such as guns or canons
4. Music, for example, at a concert or other amplified music
5. People
6. Other
   DK, RF

NEX_Q04
Are you currently working in a noisy environment?

• 1 Yes
• 2 No
• DK, RF

NEX_D05

• If NEX_Q04 = 1, DT_NEXTEXT5E = "do".
• Otherwise, DT_NEXTEXT5E = "did".

NEX_Q05
How often [do/did] you use hearing protection at work when in a noisy area?

Instruction: Read categories to respondent.

• 1 Always
• 2 Often
• 3 Sometimes
• 4 Rarely
• 5 Never
• DK, RF

NEX_D06

• If NEX_Q04 = 1, DT_NEXTEXT6E = "Are".
• Otherwise, DT_NEXTEXT6E = "Were".

NEX_Q06
[Are/Were] you required to wear hearing protection at work?

Instruction: If the respondent did not have an employer (e.g., was self-employed), select <Not applicable>.

• 1 Yes
• 2 No
• 3 Not applicable
• DK, RF

NEX_D07

• If CON_AGE < 16, DT_NEXTEXTR07E = "By".
• Otherwise, DT_NEXTEXTR07E = "Again, by".

NEX_R07
Now I would like to ask you about your exposure to specific sources of loud noise during the past year.

[By/Again, by] loud I mean where you would have had to speak in a raised voice to be understood by or communicate with someone standing an arm's length away.

Instruction: Press <1> to continue.

NEX_Q07
Within the past 12 months, have you been exposed to noise from any of the following? Please include activities that took place at work, at school or during your leisure time.

... loud power tools such as circular saws, grinders, belt sanders or hammer drills?

• 1 Yes
• 2 No
• DK, RF

NEX_Q08
Within the past 12 months, have you been exposed to noise from any of the following? Please include activities that took place at work, at school or during your leisure time.

... loud heavy industrial, farming or construction equipment such as bulldozers, gas turbines or large compressors?

• 1 Yes
• 2 No
• DK, RF

NEX_Q09
Within the past 12 months, have you been exposed to noise from any of the following? Please include activities that took place at work, at school or during your leisure time.

... loud hand-held gasoline engines such as gas-powered chainsaws, hedge trimmers or leaf blowers? Please do not include lawn mowers.

Instruction: Hand held gasoline engines do not include electric items.

• 1 Yes
• 2 No
• DK, RF

NEX_Q10
Within the past 12 months, have you been exposed to noise from any of the following? Please include activities that took place at work, at school or during your leisure time.

... motorcycles or snowmobiles driven at highway speed?

Instruction: Highway speed is defined as speeds at or above 80 km/h.

• 1 Yes
• 2 No
• DK, RF

NEX_Q11
Within the past 12 months, have you been exposed to noise from any of the following? Please include activities that took place at work, at school or during your leisure time.

... loud sporting or entertainment events such as hockey, rodeo or demolition derby? Please do not include music events.

• 1 Yes
• 2 No
• DK, RF

NEX_Q12
Within the past 12 months, have you been exposed to noise from any of the following? Please include activities that took place at work, at school or during your leisure time.

... loud amplified music such as at concerts or nightclubs or as a member of a band?

• 1 Yes
• DK, RF

NEX_Q13
Within the past 12 months, have you been exposed to noise from any of the following? Please include activities that took place at work, at school or during your leisure time.

... other types of loud music without the use of headphones or earbuds, for example, a home or car stereo?

Instruction: Loud music is defined as a volume at or above three quarters the maximum volume level for a given audio device.

• 1 Yes
• 2 No
• DK, RF

NEX_C14

• If CON_AGE < 12, go to NEX_C15.
• Otherwise, go to NEX_Q14.

NEX_Q14
Within the past 12 months, have you been exposed to noise from any of the following? Please include activities that took place at work, at school or during your leisure time.

...firearms, for example guns?

• 1 Yes
• 2 No
• DK, RF

Content type - Note to data users:

• For each positive response to NEX_Q07-NEX_Q13, the Activity Details block is called to quantify the frequency and duration of the specific noise exposure in the past 12 months and whether or not hearing protection was worn (NEX_C15 through NEX_B21).

NEX_C15

• If NEX_Q07 = 1, go to NEX_B15.
• Otherwise, go to NEX_C16.

NEX_B15

• Call the Activity Details (ACD) block.

Programmer:

• Pass "DT_QuestionE = During the past 12 months, how often were you exposed to noise from loud power tools?" as parameter.

NEX_C16

• If NEX_Q08 = 1, go to NEX_B16.
• Otherwise, go to NEX_C17.

NEX_B16

• Call the Activity Details (ACD) block.

Programmer:

• Pass "DT_QuestionE = During the past 12 months, how often were you exposed to noise from loud heavy industrial, farming or construction equipment?" as parameter.

NEX_C17

• If NEX_Q09 = 1, go to NEX_B17.
• Otherwise, go to NEX_C18.

NEX_B17

• Call the Activity Details (ACD) block.

Programmer:

• Pass "DT_QuestionE = During the past 12 months, how often were you exposed to loud noise from hand-held gasoline engines?" as parameter.

NEX_C18

• If NEX_Q10 = 1, go to NEX_B18.
• Otherwise, go to NEX_C19.

NEX_B18

• Call the Activity Details (ACD) block.

Programmer:

• Pass "DT_QuestionE = During the past 12 months, how often were you exposed to noise from motorcycles or snowmobiles driven at highway speeds?" as parameter.

NEX_C19

• If NEX_Q11 = 1, go to NEX_B19.
• Otherwise, go to NEX_C20.

NEX_B19

• Call the Activity Details (ACD) block.

Programmer:

• Pass "DT_QuestionE = During the past 12 months, how often did you attend loud sporting or entertainment events? Please do not include music events." as parameter.

NEX_C20

• If NEX_Q12 = 1, go to NEX_B20.
• Otherwise, go to NEX_C21.

NEX_B20

• Call the Activity Details (ACD) block.

Programmer:

• Pass "DT_QuestionE = During the past 12 months, how often were you exposed to loud amplified music such as at concerts or nightclubs or as a member of a band?" as parameter.

NEX_C21

• If NEX_Q13 = 1, go to NEX_B21.
• Otherwise, go to NEX_C22.

NEX_B21

• Call the Activity Details (ACD) block.

Programmer:

• Pass "DT_QuestionE = During the past 12 months, how often did you listen to other types of loud music without the use of headphones or earbuds?" as parameter.

NEX_C22

• If NEX_Q14 = 1, go to NEX_Q23.
• Otherwise, go to NEX_R25.

NEX_Q23
In the past 12 months, how many times have you fired, or been exposed to noise from the shot of a gun or firearm?

Instruction: Read categories to respondent.

1. 1 to 19 times
2. 20 to 99 times
3. 100 to 9999 times
4. 10,000 times or more
   DK, RF (Go to NEX_R25)

NEX_Q24
How often did you wear hearing protection?

Instruction: Read categories to respondent.

1. Always
2. Often
3. Sometimes
4. Rarely
5. Never
   DK, RF

NEX_R25
The next few questions concern your use of headphones or earbuds to listen to music, movies, or other types of audio. Examples of audio devices that you may have listened to using headphones or earbuds include mp3 players, iPods, cell phones, stereo systems, televisions or computers.

Instruction: Press <1> to continue.

NEX_Q25
In the past 12 months have you listened to audio devices using headphones or earbuds?

• 1 Yes
• 2 No (Go to NEX_R40)
• DK, RF (Go to NEX_R40)

NEX_Q26
On average, in the past 12 months, how many hours per week did you usually listen to music, movies or other types of audio using headphones or earbuds?

Instruction: If respondent answers in hours and minutes, enter the number of hours on this screen and the number of minutes on the next screen. If respondent answers in minutes only, enter 0 hours on this screen and number of minutes on the next screen.

You may enter the answer either per week or per day.

• Hours
• (MIN: 0)
• (MAX: 168)
• DK, RF (Go to NEX_Q27)

NEX_N26A

Instruction: Enter number of minutes.

• Minutes
• (MIN: 0)
• (MAX: 960)
  DK, RF

NEX_C26

• If NEX_Q26 = 0 and NEX_N26A = 0, go to NEX_R40.
• Otherwise, if NEX_Q26 = 0 and NEX_N26A = DK or RF, go to NEX_Q27.
• Otherwise, go to NEX_N26B.

NEX_N26B

Instruction: Select the reporting period.

• 1 Per day
• 2 Per week
• (DK, RF not allowed)

NEX_Q27
Is the volume level usually at or above three quarters of the maximum volume?

• 1 Yes
• 2 No
• DK, RF

NEX_Q28
Is the volume usually so loud that someone standing an arm's length away would have to speak in a raised voice for you to understand what they were saying?

Instruction: A raised voice is a volume of speech between a normal voice and shouting.

• 1 Yes
• 2 No
• DK, RF

NEX_C29

• If (NEX_Q27 = 2, DK or RF) and (NEX_Q28 = 2, DK or RF), go to NEX_R40.
• Otherwise, go to NEX_D29.

NEX_D29

• If NEX_Q27 = 1 and NEX_Q28 = 1, DT_NEXTEXT29E = "at or above three quarters of the maximum volume or so loud that someone standing an arm's length away would have to speak in a raised voice for you to understand what they were saying".
• If NEX_Q27 = 1 and NEX_Q28 < > 1, DT_NEXTEXT29E = "at or above three quarters of the maximum volume".
• If NEX_Q27 < > 1 and NEX_Q28 = 1, DT_NEXTEXT29E = "so loud that someone standing an arm's length away would have to speak in a raised voice for you to understand what they were saying".

NEX_Q29
How many hours per week do you usually listen to audio devices, using headphones or earbuds, at a volume that is ^DT_NEXTEST29E?

Instruction: If respondent answers in hours and minutes, enter the number of hours on this screen and the number of minutes on the next screen. If respondent answers in minutes only, enter 0 hours on this screen and number of minutes on the next screen.

You may enter the answer either per week or per day.

• Hours
• (MIN: 0)
• (MAX: 168)
• DK, RF (Go to NEX_Q30)

NEX_N29A

Instruction: Enter number of minutes.

• Minutes
• (MIN: 0)
• (MAX: 960)
• DK, RF

NEX_C29A

• If NEX_Q29 = 0 and NEX_N29A = DK or RF, go to NEX_Q30.
• Otherwise, go to NEX_N29B.

NEX_N29B

Instruction: Select the reporting period.

• 1 Per day
• 2 Per week
• (DK, RF not allowed)

NEX_D29E

• If NEX_N26B = 1, DV_PERWKFCTR26 = 7
• Otherwise, DV_PERWKFCTR26 = 1
• If NEX_N29B = 1, DV_PERWKFCTR29 = 7
• Otherwise, DV_PERWKFCTR29 = 1

NEX_Q30
For how long has this been your usual listening volume?

Instruction: Enter amount only.

• Amount
• (MIN: 1)
• (MAX: 995)
• DK, RF (Go to NEX_R40)

NEX_N30

Instruction: Select the reporting period.

1. Days
2. Weeks
3. Months
4. Years
   (DK, RF not allowed)

NEX_R40
Now I'd like to ask you about tinnitus. Tinnitus is the presence of hissing, buzzing, ringing, rushing or roaring sounds in your ears when there is no other sound around you.

Instruction: Press <1> to continue.

NEX_Q40
Have you ever experienced tinnitus?

• 1 Yes
• 2 No (Go to NEX_END)
• DK, RF (Go to NEX_END)

NEX_Q41
When was the last time you experienced these sounds in your ears? Was it... ?

Instruction: Read categories to respondent.

1. Within the last 7 days
2. 8 days to less than 1 month ago (Go to NEX_Q43)
3. 1 month to less than 6 months ago (Go to NEX_D45)
4. 6 months to less than 1 year ago (Go to NEX_D45)
5. 1 year ago or more (Go to NEX_END)
   DK, RF (Go to NEX_END)

NEX_Q42
Are you experiencing these sounds right now?

• 1 Yes
• 2 No
• DK, RF

NEX_Q43
When it is quiet, do you experience these sounds in your ears... ?

Instruction: Read categories to respondent.

1. Always
2. Often
3. Sometimes (Go to NEX_D45)
4. Rarely (Go to NEX_D45)
5. Never (Go to NEX_D45)
   DK, RF

NEX_Q44
For how long have you had this?

Instruction: Enter amount only.

• (MIN: 1)
• (MAX: 995)
• DK, RF (Go to NEX_D45)

NEX_N44

Instruction: Select the reporting period.

1. Days
2. Weeks
3. Months
4. Years
   (DK, RF not allowed)

NEX_D45

• If NEX_Q42 = 1, DT_NEXTEXT45AE = "Does".
• Otherwise, DT_NEXTEXT45AE = "Did".
• If NEX_Q42 = 1 , DT_NEXTEXT45BE = "does".
• Otherwise, DT_NEXTEXT45BE = "did".

NEX_Q45
[Does/Did] this bother you? For example, [does/did] it affect your sleep, concentration or mood?

• 1 Yes
• 2 No
• DK, RF

NEX_C46

• If CON_AGE < 10, go to NEX_END.
• Otherwise, go to NEX_D46.

NEX_D46

• If NEX_Q43 = 1 and [(NEX_Q44 => 6 and NEX_N44 = 3) or NEX_N44 = 4], DT_NEXTINNITUSE = "were they louder or more pronounced".
• Otherwise, DT_NEXTINNITUSE = "did they occur".

NEX_C47

• If NEX_Q25 = 1, go to NEX_Q47.
• Otherwise, go to NEX_C48.

NEX_Q47
In the past 12 months, when you experienced these noises in your ears, [were they louder or more pronounced/did they occur] ...

...after using headphones or earbuds to listen to audio devices such as an mp3 player, iPod, cell phone, stereo system, television or computer?

• 1 Yes
• 2 No
• DK, RF

NEX_C48

• If NEX_Q12 = 1, go to NEX_Q48.
• Otherwise, go to NEX_C49.

NEX_Q48
(In the past 12 months, when you experienced these noises in your ears, [were they louder or more pronounced/did they occur] ...)

...after being exposed to loud amplified music such as at a concert, nightclub or as a member of a band?

• 1 Yes
• 2 No
• DK, RF

NEX_C49

• If NEX_Q11 = 1, go to NEX_Q49.
• Otherwise, go to NEX_C50.

NEX_Q49
(In the past 12 months, when you experienced these noises in your ears, [were they louder or more pronounced/did they occur] ...)

...after being at a loud sporting or entertainment event?

• 1 Yes
• 2 No
• DK, RF

NEX_C50

• If NEX_Q07 = 1, go to NEX_Q50.
• Otherwise, go to NEX_C51.

NEX_Q50
(In the past 12 months, when you experienced these noises in your ears, [were they louder or more pronounced/did they occur] ...)

...after being exposed to noise from loud power tools (for example, circular saw, grinder, belt sander or hammer drill)?

• 1 Yes
• 2 No
• DK, RF

NEX_C51

• If NEX_Q14 = 1, go to NEX_Q51.
• Otherwise, go to NEX_D52.

NEX_Q51
(In the past 12 months, when you experienced these noises in your ears, [were they louder or more pronounced/did they occur] ...)

...after being exposed to noise from firearms or guns?

• 1 Yes
• 2 No
• DK, RF

NEX_D52

• If NEX_Q07 = 1 or NEX_Q11 = 1 or NEX_Q12 = 1 or NEX_Q14 = 1 or NEX_Q25 = 1, DT_NEXTEXT52E = "any other".
• Otherwise, DT_NEXTEXT52E = "any".

NEX_Q52
(In the past 12 months, when you experienced these noises in your ears, [were they louder or more pronounced/did they occur] ...)

... in [any other/any] specific circumstances?

• 1 Yes (Go to NEX_S52)
• 2 No (Go to NEX_END)
• DK, RF (Go to NEX_END)

NEX_S52

Instruction: Specify.

• (80 spaces)
• DK, RF

Go to NEX_END

NEX_N70

Instruction: Why was the component not fully completed?

• 01 Respondent unable to continue for health reasons
• 06 No time
• 20 Other - Specify
• (DK, RF not allowed)

Go to NEX_END

NEX_S70
(Why was the component not fully completed?)

Instruction: Specify.

• (80 spaces)
• DK, RF

NEX_END

Activity Detail (ACD)

ACD_BEG

• External variables required:
• QuestionE: English question text

ACD_Q11
^QuestionE

The answer categories are number of times per day, per week, per month or per year.

Instruction: Enter frequency only.

• (MIN: 1)
• (MAX: 995)
• DK, RF (Go to ACD_END)

ACD_N11

Instruction: The reference period for this question is the past 12 months. Report seasonal activities as number of times per year.

Select the reporting period.

1. Per day
2. Per week
3. Per month
4. Per year
   (DK, RF not allowed)

ACD_Q12
How much time did you typically spend on each occasion?

Instruction: Read categories to respondent.

1. Less than 10 minutes
2. 10 to less than 30 minutes
3. 30 minutes to less than 1½ hours
4. 1½ hours to less than 5 hours
5. 5 hours or more
   DK, RF

ACD_Q13
How often did you wear hearing protection?

Instruction: Read categories to respondent.

1. Always
2. Often
3. Sometimes
4. Rarely
5. Never
   DK, RF

ACD_END

Sun Exposure Component (SEB)

SEB_BEG

Variables taken from sample file:

• STAND: name of the city/town/village in which the clinic has been set up
• CLINICID:8 digit respondent identifier

Variables assigned in Variable Creation:

• CurrentYear: numeric year during which clinic visit is taking place
• CurrentMonth: numeric month during which clinic visit is taking place
• CurrentDay: numeric day during which clinic visit is taking place
• SessionE: English text of when the clinic visit is taking place
• Date2MonthsAgoE

Variables from previously completed blocks:

• RespondentName: name of respondent
• CON_AGE: age of respondent
• CON_SEX: sex of respondent
• GenderE: English text for sex of respondent
• SCS_N12: visit type (3= clinic visit; 4= home visit)

SEB_R01A
In order to better understand the relationship between sun exposure and vitamin D, we will be asking you questions about behaviours and habits that affect your body's ability to create vitamin D. Please answer the following questions as accurately as possible.

Instruction: Press <1> to continue.

Programmer:

• Allow ‘DK’ as a response category.

SEB_C01A

• If SEB_R01A = DK, go to SEB_N60.
• Otherwise, go to SEB_D01A.

SEB_D01A

Programmer:

• IF SCS_N12 = 4 THEN
  • SEB_D01A = EMPTY
• ELSE
  • IF SEB_R01A = 1 and SEB_D01A = EMPTY THEN
    • SET SEB_D01A = Current Time (in HH:MM:SS format)
• ENDIF

SEB_D01B

• If CurrentMonth = 10, 11, 12, 01, 02, 03 or 04, DT_SEBMONTHE = "this past May to September".
• If CurrentMonth = 08 or 09, DT_SEBMONTHE = "the months of May to ^CURRENTMONTHE this year".
• If CurrentMonth = 05, 06 or 07, DT_SEBMONTHE = "the months of May to September last year".

SEB_R01B
The next few questions concern time spent in the sun. Think about [this past May to September/the months of May to ^CURRENTMONTHE this year/the months of May to September last year].

Instruction: Press <1> to continue.

SEB_D01C

• If CON_AGE=3 to 6, DT_SEBTEXT2E = " or daycare".
• Otherwise, DT_SEBTEXT2E = "EMPTY".

SEB_C01

• If CON_AGE=3 to 11 , go to SEB_Q01.
• Otherwise, go to SEB_Q02.

SEB_Q01
Did you attend school[ or daycare/EMPTY] at any time during these months?

• 1 Yes (Go to SEB_D03A)
• 2 No (Go to SEB_Q13A)
• DK, RF (Go to SEB_Q13A)

SEB_Q02
Did you do any of the following during these months:

- work at a job?

- work at a business?

- attend school?

• 1 Yes
• 2 No (Go to SEB_Q13A)
• DK, RF (Go to SEB_Q13A)

SEB_D03A

• If CON_AGE > 11, DT_SEBTEXT3E = " work or".
• Otherwise, DT_SEBTEXT3E = "EMPTY".

SEB_D03B

• Not Applicable

SEB_Q03
During these months, how much time did you spend in the sun between 10 a.m. and 4 p.m., on a typical day at [work or/EMPTY] school[ or daycare/EMPTY]?

Instruction: Read categories to respondent.

1. Less than 5 minutes (Go to SEB_Q13A)
2. 5 to less than 30 minutes
3. 30 minutes to less than 1 hour
4. 1 hour to less than 2 hours
5. 2 hours or more
   DK, RF (Go to SEB_Q13A)

SEB_D04

• If CON_SEX=1, DT_SEBTEXT5E = "EMPTY".
• Otherwise, DT_SEBTEXT5E = ", veil".

SEB_Q04
When you were exposed to the sun during these hours on a day at[ work or/EMPTY] school[ or daycare/EMPTY], how often did you wear something on your head that shaded your face, ears or neck, for example, a cap[EMPTY/, veil] or sunhat?

Instruction: Read categories to respondent.

1. Always (Go to SEB_Q06)
2. Often
3. Sometimes
4. Rarely
5. Never
   DK, RF

SEB_Q05
Please identify whether the following areas of skin were typically covered or uncovered when you were out in the sun:

Face, ears or neck

Instruction: The reference period for these questions is [this past May to September/the months of May to ^CURRENTMONTHE this year/the months of May to September last year], between the hours of 10 a.m. and 4 p.m.

1. Covered
2. Uncovered
   DK, RF

SEB_Q06
Please identify whether the following areas of skin were typically covered or uncovered when you were out in the sun:

Hands

1. Covered
2. Uncovered
   DK, RF

SEB_Q07
Please identify whether the following areas of skin were typically covered or uncovered when you were out in the sun:

Arms

1. Covered
2. Uncovered
   DK, RF

SEB_Q08
Please identify whether the following areas of skin were typically covered or uncovered when you were out in the sun:

Legs

1. Covered
2. Uncovered
   DK, RF

SEB_Q09
Please identify whether the following areas of skin were typically covered or uncovered when you were out in the sun:

Feet

1. Covered
2. Uncovered
   DK, RF

SEB_Q10
Please identify whether the following areas of skin were typically covered or uncovered when you were out in the sun:

Other (for example, shoulders or back)

1. Covered
2. Uncovered
   DK, RF

SEB_Q11
How often did you usually use sunscreen...

...on your face, ears or neck?

Instruction: The reference period for these questions is [this past May to September/the months of May to ^CURRENTMONTHE this year/the months of May to September last year], between the hours of 10 a.m. and 4 p.m.

Read categories to respondent.

1. Always
2. Often
3. Sometimes
4. Rarely
5. Never
   DK, RF

SEB_Q12A
How often did you usually use sunscreen...

...on other areas (for example, hands, arms or legs)?

1. Always
2. Often
3. Sometimes
4. Rarely
5. Never
   DK, RF

SEB_Q13A
Again, please think about [this past May to September/the months of May to ^CURRENTMONTHE this year/the months of May to September last year]. During these months, how much time did you spend in the sun between 10 a.m. and 4 p.m. on a typical day when not at[ work or/EMPTY] school[ or daycare/EMPTY]?

Instruction: If the respondent was never in the sun during these hours, select <1> 'Less than 5 minutes'.

Read categories to respondent.

1. Less than 5 minutes (Go to SEB_Q23)
2. 5 to less than 30 minutes
3. 30 minutes to less than 1 hour
4. 1 hour to less than 2 hours
5. 2 hours or more
   DK, RF (Go to SEB_Q23)

SEB_Q14
When you were exposed to the sun during these hours on a day when you were not at[ work or/EMPTY] school[ or daycare/EMPTY], how often did you wear something on your head that shaded your face, ears or neck, for example, a cap[EMPTY/, veil] or sunhat?

Instruction: Read categories to respondent.

1. Always (Go to SEB_Q16)
2. Often
3. Sometimes
4. Rarely
5. Never
   DK, RF

SEB_Q15
Please identify whether the following areas of skin were typically covered or uncovered when you were out in the sun:

Face, ears or neck

Instruction: The reference period for these questions is [this past May to September/the months of May to ^CURRENTMONTHE this year/the months of May to September last year], between the hours of 10 a.m. and 4 p.m.

1. Covered
2. Uncovered
   DK, RF

SEB_Q16
Please identify whether the following areas of skin were typically covered or uncovered when you were out in the sun:

Hands

1. Covered
2. Uncovered
   DK, RF

SEB_Q17
Please identify whether the following areas of skin were typically covered or uncovered when you were out in the sun:

Arms

1. Covered
2. Uncovered
   DK, RF

SEB_Q18
Please identify whether the following areas of skin were typically covered or uncovered when you were out in the sun:

Legs

1. Covered
2. Uncovered
   DK, RF

SEB_Q19
Please identify whether the following areas of skin were typically covered or uncovered when you were out in the sun:

Feet

1. Covered
2. Uncovered
   DK, RF

SEB_Q20
Please identify whether the following areas of skin were typically covered or uncovered when you were out in the sun:

Other (for example, shoulders or back)

1. Covered
2. Uncovered
   DK, RF

SEB_Q21
How often did you usually use sunscreen...

...on your face, ears or neck?

Instruction: The reference period for these questions is [this past May to September/the months of May to ^CURRENTMONTHE this year/the months of May to September last year], between the hours of 10 a.m. and 4 p.m.

Read categories to respondent.

1. Always
2. Often
3. Sometimes
4. Rarely
5. Never
   DK, RF

SEB_Q22
How often did you usually use sunscreen...

...on other areas (for example, hands, arms or legs)?

1. Always
2. Often
3. Sometimes
4. Rarely
5. Never
   DK, RF

SEB_Q23
In the past 2 months, that is, from ^Date2MonthsAgoE to yesterday, have you traveled to a warm, sunny climate?

1. Yes
2. No (Go to SEB_C35)
   DK, RF (Go to SEB_C35)

SEB_Q24
How long were you there?

Instruction: Enter amount only.

• Amount
• (MIN: 1)
• (MAX: 61)
• DK, RF (Go to SEB_Q25)

SEB_N24

Instruction: Select the reporting period.

1. Days
2. Weeks
3. Months
4. Years
   (DK, RF not allowed)

SEB_Q25
While you were in this warm, sunny climate...

...how much time did you typically spend in the sun between 10 a.m. and 4 p.m.?

1. Less than 5 minutes (Go to SEB_C35)
2. 5 to less than 30 minutes
3. 30 minutes to less than 1 hour
4. 1 hour to less than 2 hours
5. 2 hours or more
   DK, RF (Go to SEB_C35)

SEB_Q26
While you were in this warm, sunny climate…

...during these hours, how often did you wear something on your head that shaded your face, ears or neck, for example, a cap [EMPTY/, veil] or sunhat?

1. Always (Go to SEB_Q28)
2. Often
3. Sometimes
4. Rarely
5. Never
   DK, RF

SEB_Q27
Please identify whether the following areas of skin were typically covered or uncovered when you were out in the sun:

Face, ears or neck

Instruction: The reference period for these questions is between the hours of 10 a.m. and 4 p.m.

1. Covered
2. Uncovered
   DK, RF

SEB_Q28
Please identify whether the following areas of skin were typically covered or uncovered when you were out in the sun:

Hands

1. Covered
2. Uncovered
   DK, RF

SEB_Q29
Please identify whether the following areas of skin were typically covered or uncovered when you were out in the sun:

Arms

1. Covered
2. Uncovered
   DK, RF

SEB_Q30
Please identify whether the following areas of skin were typically covered or uncovered when you were out in the sun:

Legs

1. Covered
2. Uncovered
   DK, RF

SEB_Q31
Please identify whether the following areas of skin were typically covered or uncovered when you were out in the sun:

Feet

1. Covered
2. Uncovered
   DK, RF

SEB_Q32
Please identify whether the following areas of skin were typically covered or uncovered when you were out in the sun:

Other (for example, shoulders or back)

1. Covered
2. Uncovered
   DK, RF

SEB_Q33
How often did you usually use sunscreen...

...on your face, ears or neck?

Instruction: Read categories to respondent. The reference period for these questions is between the hours of 10 a.m. and 4 p.m.

1. Always
2. Often
3. Sometimes
4. Rarely
5. Never
   DK, RF

SEB_Q34
How often did you usually use sunscreen...

...on other areas (for example, hands, arms or legs)?

1. Always
2. Often
3. Sometimes
4. Rarely
5. Never
   DK, RF

SEB_C35

• If CON_AGE < 12, go to SEB_END.
• Otherwise, go to SEB_R35.

SEB_R35
The following questions are about your use of tanning equipment.

Instruction: Press <1> to continue.

SEB_Q35
In the past 12 months, have you used a tanning bed or booth with tanning lamps?

1. Yes
2. No (Go to SEB_END)
   DK, RF (Go to SEB_END)

SEB_Q36
How often?

Instruction: Enter amount only.

• Times
• (MIN: 1)
• (MAX: 365)
  DK, RF (Go to SEB_Q37)

SEB_N36

Instruction: Select the reporting period.

1. Per day
2. Per week
3. Per month
4. Per year
   (DK, RF not allowed)

SEB_Q37
Have you used a tanning bed or booth with tanning lamps in the past 2 months, that is, from ^Date2MonthsAgoE to today?

1. Yes
2. No
   DK, RF (Go to SEB_END)

SEB_Q38
During which months do you typically use a tanning bed or booth?

Instruction: Mark all that apply.

• 01 January
• 02 February
• 03 March
• 04 April
• 05 May
• 06 June
• 07 July
• 08 August
• 09 September
• 10 October
• 11 November
• 12 December
• 13 All months
• DK, RF

Go to SEB_END

SEB_N60

Instruction: Why was the component not fully completed?

• 01 Respondent unable to continue for health reasons
• 06 No time
• 20 Other - Specify (Go to SEB_S60)
• (DK, RF not allowed)

Go to SEB_END

SEB_S60
(Why was the component not fully completed?)

Instruction: Specify the reason.

• (80 spaces)
• (DK, RF not allowed)

SEB_END

Skin Pigmentation Component

Skin Pigmentation Component Introduction (SKI)

SKI_BEG

External variables required:

Variables taken from sample file:

• STAND: name of the city/town/village in which the clinic has been set up
• CLINICID: 8 digit respondent identifier

Variables assigned in Variable Creation:

• CurrentYear: numeric year during which clinic visit is taking place
• CurrentMonth: numeric month during which clinic visit is taking place
• CurrentDay: numeric day during which clinic visit is taking place
• SessionE: English text of when the clinic visit is taking place

Variables from previously completed blocks:

• RespondentName: name of respondent
• GenderE: English text for sex of respondent
• CON_AGE: age of respondent
• SCS_N12: visit type (3= clinic visit; 4= home visit)

SKI_Q01
To better understand the relationship between skin colour, sun exposure and vitamin D, I will be measuring your skin pigmentation. To do this, I will gently hold a light sensor against your skin in order to measure the amount and type of light reflected by your skin.

Let me show you how it feels on your hand.

Instruction: Show the spectrophotometer to the respondent and demonstrate the technique on the back of the respondent's hand.

Press <1> to continue.

• 1 Continue
• DK (Go to SKI_END)
• (RF is not allowed)

SKI_D01

Programmer:

• IF SCS_N12 = 4 THEN
  • SKI_D01 = EMPTY
• ELSE
  • IF SKI_R01 = 1 and SKI_D01 = EMPTY,
  • SET SKI_D01 = Current Time (in HH:MM:SS format)
• ENDIF

SKI_R02
I will be measuring skin pigmentation at two sites: the back of the hand and the inside of the upper arm. At each site I will take 3 or 4 measurements.

The measurement must be taken directly against the skin (so I may need you to adjust your clothing slightly to have access to the sites).

Before I begin I will need to examine your hand(s) and arm(s) to determine if an accurate measurement can be taken. (Please remove your long sleeved clothing.)

Instruction: If the respondent is unwilling to remove long sleeved clothing, ask him/her to roll his/her sleeve(s) up to the shoulder or to put on a short sleeved gown.

Examine the respondent's right/left hand(s) and arm(s) to determine if an accurate skin pigmentation measurement can be taken.

• Press <1> to continue.
• DK and RF are not allowed.

SKI_N04

Instruction: Record which arm will be used for the inner arm skin pigmentation measurement.

• 1 Right (Go to SKI_N06)
• 2 Left (Go to SKI_N06)
• 3 None
  (DK, RF not allowed)

SKI_N05

Instruction: Why will an inner arm measurement not be taken?

Mark all that apply.

• 1 Measurement site is covered (e.g., cast, dressing)
• 2 Altered skin pigmentation (e.g., tattoo, scar, mole)
• 3 Blanching of skin due to restrictive clothing
• 4 Respondent refused
• 5 Other - Specify (Go to SKI_S05)
  (DK, RF not allowed)

Go to SKI_N06

SKI_S05

Instruction: Specify the reason.

• (80 spaces)
• (DK, RF not allowed)

SKI_N06

Instruction: Record which hand will be used for the hand skin pigmentation measurement:

• 1 Right (Go to SKI_C07)
• 2 Left (Go to SKI_C07)
• 3 None
  (DK, RF not allowed)

SKI_N07

Instruction: Why will a hand measurement not be taken?

Mark all that apply.

• 1 Measurement site is covered (e.g., cast, dressing)
• 2 Altered skin pigmentation (e.g., tattoo, scar, mole)
• 3 Blanching of skin due to restrictive clothing
• 4 Respondent refused
• 5 Other - Specify (Go to SKI_S07)
  (DK, RF not allowed)

Go to SKI_C07

SKI_S07

Instruction: Specify the reason.

• (80 spaces)
• (DK, RF not allowed)

SKI_C07

• If SKI_N04 = 3 and SKI_N06 = 3, go to SKI_R08.
• Otherwise, go to SKI_C08.

SKI_R08
Unfortunately I will not be able to take an accurate measurement of your skin pigmentation today.

Instruction: Answer any questions about why an accurate skin pigmentation measurement cannot be collected.

• Press <1> to continue.

Go to SKI_END

SKI_C08

• If CON_AGE < 12, go to SKI_END.
• Otherwise, go to SKI_R09.

SKI_R09
Now I am going to ask you questions about sunless tanning products. This information will help us better understand the results from your skin pigmentation measure.

Instruction: Press <1> to continue.

SKI_D09

Programmer:

• ^DT_Date10DaysAgoE = English text of date 10 days ago.

SKI_Q09
In the past 10 days, that is, from ^Date10DaysAgoE to today, have you used sunless tanning products such as creams or lotions, or received a spray-on or mist tan?

Instruction: Do not include cosmetic products like blush or bronzing powders.

• 1 Yes
• 2 No (Go to SKI_END)
  DK, RF (Go to SKI_END)

SKI_Q10
Was it applied to the back of your hands?

• 1 Yes
• 2 No
  DK, RF

SKI_Q11
Was it applied to your inner arms between the elbow and armpit?

• 1 Yes
• 2 No
  DK, RF

SKI_END

Skin Pigmentation Measurement (SKM)

SKM_BEG

External variables required:

Variables taken from sample file:

• STAND: name of the city/town/village in which the clinic has been set up
• CLINICID: 8 digit respondent identifier

Variables assigned in Variable Creation:

• CurrentYear: numeric year during which clinic visit is taking place
• CurrentMonth: numeric month during which clinic visit is taking place
• CurrentDay: numeric day during which clinic visit is taking place
• SessionE: English text of when the clinic visit is taking place

Variables from previously completed blocks:

• RespondentName: name of respondent
• GenderE: English text for sex of respondent
• CON_AGE: age of respondent
• SKI_N04: indicates arm for measurement
• SKI_N06: indicates hand for measurement

SKM_C10A

• If SKI_Q01 = DK, go to SKM_N220.
• Otherwise, go to SKM_C10B.

SKM_C10B

• If SKI_N04 =3 and SKI_N06 = 3, go to SKM_END.
• Otherwise, go to SKM_D10A.

SKM_D10A

• If SKI_N04 = 1 and SKI_N06 = 1, DT_SKMR10_TEXTE = "your right inner arm and right hand".
• If SKI_N04 = 2 and SKI_N06 = 2, DT_SKMR10_TEXTE = "your left inner arm and left hand".
• If SKI_N04 = 1 and SKI_N06 = 2, DT_SKMR10_TEXTE = "your right inner arm and left hand".
• If SKI_N04 = 2 and SKI_N06 = 1, DT_SKMR10_TEXTE = "your left inner arm and right hand".
• If SKI_N04 = 1 and SKI_N06 = 3, DT_SKMR10_TEXTE = "your right inner arm ".
• If SKI_N04 = 2 and SKI_N06 = 3, DT_SKMR10_TEXTE = "your left inner arm".
• If SKI_N04 = 3 and SKI_N06 = 1, DT_SKMR10_TEXTE = "your right hand".
• If SKI_N04 = 3 and SKI_N06 = 2, DT_SKMR10_TEXTE = "your left hand".

SKM_D10B

• If SKI_N04 = 1 and SKI_N06 = 3 or SKI_N04 = 2 and SKI_N06 = 3 or SKI_N04 = 3 and SKI_N06 = 1 or SKI_N04 = 3 and SKI_N06 = 2, DT_SKMD10B_TEXTE = "the".
• otherwise, DT_SKMD10B_TEXTE = "each"

SKM_D10C

• If SKI_N04 = 1 and SKI_N06 = 3 or SKI_N04 = 2 and SKI_N06 = 3 or SKI_N04 = 3 and SKI_N06 = 1 or SKI_N04 = 3 and SKI_N06 = 2, DT_SKMD10C_TEXTE = "it".
• Otherwise, DT_SKMD10C_TEXTE = "them".

SKM_R10
Now I am going to take a skin pigmentation measurement on ^DT_SKMR10_TEXTE. First, I need to mark the location of [the/each] measurement using this washable marker. When I am finished, I'll remove [it/them] with a wipe.

Instruction: Mark all locations.

• Press <1> to continue.

SKM_C20

• If SKI_N04 = 3 (No inner arm measurement), go to SKM_C130.
• Otherwise, go to SKM_N20.

SKM_N20

Instruction: Record how the inner arm skin pigmentation data will be captured.

• 1 Electronically
• 2 Electronic data captured manually (Go to SKM_C110)
  (DK, RF not allowed)

SKM_N21

Instruction: Press < ON/MEASURES > to take the first inner arm skin pigmentation measurement.

• Press < 1 > to continue
• DK, RF (Go to SKM_C130)

SKM_N21A

Instruction: Press <1> to save the measurements in Blaise.

• 1 Save the measurements
• (DK, RF not allowed)

SKM_N21B

Instruction: Check the skin pigmentation data.

• 1 Accept the measurements
• 2 Reject the measurements (Go to SKM_B110)
• (DK, RF not allowed)

SKM_N22

Instruction: Press < ON/MEASURES > to take the second inner arm skin pigmentation measurement.

• Press < 1 > to continue.
• 1 Continue
• DK, RF (Go to SKM_C130)

SKM_N22A

Instruction: Press <1> to save the measurements in Blaise.

• 1 Save the measurements
• (DK, RF not allowed)

SKM_N22B

Instruction: Check the skin pigmentation data.

• 1 Accept the measurements
• 2 Reject the measurements (Go to SKM_B111)
• (DK, RF not allowed)

SKM_N23

Instruction: Press < ON/MEASURES > to take the third inner arm skin pigmentation measurement.

• Press < 1 > to continue.
• 1 Continue
• DK, RF (Go to SKM_C130)

SKM_N23A

Instruction: Press <1> to save the measurements in Blaise.

• 1 Save the measurements
• (DK, RF not allowed)

SKM_N23B

Instruction: Check the skin pigmentation data.

• 1 Accept the measurements
• 2 Reject the measurements (Go to SKM_B112)
• (DK, RF not allowed)

SKM_D24

Programmer:

• If the difference between any two of SKM_B110.SKR_N1A, SKM_B111.SKR_N1A, SKM_B112.SKR_N1A is > 10 units, OR
• If the difference between any two of SKM_B110.SKR_N2A, SKM_B111.SKR_N2A, SKM_B112.SKR_N2A is > 10 units,
• Go to SKM_N24.
• Otherwise, go to SKM_C130.

SKM_N24

Instruction: Press < ON/MEASURES > to take the fourth inner arm skin pigmentation measurement.

• Press < 1 > to continue.
• 1 Continue
• DK, RF (Go to SKM_C130)

SKM_N24A

Instruction: Press <1> to save the measurements in Blaise.

• 1 Save the measurements
• (DK, RF not allowed)

SKM_N24B

Instruction: Check the skin pigmentation data.

• 1 Accept the measurements
• 2 Reject the measurements (Go to SKM_B113)
• (DK, RF not allowed)

SKM_C110

• If SKM_N20 = 1 (electronically), go to SKM_C130.
• Otherwise, go to SKM_B110.

SKM_B110

• Call the Skin Pigmentation Recording (SKR) Block.

Programmer:

• Pass ^DT_SKR_TEXTE1 = "first" and ^DT_SKR_TEXTE2 = "inner arm" as a parameters.

SKM_C111

• If SKM_B110.SKR_N1A = DK or RF, go to SKM_C130.
• Otherwise, go to SKM_N111.

SKM_N111

Instruction: Check the skin pigmentation data.

• 1 Accept the measurements
• 2 Reject the measurements (Go to SKM_B110)
• (DK, RF not allowed)

SKM_B111

• Call the Skin Pigmentation Recording (SKR) Block.

Programmer:

• Pass ^DT_SKR_TEXTE1 = "second" and ^DT_SKR_TEXTE2 = "inner arm" as a parameters.

SKM_C112

• If SKM_B111.SKR_N1A = DK or RF, go to SKM_C130.
• Otherwise, go to SKM_N112.

SKM_N112

Instruction: Check the skin pigmentation data.

• 1 Accept the measurements
• 2 Reject the measurements (Go to SKM_B111)
• (DK, RF not allowed)

SKM_B112

• Call the Skin Pigmentation Recording (SKR) Block.

SKM_C113

• If SKM_B112.SKR_N1A = DK or RF, go to SKM_C130.
• Otherwise, go to SKM_N113.

SKM_N113

Instruction: Check the skin pigmentation data.

• 1 Accept the measurements
• 2 Reject the measurements (Go to SKM_B112)
• (DK, RF not allowed)

SKM_D113

Programmer:

• If the difference between any two of SKM_B110.SKR_N1A, SKM_B111.SKR_N1A, SKM_B112.SKR_N1A is > 10 units, OR
• If the difference between any two of SKM_B110.SKR_N2A, SKM_B111.SKR_N2A, SKM_B112.SKR_N2A is > 10 units,
• go to SKM_B113
• Otherwise, go to SKM_C130

SKM_B113

• Call the Skin Pigmentation Recording (SKR) Block.

SKM_C114

• If SKM_B113.SKR_N1A = DK or RF, go to SKM_C130.
• Otherwise, go to SKM_N114.

SKM_N114

Instruction: Check the skin pigmentation data.

• 1 Accept the measurements
• 2 Reject the measurements (Go to SKM_B113)
• (DK, RF not allowed)

SKM_C130

• If SKI_N06 = 3 (No hand measurement), go to SKM_C220.
• Otherwise, go to SKM_N131.

SKM_N131

Instruction: Record how the hand skin pigmentation data will be captured.

• 1 Electronically
• 2 Electronic data captured manually (Go to SKM_C210)
• (DK, RF not allowed)

SKM_N132

Instruction: Press < ON/MEASURES > to take the first hand skin pigmentation measurement.

• Press < 1 > to continue.
• 1 Continue
• DK, RF (Go to SKM_C220)

SKM_N132A

Instruction: Press <1> to save the measurements in Blaise.

• 1 Save the measurements
• (DK, RF not allowed)

SKM_N132B

Instruction: Check the skin pigmentation data.

• 1 Accept the measurements
• 2 Reject the measurements (Go to SKM_B210)
• (DK, RF not allowed)

SKM_N133

Instruction: Press < ON/MEASURES > to take the second hand skin pigmentation measurement.

• Press < 1 > to continue
• 1 Continue
• DK, RF (Go to SKM_C220)

SKM_N133A

Instruction: Press <1> to save the measurements in Blaise.

• 1 Save the measurements
• (DK, RF not allowed)

SKM_N133B

Instruction: Check the skin pigmentation data.

• 1 Accept the measurements
• 2 Reject the measurements (Go to SKM_B211)
• (DK, RF not allowed)

SKM_N134

Instruction: Press < ON/MEASURES > to take the third hand skin pigmentation measurement.

• Press < 1 > to continue.
• 1 Continue
• DK, RF (Go to SKM_C220)

SKM_N134A

Instruction: Press <1> to save the measurements in Blaise.

• 1 Save the measurements
• (DK, RF not allowed)

SKM_N134B

Instruction: Check the skin pigmentation data.

• 1 Accept the measurements
• 2 Reject the measurements (Go to SKM_B212)
• (DK, RF not allowed)

SKM_D135

Programmer:

• If the difference between any two of SKM_B210.SKR_N1A, SKM_B211.SKR_N1A, SKM_B212.SKR_N1A is > 10 units, OR
• If the difference between any two of SKM_B210.SKR_N2A, SKM_B211.SKR_N2A, SKM_B212.SKR_N2A is > 10 units,
• go to SKM_N136.
• Otherwise, go to SKM_C210

SKM_N136

Instruction: Press < ON/MEASURES > to take the fourth hand skin pigmentation measurement.

• Press < 1 > to continue.
• 1 Continue
• DK, RF (Go to SKM_C220)

SKM_N136A

Instruction: Press <1> to save the measurements in Blaise.

• 1 Save the measurements
• (DK, RF not allowed)

SKM_N136B

Instruction: Check the skin pigmentation data.

• 1 Accept the measurements
• 2 Reject the measurements (Go to SKM_B213)
• (DK, RF not allowed)

SKM_C210

• If SKM_N131 = 1 (Electronically), go to SKM_C220.
• Otherwise, go to SKM_B210.

SKM_B210

• Call the Skin Pigmentation Recording (SKR) Block.

Programmer:

• Pass ^DT_SKR_TEXTE1 = "first" and ^DT_SKR_TEXTE2 = "hand" as a parameters.

SKM_C211

• If SKM_B210.SKR_N1A = DK or RF, go to SKM_C220.
• Otherwise, go to SKM_N211.

SKM_N211

Instruction: Check the skin pigmentation data.

• 1 Accept the measurements
• 2 Reject the measurements (Go to SKM_B210)
• (DK, RF not allowed)

SKM_B211

• Call the Skin Pigmentation Recording (SKR) Block.

Programmer:

• Pass ^DT_SKR_TEXTE1 = "second" and ^DT_SKR_TEXTE2 = "hand" as a parameters.

SKM_C212

• If SKM_B211.SKR_N1A = DK or RF, go to SKM_C220.
• Otherwise, go to SKM_N212.

SKM_N212

Instruction: Check the skin pigmentation data.

• 1 Accept the measurements
• 2 Reject the measurements (Go to SKM_B211)
• (DK, RF not allowed)

SKM_B212

• Call the Skin Pigmentation Recording (SKR) Block.

Programmer:

• Pass ^DT_SKR_TEXTE1 = "third" and ^DT_SKR_TEXTE2 = "hand" as a parameters.

SKM_C213

• If SKM_B212.SKR_N1A = DK or RF, go to SKM_C220.
• Otherwise, go to SKM_N213.

SKM_N213

Instruction: Check the skin pigmentation data.

• 1 Accept the measurements
• 2 Reject the measurements (Go to SKM_B212)
• (DK, RF not allowed)

SKM_D213

Programmer:

• If the difference between any two of SKM_B210.SKR_N1A, SKM_B211.SKR_N1A, SKM_B212.SKR_N1A is > 10 units, OR
• If the difference between any two of SKM_B210.SKR_N2A, SKM_B211.SKR_N2A, SKM_B212.SKR_N2A is > 10 units,
• go to SKM_B213.
• Otherwise, go to SKM_C220

SKM_B213

• Call the Skin Pigmentation Recording (SKR) Block.

SKM_C214

• If SKM_B213.SKR_N1A = DK or RF, go to SKM_C220.
• Otherwise, go to SKM_N214.

SKM_N214

Instruction: Check the skin pigmentation data.

• 1 Accept the measurements
• 2 Reject the measurements (Go to SKM_B213)
• (DK, RF not allowed)

SKM_C220

• If SKM_N21 = DK or SKM_N22 = DK or SKM_N23 = DK or SKM_N24 = DK or SKM_B110. SKR_N1A = DK or SKM_B111. SKR_N1A = DK, or SKM_B112. SKR_N1A = DK, or SKM_B113. SKR_N1A = DK, or SKM_N132 = DK or SKM_N133= DK or SKM_N134 = DK or SKM_N136 = DK or SKM_B210.SKR_N1A = DK or SKM_B211.SKR_N1A = DK or SKM_B212.SKR_N1A = DK or SKM_B213.SKR_N1A = DK, go to SKM_N220.
• Otherwise, go to SKM_END.

SKM_N220

Instruction: Why was the component not fully completed?

• 01 Respondent unable to continue for health reasons
• 02 Respondent unable to understand technique / Health Measures Specialist unable to adapt coaching
• 04 Equipment problem / technical difficulty
• 05 Respondent's mental condition
• 06 No time
• 20 Other - Specify (Go to SKM_S220)
• (DK, RF not allowed)

Go to SKM_END

SKM_S220

• (Why was the component not fully completed?)
• Instruction: Specify.
• (80 spaces)
• (DK, RF not allowed)

SKM_END

Skin Pigmentation Recording (SKR)

SKR_BEG

Import the following variables:

• DT_SKR_TEXTE1
• DT_SKR_TEXTE2

SKR_N1A

Instruction: Record the ^DT_SKR_TEXTE1 ^DT_SKR_TEXTE2 Erythema measurement.

• (MIN: ­240)
• (MAX: 240)
• DK, RF

SKR_N1B

Instruction: Re-enter the ^DT_SKR_TEXTE1 ^DT_SKR_TEXTE2 Erythema measurement.

• (MIN: ­240)
• (MAX: 240)
• DK, RF

SKR_C1

• If SKR_N1A = RF or DK, go to SKR_END.
• Otherwise, go to SKR_N2A.

SKR_N2A

Instruction: Record the ^DT_SKR_TEXTE1 ^DT_SKR_TEXTE2 Melanin measurement.

• (MIN: 0)
• (MAX: 240)
• (DK, RF not allowed)

SKR_N2B

Instruction: Re-enter the ^DT_SKR_TEXTE1 ^DT_SKR_TEXTE2 Melanin measurement.

• (MIN: 0)
• (MAX: 240)
• (DK, RF not allowed)

SKR_N3A

Instruction: Record the ^DT_SKR_TEXTE1 ^DT_SKR_TEXTE2 L* measurement.

• (MIN: 0)
• (MAX: 100)
• (DK, RF not allowed)

SKR_N3B

Instruction: Re-enter the ^DT_SKR_TEXTE1 ^DT_SKR_TEXTE2 L* measurement.

• (MIN: 0)
• (MAX: 100)
• (DK, RF not allowed)

SKR_N4A

Instruction: Record the ^DT_SKR_TEXTE1 ^DT_SKR_TEXTE2 a* measurement.

• (MIN: ­120)
• (MAX: 120)
• (DK, RF not allowed)

SKR_N4B

Instruction: Re-enter the ^DT_SKR_TEXTE1 ^DT_SKR_TEXTE2 a* measurement.

• (MIN: ­120)
• (MAX: 120)
• (DK, RF not allowed)

SKR_N5A

Instruction: Record the ^DT_SKR_TEXTE1 ^DT_SKR_TEXTE2 b* measurement.

• (MIN: ­120)
• (MAX: 120)
• (DK, RF not allowed)

SKR_N5B

Instruction: Re-enter the ^DT_SKR_TEXTE1 ^DT_SKR_TEXTE2 b* measurement.

• (MIN: ­120)
• (MAX: 120)
• (DK, RF not allowed)

SKR_END

Anthropometric Component

Anthropometric Component Introduction (ACI)

ACI_BEG

External variables required:

Variables taken from sample file:

• STAND: name of the city/town/village in which the clinic has been set up
• CLINICID: 8 digit respondent identifier

Variables assigned in Variable Creation:

• CurrentYear: numeric year during which clinic visit is taking place
• CurrentMonth: numeric month during which clinic visit is taking place
• CurrentDay: numeric day during which clinic visit is taking place
• SessionE: English text of when the clinic visit is taking place

Variables from previously completed blocks:

• RespondentName: name of respondent
• GenderE: English text for sex of respondent
• CON_AGE: age of respondent
• ANCREP: whether an anthropometric replicate has been assigned
• SCS_N12: Visit Type (3= clinic visit; 4= home visit)

ACI_C01A

• If ANCREP=1, go to ACI_R01.
• Otherwise, go to ACI_R02.

ACI_R01
You have been randomly selected to repeat the anthropometric component where we take body measurements such as your height and weight. You did nothing wrong when these measurements were taken earlier. We repeat these measurements with about 1 out of every 10 participants as a way to ensure consistency of the results.

Do you have any questions?

Instruction: Accompany the respondent to the waiting room and ask him/her to have a seat. Inform the respondent that an HMS will arrive shortly to complete the replicate anthropometric component.

Inform the next available HMS that a respondent has been selected for a replicate and is sitting in the waiting area. Ensure you mention the name of the selected respondent as there may be several respondents in the waiting room.

• Press <1> to continue.

Programmer:

• Allow ‘DK’ as a response category.

ACI_C01B

• If ACI_R01 = DK, go to ACI_END.
• Otherwise, go to ACI_D02.

ACI_R02
Next will be a series of body measurements.

Instruction: Press <1> to continue.

Programmer:

• Allow ‘DK’ as a response category.

ACI_C02

• If ACI_R02 = DK, go to ACI_END.
• Otherwise, go to ACI_D02.

ACI_D02

Programmer:

• IF SCS_N12 = 4 THEN
  • ACI_D02 = EMPTY
• ELSE
  • IF ACI_R02 = 1 and ACI_D02 = EMPTY THEN
    • Set ACI_D02 = Current Time (in HH:MM:SS format)
  • ELSE IF ACI_R01 = 1 THEN
    • Set ACI_D02 = Current Time (in HH:MM:SS format)
  • ENDIF
• ENDIF

ACI_END

Height and Weight Measurements (HWM)

HWM_BEG

External variables required:

Variables taken from sample file:

• STAND: name of the city/town/village in which the clinic has been set up
• CLINICID: 8 digit respondent identifier

Variables assigned in Variable Creation:

• CurrentYear: numeric year during which clinic visit is taking place
• CurrentMonth: numeric month during which clinic visit is taking place
• CurrentDay: numeric day during which clinic visit is taking place
• SessionE: English text of when the clinic visit is taking place

Variables from previously completed blocks:

• RespondentName: name of respondent
• CON_SEX: sex of respondent
• GenderE: English text for sex of respondent
• CON_AGE: age of respondent
• PHC_Q11: whether the respondent is pregnant
• PHC_Q12: number of weeks of pregnancy
• ACI_R01: anthropometry component replicate introduction
• ACI_R02: anthropometry component introduction

HWM_C10

• If ACI_R01 = DK or ACI_R02 = DK, go to HWM_N60.
• Otherwise, go to HWM_R11.

HWM_R11
I'm going to start by measuring how tall you are. Please remove your shoes and stand with your feet together and your heels, buttocks, back, and head in contact with the measuring device. Look straight ahead and stand as tall as possible.

Now, take a deep breath in and hold it.

Instruction: Ensure the respondent's head is in the Frankfort plane and all hair ties or ornaments (e.g., buns, braids, clips) have been removed.

Take the measurement while the breath is being held.

• Press <1> to continue

HWM_N11

Instruction: Record how the data will be captured.

• 1 Electronically
• 2 Manually with a portable device (Go to HWM_N11B)
• 3 Self-report (Go to HWM_N11B)
• 4 Electronic data entered manually
• (DK, RF not allowed)

HWM_N11A

Instruction: Ensure that the stadiometer is set to millimeters (mm).

Press the "Send" button on the left side of the digital display box or the "Data" button on the SPC (send to PC) device.

• (MIN: 770.00)
• (MAX: 2070.90)
• (DK, RF not allowed)

HWM_C11

• If HWM_N11 = 4, go to HWM_N11D.
• Otherwise, go to HWM_D11.

HWM_N11B

Instruction: Record the standing height in centimetres.

• (MIN: 19.00)
• (MAX: 207.60)
• DK, RF (Go to HWM_D11)

HWM_N11C

Instruction: Re-enter the standing height in centimetres.

• (MIN: 19.00)
• (MAX: 207.60)
• DK, RF

Go to HWM_D11

HWM_N11D

Instruction: Re-enter the standing height in millimeters.

• Millimeters
• (MIN: 770.00)
• (MAX: 2070.90)
• DK, RF

HWM_D11

Programmer:

• Set standing height in centimeters and derive standing height in inches (HWM_D11).
• IF HWM_N11 = 1 or 4 THEN
  • HWM_Q11 = Round((HWM_N11A / 10), .01)
• ELSE
  • HWM_Q11 = HWM_N11B
• ENDIF

• IF HWM_Q11 = RESPONSE THEN
  • HWM_D11 = Round((HWM_Q11 * 0.3937), .1)
• ENDIF

HWM_C11A

• If HWM_Q11 = DK, go to HWM_S11.
• Otherwise, go to HWM_C11B.

HWM_S11

Instruction: Specify the reason why the measurement could not be taken.

• (80 spaces)
• (DK, RF not allowed)

HWM_C11B

• If HWM_N11 = 3, go to HWM_R13.
• Otherwise, go to HWM_R12.

HWM_R12
Next, I'd like you to sit on this box so that I can measure how tall you are when you are sitting. Sit with your back and head against the measuring device. Put your hands on your lap and keep your legs still. Look straight ahead and sit up as straight as possible.

Now, take a deep breath in and hold it.

Instruction: Ensure the respondent's head is in the Frankfort plane.

Ensure the respondent does not contract the gluteal muscles nor push with the legs.

Take the measurement while the breath is being held.

• Press <1> to continue.

HWM_C12A

• If HWM_N11 = 1 or 4, go to HWM_N12A.
• Otherwise, go to HWM_N12B.

HWM_N12A

Instruction: Ensure that the stadiometer is set to millimetres (mm). Press the "Send" button on the left side of the digital display box or the "Data" button on the SPC (send to PC) device.

• (MIN: 770.00)
• (MAX : 2070.90)
• DK, RF (Go to HWM_D12)

HWM_C12B

• If HWM_N11 = 4, go to HWM_N12D.
• Otherwise, go to HWM_D12.

HWM_N12B

Instruction: Record the sitting height in centimetres.

• (MIN: 73.00)
• (MAX: 207.60)
• DK, RF (Go to HWM_D12)

HWM_N12C

Instruction: Re-enter the sitting height in centimetres.

• (MIN: 73.00)
• (MAX: 207.60)
• DK, RF

Go to HWM_D12

HWM_N12D

Instruction: Re-enter the sitting height in millimeters.

• (MIN: 770.00)
• (MAX: 2070.90)
• DK, RF

HWM_D12

Programmer:

• Set sitting height in centimeters and derive sitting height in inches (HWM_D12).
• IF HWM_N11 = 1 or 4 THEN
  • IF HWM_N12A = RESPONSE THEN
    • HWM_Q12 = Round(((HWM_N12A / 10) - 73), .01)
  • ELSE
    • HWM_Q12 = HWM_N12A
  • ENDIF
• ELSE
  • IF HWM_N12B = RESPONSE THEN
    • HWM_Q12 = (HWM_N12B - 73)
  • ELSE
    • HWM_Q12 = HWM_N12B
  • ENDIF
• ELSE
  • IF HWM_Q12 = RESPONSE THEN
    • HWM_D12 = Round((HWM_Q12 * 0.3937), .1)
• ENDIF

HWM_C12C

• If HWM_Q12 = DK, go to HWM_S12.
• Otherwise, go to HWM_R13.

HWM_S12

Instruction: Specify the reason why the measurement could not be taken.

• (80 spaces)
• (DK, RF not allowed)

HWM_R13
Next I'm going to measure how much you weigh. Please empty your pockets, remove all heavy accessories, step onto the centre of the scale and face me. Keep your hands at your sides and look straight ahead.

Instruction: Ensure the respondent has on only minimal clothing (no shoes), has nothing in his/her pockets and has removed all heavy accessories (e.g., a watch, belt, pair of glasses).

• Press <1> to continue.

HWM_N13

Instruction: Record how the data will be captured.

1. Electronically
2. Manually with a portable device (Go to HWM_N13B)
3. Self-report (Go to HWM_N13B)
4. Electronic data entered manually (Go to HWM_N13B)
   (DK, RF not allowed)

HWM_N13A

Instruction: Ensure the scale is set to kilograms (kg).

• Press <Print> on the scale.
• Press <1> to save the measurement in Blaise.
• 1 Save the measurement
• (DK, RF not allowed)

HWM_R13A

Instruction: Check the data returned from the scale.

• Press <1> to continue.
• Go to HWM_C14A

HWM_N13B

Instruction: When the measurement is stable, record the weight in kilograms.

• (MIN: 0.5)
• (MAX: 500.0)
• DK, RF (Go to HWM_D13)

HWM_N13C

Instruction: Re-enter the weight in kilograms.

• (MIN: 0.5)
• (MAX: 500.0)
• DK, RF

HWM_D13

Programmer:

• Set weight in kilograms and derive weight in pounds (HWM_D13).
• IF HWM_N13 = 1 THEN
  • HWM_Q13 = HWM_N13A
• ELSE
  • HWM_Q13 = HWM_N13B
• ENDIF

• IF HWM_Q13 = RESPONSE THEN
  • HWM_D13 = Round((HWM_Q13 * 2.205), .1)
• ENDIF

HWM_C13

• If HWM_Q13 = DK, go to HWM_S13.
• Otherwise, go to HWM_C14A.

HWM_S13

Instruction: Specify the reason why the measurement could not be taken.

• (80 spaces)
• (DK, RF not allowed)

HWM_C14A

• If PHC_Q11 = 1, go to HWM_C20.
• Otherwise, go to HWM_R14.

HWM_R14
Now I'm going to measure your waist circumference. Please stand up straight with your arms hanging loosely at your sides, and breathe normally. I may need to move your clothing slightly because the measurement has to be taken directly on the skin. In order to ensure I have the correct position, I am going to feel for certain landmarks and make a few small marks on your skin with a washable marker where the tape measure is to go. When I'm done, I'll remove them with a wipe.

Instruction: Landmark both sides.

• Read the measurement at the right side of the body.
• Take the measurement at the end of a normal expiration.
• Press <1> to continue.

HWM_N14A

Instruction: Record the waist circumference in centimetres.

• (MIN: 0.1)
• (MAX: 305.0)
• DK, RF (Go to HWM_D14)

HWM_N14B

Instruction: Re-enter the waist circumference in centimetres.

• (MIN: 0.1)
• (MAX: 305.0)
• DK, RF

HWM_D14

Programmer:

• Set waist circumference in centimeters and derive waist circumference in inches (HWM_D14).
• HWM_Q14 = HWM_N14A
• IF HWM_Q14 = RESPONSE THEN
  • HWM_D14 = Round((HWM_Q14 * 0.3937), .1)
• ENDIF

HWM_C14B

• If HWM_Q14 = DK, go to HWM_S14.
• Otherwise, go to HWM_R15.

HWM_S14

Instruction: Specify the reason why the measurement could not be taken.

• (80 spaces)
• (DK, RF not allowed)

HWM_R15
Now I'm going to measure your hip circumference. Please stand up straight with your feet together, your arms hanging loosely at your sides, and breathe normally. I may need to move your clothing slightly to ensure the measurement is accurate.

Instruction: Read the measurement at the right side of the body.

• Press <1> to continue.

HWM_N15A

Instruction: Record the hip circumference in centimetres.

• (MIN: 0.1)
• (MAX: 305.0)
• DK, RF (Go to HWM_D15)

HWM_N15B

Instruction: Re-enter the hip circumference in centimetres.

• (MIN: 0.1)
• (MAX: 305.1)
• DK, RF

HWM_D15

Programmer:

• Set hip circumference in centimeters and derive hip circumference in inches (HWM_D15).
• HWM_Q15 = HWM_N15A

• IF HWM_Q15 = RESPONSE THEN
  • HWM_D15 = Round((HWM_Q15 * 0.3937), .1)
• ENDIF

HWM_C15

• If HWM_Q15 = DK, go to HWM_S15.
• Otherwise, go to HWM_D20.

HWM_S15

Instruction: Specify the reason why the measurement could not be taken.

• (80 spaces)
• (DK, RF not allowed)

HWM_C20

• If ANCREP = 1, go to HWM_D21.
• Otherwise, go to HWM_D20.

HWM_D20

• If PHC_Q11=1, DT_HWMTEXT20E = "EMPTY".
• Otherwise, DT_HWMTEXT20E = "In case you are selected, I will now erase the marks I put on your skin to ensure that they do not influence a possible second set of measurements.".
• If PHC_Q11=1, DT_HWMINT20E = "EMPTY".
• Otherwise, DT_HWMINT20E = "Use a wipe to wash off all marks on the respondent's skin.".

HWM_R20
At the end of the appointment, we may need to repeat the measurements I have just completed. The computer randomly selects people to be re-measured for quality control purposes. [EMPTY/In case you are selected, I will now erase the marks I put on your skin to ensure that they do not influence a possible second set of measurements.]

Instruction: Press <1> to continue.

[EMPTY/Use a wipe to wash off all marks on the respondent's skin.]

HWM_D21

Programmer:

• Calculate the body mass index.

HWM_D22

Programmer:

• Calculate the body mass index norms for respondents 18 or older.

HWM_D23

Programmer:

• Calculate the body mass index norms for respondents less than 18.

HWM_D24

Programmer:

• Calculate the waist circumference norms for respondents 15 - 69.

HWM_D25

Programmer:

• Calculate the waist-to-hip ratio.

HWM_C59

• If 1 = 1, go to HWM_END.
• Otherwise, go to HWM_END.

HWM_N60

Instruction: Why was the component not fully completed?

• 01 Respondent unable to continue for health reasons
• 06 No time
• 20 Other - Specify
• (DK, RF not allowed)

Go to HWM_END

HWM_S60
(Why was the component not fully completed?)

Instruction: Specify.

• (80 spaces)
• (DK, RF not allowed)

HWM_END

Blood Pressure Component

Blood Pressure Measurement (BPM)

BPM_BEG

External variables required:

Variables taken from sample file:

• STAND: name of the city/town/village in which the clinic has been set up
• CLINICID: 8 digit respondent identifier

Variables assigned in Variable Creation:

• CurrentYear: numeric year during which clinic visit is taking place
• CurrentMonth: numeric month during which clinic visit is taking place
• CurrentDay: numeric day during which clinic visit is taking place
• SessionE: English text of when the clinic visit is taking place

Variables from previously completed blocks:

• RespondentName: name of respondent
• CON_SEX: sex of respondent
• GenderE: English text for sex of respondent
• CON_AGE: age of respondent
• HWM_Q11: standing height (in centimetres)
• SCS_N12: visit type (3= clinic visit; 4= home visit)
• PHC_Q57B: indicator of which side the respondent has had a mastectomy

BPM_N101

Instruction: Record how the first set of data will be captured.

• 1 Electronically (BpTRU)
• 3 BpTRU data entered manually (Go to BPM_B110)
  DK (Go to BPM_N600)
• (RF is not allowed)

Programmer:

• If BPM_N101= 3 is selected, please do not pre-fill the values with previous data.

BPM_D101

Programmer:

• IF SCS_N12 = 4 THEN
  • BPM_D101 = EMPTY
• ELSE
  • If BPM_N101 = RESPONSE and BPM_D101 = EMPTY,
  • Set BPM_D101 = Current Time (in HH:MM:SS format)
• ENDIF

BPM_D101B

• If PHC_Q57B = 1, DT_ARME = "left".
• Otherwise, DT_ARME = "right".

BPM_Q101A
Now I will take your blood pressure and heart rate using an automated blood pressure cuff. During this test you will need to sit up straight with your feet flat on the floor, your back against the back rest of the chair, and your [left/right] arm on the table.

Instruction:

- Ensure the BpTRU is communicating with Health Listener

- Set the BpTRU to cycle 1 (1 - minute intervals)

- Turn the BpTRU away from the respondent.

• Press <1> to continue.
• 1 Continue
• (DK is not allowed)
• RF (Go to BPM_END)

BPM_D102B

• If CON_AGE < 14, DT_BPM102TEXTE = "The cuff will fill with air and it will squeeze your arm a little. It will do this 6 times. During the test you cannot talk. You need to sit really still and keep both feet flat on the floor. You should stay relaxed to ensure we get good results. Before we start, I will leave you alone to sit and relax for 5 minutes. I will then come back to start the machine. It is very important that we don’t talk until the test is done.".
• Otherwise, DT_BPM102TEXTE = "The cuff will inflate automatically once every minute, applying pressure to your arm. A total of 6 measures will be taken. I will stay in the room for the first measurement then I will leave the room. Although I will not be present during the test, should you require assistance, I will be just outside the room. You should not move or talk during the test, and you need to keep both feet flat on the floor. It is important that you stay relaxed to ensure we get good results. Before we begin, I will leave you alone to sit and relax for 5 minutes. I will then return to start the machine. I ask that you do not talk when I return to take the first measurement.".

BPM_Q102
^DT_BPM102TEXTE.

Do you have any questions before we begin?

Instruction: Answer any questions as thoroughly as possible.

• Select the appropriate cuff size by using the range indicated on the inside of the cuff.
• Secure the cuff on the respondent's [left/right] arm.
• Ensure respondent is in the correct position (palm down, feet flat, arm and back rested, relaxed).
• Start the stopwatch to return to the room after 5 minutes.
• After the 5-minute rest period, return to the room and press the <Start> button on the BpTRU.
• Stay in the room for the first measure and write down the result.
• Press CTL-ALT-DELETE and then ENTER to lock the computer before leaving the room.
• Press <1> to continue.
• 1 Continue
• (DK, RF not allowed)

PM_N105

Instruction: Press <1> to save the measurements in Blaise.

• 1 Save the measurements (Go to BPM_D160A)
• (DK, RF not allowed)

BPM_B110

• Call the Blood Pressure Recording (BPR) block.

BPM_C111

• If BPM_B110.BPR_N1A = RF, go to BPM_END.
• Otherwise, go to BPM_B111.

BPM_C112

• If BPM_B111.BPR_N1A = RF, go to BPM_N160.
• Otherwise, go to BPM_B121.

BPM_B111

• Call the Blood Pressure Recording (BPR) block.

BPM_B121

• Call the Blood Pressure Recording (BPR) block.

BPM_B131

• Call the Blood Pressure Recording (BPR) block.

BPM_B141

• Call the Blood Pressure Recording (BPR) block.

BPM_B151

• Call the Blood Pressure Recording (BPR) block.

BPM_D160A

Programmer:

• IF any three of (BPM_B111.BPR_N4, BPM_B121.BPR_N4, BPM_B131.BPR_N4, BPM_B141.BPR_N4 and BPM_B151.BPR_N4) or (BPM_B111.DT_BPR_N4, BPM_B121. DT_BPR_N4, BPM_B131. DT_BPR_N4, BPM_B141. DT_BPR_N4 and BPM_B151. DT_BPR_N4) = RESPONSE THEN
  • BPM_D160A = 1
• ENDIF

BPM_D160B

• If BPM_N105 = 1, DT_BPM160INSTE = "Press <Clear> on the BPTru screen.".
• Otherwise, DT_BPM160INSTE = "EMPTY".

BPM_N160

Instruction: Check the blood pressure and heart rate data.

• [Press <Clear> on the BPTru screen./EMPTY]
• Accept the measurements
• Re-do the measurements
• (DK, RF not allowed)

Help text:

• Select "Re-do the measurements" if the blood pressure measurements are invalid. For example:
• There was a noteworthy distraction or noise in the room while the measurement was being taken (e.g., something fell from a shelf or desk, likely startling the respondent); or
• The protocol was not respected (e.g., the respondent is not in the correct position, moves or talks during the measurements).
• The measurements were stopped before obtaining three or more valid measures (e.g., error code 6)

BPM_C161A

• If (BPM_N101=1 and BPM_Q101A=1) or BPM_N101=3, go to BPM_N161.
• Otherwise, go to BPM_C161B.

BPM_N161

Instruction: Was anyone in the room with the respondent (e.g., HMS, parent or guardian) when the blood pressure measurements were taken?

• 1 Yes
• 2 No
  (DK, RF not allowed)

BPM_C161

• If BPM_N160 = 2, go to BPM_C201.
• Otherwise, go to BPM_D161.

BPM_D161

Programmer:

• Calculate the first average systolic blood pressure.

BPM_D162

Programmer:

• Calculate the first average diastolic blood pressure.

BPM_D163

Programmer:

• Calculate the first average resting heart rate.

BPM_C164

• If BPM_D160A = 1, go to BPM_N201.
• Otherwise, go to BPM_D402.

BPM_N201

Instruction: Record how the second set of data will be captured.

• 1 Electronically (BpTRU)
• 3 BpTRU data entered manually (Go to BPM_B210)
  (DK, RF not allowed)

BPM_Q201
There were too many errors with that set of measurements, so we have to do the test again. I will retake your blood pressure and heart rate. Remember, you should not move or talk during the test, and you need to keep both feet flat on the floor. It's important that you stay relaxed to ensure we get good results.

Instruction:

• Ensure the BpTRU is communicating with Health Listener.
• Set the BpTRU to cycle 1.
• Turn the BpTRU away from the respondent.
• Answer any questions as thoroughly as possible.
• Select the appropriate cuff size by using the range indicated on the inside of the cuff.
• Secure the cuff on the respondent's [left/right] arm.
• Ensure respondent is in the correct position (palm down, feet flat, arm and back rested, relaxed).
• Start the BpTRU.
• Stay in the room for the first measure and write down the result.
• Press CTL-ALT-DELETE and then ENTER to lock the computer before leaving the room.

• Press <1> to continue.
• (DK is not allowed)
• RF (Go to BPM_D402)

BPM_N205

Instruction: Press <1> to save the measurements in Blaise.

• 1 Save the measurements (Go to BPM_D260A)
• (DK, RF not allowed)

BPM_B210

• Call the Blood Pressure Recording (BPR) block.

BPM_C211

• If BPM_B210.BPR_N1A = RF, go to BPM_D402.
• Otherwise, go to BPM_B211.

BPM_B211

• Call the Blood Pressure Recording (BPR) block.

BPM_B221

• Call the Blood Pressure Recording (BPR) block.

BPM_B231

• Call the Blood Pressure Recording (BPR) block.

BPM_B241

• Call the Blood Pressure Recording (BPR) block.

BPM_B251

• Call the Blood Pressure Recording (BPR) block.

BPM_D260A

Programmer:

• If any three of (BPM_B211.BPR_N4, BPM_B221.BPR_N4, BPM_B231.BPR_N4, BPM_B241.BPR_N4 and BPM_B251.BPR_N4) or (BPM_B211.DT_BPR_N4, BPM_B221. DT_BPR_N4, BPM_B231. DT_BPR_N4, BPM_B241. DT_BPR_N4 and BPM_B251. DT_BPR_N4) = RESPONSE THEN
  • BPM_D260A = 1
• ENDIF

BPM_D260B

• If BPM_N205 = 1, DT_BPM260INSTE = "Press <Clear> on the BPTru screen.".
• Otherwise, DT_BPM260INSTE = "EMPTY".

BPM_N260

Instruction: Check the blood pressure and heart rate data.

[Press <Clear> on the BPTru screen./EMPTY]

• 1 Accept the measurements
• 2 Reject the measurements
  (DK, RF not allowed)

Help text:

Select "Reject the measurements" if the blood pressure measurements are invalid. For example:

• There was a noteworthy distraction or noise in the room while the measurement was being taken (e.g., something fell from a shelf or desk, likely startling the respondent);
• The protocol was not respected (e.g., the respondent is not in the correct position, moves or talks during the measurements).

BPM_N261

Instruction: Was anyone in the room with the respondent (e.g., HMS, parent or guardian) when the blood pressure measurements were taken?

• 1 Yes
• 2 No
• (DK, RF not allowed)

BPM_C261B

• If BPM_N260 = 2, go to BPM_D402.
• Otherwise, go to BPM_D261. BPM_D261

Programmer:

• Calculate the second average systolic blood pressure.

BPM_D262

Programmer:

• Calculate the second average diastolic blood pressure.

BPM_D263

Programmer:

• Calculate the second average resting heart rate.

BPM_D402

Content type - Note to data users:

• If two sets of blood pressure measurements are taken, the set with the greatest number of valid measurements is used to set the final resting blood pressure and heart rate results.

Programmer:

• IF BPM_D260A = 1 or BPM_D261 = EMPTY OR 999 THEN
• IF BPM_D160A = 1 or BPM_D161 = EMPTY OR 999 THEN
• IF BPM_D261 = RESPONSE AND BPM_D262 = RESPONSE AND BPM_D263 = RESPONSE THEN
• IF BPM_D161 = RESPONSE AND BPM_D162 = RESPONSE AND BPM_D163 = RESPONSE THEN
• IF second set has more valid measures than first set* THEN
  • BPM_D314 = BPM_D261
  • BPM_D315 = BPM_D262
  • BPM_D316 = BPM_D263
• ELSE
  • BPM_D314 = BPM_D161
  • BPM_D315 = BPM_D162
  • BPM_D316 = BPM_D163
• ENDIF
• ELSE
  • BPM_D314 = BPM_D261
  • BPM_D315 = BPM_D262
  • BPM_D316 = BPM_D263
• ENDIF
• ELSE
  • IF BPM_D161 = RESPONSE AND BPM_D162 = RESPONSE AND BPM_D163 = RESPONSE THEN
    • BPM_D314 = BPM_D161
    • BPM_D315 = BPM_D162
    • BPM_D316 = BPM_D163
  • ELSE
    • BPM_D314 = EMPTY
    • BPM_D315 = EMPTY
    • BPM_D316 = EMPTY
  • ENDIF
  • ENDIF
  • ELSE
    • BPM_D314 = BPM_D161
    • BPM_D315 = BPM_D162
    • BPM_D316 = BPM_D163
  • ENDIF
  • ELSE
    • IF BPM_D160A = 1 or BPM_D161 = EMPTY OR 999 THEN
      • BPM_D314 = BPM_D261
      • BPM_D315 = BPM_D262
      • BPM_D316 = BPM_D263
    • ELSE
      • BPM_D314 = BPM_D161
      • BPM_D315 = BPM_D162
      • BPM_D316 = BPM_D163
  • ENDIF
• ENDIF

* a valid measure within a set has N1A = RESPONSE and N2A = RESPONSE and N3A = RESPONSE

BPM_D403

Programmer:

• BPM_D317 = BPM_D314
• BPM_D318 = BPM_D315
• BPM_D319 = BPM_D316

BPM_D411A

Programmer:

• Calculate the blood pressure norms for respondents 18 or older.

BPM_C411

• If BPM_D411A = RESPONSE and BPM_D411A > 2, go to BPM_D411B.
• Otherwise, go to BPM_D412A.

BPM_D411B

• If BPM_D411A = 3, DT_BPM411TEXTE = "above the acceptable range".
• If BPM_D411A = 4, DT_BPM411TEXTE = "moderately high".
• If BPM_D411A = 5, DT_BPM411TEXTE = "high".
• If BPM_D411A = 6, DT_BPM411TEXTE = "very high".

• If BPM_D411A = 6, DT_BPM411TEXT2E = "Your average blood pressure today was ^BPM_D317 / ^BPM_D318 mmHg, which means your blood pressure is very high. You should see a doctor or clinic today, or go to a hospital emergency room, to have your blood pressure re-checked.
  Because of these results, we will not continue with your clinic visit.".
• Otherwise, DT_BPM411TEXT2E = "EMPTY".
• If BPM_D411A = 6, DT_BPM411INSTE = "
  • Answer any questions as thoroughly as possible
  • Skip each of the remaining components by entering “DK” at the first question and selecting “Respondent unable to continue for health reasons”
  • Sign the blood pressure reporting letter and ensure that the exit and sign-out components are completed as soon as possible.".
• Otherwise, DT_BPM411INSTE = "The respondent's average blood pressure was ^BPM_D317 / ^BPM_D318 mmHg, which means their blood pressure is ^DT_BPM411TEXTE. A blood pressure reporting letter will be generated at the end of the clinic visit.".

BPM_R411
^DT_BPM411TEXT2E

Instruction: ^DT_BPM411INSTE

• Go to BPM_END

BPM_D412A

Programmer:

• Calculate the blood pressure norms for respondents less than 18.
• See the DV "include" file.

BPM_C412

• If BPM_D412A = RESPONSE and BPM_D412A > 2, go to BPM_D412B.
• Otherwise, go to BPM_C599.

BPM_D412B

• If BPM_D412A = 4, DT_BPM412TEXTE = "Your average blood pressure today was ^BPM_D317 / ^BPM_D318 mmHg, this means your blood pressure is very high. You should see a doctor or clinic today, or go to a hospital emergency room, to have your blood pressure re-checked.
  Because of these results we will not continue with your clinic visit.".
• Otherwise, DT_BPM412TEXTE = "EMPTY".
• If BPM_D412A = 4, DT_BPM412INSTE = "
  • Answer any questions as thoroughly as possible
  • Skip each of the remaining components by entering “DK” at the first question and selecting "Respondent unable to continue for health reasons"
  • Sign the blood pressure reporting letter and ensure that the exit and sign-out components are completed as soon as possible.".
• Otherwise, DT_BPM412INSTE = "The respondent's average blood pressure was ^BPM_D317 / ^BPM_D318 mmHg, this means their blood pressure was high. A blood pressure reporting letter will be generated at the end of the clinic visit.".

BPM_R412
^DT_BPM412TEXTE

Instruction: ^DT_BPM412INSTE

• Press <1> to continue.
• Go to BPM_END

BPM_C599

• If BPM_D317 = RESPONSE, go to BPM_END.
• Otherwise, go to BPM_N600.

BPM_N600

Instruction: Why was the component not fully completed?

• 01 Respondent unable to continue for health reasons
• 02 Respondent unable to understand technique / Health Measures Specialist unable to adapt coaching
• 03 Respondent refuses to continue
• 04 Equipment problem / technical difficulty
• 05 Respondent’s mental condition
• 06 No time
• 20 Other - Specify (Go to BPM_S600)
• (DK, RF not allowed)

Go to BPM_END

BPM_S600
(Why was the component not fully completed?)

Instruction: Specify.

• (80 spaces)
• (DK, RF not allowed)

BPM_END

Blood Pressure Recording (BPR)

BPR_BEG

External variables required:

• BPM_N101: record how the data will be captured.
  BPM_N201: record how the data will be captured.

BPR_N1A

Instruction: Record the systolic blood pressure measurement.

• Systolic blood pressure (in mmHg)
• (MIN: 30)
• (MAX: 300)
• DK, RF

BPR_N1B

Instruction: Re-enter the systolic blood pressure measurement.

• (MIN: 30)
• (MAX: 300)
• DK, RF

BPR_C2

• If BPR_N1A = RF, go to BPR_END.
• Otherwise, go to BPR_N2A.

BPR_N2A

Instruction: Record the diastolic blood pressure measurement.

• Diastolic blood pressure (in mmHg)
• (MIN: 30)
• (MAX: 200)
• DK
• (RF is not allowed)

BPR_N2B

Instruction: Re-enter the diastolic blood pressure measurement.

• (MIN: 30)
• (MAX: 200)
• DK
• (RF is not allowed)

BPR_N3A

Instruction: Record the heart rate.

• Heart rate (in beats per minute)
• (MIN: 30)
• (MAX: 200)
• DK
• (RF is not allowed)

BPR_N3B

Instruction: Re-enter the heart rate.

• (MIN: 30)
• (MAX: 200)
• DK
• (RF is not allowed)

BPR_C4

• If BPR_N1A = DK or BPR_N2A = DK, go to BPR_N4.
• Otherwise, go to BPR_END.

BPR_N4

Instruction: Record the reason why the measurement could not be taken. Mark all that apply.

• 00 Too few pulses detected
• 01 Excessive motion artifacts
• 06 Deflation too fast
• 08 Low pulse amplitude
• 20 Indeterminate systolic blood pressure
• 21 Indeterminate diastolic blood pressure
• 23 Systolic blood pressure under-range
• 24 Diastolic blood pressure under-range
• 25 Systolic blood pressure over-range
• 26 Diastolic blood pressure over-range
• 88 Other - Specify (Go to BPR_S5)
• (DK, RF not allowed)

BPR_C5

• If BPR_N4 = 88, go to BPR_S5.
• Otherwise, go to BPR_END.

BPR_S5

(Record the reason why the measurement could not be taken.)

Instruction: Specify.

• (80 spaces)
• (DK, RF not allowed)

BPR_END

Activity Monitor Component (AM)

AM_BEG

External variables required:

Variables taken from sample file:

• STAND: name of the city/town/village in which the clinic has been set up
• CLINICID: 8 digit respondent identifier

Variables assigned in Variable Creation:

• CurrentYear: numeric year during which clinic visit is taking place
• CurrentMonth: numeric month during which clinic visit is taking place
• CurrentDay: numeric day during which clinic visit is taking place
• SessionE: English text of when the clinic visit is taking place
• DateMailBackE: English text of date 8 days after the clinic visit

Variables output from Clinic Shell:

• DateMailBackE: English text of date 8 days after the clinic visit

Variables from previously completed blocks:

• RespondentName: name of respondent
• GenderE: English text for sex of respondent
• CON_AGE: age of respondent
• IAS_N32: the waybill number of the postage-paid envelope
• SCS_N12: Visit type (3= clinic visit; 4= home visit)

AM_N11

Instruction: Record whether an activity monitor is available.

• 1 Yes
• 2 No (Go to AM_END)
• DK (Go to AM_N90)
• (RF is not allowed)

AM_D11

Programmer:

• IF SCS_N12 = 4 THEN
  • AM_D11 = EMPTY
• ELSE
  • IF AM_N11 = RESPONSE and AM_D11 = EMPTY,
    • Set AM_D11 = Current Time (in HH:MM:SS format)
• ENDIF

AM_R11
It is crucial to obtain information about Canadians' daily activity patterns. As a result, this survey will be measuring your daily activity patterns over a 7 day period. In order to do this, we would like you to wear an activity monitor for the next 7 days.

An activity monitor is a small battery-operated electronic device that is worn on a belt around the waist, on the right hip bone. The monitor records all daily activities as electronic signals. It is pre-programmed to start recording tomorrow morning, there is no activation required and it does not need to be turned on or off.

Instruction: Hold up the activity monitor (on the belt) for display.

• Press <1> to continue.

AM_Q11
The activity monitor is to be worn for the next 7 days and mailed back after the 7 days are over. Do you have any questions before we proceed?

Instruction: Answer any questions as thoroughly as possible.Press <1> to continue.

• 1 Continue (Go to AM_R21)
• (DK is not allowed)
• RF

AM_N12

Instruction: Record the reason why the respondent is not willing to wear an activity monitor for the next 7 days.

• 01 Burden
• 02 Invasive
• 03 Aesthetics
• 04 Away during the collection period
• 05 Anticipating change in normal activity
• 06 Sick or laid up
• 07 Worried about losing or damaging the device
• 08 Other - Specify (Go to AM_S12)
• (DK, RF not allowed)

Go to AM_END

AM_S12

(Record the reason why the respondent is not willing to wear an activity monitor for the next 7 days.)

Instruction: Specify the reason.

• (80 spaces)
• (DK, RF not allowed)

Go to AM_END

AM_R21
We ask that you start wearing this monitor as soon as you wake up tomorrow morning and that you keep wearing it for 7 full days.

• Place it on your right hip bone with the arrow pointing up and the belt snug.
• You can wear it over or under your clothes.
• It is important that you put on the activity monitor as soon as you wake up in the morning and take it off only when going to bed at night. We do not want to miss a step!
• Since the device is waterproof please wear it all day long without interruption (when showering, swimming, taking a nap, etc.).

Please do not alter your usual physical activity behaviour, since we are interested in your normal activity level.

Instruction: Assist the respondent in putting the belt on. Check to ensure the belt fits snugly around the waist and that the activity monitor is positioned on the right hip bone with the arrow pointing up.

Write the respondent's initials on the belt if more than one member of the same household will receive a monitor.

• Press <1> to continue.

AM_N21

Instruction: Record whether the respondent took an activity monitor.

• 1 Yes (Go to AM_N31A)
• 2 No
• (DK, RF not allowed)

AM_N22

Instruction: Record the reason why the respondent did not take an activity monitor.

• 01 Burden
• 02 Invasive
• 03 Aesthetics
• 04 Away during the collection period
• 05 Anticipating change in normal activity
• 06 Sick or laid up
• 07 Worried about losing or damaging the device
• 08 Other - Specify (Go to AM_S22)
• (DK, RF not allowed)

Go to AM_END

AM_S22

(Record the reason why the respondent did not take an activity monitor.)

Instruction: Specify.

• (80 spaces)
• (DK, RF not allowed)

Go to AM_END

AM_N31A

Instruction: To log in the serial number of the activity monitor, scan the bar code on the monitor.

• (7 spaces)
• (DK, RF not allowed)

AM_N31B

Instruction: Re-scan the bar code on the activity monitor.

• (7 spaces)
• (DK, RF not allowed)

AM_N32

Instruction: To log in the waybill number of the postage-paid envelope, scan the bar code on the envelope.

• (13 spaces)
• (DK, RF not allowed)

AM_R33
On the morning of ^DateMailBackE, please put the activity monitor into this postage-paid envelope and put the envelope into any Canada Post mailbox. Full descriptions of what the activity monitor is, what it measures, how it works, and why it is important are included on the information sheet in the envelope. Should you have any questions or concerns, you will find a toll free number on this sheet.

Instruction: Give the postage-paid envelope (addressed to Statistics Canada), the monitor and the information sheet to the respondent.

Ensure they do not confuse this material with the Indoor Air Sampler material.Inform the respondent that he/she will receive a reminder call to ensure he/she has started to wear the monitor and another call to remind him/her to return it.

• Press <1> to continue.

Go to AM_END

AM_N90

Instruction: Why was the component not fully completed?

• 01 Respondent unable to continue for health reasons
• 02 Respondent unable to understand technique / Health Measures Specialist unable to adapt coaching
• 04 Equipment problem / technical difficulty
• 05 Respondent's mental condition
• 06 No time
• 20 Other - Specify (Go to AM_S90)
• (DK, RF not allowed)

Go to AM_END

AM_S90
(Why was the component not fully completed?)

Instruction: Specify the reason.

• (80 spaces)
• (DK, RF not allowed)

AM_END

Indoor Air Sampler Component

Indoor Air Sampler (IAS)

Overview: The indoor air sampler measurement is only administered to one person per household. In households with two selected respondents, the IAS block is administered to the first respondent that begins the clinic visit.

IAS_BEG

External variables required:

Variables taken from sample file:

• STAND: name of the city/town/village in which the clinic has been set up
• CLINICID: 8 digit respondent identifier
• REPLICID: 8 digit replicate identifier
• IASPCT: selection percentage for an Indoor Air replicate

Variables assigned in Variable Creation:

• CurrentYear: numeric year during which clinic visit is taking place
• CurrentMonth: numeric month during which clinic visit is taking place
• CurrentDay: numeric day during which clinic visit is taking place
• SessionE: English text of when the clinic visit is taking place

Variables output from Clinic Shell:

• DateMailBackE: English text of date 8 days after the clinic visit

Variables from previously completed blocks:

• RespondentName: name of respondent
• CON_SEX: sex of respondent
• GenderE: English text for sex of respondent
• CON_AGE: age of respondent
• AM_N32: the waybill number of the postage-paid envelope
• SCS_N12: visit type (3= clinic visit; 4= home visit)

IAS_N11

Instruction: Record whether an indoor air sampler is available.

• 1 Yes
• 2 No
• DK (Go to IAS_N90)
• (RF is not allowed)

IAS_D11

Programmer:

• IF SCS_N12 = 4 THEN
  • IAS_D11 = EMPTY
• ELSE
  • IF IAS_N11 = RESPONSE and IAS_D11 = EMPTY,
    • Set IAS_D11 = Current Time (in HH:MM:SS format)
• ENDIF

IAS_C11

• If IAS_N11 = 2, go to IAS_END.
• Otherwise, go to IAS_R11.

IAS_R11
As part of this survey we will be assessing the air in your home. To do this, we would like you to bring this indoor air sampler home and place it in your living or family room for the next 7 days.

An indoor air sampler is a small tubular device that collects air from your home. Specifically, the sampler will measure a number of substances that may be present in the air of your household, such as benzene, methane and ethanol. The indoor air sampler is quite easy to use.

It is important for us to collect this information because it will allow us to establish national baselines for indoor air concentrations of substances that could affect the health of Canadians.

Instruction: Hold up the sampler for display.

• Press <1> to continue.
• DK, RF not allowed.

IAS_Q11
The indoor air sampler should be placed in your home for the next 7 days and mailed back after the 7 days are over. Do you have any questions before we proceed?

Instruction: Answer any questions as thoroughly as possible. If the respondent is not available to mail back the sampler at the end of the 7 days, it can be mailed backed a few days earlier or later. The sampler must be set up for at least 4 days, to a maximum of 9 days before being sent back. Do not provide the sampler if these conditions cannot be met.

• Press <1> to continue. (Go to IAS_R21)
• (DK is not allowed)
• RF (Go to IAS_N12)

IAS_N12

Instruction: Record the reason why the respondent is not willing to take an indoor air sampler to place in their home for the next 7 days.

1. Burden
2. Invasive
3. Away during the collection period
4. Worried about losing or damaging the device
5. Other - Specify (Go to IAS_S12)
6. (DK, RF not allowed)

Go to IAS_END

IAS_S12
(Record the reason why the respondent is not willing to take an indoor air sampler to place in their home for the next 7 days.)

Instruction: Specify the reason.

• (80 spaces)
• (DK, RF not allowed)

Go to IAS_END

IAS_R21
In this postage-paid envelope, you will find: An aluminium container with:

• A brass tube with a round clip-on white cap
• A grey metal cap with mesh screen
• A small pencil

I will now go through the detailed instructions with you.

Instruction: Ensure respondent has entire contents of the indoor air sampler envelope. Go through and demonstrate each step of the instruction sheet carefully with the respondent.

• Press <1> to continue.
• DK, RF not allowed

IAS_N21

Instruction: Record whether the respondent took an indoor air sampler.

• 1 Yes (Go to IAS_N31A)
• 2 No
• (DK, RF not allowed)

IAS_N22

Instruction: Record the reason why the respondent did not take an indoor air sampler.

1. Burden
2. Invasive
3. Away during the collection period
4. Worried about losing or damaging the device
5. Other - Specify (Go to IAS_S22)
   (DK, RF not allowed)

Go to IAS_END

IAS_S22
(Record the reason why the respondent did not take an indoor air sampler.)

Instruction: Specify the reason.

• (80 spaces)
• (DK, RF not allowed)

Go to IAS_END

IAS_N31A

Instruction: Press <1> to print the label with the respondent's CLINIC ID.

Stick the label to the aluminium container with the indoor air sampler.

• 1 Print the label
• (DK, RF not allowed)

IAS_N31B

Instruction: To log in the serial number of the indoor air sampler, scan the sampler ID bar code on the aluminium container.

• (8 spaces)
• (DK, RF not allowed)

IAS_N31C

Instruction: Re-scan the sampler ID bar code on the aluminium container.

• (8 spaces)
• (DK, RF not allowed)

IAS_N32

Instruction: To log in the waybill number of the postage-paid envelope, scan the bar code on the envelope.

• (13 spaces)
• (DK, RF not allowed)

IAS_R71
On the morning of ^DateMailBackE please put the aluminium container with the sampler inside into this postage-paid envelope and put the envelope into any Canada Post mailbox. Please remember to refer to the information sheet under the section: "What to do at the end of the 7 days".Should you have any questions or concerns, you will find a toll free number on this sheet.

Instruction: Give the postage-paid envelope (addressed to CASSEN Testing Laboratories), the container with sampler and the information sheet to the respondent. Ensure they do not confuse this material with the Activity Monitor material.

Inform the respondent that they will receive a reminder call to ensure they have set up the sampler and another call to remind them to return it.

• Press <1> to continue.
• DK, RF not allowed

Go to IAS_END

IAS_N90

Instruction: Why was the component not fully completed?

• 01 Respondent unable to continue for health reasons
• 02 Respondent unable to understand technique / Health Measures Specialist unable to adapt coaching
• 04 Equipment problem / technical difficulty
• 05 Respondent's mental condition
• 06 No time
• 20 Other - Specify (Go to IAS_S90)
• (DK, RF not allowed)

Go to IAS_END

IAS_S90
(Why was the component not fully completed?)

Instruction: Specify.

• (80 spaces)
• (DK, RF not allowed)

IAS_END

Indoor Air Questions (IAQ)

IAQ_BEG

External variables required:

Variables taken from sample file:

• STAND: name of the city/town/village in which the clinic has been set up
• CLINICID: 8 digit respondent identifier
• DW_Q01: type of dwelling that the respondent lives in, collected when the method of interview is by telephone
• DW_N02: type of dwelling that the respondent lives in, collected when the method of Interview is personal
• DW_S02: Other - Specify response for type of dwelling that the respondent lives in

Variables assigned in Variable Creation:

• CurrentYear: numeric year during which clinic visit is taking place
• CurrentMonth: numeric month during which clinic visit is taking place
• CurrentDay: numeric day during which clinic visit is taking place
• SessionE: English text of when the clinic visit is taking place

Variables output from Clinic Shell:

• Date1WeekAgoE: English text of date one week before the clinic visit
• DateLastMonthE: English text of date one month before the clinic visit
• Date6MonthsAgoE: English text of date six months before the clinic visit

Variables from previously completed blocks:

• RespondentName: name of respondent
• CON_SEX: sex of respondent
• GenderE: English text for sex of respondent
• CON_AGE: age of respondent
• IAS_N21: whether respondent took an indoor air sampler

IAQ_C01

• If IAS_N21 = 1, go to IAQ_R01.
• Otherwise, go to IAQ_END.

IAQ_R01
Now I'm going to ask you some questions about your home and the environment around your home.

Instruction: Press <1> to continue.

IAQ_C02

• If DW_Q01 <> RESPONSE and DW_N02 <> RESPONSE, go to IAQ_Q03.
• Otherwise, go to IAQ_D02A.

IAQ_D02A

Programmer:

• IF DW_Q01 = 10 THEN
  • DT_IAQ02TextE = DW_S02
  • DT_IAQ02TextF = DW_S02
• ELSE
  • IF DW_N02 = 10 THEN<
    • DT_IAQ02TextE = DW_S02
    • DT_IAQ02TextF = DW_S02
• ENDIF

IAQ_D02B

• If DW_Q01 = 1 or DW_N02 = 1, DT_IAQ02TEXTE = "single detached home".
• If DW_Q01 = 2 or DW_N02 = 2, DT_IAQ02TEXTE = "double".
• If DW_Q01 = 3 or DW_N02 = 3, DT_IAQ02TEXTE = "row house or terrace home".
• If DW_Q01 = 4 or DW_N02 = 4, DT_IAQ02TEXTE = "duplex".
• If DW_Q01 = 5 or DW_N02 = 5, DT_IAQ02TEXTE = "low-rise apartment of fewer than 5 stories or a flat".
• If DW_Q01 = 6 or DW_N02 = 6, DT_IAQ02TEXTE = "high-rise apartment of 5 stories or more".
• If DW_Q01 = 7 or DW_N02 = 7, DT_IAQ02TEXTE = "institution".
• If DW_Q01 = 8 or DW_N02 = 8, DT_IAQ02TEXTE = "hotel; rooming/lodging house; camp".
• If DW_Q01 = 9 or DW_N02 = 9, DT_IAQ02TEXTE = "mobile home".

IAQ_Q02
It was recorded during the household interview that you live in a(n) ^DT_IAQ02TEXTE. Is this correct?

• 1 Yes (Go to IAQ_D04)
• 2 No
• (DK, RF not allowed)

IAQ_Q03
What type of dwelling do you live in? Is it a... ?

Instruction: Read categories to respondent.

• 01 Single detached
• 02 Double
• 03 Row or terrace
• 04 Duplex
• 05 Low-rise apartment of fewer than 5 stories or a flat
• 06 High-rise apartment of 5 stories or more
• 07 Institution
• 08 Hotel; rooming/lodging house; camp
• 09 Mobile home
• 10 Other - Specify (Go to IAQ_S03)
• DK, RF

Go to IAQ_D04

IAQ_S03
(What type of dwelling do you live in? Is it a... ?)

Instruction: Specify.

• (80 spaces)
• (DK, RF not allowed)

IAQ_D04

Content type - Note to data users:

• IAQ_D04 (dwelling type) is set based on IAQ_Q02 (dwelling type confirmation from home interview) or IAQ_Q03 (response to dwelling type question during the clinic visit)

Programmer:

• IF IAQ_Q02 = 1
  • IF DW_N02 = RESPONSE THEN
    • IAQ_D04 = DW_N02
  • ELSE
    • IAQ_D04 = DW_Q01
  • ENDIF
• ELSE
  • IAQ_D04 = IAQ_Q03
• ENDIF

IAQ_Q04
How old is your home? Is it...?

Instruction: Read categories to respondent. If necessary state: If you do not know the exact age, please provide an estimate.

1. Less than 10 years old
2. 10 years old to less than 20
3. 20 years old to less than 30
4. 30 years old to less than 40
5. 40 years old to less than 50
6. 50 or more years old
7. DK, RF

IAQ_Q05
How long have you lived in your home?

Instruction: Minimum is 0; maximum is ^CON_AGE.
If less than one year enter "0".

• Years
• (MIN: 0)
• (MAX: 79)
• DK, RF

Content type - Note to data users:

• A hard edit will ensure that the age of the home is always greater or equal to the length of time the respondent has lived in his/her home.

IAQ_Q06
Excluding the basement and garage, what is the approximate area of your home in square feet or square metres? Would you say it is...?

Instruction: Read categories to respondent.

1. 600 sq. ft (55 square metres) or less
2. 601 to 1,000 sq. ft (56 to 95 square metres)
3. 1,001 to 2,000 sq. ft (96 to 185 square metres)
4. 2,001 to 3,000 sq. ft (186 to 280 square metres)
5. 3,001 to 4,000 sq. ft (281 to 371 square metres)
6. 4,001 sq. ft (372 square metres) or more
   DK, RF

IAQ_Q07
What is the main source of heat in your home?

Instruction: If the respondent reports the distribution method of the heat (e.g., hot water), probe to determine the original source of the heat (e.g., the means of heating the water such as an oil or gas furnace). Mark all that apply.

• 1 Oil furnace
• 2 Gas furnace
• 3 Electric heat
• 4 Wood-burning stove
• 5 Wood-burning fireplace
• 6 Gas fireplace
• 7 Other - Specify (Go to IAQ_S07)
• DK, RF

Go to IAQ_C11

IAQ_S07
(What is the main source of heat in your home?)

Instruction: Specify.

• (80 spaces)
• (DK, RF not allowed)

IAQ_C11

• If IAQ_D04 = 5, 6 or 7 (dwelling is low-rise apartment, high-rise apartment or institution), go to IAQ_Q14.
• Otherwise, go to IAQ_Q11.

IAQ_Q11
Do you have a garage on your property?

Instruction: Do not include carports.

• 1 Yes
• 2 No (Go to IAQ_Q15)
• (DK is not allowed)
• RF (Go to IAQ_Q15)

IAQ_C12A

• If IAQ_Q11 = 1, go to IAQ_Q12.
• Otherwise, go to IAQ_C12B.

IAQ_C12B

• If (IAQ_D04 = 1, 2, 3, 4, 9 (single detached, double, row or terrace, duplex or mobile home) and IAQ_Q11 = 2 or RF), go to IAQ_Q15.
• Otherwise, go to IAQ_C12C.

IAQ_C12C

• If (IAQ_D04 = 8, 10, DK, RF (hotel; rooming/lodging house; camp, other - specify, don’t know or refuse) and IAQ_Q11 = 2 or RF), go to IAQ_Q14.
• Otherwise, go to IAQ_Q12.

IAQ_Q12
Is it a... ?

Instruction: Read categories to respondent.

If respondent has more than one garage, ask about the garage situated closest to the home.

1. Detached garage
2. Attached garage without a connecting door to your home
3. Attached garage with a connecting door to your home
   DK, RF

IAQ_Q13
In the past month, that is from ^DateLastMonthE until today, how often has a car, truck, or other vehicle been parked in this garage after being used?

Instruction: Read categories to respondent.

1. More than 5 times a week
2. 1 to 5 times a week
3. Less than once a week
4. Never
   DK, RF

IAQ_C14

• If IAQ_Q11 = 1, go to IAQ_Q15.
• Otherwise, go to IAQ_Q14.

IAQ_Q14
Does your building have any of the following parking facilities?

Instruction: Read categories to respondent. Mark all that apply.

1. Indoor or underground parking lot
2. Outdoor or partially enclosed parking lot
3. Neither
   DK, RF

IAQ_Q15
In the past month, that is from ^DateLastMonthE until today, have you or anyone else ever smelled fumes in your home from cars, trucks or other vehicles?

Instruction: These fumes could come from a garage, driveway, parking lot, the street, etc.

• 1 Yes
• 2 No (Go to IAQ_Q17)
• DK, RF (Go to IAQ_Q17)

IAQ_Q16
How often were these fumes smelt?

Instruction: Read categories to respondent.

1. More than 5 times a week
2. 1 to 5 times a week
3. Less than once a week
   DK, RF

IAQ_Q17
In the past month, have you had a major home renovation such as finishing of the basement, painting walls or windows, changing floors/ceilings or upgrading a kitchen or bathroom?

Instruction: Do not include home renovations that took place more than one month ago or that will occur during the collection period.

• 1 Yes
• 2 No
• DK, RF

IAQ_Q18
In the past month, have new carpeting or rugs been installed in your home?

• 1 Yes
• 2 No
• DK, RF

IAQ_Q19
In the past week, that is from ^Date1WeekAgoE to today, which of the following products did you or anyone else use inside your home? Do not include products used in your garage or outside of your home.

Instruction: Read categories to respondent. Mark all that apply.

• 01 Gasoline or gasoline-powered devices
• 02 Kerosene
• 03 Moth balls or moth crystals
• 04 Oil-based (alkyd) paints
• 05 Latex paint
• 06 Paint remover
• 07 Solvents (e.g., Varsol, paint thinners)
• 08 Oil based (alkyd) wood stains
• 09 Latex wood stains
• 10 Candles
• 11 Paints, type unknown
• 12 Wood stains, type unknown
• 13 None
• DK, RF

Help text: The following products should be included in the corresponding response category:

• 01 Gasoline or gasoline-powered devices: devices working with lighter fuel
• 05 Latex paint: water based paint
• 10 Candles: candles on a birthday cake
• 11 Paints, type unknown: acrylic paint

The following products should not be included in the corresponding response category:

• Finger paints for kids
• Nail polish remover
• Incense

IAQ_Q20
On a typical day over the past week, did you normally open windows or doors to get fresh air into your home?

• 1 Yes
• 2 No
• DK, RF

IAQ_Q21
In the past 6 months, that is from ^Date6MonthsAgoE to today, how often did you or anyone else in your home bring home clothing or any other items from the dry cleaners?

Instruction: Read categories to respondent.

1. More than once a week
2. About once a week
3. Less than once a week
4. Never
   DK, RF

IAQ_END

Spirometry Measurement Component (SPM)

SPM_BEG

External fields required:

Variables taken from sample file:

• STAND: name of the city/town/village in which the clinic has been set up
• CLINICID: 8 digit respondent identifier
• SDC_Q36: respondent's racial background is Aboriginal
• SDC_Q38A: respondent's racial background is White
• SDC_Q38B: respondent's racial background is South Asian
• SDC_Q38C: respondent's racial background is Chinese
• SDC_Q38D: respondent's racial background is Black
• SDC_Q38E: respondent's racial background is Filipino
• SDC_Q38F: respondent's racial background is Latin American
• SDC_Q38G: respondent's racial background is Arab
• SDC_Q38H: respondent's racial background is Southeast Asian
• SDC_Q38I: respondent's racial background is West Asian
• SDC_Q38J: respondent's racial background is Korean
• SDC_Q38K: respondent's racial background is Japanese
• SDC_Q38L: respondent's racial background is Other
• SDC_S38: Other - Specify for respondent's racial background

Variables assigned in Variable Creation:

• CurrentYear: numeric year during which clinic visit is taking place
• CurrentMonth: numeric month during which clinic visit is taking place
• CurrentDay: numeric day during which clinic visit is taking place
• SessionE: English text of when the clinic visit is taking place

Variables from previously completed blocks:

• RespondentFirstName: first name of respondent
• RespondentLastName: last name of respondent
• RespondentName: name of respondent
• CON_SEX: sex of respondent
• GenderE: English text for sex of respondent
• CON_DDN: date of birth of respondent (in YYYYMMDD format)
• CON_AGE: age of respondent
• HWM_D11: height of respondent in inches
• SCS_N12: visit type (3= clinic visit; 4= home visit)

SPM_D011

Content type - Note to data users:

• If the respondent's date of birth is not available, it will be estimated by subtracting the respondent's age from the current year (Using January 1st as the reference date).

SPM_Q021
Now we will be doing a test to measure your lung function. The results of this test greatly depend on your effort; so, to get good results we really need you to give 100%.

Instruction: Press <1> to continue.

• 1 Continue
• DK (Go to SPM_N901)
• RF (Go to SPM_END)

SPM_D021

Programmer:

• IF SCS_N12 = 4 THEN
  • SPM_D021 = EMPTY
• ELSE
• IF SPM_Q021 = 1 or RF and SPM_D021 = EMPTY,
  • Set SPM_D021 = Current Time (in HH:MM:SS format)
• ENDIF

SPM_R022
First I need to enter some information into our computer system to prepare the test. This will only take a few minutes.

Instruction: Press <1> to continue.

SPM_D022A

• If SDC_Q36 = 1, DT_RBE1 = "Aboriginal".
• If SDC_Q38A = 1, DT_RBE2 = "White".
• If SDC_Q38B = 1, DT_RBE3 = "South Asian ".
• If SDC_Q38C = 1, DT_RBE4 = "Chinese".
• If SDC_Q38D = 1, DT_RBE5 = "Black".
• If SDC_Q38E = 1, DT_RBE6 = "Filipino".
• If SDC_Q38F = 1, DT_RBE7 = "Latin American".
• If SDC_Q38G = 1, DT_RBE8 = "Arab".
• If SDC_Q38H = 1, DT_RBE9 = "Southeast Asian".
• If SDC_Q38I = 1, DT_RBE10 = "West Asian".
• If SDC_Q38J = 1, DT_RBE11 = "Korean".
• If SDC_Q38K = 1, DT_RBE12 = "Japanese".
• If SDC_Q38L = 1, DT_RBE13 = "^SDC_S38".

SPM_D022B

Programmer:

^DT_SPM022TextE = DT_RBE1 + DT_RBE2 + DT_RBE3 + DT_RBE4 + DT_RBE5 + DT_RBE6 + DT_RBE7 + DT_RBE8 + DT_RBE9 + DT_RBE10 + DT_RBE11 + DT_RBE12 + DT_RBE13 (separated by slashes)

SPM_D022C

• If SDC_Q36=1 or SDC_Q38A=1 or SDC_Q38G=1, DT_RACEWE = "White".
• If SDC_Q38D=1, DT_RACEBE = "Black".
• If SDC_Q38F=1, DT_RACEHE = "Hispanic".
• If SDC_Q38B=1 or SDC_Q38C=1 or SDC_Q38E=1 or SDC_Q38H=1 or SDC_Q38I=1 or SDC_Q38J=1 or SDC_Q38K=1, DT_RACEAE = "Asian".
• If SDC_Q38L=1, DT_RACEOE = "Other".

Programmer:

• ^DT_RACEADJE = [White] or [Black] or [Hispanic] or [Asian] or [Other]

SPM_D022D

• If ^DT_RACEADJE = more than 1 race adjustment category, DT_PGTEXT1E = " either".
• Otherwise, DT_PGTEXT1E = "EMPTY".
• If ^DT_RACEADJE = more than 1 race adjustment category, DT_PGTEXT2E = " based on the respondent's morphology".
• Otherwise, DT_PGTEXT2E = "EMPTY".

SPM_N022

Instruction: The racial background reported during the household interview is ^DT_SPM022TEXTE. Based on this information you should pick [ either/EMPTY] the ^DT_RACEADJE race adjustment category[ based on the respondent's morphology/EMPTY].

Record the appropriate race adjustment for the respondent.

• 1 White
• 2 Black
• 3 Hispanic
• 4 Asian
• 5 Other
• (DK, RF not allowed)

Content type - Note to data users:

• Using the information collected from the household interview, the health measures specialist (HMS) is prompted to select one race adjustment category. If more than one race adjustment category is possible, the HMS will decide based on the respondent's morphology.

SPM_C022

• If Edit = Suppressed, go to SPM_N022B.
• Otherwise, go to SPM_D023.

Content type - Note to data users:

• If a race adjustment category different from that which was prompted at SPM_N022 is selected then go to SPM_022B.
• Otherwise, go to SPM_D023.

SPM_N022B

Instruction: Why was ^SPM_N022 selected as the race adjustment category?

1. Morphology does not match race adjustment category
2. No reported racial background during household interview
3. Incomplete/incorrect racial background from household interview
4. Other - Specify (Go to SPM_S022B)
   (DK, RF not allowed)

Go to SPM_D023

SPM_S022B

Instruction: Specify.

• (80 spaces)
• (DK, RF not allowed)

SPM_D023

• If CON_SEX = 1, DT_SPM_SEX = "M".
• If CON_SEX = 2, DT_SPM_SEX = "F".

SPM_N023

Instruction: Check the data to be sent to the spirometry software.

• Press <1> to transmit the data.
• Press <2> to retransmit the data.
• 1 Transmit the data
• 2 Retransmit the data
• (DK, RF not allowed)

SPM_D024

Programmer:

• IF CON_AGE < 8 THEN
  • SPM024Text1 = "Corey 1976"
• IF SPM_N022 = 1 THEN
  • SPM024Text2 = "W H U"
• ELSE IF SPM_N022 = 2 THEN
  • SPM024Text2 = "B A"
• ELSE IF SPM_N022 = 3 THEN
  • SPM024Text2 = "W H U"
• ELSE IF SPM_N022 = 4 THEN
  • SPM024Text2 = "B A"
• ELSE
  • SPM024Text2 = "W H U"
• ENDIF
• ELSE
  • SPM024Text1 = "Hankinson (NHANES III)"
• IF SPM_N022 = 1 THEN
  • SPM024Text2 = "Caucasian"
• ELSE IF SPM_N022 = 2 THEN
  • SPM024Text2 = "African-American"
• ELSE IF SPM_N022 = 3 THEN
  • SPM024Text2 = "Mexican-American"
• ELSE IF SPM_N022 = 4 THEN
  • SPM024Text2 = "Other - Asian"
• ELSE
  • SPM024Text2 = "Other - Unknown"
• ENDIF
• ENDIF

SPM_R024

Instruction: Open the KoKo software.Follow the instructions on importing and retrieving respondent information.

In the KoKo patient information screen, choose "^SPM024Text1" for "Predicteds" and "^SPM024Text2" for "Ethnic Group".

• Press <1> to continue.

SPM_Q031
During the test, you will wear this clip on your nose and place this mouthpiece in your mouth. Your lips and teeth should be nice and tight around the mouthpiece, so that no air escapes. Once you have the mouthpiece in your mouth, you will follow a few easy steps.

1. First, you are going to breathe normally.
2. Next, I'm going to tell you to take a big breath in! I want you to fill up your lungs with as much air as possible, and as quickly as possible.
3. As soon as you've filled your lungs, I'm going to tell you to blow the air out as fast, as hard, and for as long as possible. Don't hold your breath at all; you need to blow it out as quickly as possible.
4. After that, I'm going to tell you to keep blowing, keep blowing, keep blowing! Even if you think no more air is coming out, keep blowing because there may be a little bit left and we want to get it all out.
5. When you've finished blowing out, I'm going to tell you to take a big breath in again, just like the first one.
6. Finally, you can remove the mouthpiece from your mouth and take the nose clip off of your nose.

Instruction: Demonstrate the test from start to finish, as realistically as possible.

• Press <1> to continue.
• 1 Continue
• (DK is not allowed)
• RF (Go to SPM_END)

SPM_Q032
I'll tell you exactly what to do and when to do it. All you need to do is listen to my instructions and give me your best effort.

We will repeat this test a few times to ensure that we get your best effort.

Do you have any questions before we begin?

Instruction: Answer any questions as thoroughly as possible.

• Press <1> to continue.
• 1 Continue
• (DK is not allowed)
• RF (Go to SPM_END)

SPM_Q033
Please sit up straight in your chair and keep both feet flat on the floor.

Instruction: Press <1> to continue.

• 1 Continue
• (DK is not allowed)
• RF (Go to SPM_END)

SPM_R033

Instruction: Common verbal cues

1. "Take a few normal breaths."
2. "Big breath in!"
3. "Blow!"
4. "Keep blowing, keep blowing, keep blowing..."
5. "Big breath in!"

Instruction: Go to the KoKo software.

Follow the instructions for performing the test.

• Press <1> to continue.

SPM_R100

Instruction: Ensure the spirometry test results have been saved in the KoKo software and the .SER file has been transferred from the KoKo software to the clinic server.

• Press <1> to continue.

SPM_N800

Instruction: Record how many trials were performed and saved.

• 1 0
• 2 1 or 2
• 3 3 or more
• (DK, RF not allowed)

SPM_C800

• If SPM_N800 = 1 or 2, go to SPM_N901.
• Otherwise, go to SPM_N900.

SPM_N900

Instruction: Record whether this test meets the American Thoracic Society (ATS) criteria.

• 1 Yes
• 2 No
• (DK, RF not allowed)

SPM_C901

• If SPM_N900 = RESPONSE, go to SPM_END.
• Otherwise, go to SPM_N901.

SPM_N901

Instruction: Why was the component not fully completed?

1. Respondent unable to continue for health reasons
2. Respondent unable to understand technique / Health Measures Specialist unable to adapt coaching
3. Respondent refuses to continue
4. Equipment problem / technical difficulty
5. Respondent's mental condition
6. Other - Specify (Go to SPM_S901)
7. No time
   (DK, RF not allowed)

Go to SPM_END

SPM_S901
(Why was the component not fully completed?)

Instruction: Specify.

• (80 spaces)
• (DK, RF not allowed)

SPM_END

Hearing Component

Otoscopy Measurement (OTM)

OTM_BEG

External variables required:

Variables taken from sample file:

• STAND: name of the city/town/village in which the clinic has been set up
• CLINICID: 8 digit respondent identifier

Variables assigned in Variable Creation:

• CurrentYear: numeric year during which clinic visit is taking place
• CurrentMonth: numeric month during which clinic visit is taking place
• CurrentDay: numeric day during which clinic visit is taking place
• SessionE: English text of when the clinic visit is taking place

Variables from previously completed blocks:

• RespondentName: name of respondent
• GenderE: English text for sex of respondent
• CON_AGE: age of respondent
• HER_Q40: whether the respondent has an ear infection or pain in ears
• HER_Q41: whether the respondent has acute infection/pain (in right, left or both ears)
• HER_Q52: whether the respondent has a hearing aid
• HER_Q53: whether the respondent has hearing aid (in right, left or both ears)

OTM_D10

• If HER_Q41 = 1, DT_OTMTEXT1E = "left ear".
• Else If HER_Q41 = 2, DT_OTMTEXT1E = "right ear".
• Otherwise, DT_OTMTEXT1E = "ears, one at a time".
• If HER_Q41 = 1 or 2, DT_OTMTEXT4E = "ear".
• Otherwise, DT_OTMTEXT4E = "ears".

OTM_R10
Now we will be doing a series of tests to measure your hearing. I'm going to start by doing a visual inspection of your [ear/ears]. To do this, I will gently place an otoscope in your [left ear/right ear/ears, one at the time] and record my observations.

Instruction: Show the otoscope to the respondent.

• Press <1> to continue.

Programmer:

• Use red font for dynamic text DT_OTMTEXT4E
• Allow ‘DK’ as a response category

OTM_C11

• If OTM_R10 = DK, go to OTM_N90.
• Otherwise, go to OTM_D11.

OTM_D11

Programmer:

• IF OTM_R10 = 1 and OTM_D11 = EMPTY,
  • Set OTM_D11 = Current Time (in HH :MM :SS format).
• ENDIF

OTM_Q20
I would like you to sit in this chair with your hands on your lap, sitting up straight and facing forward. Please sit as still as you can. This will only take a few seconds.

Instruction: Select the appropriately sized speculum and place it on the otoscope. Ensure the respondent is sitting still in the correct position and any glasses, hair ties or ornaments, hats or chewing gum that may interfere with otoscopic examination have been removed.

• Press <1> to continue.
• 1 Continue
• (DK is not allowed)
• RF (Go to OTM_END)

OTM_C30A

• If HER_Q52 = 1, go to OTM_D30.
• Otherwise, go to OTM_C30E.

OTM_D30

• If HER_Q53 = 1 or 2, DT_OTMTEXT2E = "aid".
• If HER_Q53 = 3 , DT_OTMTEXT2E = "aids".

OTM_Q30
Before we start, I would like to ask you to please remove your hearing [aid/aids].

Instruction: If the respondent cannot remove his or her own hearing [aid/aids] (or is not accompanied by a parent or guardian who can assist), press <F5> to refuse.

• Press <1> to continue.
• 1 Continue (Go to OTM_C30E)
• (DK is not allowed)
  RF (Go to OTM_C30B)

OTM_C30B

• If HER_Q53 = 1, go to OTM_C60A.
• Otherwise, go to OTM_C30C.

OTM_C30C

• If HER_Q53 = 2, go to OTM_C30E.
• Otherwise, go to OTM_C30D.

OTM_C30D

• If HER_Q53 = 3, go to OTM_END.
• Otherwise, go to OTM_C30E.

OTM_C30E

• If HER_Q41 = 1 , go to OTM_C60A.
• Otherwise, go to OTM_N31.

OTM_N31

Instruction: Is the entrance to the right ear canal completely obstructed?

• 1 Yes (Go to OTM_C60A)
• 2 No
• (DK, RF not allowed)

OTM_N40

Instruction: Perform otoscopic examination of the right ear. Record the presence of any of the following in the right ear. Mark all that apply.

1. Blood
2. Pus / Wax
3. Foreign object
4. Pressure equalization tube
5. Narrow, collapsible ear canal
6. Other - Specify (Go to OTM_S40)
7. None
   (DK is not allowed)
   RF (Go to OTM_C60A)

Go to OTM_C50

OTM_S40

Instruction: Specify the observed abnormality.

• (80 spaces)
• (DK, RF not allowed)

OTM_C50

• If OTM_N40 = 2, go to OTM_N50.
• Otherwise, go to OTM_C60A.

OTM_N50

Instruction: Record the amount of pus / wax in the right ear.

1. Normal
2. Excessive
3. Impacted
   (DK, RF not allowed)

OTM_C60A

• If OTM_Q30 = RF and HER_Q53 = 2, go to OTM_END.
• Otherwise, go to OTM_C60B.

OTM_C60B

• If HER_Q41 = 2, go to OTM_END.
• Otherwise, go to OTM_N60.

OTM_N60

Instruction: Is the entrance to the left ear canal completely obstructed?

• 1 Yes (Go to OTM_END)
• 2 No
• (DK, RF not allowed)

OTM_N70

Instruction: Perform otoscopic examination of the left ear. Record the presence of any of the following in the left ear.

Mark all that apply.

1. Blood
2. Pus / Wax
3. Foreign object
4. Pressure equalization tube
5. Narrow, collapsible ear canal
6. Other - Specify (Go to OTM_S70)
7. None
   (DK is not allowed)
   RF (Go to OTM_END)

Go to OTM_C80

OTM_S70

Instruction: Specify the observed abnormality.

• (80 spaces)
• (DK, RF not allowed)

OTM_C80

• If OTM_N70 = 2, go to OTM_N80.
• Otherwise, go to OTM_END.

OTM_N80

Instruction: Record the amount of pus / wax in the left ear.

1. Normal
2. Excessive
3. Impacted
   (DK, RF not allowed)

Go to OTM_END

OTM_N90

Instruction: Why was the component not fully completed?

• 01 Respondent unable to continue for health reasons
• 02 Respondent unable to understand technique / Health Measures Specialist unable to adapt coaching
• 04 Equipment problem / technical difficulty
• 05 Respondent's mental condition
• 06 No time
• 20 Other - Specify (Go to OTM_S90)
  (DK, RF not allowed)

Go to OTM_END

OTM_S90
(Why was the component not fully completed?)

Instruction: Specify.

• (80 spaces)
• (DK, RF not allowed)

OTM_END

Tympanometry Measurement (TYM)

TYM_BEG

External variables required:

Variables taken from sample file:

• STAND: name of the city/town/village in which the clinic has been set up
• CLINICID: 8 digit respondent identifier

Variables assigned in Variable Creation:

• CurrentYear: numeric year during which clinic visit is taking place
• CurrentMonth: numeric month during which clinic visit is taking place
• CurrentDay: numeric day during which clinic visit is taking place
• SessionE: English text of when the clinic visit is taking place

Variables from previously completed blocks:

• RespondentName: name of respondent
• GenderE: English text for sex of respondent
• CON_AGE: age of respondent
• HER_Q31: whether the respondent had an ear surgery (right, left or both ears)
• HER_Q41: whether the respondent has acute infection /pain in (right, left or both ears)
• HER_Q53: whether the respondent has hearing aid (right, left or both ears)
• OTM_N31: whether the respondent has occluded right ear
• OTM_N60: whether the respondent has occluded left ear
• OTN_N40: record of the otoscopic examination of the right ear
• OTM_N70: record of the otoscopic examination of the left ear
• OTM_N50: record of the amount pus/wax in the right ear
• OTM_N80: record of the amount pus/wax in the left ear
• OTM_Q30: if the respondent refused removing his or her hearing aid(s)
• OTM_Q20: whether the respondent started otoscopy measurements
• OTM_R10: introduction to the otoscopy measurement

TYM_C10

• If (OTM_Q20 = RF) or HER_Q31 = 3 or (OTM_N31 = 1 and OTM_N60 = 1) or ((OTM_N40 in (1, 3, 6 or RF) and OTM_N70 in (1, 3, 6 or RF)) or (OTM_N50 = 3 and OTM_N80 = 3) or (OTM_Q30 = RF and HER_Q53 = 3) or OTM_R10 = DK, go to TYM_END.
• Otherwise, go to TYM_D11.

Content type - Note to data users:

• If the respondent did not complete otoscopy, had surgery in both ears, had occlusions in both ears, had blood, a foreign object or another object/substance in both ears, had impacted wax in both ears or was unwilling to remove his/her hearing aids from both ears, then the tympanometry test is not completed.

TYM_D11

Content type - Note to data users:

• If the respondent has an occlusion in the right ear, has acute pain or infection in the right ear, has had surgery in the right ear, has blood, a foreign object or another object/substance in the right ear, has impacted wax in the right ear, or is unwilling to remove his/her hearing aid from the right ear, then REFLAG is set to 1.

Programmer:

• IF ((HER_Q31 = 1 or HER_Q41 = 1 or OTM_N31 = 1 or OTM_N40 in (1,3,6 or RF) or OTM_N50 = 3) or (OTM_Q30 = RF and HER_Q53 = 1)), set REFLAG = 1
• Otherwise, set REFLAG = 2

TYM_D12

Content type - Note to data users:

• If the respondent has an occlusion in the left ear, has acute pain or infection in the left ear, has had surgery in the left ear, has blood, a foreign object or another object/substance in the left ear, has impacted wax in the left ear, or is unwilling to remove his/her hearing aid from the left ear, then LEFLAG is set to 1.

Programmer:

• IF ((HER_Q31 = 2 or HER_Q41 = 2 or OTM_N60 = 1 or OTM_N70 in (1,3,6 or RF) or OTM_N80 = 3) or (OTM_Q30 = RF and HER_Q53 = 2)), set LEFLAG = 1
• Otherwise, set LEFLAG = 2

TYM_C13

• If REFLAG = 1 and LEFLAG = 1, go to TYM_END.
• Otherwise, go to TYM_D13.

TYM_D13

• If REFLAG=2 and LEFLAG = 2, DT_TYMSIDEE = "ears, one at a time".
• Else If REFLAG =1 and LEFLAG = 2 , DT_TYMSIDEE = "left ear".
• Otherwise (if REFLAG = 2 and LEFLAG =1), DT_TYMSIDEE = "right ear".
• If REFLAG=2 and LEFLAG = 2, DT_TYMDRUME = "eardrums".
• Otherwise, DT_TYMDRUME = "eardrum".

TYM_R20
This tympanometry test will measure the flexibility of your [eardrums/eardrum]. I will place a probe in your [ears, one at a time/left ear/right ear]. You will hear a soft humming sound and feel a gentle pressure when I take the measurement.

Instruction:

• Show the tympanometer to the respondent.
• Select the appropriate ear tip and slip it onto the nose cone of the probe.
• Press <1> to continue.

Programmer:

• Allow ‘DK’ as a response category

TYM_C20

• If TYM_R20 = DK, go to TYM_N56.
• Otherwise, go to TYM_Q21.

TYM_Q21
I would like you to sit in this chair with your hands on your lap, sitting up straight and facing forward. Please sit as still as you can. This will only take a few seconds.

Instruction:

• Turn the device on.
• Select the Tympanometry only mode by pressing the "Tymp" button on the front panel.
• Ensure the respondent is sitting still in the correct position.
• Press <1> to continue.
• 1 Continue
• (DK is not allowed)
• RF (Go to TYM_END)

TYM_C30

• If REFLAG = 1, go to TYM_C40.
• Otherwise, go to TYM_N30.

TYM_N30

Instruction: Perform measurement on the right ear.

• Select the right ear by pressing the "R" button.
• Make sure that the green light on the probe is blinking.
• Put the probe in the respondent's right ear, applying a gentle pressure to maintain a tight seal.
• As soon as a good seal is obtained, the blinking green light will change to a steady glow.
• Remain steady while the test is in progress.
• Once the test is over, all lights on the probe will be turned off and the test results can be viewed on the instrument display.

• Press <1> to continue.
• 1 Continue
• (DK, RF not allowed)

Help text:

• Green light: Still blinking - seal has not been obtained to initiate the test sequence.
• Orange light: The ear canal is not properly sealed and a large pressure leak exists.
• Yellow light: The probe tip is occluded with ear wax or you are pressing the tip of the probe against the ear canal wall causing an occlusion.

TYM_N31

Instruction:

Capture the results of the right ear.

• Press <1> to continue.
• 1 Continue
• (DK is not allowed)
• RF (Go to TYM_C40)

TYM_N32A

Instruction: Record the canal volume (ECV cm3) for the right ear.

• (MIN: 0.0)
• (MAX: 5.0)
• DK
• (RF is not allowed)

TYM_N32B

Instruction: Re-enter the canal volume (ECV cm3) for the right ear.

• (MIN: 0.0)
• (MAX: 5.0)
• DK
• (RF is not allowed)

TYM_C33

• If TYM_N32A = DK, go to TYM_C40.
• Otherwise, go to TYM_N33A.

TYM_N33A

Instruction: Record whether a no peak message, " NP", was displayed for the compliance peak (PEAK cm3) value for the right ear.

• 1 Yes (Go to TYM_D33)
• 2 No
• (DK, RF not allowed)

TYM_N33B

Instruction: Record the compliance peak value (PEAK cm3) for the right ear.

• (MIN: 0.0)
• (MAX: 5.0)
• (DK, RF not allowed)

TYM_N33C

Instruction: Re-enter the compliance peak value (PEAK cm3) for the right ear.

• (MIN: 0.0)
• (MAX: 5.0)
• DK, RF not allowed)

TYM_D33

• If TYM_N33A = 1 then , DV_TYMN33 = "NP"
• Otherwise, DV_TYMN33 = "TYM_N33B"

TYM_N34A

Instruction: Record whether a no peak message, "NP", was displayed for the pressure peak (PEAK daPa) value for the right ear.

• 1 Yes (Go to TYM_D34)
• 2 No
• (DK, RF not allowed)

TYM_N34B

Instruction: Record the pressure peak value (PEAK daPa) for the right ear.

• daPa
• (MIN: -400)
• (MAX: 200)
• (DK, RF not allowed)

TYM_N34C

Instruction: Re-enter the pressure peak value (PEAK daPa) for the right ear.

• cm3
• (MIN: -400)
• (MAX: 200)
• (DK, RF not allowed)

TYM_D34

• If TYM_N34A = 1 then , DV_TYMN34 = "NP"
• Otherwise, DV_TYMN34 = "TYM_N34B"

TYM_N35

Instruction: Check the tympanometry data.

1. Accept the measurements
2. Reject the measurements (Go to TYM_N32A)
   (DK, RF not allowed)

TYM_D35

• If TYM_N32A in (0.2 to 2.0 cm3) and TYM_N33B in (0.2 to 1.8 cm3) and TYM_N34B in (-150 to 100 daPa), DV_TYMD35 = 1 (pass).
• Else, DV_TYMD35 = 2 (refer).

TYM_C40

• If LEFLAG = 1 and TYM_N32A = DK, go to TYM_C56
• Else if LEFLAG = 1 and TYM_N32A = (0.0 to 5.0) or "EMPTY", go to TYM_END.
• Otherwise, go to TYM_N50.

TYM_N50

Instruction: Perform measurement on the left ear.

• Select the left ear by pressing the "L" button.
• Make sure that the green light on the probe is blinking.
• Put the probe in the respondent's left ear, applying a gentle pressure to maintain a tight seal.
• As soon as a good seal is obtained, the blinking green light will change to a steady glow.
• Remain steady while the test is in progress.
• Once the test is over, all lights on the probe will be turned off and the test results can be viewed on the instrument display.

• Press <1> to continue.
• 1 Continue
• (DK, RF not allowed)

Help text:

• Green light: Still blinking - seal has not been obtained to initiate the test sequence.
• Orange light: The ear canal is not properly sealed and a large pressure leak exists.
• Yellow light: The probe tip is occluded with ear wax or you are pressing the tip of the probe against the ear canal wall causing an occlusion.

TYM_N51

Instruction: Capture the results of the left ear.

• Press <1> to continue.
• 1 Continue
• (DK is not allowed)
• RF (Go to TYM_C56)

TYM_N52A

Instruction: Record the canal volume (ECV cm3) for the left ear.

• (MIN: 0.0)
• (MAX: 5.0)
• DK
• (RF is not allowed)

TYM_N52B

Instruction: Re-enter the canal volume (ECV cm3) for the left ear.

• (MIN: 0.0)
• (MAX: 5.0)
• DK
• (RF is not allowed)

TYM_C53

• If TYM_N52A = DK, go to TYM_C56.
• Otherwise, go to TYM_N53A.

TYM_N53A

Instruction: Record whether a no peak message, NP, was displayed for the compliance peak (PEAK cm3) value for the left ear.

• 1 Yes (Go to TYM_D53)
• 2 No
• (DK, RF not allowed)

TYM_N53B

Instruction: Record the compliance peak value (PEAK cm3) for the left ear.

• (MIN: 0.0)
• (MAX: 5.0)
• (DK, RF not allowed)

TYM_N53C

Instruction: Re-enter the compliance peak value (PEAK cm3) for the left ear.

• (MIN: 0.0)
• (MAX: 5.0)
• (DK, RF not allowed)

TYM_D53

• If TYM_N53A = 1 then , DV_TYMN53 = "NP"
• Otherwise, DV_TYMN53 = "TYM_N53B"

TYM_N54A

Instruction: Record whether a no peak message, "NP", was displayed for the pressure peak (PEAK daPa) value for the left ear.

• 1 Yes (Go to TYM_D54)
• 2 No
• (DK, RF not allowed)

TYM_N54B

Instruction: Record the pressure peak value (PEAK daPa) for the left ear.

• daPa
• (MIN: -400)
• (MAX: 200)
• (DK, RF not allowed)

TYM_N54C

Instruction: Re-enter the pressure peak value (PEAK daPa) for the left ear.

• cm3
• (MIN: -400)
• (MAX: 200)
• (DK, RF not allowed)

TYM_D54

• If TYM_N54A = 1 then , DV_TYMN54 = "NP"
• Otherwise, DV_TYMN54 = "TYM_N54B"

TYM_N55

Instruction: Check the tympanometry data.

1. Accept the measurements
2. Reject the measurements (Go to TYM_N52A)
   (DK, RF not allowed)

TYM_D55

• If TYM_N52A in (0.2 to 2.0 cm3) and TYM_N53B in (0.2 to 1.8 cm3) and TYM_N54B in (-150 to 100 daPa), DV_TYMD55 = 1 (pass).
• Else, DV_TYMD55 = 2 (refer).TYM_C56If TYM_N32A = DK or TYM_N52A = DK, go to TYM_N56.
• Otherwise, go to TYM_END.

TYM_N56

Instruction: Why was the component not fully completed?

• 01 Respondent unable to continue for health reasons
• 02 Respondent unable to understand technique / Health Measures Specialist unable to adapt coaching
• 04 Equipment problem / technical difficulty
• 05 Respondent's mental condition
• 06 No time
• 20 Other - Specify (Go to TYM_S56)
• (DK, RF not allowed)

Go to TYM_END

TYM_S56
(Why was the component not fully completed?)

Instruction: Specify.

• (80 spaces)
• (DK, RF not allowed)

TYM_END

Otoacoustic Emissions Measurement (OAE)

OAE_BEG

External variables required:

Variables taken from sample file:

• STAND: name of the city/town/village in which the clinic has been set up
• CLINICID: 8 digit respondent identifier
• SITE: site number

Variables assigned in Variable Creation:

• CurrentYear: numeric year during which clinic visit is taking place
• CurrentMonth: numeric month during which clinic visit is taking place
• CurrentDay: numeric day during which clinic visit is taking place
• SessionE: English text of when the clinic visit is taking place

Variables from previously completed blocks:

• RespondentFirstName: first name of respondent
• RespondentLastName: last name of respondent
• GenderE: English text for sex of respondent
• CON_AGE: age of respondent
• PROXYSEX: gender of targeted respondent
• HER_Q41: whether the respondent has acute infection /pain in (right, left or both ears)
• HER_Q53: whether the respondent has hearing aid (right, left or both ears)
• OTM_Q20: whether the respondent started the otoscopy measurements
• OTM_N31: whether the respondent has occluded right ear
• OTM_N60: whether the respondent has occluded left ear
• OTM_N40: record of the otoscopic examination of the right ear
• OTM_N70: record of the otoscopic examination of the left ear
• OTM_N50: record of the amount of pus/wax in the right ear
• OTM_N80: record of the amount of pus/wax in the left ear
• OTM_Q30: if the respondent refused removing his or her hearing aid(s)
• OTM_R10: introduction to the otoscopy measurement

OAE_C10

• If (OTM_Q20 = RF) or (OTM_N31=1 and OTM_N60 = 1) or (OTM_N40 IN (1, 3, 6 or RF) and OTM_N70 IN (1, 3, 6 or RF)) or (OTM_N50 = 3 and OTM_N80 = 3) or (OTM_Q30 = RF and HER_Q53 = 3) or OTM_R10 = DK, go to OAE_END.
• Otherwise, go to OAE_D10.

Content type - Note to data users:

• If the respondent did not complete otoscopy, had occlusions in both ears, had blood, a foreign object or another object/substance in both ears, had impacted wax in both ears, or is unwilling to remove his/her hearing aids from both ears, then the otoacoustic emissions test is not completed.

OAE_D10

Content type - Note to data users:

• If the respondent has acute pain or infection in the right ear, an occlusion in the right ear, has blood, a foreign object or another object/substance in the right ear, has impacted wax in the right ear, is unwilling to remove his/her hearing aid from the right ear, or refuses to continue with otoscopy on the right ear, then REFLAG is set to 1.

Programmer:

• IF ((HER_Q41 = 1 or OTM_N31 = 1 or OTM_N40 in (1,3,6 or RF) or OTM_N50 = 3) or (OTM_Q30 = RF and HER_Q53 = 1)), set REFLAG = 1
• Otherwise, set REFLAG = 2

OAE_D11

Content type - Note to data users:

• If the respondent has acute pain or infection in the left ear, an occlusion in the left ear, has blood, a foreign object or another object/substance in the left ear, has impacted wax in the left ear, is unwilling to remove his/her hearing aid from the left ear, or refuses to continue with otoscopy on the left ear, then LEFLAG is set to 1.

Programmer:

• IF ((HER_Q41 = 2 or OTM_N60 = 1 or OTM_N70 in (1, 3, 6 or RF) or OTM_N80 = 3) or (OTM_Q30 = RF and HER_Q53 = 2)), set LEFLAG = 1
• Otherwise, set LEFLAG = 2

OAE_C11

• If REFLAG = 1 and LEFLAG = 1, go to OAE_END.
• Otherwise, go to OAE_D12.

OAE_D12

• If REFLAG = 2, DT_RIGHTEARE = "Right ear ".
• Otherwise, DT_RIGHTEARE = "EMPTY".
• If LEFLAG = 2, DT_LEFTEARE = "Left ear".
• Otherwise, DT_LEFTEARE = "EMPTY".

OAE_D14

• If REFLAG = 2 and LEFLAG = 2, DT_OAESIDEE = "ears, one at a time".
• If REFLAG = 1 and LEFLAG = 2, DT_OAESIDEE = "left ear".
• If REFLAG = 2 and LEFLAG = 1, DT_OAESIDEE = "right ear".

OAE_Q15
This otoacoustic emissions test will measure how well your inner ear is working. I will place a probe in your [ears, one at a time/left ear/right ear]. You may hear a series of different pitched tones and faint sounds when I take the measurement.

During this test you will sit in the sound booth.

Instruction: Press <1> to continue.

• 1 Continue
• DK (Go to OAE_N47)
• RF (Go to OAE_END)

OAE_R16
First, I will need to enter some information into our computer system to prepare the test. This will only take a few minutes.

Instruction: Press <1> to continue.

OAE_N17

Instruction: Check the data to be sent to the OtoAccess software.

• Press <1> to transmit the data.
• 1 Transmit the data
• (DK, RF not allowed)

OAE_N18

Instruction: Open the OtoAccess software.

Follow the instructions on importing and retrieving respondent information.

• Press <1> to continue.
• 1 Continue
• (DK, RF not allowed)

OAE_Q30
I will now ask you to sit in the sound booth so that I can take the measurement.

Again, during the test I would like you to sit up straight, and remain as still as you can. This will only take a few minutes.

Do you have any questions before we start the test?

Instruction:

• Show the probe, ear tip and the sound booth to the respondent.
• Answer any questions as thoroughly as possible.
• Select the appropriate ear tip and slip it onto the nose cone of the probe.
• Insert the probe into the respondent's ear to obtain a seal that is flush with the ear canal.
• Press <1> to continue.
• 1 Continue
• (DK is not allowed)
• RF (Go to OAE_END)

OAE_N35

Instruction: Perform the measurement on the [Right ear/(and) Left ear].

Ensure that the sound meter readout is below 55 dB before and during the test.

• Press <1> to continue.
• 1 Continue
• (DK, RF not allowed)

OAE_N40

Instruction: Ensure the test results have been saved in the OtoAccess software and the respondent's .xml file has been transferred from the OtoAccess software to the clinic server.

• Press <1> to continue.
• 1 Continue
  (DK, RF not allowed)

OAE_C40

• If REFLAG = 2, go to OAE_N41.
• Otherwise, go to OAE_C45.

OAE_N41

Instruction: Was a successful test completed and saved for the right ear?

• 1 Yes
• 2 No
  (DK, RF not allowed)

OAE_C45

• If LEFLAG = 2, go to OAE_N45.
• Otherwise, go to OAE_N46.

OAE_N45

Instruction: Was a successful test completed and saved for the left ear?

• 1 Yes
• 2 No
• (DK, RF not allowed)

OAE_N46

Instruction: Record whether the maximum recommended sound level inside the booth (55 dB) was exceeded at any point during the test.

• 1 Yes
• 2 No
• (DK, RF not allowed)

OAE_C46

• If OAE_N41 = 2 or OAE _N45 = 2, go to OAE_N47.
• Otherwise, go to OAE_END.

OAE_N47

Instruction: Why was the component not fully completed?

• 01 Respondent unable to continue for health reasons
• 02 Respondent unable to understand technique / Health Measures Specialist unable to adapt coaching
• 03 Respondent refuses to continue
• 04 Equipment problem / technical difficulty
• 05 Respondent's mental condition
• 06 No time
• 20 Other - Specify (Go to OAE_S47)
• (DK, RF not allowed)

Go to OAE_END

OAE_S47
(Why was the component not fully completed?)

Instruction: Specify.

• (80 spaces)
• (DK, RF not allowed)

OAE_END

Audiometry Measurement (AUD)

AUD_BEG

External fields required:

Variables taken from sample file:

• STAND: name of the city/town/village in which the clinic has been set up
• CLINICID: 8 digit respondent identifier
• SITE: site number

Variables assigned in Variable Creation:

• CurrentYear: numeric year during which clinic visit is taking place
• CurrentMonth: numeric month during which clinic visit is taking place
• CurrentDay: numeric day during which clinic visit is taking place
• SessionE: English text of when the clinic visit is taking place

Variables from previously completed blocks:

• RespondentName: name of respondent
• RespondentLastName: Last name of the respondent
• RespondentFirstName: First name of the respondent
• GenderE: English text for sex of respondent
• CON_AGE: age of respondent
• HER_Q40: whether the respondent has an ear infection or pain in ears
• HER_Q41: whether the respondent has an acute infection/pain (in right,left or both ears)
• HER_Q52: whether the respondent has a hearing aid
• HER_Q53: whether the respondent has a hearing aid (in right,left or both ears)
• OTM_Q30: if the respondent refused removing his or her hearing aid(s)
• OTM_N31: whether the respondent has occluded right ear
• OTM_N40: record of the otoscopic examination of the right ear
• OTM_N50: record of the amount of pus/wax in the right ear
• OTM_N60: whether the respondent has occluded left ear
• OTM_N70: record of the otoscopic examination of the left ear
• OTM_N80: record of the amount of pus/wax in the left ear
• OTO.Outcome: Otoscopy outcome code
• OAE.Outcome: DPOAE outcome code

AUD_C10

• If CON_AGE < 6 or (OTO.Outcome = 79 or 80) or (OTM_Q30 = RF and HER_Q53 = 3), go to AUD_END.
• Otherwise, go to AUD_D10.

Content type - Note to data users:

• If the respondent is less than 6 years of age, or refuses to remove hearing aids from both ears, or if the component outcome code for the otoscopy measurement is set to not done (79) or refusal (80), then the audiometry test is not completed.

AUD_D10

Content type - Note to data users:

• If the respondent has acute pain or infection in the right ear, an occlusion in the right ear, has blood, a foreign object or another object/substance in the right ear along with a narrow/collapsible ear canal, has excessing or impacted wax in the right ear along with a narrow/collapsible ear canal, is unwilling to remove his/her hearing aid from the right ear, or refuses to continue with otoscopy on the right ear, then REFLAG is set to 1.

Programmer:

• IF HER_Q41 = 1 or OTM_N31 = 1 or [OTM_N40 in (1,3,6) and OTM_N40 = 5] or [OTM_N50 in (2,3) and OTM_N40 = 5] or [OTM_Q30 = RF and HER_Q53 = 1] , or OTM_N40 = RF, set REFLAG = 1
• Otherwise, set REFLAG = 2

AUD_D11

Content type - Note to data users:

• If the respondent has acute pain or infection in the left ear, an occlusion in the left ear, has blood, a foreign object or another object/substance in the left ear along with a narrow/collapsible ear canal, has excessing or impacted wax in the left ear along with a narrow/collapsible ear canal, is unwilling to remove his/her hearing aid from the left ear, or refuses to continue with otoscopy on the left ear, then LEFLAG is set to 1.

Programmer:

• IF HER_Q41 = 2 or OTM_N60 = 1 or [OTM_N70 in (1,3,6) and OTM_N70 = 5] or [OTM_N80 in (2,3) and OTM_N70 = 5] or [OTM_Q30 = RF and HER_Q53 = 2], or OTM_N70 = RF, set LEFLAG = 1
• Otherwise, set LEFLAG = 2AUD_C11 If REFLAG = 1 and LEFLAG = 1, go to AUD_END.
• Otherwise, go to AUD_D13A.

Content type - Note to data users:

• The type of earphones to be used for the audiometry test is derived at AUD_D13A, AUD_D13B, and AUD_D13C, based on the otoscopy observations from the right and left ear (responses to OTM_N40 and OTM_N70).

AUD_D13A

Programmer:

• IF REFLAG = 1 go to AUD_D13B ELSE
  • IF OTM_N40 in (1, 3, 6) or OTM_N50 in (2,3), THEN
    • set AUD_D13A = 3 (supra-aural headphones only)
  • ELSE IF OTM_N40 = 5 THEN
    • set AUD_D13A = 2 (insert earphones only)
  • ELSE
    • set AUD_D13A = 1 (insert or supra-aural)
  • ENDIF
• ENDIF

AUD_D13B

Programmer:

• IF LEFLAG = 1 go to AUD_D13C ELSE
  • IF OTM_N70 in (1, 3, 6) or OTM_N80 in (2,3), THEN
    • set AUD_D13B = 3 (supra-aural headphones only)
  • ELSE IF OTM_N70 = 5 THEN
    • set AUD_D13B = 2 (insert earphones only)
  • ELSE
    • set AUD_D13B = 1 (insert or supra-aural)
  • ENDIF
• ENDIF

AUD_D13C

Programmer:

• IF AUD_D13A = AUD_D13B THEN
  • AUDEFLAG = AUD_D13A
• ELSE IF AUD_D13A = EMPTY THEN
  • AUDEFLAG = AUD_D13B
• ELSE IF AUD_D13B = EMPTY THEN
  • AUDEFLAG = AUD_D13A
• ELSE IF AUD_D13A = 1 THEN
  • AUDEFLAG = AUD_D13B
• ELSE IF AUD_D13B = 1 THEN
  • AUDEFLAG = AUD_D13A
• ELSE IF AUD_D13A and AUD_D13B in (2, 3) THEN
  • AUDEFLAG = 3
• ENDIF

AUD_D13D

Programmer:

• IF (AUD_D13A = 2 and AUD_D13B = 3) THEN
  • reset REFLAG = 1
• ELSE IF (AUD_D13A = 3 and AUD_D13B = 2) THEN
  • reset LEFLAG = 1
• ENDIF
• ENDIF

AUD_D16

• If AUDEFLAG in (1,2) , DT_AUDTEXT1E = "earphones".
• Otherwise, DT_AUDTEXT1E = "headphones".
• If AUDEFLAG in (1,2) , DT_AUDTEXT2E = "in".
• Otherwise, DT_AUDTEXT2E = "over".
• If AUDEFLAG in (1,2) , DT_AUDTEXT3E = "insert earphones".
• Otherwise, DT_AUDTEXT3E = "supra-aural headphones".

AUD_Q18
This audiometry test will measure your hearing sensitivity. This test needs to be done in the sound booth.

Instruction: Press <1> to continue.

• 1 Continue
• DK (Go to AUD_N36)
• RF (Go to AUD_END)

AUD_D19

Programmer:

• IF AUD_Q18 = 1 and AUD_D19 = EMPTY,
  • Set AUD_D19 = Current Time (in HH :MM :SS format).
• ENDIF

AUD_Q20
For this test, I will place [earphones/headphones] [in/over] your ears and ask you to press a button every time you hear a sound.

Instruction: Press <1> to continue.

• Press <1> to continue.
• 1 Continue (Go to AUD_R22)
• (DK is not allowed)
• RF

AUD_C20

• If AUDEFLAG = 1, go to AUD_Q21.
• Otherwise, go to AUD_END.

AUD_Q21
If you are uncomfortable using insert earphones, we can use headphones instead. Would you then be willing to try this test?

• 1 Yes
• 2 No (Go to AUD_END)
• (DK, RF not allowed)

AUD_R22
First, I need to enter some information into our computer system in order to prepare the test. This will only take a few minutes.

Instruction: Press <1> to continue.

AUD_N22

Instruction: Check the data to be sent to the Audiometry software.

• Press <1> to transmit the data.
• 1 Transmit the data
• (DK, RF not allowed)

AUD_N23

Instruction: Open the Audiometry software (CCA-100).

• Follow the instructions on importing and retrieving respondent information.
• Press the "Examiner" button and choose your identification number.
• Press "Language" and choose a language for the instructions.
• 1 Continue
• (DK, RF not allowed)

AUD_R24
For the test, I will ask you to sit up straight holding the button in front of you. You will need to press the button whenever you hear a sound, no matter how faint. Press the button only once and release it quickly. The test will begin after a series of pre-recorded instructions and I will give you a "thumbs up" to let you know the test is about to start. Do you have any questions before we begin?

Instruction: Answer any questions as thoroughly as possible.

• Press <1> to continue.

AUD_D25A

• If AUDEFLAG in (1,2) and AUD_Q20 is not RF, DT_AUDTEXT4E = "earphones in".
• Otherwise, DT_AUDTEXT4E = "headphones over".
• If AUDEFLAG in (1,2) and AUD_Q20 is not RF, DT_AUDTEXT5E = "earphones".
• Otherwise, DT_AUDTEXT5E = "headphones".

AUD_D25B

• If AUDEFLAG = 3 , DT_AUDTEXT25AE = "Only supra-aural headphones can be used for this test.".
• If AUDEFLAG = 2 , DT_AUDTEXT25AE = "Only insert earphones can be used for this test.".
• Otherwise, DT_AUDTEXT25AE = "Either insert earphones or supra-aural headphones can be used for this test.".

AUD_Q25
I am now going to place the [earphones in/headphones over] your ears.

When the test is over I will help you remove them to make sure the equipment is not damaged.Remember to stay as still as possible throughout the test, since noise or movement can interfere with the test.

Instruction:

• Show the [earphones/headphones] and the response button to the respondent.
• Ensure any glasses, hair ties or ornaments, hats or chewing gum that may interfere with the examination have been removed.
• ^DT_AUDTEXT25AE
• Complete the audiometry test on the:
  • [right ear/EMPTY]
  • [left ear/EMPTY]
• Ensure that the correct cords are plugged into the audiometer before starting the test.

• Press <1> to continue.
• 1 Continue
• (DK is not allowed)
• RF (Go to AUD_END)

AUD_D25C

• If REFLAG = 2, DT_RIGHTEARE = "right ear".
• Otherwise, DT_RIGHTEARE = "EMPTY".
• If LEFLAG = 2, DT_LEFTEARE = "left ear".
• Otherwise, DT_LEFTEARE = "EMPTY".

AUD_C26

• If AUDEFLAG = 3 or if (AUD_Q20 = RF and AUD_Q21 = 1), go to AUD_N27.
• Otherwise, go to AUD_N26.

AUD_N26

Instruction: Confirm that insert earphones will be used for the test.

• 1 Yes (Go to AUD_D28)
• 2 No
• (DK, RF not allowed)

AUD_C27

• If AUDEFLAG = 2, go to AUD_N36.
• Otherwise, go to AUD_N27.

AUD_N27

Instruction: Confirm that supra-aural headphones will be used for the test.

• 1 Yes
• 2 No (Go to AUD_N36)
• (DK, RF not allowed)

AUD_D28

• If AUD_N26=1 , DT_AUDTEXT29E = "green curve".
• If AUD_N27=1 , DT_AUDTEXT29E = "red curve".

AUD_N29

Instruction:

• Perform the test on the [right ear/EMPTY] and [left ear/EMPTY].
• Give a ''thumbs-up'' to the respondent when test is ready to start.
• Play the instructions for the audiometry test.
• Ensure that the sound meter readout is below the [green curve/red curve] before and during the test.

• 1 Continue
• (DK is not allowed)
• RF (Go to AUD_END)

AUD_N30

Instruction: Ensure the test results have been saved in the CCA-100 software and the respondent's .asc file has been transferred from the software to the clinic server.

• Press <1> to continue.
• 1 Continue
• (DK, RF not allowed)

AUD_C30

• If REFLAG = 2 , go to AUD_N31.
• Otherwise, go to AUD_C32.

AUD_N31

Instruction: Record if the test was performed on the right ear.

• 1 Yes
• 2 No
• (DK, RF not allowed)

AUD_C32

• If LEFLAG = 2, go to AUD_N32.
• Otherwise, go to AUD_C33.

AUD_N32

Instruction: Record if the test was performed on the left ear.

• 1 Yes
• 2 No
• (DK, RF not allowed)

AUD_C33

• If AUD_N31 = 1 or AUD_N32 = 1, go to AUD_N33.
• Otherwise, go to AUD_N36.

AUD_N33

Instruction: Rate the test reliability.

1. 3 error codes or more
2. 1-2 error codes
3. No error codes
   (DK, RF not allowed)

AUD_N34

Instruction: Record how the test was administered.

1. Automatic Mode
2. Manual Mode
3. Both
   (DK, RF not allowed)

AUD_N35

Instruction: Record whether the sound level meter exceeded the peak noise threshold ([green curve/red curve]) during the test.

• 1 Yes
• 2 No
  (DK, RF not allowed)

AUD_C36

• If (AUD_N31 = 1 or EMPTY) and (AUD_N32 = 1 or EMPTY), go to AUD_END.
• Otherwise, go to AUD_N36.

AUD_N36

Instruction: Why was the component not fully completed?

• 01 Respondent unable to continue for health reasons
• 02 Respondent unable to understand technique / Health Measures Specialist unable to adapt coaching
• 03 Respondent refuses to continue
• 04 Equipment problem / technical difficulty
• 05 Respondent's mental condition
• 06 No time
• 20 Other - Specify (Go to AUD_S36)
• (DK, RF not allowed)

Go to AUD_END

AUD_S36
(Why was the component not fully completed?)

Instruction: Specify.

• (80 spaces)
• (DK, RF not allowed)

AUD_END

Grip Strength Component

Grip Strength Component Introduction (GSI)

GSI_BEG

External variables required:

Variables taken from sample file:

• STAND: name of the city/town/village in which the clinic has been set up
• CLINICID: 8 digit respondent identifier

Variables assigned in Variable Creation:

• CurrentYear: numeric year during which clinic visit is taking place
• CurrentMonth: numeric month during which clinic visit is taking place
• CurrentDay: numeric day during which clinic visit is taking place
• SessionE: English text of when the clinic visit is taking place

Variables from previously completed blocks:

• RespondentName: name of respondent
• GenderE: English text for sex of respondent
• CON_AGE: age of respondent
• SCS_N12: visit type (3= clinic visit; 4= home visit)

GSI_R1
Next I am going to measure your upper body strength with a hand grip dynamometer. You will perform this test twice on each hand, alternating each time. When performing the test, hold your hand away from your body and squeeze the handle as hard as you can, blowing out while you squeeze.

Instruction: Demonstrate the procedure while explaining the technique.

• Press <1> to continue.

Programmer:

• Allow ‘DK’ as a response category.

GSI_C1

• If GSI_R1 = DK, go to GSI_END.
• Otherwise, go to GSI_D1.

GSI_D1

Programmer:

• IF SCS_N12 = 4 THEN
  • GSI_D1 = EMPTY
• ELSE
• IF GSI_R1 = 1 and GSI_D1 = EMPTY,
  • Set GSI_D1 = Current Time (in HH:MM:SS format)
• ENDIF

GSI_R2
Hold the handle so that the 2nd joint of your fingers fits comfortably under the handle; we can adjust the size if necessary. Remember, hold your arm straight and away from your body and squeeze the handle as hard as you can, blowing out while you squeeze.

Instruction: Ensure respondent has removed all rings or hand jewellery.

• Press <1> to continue.

GSI_END

Grip Strength Measurement (GSM)

GSM_BEG

External variables required:

Variables taken from sample file:

• STAND: name of the city/town/village in which the clinic has been set up
• CLINICID: 8 digit respondent identifier

Variables assigned in Variable Creation:

• CurrentYear: numeric year during which clinic visit is taking place
• CurrentMonth: numeric month during which clinic visit is taking place
• CurrentDay: numeric day during which clinic visit is taking place
• SessionE: English text of when the clinic visit is taking place

Variables from previously completed blocks:

• RespondentName: name of respondent
• GenderE: English text for sex of respondent
• CON_AGE: age of respondent
• GSI_R1: grip strength introduction

GSM_C10

• If GSI_R1 = DK, go to GSM_N60.
• Otherwise, go to GSM_N11A.

GSM_N11A

Instruction: Record the first grip strength measurement for the right hand to the nearest kilogram (kg).

• Right hand grip strength (in kg)
• (MIN: 1)
• (MAX: 100)
• DK, RF

GSM_N11B

Instruction: Re-enter the first grip strength measurement for the right hand to the nearest kilogram (kg).

• Right hand grip strength (in kg)
• (MIN: 1)
• (MAX: 100)
• DK, RF

GSM_C11B

• If GSM_N11A = RF, go to GSM_END.
• Otherwise, go to GSM_N12A.

GSM_N12A

Instruction: Record the first grip strength measurement for the left hand to the nearest kilogram (kg).

• Left hand grip strength (in kg)
• (MIN: 1)
• (MAX: 100)
• DK, RF

GSM_N12B

Instruction: Re-enter the first grip strength measurement for the left hand to the nearest kilogram (kg).

• Left hand grip strength (in kg)
• (MIN: 1)
• (MAX: 100)
• DK, RF

GSM_N21A

Instruction: Record the second grip strength measurement for the right hand to the nearest kilogram (kg).

• Right hand grip strength (in kg)
• (MIN: 1)
• (MAX: 100)
• DK, RF

GSM_N21B

Instruction: Re-enter the second grip strength measurement for the right hand to the nearest kilogram (kg).

• Right hand grip strength (in kg)
• (MIN: 1)
• (MAX: 100)
• DK, RF

GSM_N22A

Instruction: Record the second grip strength measurement for the left hand to the nearest kilogram (kg).

• Left hand grip strength (in kg)
• (MIN: 1)
• (MAX: 100)
• DK, RF

GSM_N22B

Instruction: Re-enter the second grip strength measurement for the left hand to the nearest kilogram (kg).

• Left hand grip strength (in kg)
• (MIN: 1)
• (MAX: 100)
• DK, RF

GSM_D51

Programmer:

• Calculate the total hand grip strength.

GSM_D52

Programmer:

• Calculate the grip strength norms for respondents 15 - 69.

GSM_D53

Programmer:

• Calculate the grip strength norms for respondents less than 15.

GSM_C59

• If (GSM_N11A = NONRESPONSE and GSM_N21A = NONRESPONSE) or (GSM_N12A = NONRESPONSE and GSM_N22A = NONRESPONSE), go to GSM_N60.
• Otherwise, go to GSM_END.

GSM_N60

Instruction: Why was the component not fully completed?

• 01 Respondent unable to continue for health reasons
• 02 Respondent unable to understand technique / Health Measures Specialist unable to adapt coaching
• 03 Respondent refuses to continue
• 04 Equipment problem / technical difficulty
• 05 Respondent’s mental condition
• 06 No time
• 20 Other - Specify (Go to GSM_S60)
• (DK, RF not allowed)

Go to GSM_END

GSM_S60
(Why was the component not fully completed?)

Instruction: Specify.

• (80 spaces)
• (DK, RF not allowed)

GSM_END

Phlebotomy Component

Phlebotomy Component Introduction (PHI)

PHI_BEG

External variables required:

Variables taken from sample file:

• STAND: name of the city/town/village in which the clinic has been set up
• CLINICID: 8 digit respondent identifier
• SELFAST: whether selected to fast for 12 hours (1=fasting, 2=non-fasting)

Variables assigned in Variable Creation:

• CurrentYear: numeric year during which clinic visit is taking place
• CurrentMonth: numeric month during which clinic visit is taking place
• CurrentDay: numeric day during which clinic visit is taking place
• SessionE: English text of when the clinic visit is taking place

Variables from previously completed blocks:

• RespondentName: name of respondent
• GenderE: English text for sex of respondent
• CON_AGE: age of respondent
• ATG_Q11: time when the respondent last ate/drank
• ATG_N11: date when the respondent last ate/drank
• DT_ATGN11E: English text for reported fasting date
• ATG_D12: whether the respondent has fasted for at least 10 hours
• SCS_N12 : visit type (3= clinic visit; 4= home visit)

PHI_R10
Hi, my name is.... Please have a seat on the chair because I need to ask you a few questions before we begin.

Instruction: Press <1> to continue.

Programmer:

• Allow ‘DK’ as a response category
• If PHI_R10 = DK, go to PHI_END.
• Otherwise, go to PHI_D10.

PHI_D10

Programmer:

• IF SCS_N12 = 4 THEN
  • PHI_D10 = EMPTY
• ELSE
• IF PHI_R10 = 1 and PHI_D10 = EMPTY,
  • Set PHI_D10 = Current Time (in HH:MM:SS format)
• ENDIF

PHI_Q11
I need to confirm your fasting status. When did you last eat or drink anything other than water (e.g., coffee, tea, alcohol, juice or flavoured water)?

The respondent reported last eating or drinking at ^ATG_Q11 ^DT_ATGN11E.

Instruction: Probe to determine the date and time at which the respondent last ate or drank something that does not meet the phlebotomy fasting requirements.

Record whether the fasting time and date recorded during the screening component are correct.

• 1 Yes (Go to PHI_D12)
• 2 No
• (DK, RF not allowed)

Help text: The respondent is still considered fasted if the following have been consumed within the indicated time-frame:

• Black coffee - up until the time of the appointment
• Coffee with milk/cream - up to 2 hours prior to the appointment
• Juice - up to 2 hours prior to the appointment
• Gum and candy are allowed - up until the time of the appointment

The respondent is not considered fasted if the following have been consumed within the past 10 hours.

• Liquids other than those indicated above, including
  • Milkshakes
  • Protein shakes
  • Meal replacements
  • Milk
  • Energy drinks
  • Any other beverages or supplements
• Any food

PHI_N11

Instruction: Enter the time (followed by "AM" or "PM") at which the respondent last ate or drank something that does not meet the phlebotomy fasting requirements.

• (MIN: 1)
• (MAX: 13)
• (DK, RF not allowed)

PHI_N12A

Instruction: Confirm the date.

• 1 Yesterday
• 2 Today
• (DK, RF not allowed)

PHI_C12

• If SCS_N12 = 3, go to PHI_D12.
• Otherwise, go to PHI_N12B.

PHI_N12B

Instruction: Enter the time (followed by "AM" or "PM") the fasting question (PHI_N11) was asked to the respondent.

• (MIN: 1)
• (MAX: 13)
• (DK, RF not allowed)

PHI_D12

Content type - Note to data users:

• Fasting status (10 hr) is confirmed based on the fasting flag (SELFAST) and the responses to PHI_Q11 and PHI_N11 (if clinic visit) along with PHI_N12B (if home visit). PHI_D12 = 1 (fasted) and PHI_D12 = 2 (not fasted).

Programmer:

• IF SCS_N12 = 3 THEN
  • IF SELFAST = 2 THEN
    • PHI_D12 = 2
  • ELSE IF (PHI_Q11 = 1 and ATG_D12 = 1) OR (PHI_Q11 = 1 and ATG_N11 = 1 and the difference between CurrentDate-1/ATG_Q11 and CurrentDate/CurrentTime is 10 hours or more) OR(PHI_Q11 = 1 and ATG_N11 = 2 and the difference between CurrentDate/ATG_Q11 and CurrentDate/CurrentTime is 10 hours or more) OR(PHI_Q11 = 2 and PHI_N12A = 1 and the difference between CurrentDate-1/PHI_N11 and CurrentDate/CurrentTime is 10 hours or more) OR(PHI_Q11 = 2 and PHI_N12A = 2 and the difference between CurrentDate/PHI_N11 and CurrentDate/CurrentTime is 10 hours or more) THEN
    • PHI_D12 = 1
  • ELSE
    • PHI_D12 = 2
  • ENDIF
• ELSE IF SCS_N12 = 4 THEN
  • IF SELFAST = 2 THEN
    • PHI_D12 = 2
  • ELSE IF (PHI_Q11 = 1 and ATG_D12 = 1) OR (PHI_Q11 = 1 and ATG_N11 = 1 and the difference between CurrentDate-1/ATG_Q11 and CurrentDate/PHI_N12B is 10 hours or more) OR(PHI_Q11 = 1 and ATG_N11 = 2 and the difference between CurrentDate/ATG_Q11 and CurrentDate/PHI_N12B is 10 hours or more) OR(PHI_Q11 = 2 and PHI_N12A = 1 and the difference between CurrentDate-1/PHI_N11 and CurrentDate/PHI_N12B is 10 hours or more) OR(PHI_Q11 = 2 and PHI_N12A = 2 and the difference between CurrentDate/PHI_N11 and CurrentDate/PHI_N12B is 10 hours or more) THEN
    • PHI_D12 = 1
  • ELSE
    • PHI_D12 = 2
  • ENDIF
• ENDIF

PHI_D13

• If ATG_D12 = 1 or PHI_D12 = 1, DT_ATGFASTE = "fasted".
• Otherwise, DT_ATGFASTE = "non-fasted".

PHI_END

Blood Collection (BDC)

BDC_BEG

External variables required:

Variables taken from sample file:

• STAND: name of the city/town/village in which the clinic has been set up
• CLINICID: 8 digit respondent identifier
•  

Variables assigned in Variable Creation:

• DryRun: whether the case is a dry run case
• CurrentYear: numeric year during which clinic visit is taking place
• CurrentMonth: numeric month during which clinic visit is taking place
• CurrentDay: numeric day during which clinic visit is taking place
• SessionE: English text of when the clinic visit is taking place

Variables from previously completed blocks:

• RespondentName: name of respondent
• CON_AGE: age of respondent
• CON_SEX: sex of respondent
• GenderE: English text for sex of respondent
• CON_N24 : whether the respondent's parent or guardian provided consent for blood and urine storage
• CON_N25 : whether the respondent provided consent for blood and urine storage
• CON_N26: whether the respondent provided consent for DNA storage
• BVOCFLG: Blood  VOC subsampling flag
• OMEGFLG: Fatty acids subsampling flag
• PHC_Q56: whether the respondent felt dizzy or fainted previously during a blood draw
• PHI_D12: whether respondent has fasted for at least 10 hours (1 = fasted; 2 = non-fasted)
• PHI_R10: introduction to the phlebotomy component
• PHC_Q57B: indicator of which side the respondent has had a mastectomy (1=right, 2=left, 3=both)

BDC_C9

• If PHI_R10 = DK, go to BDC_N44.
• Otherwise, go to BDC_C10.

BDC_C10

• If PHC_Q56 = 1, go to BDC_N10.
• Otherwise, go to BDC_Q21.

BDC_D10

• If PHC_N57B=1, DT_ARME = "the left arm".
• If PHC_N57B=2, DT_ARME = "the right arm".
• Otherwise, DT_ARME = "either the left or the right arm ".

Programmer:

• If PHC_N57B= 1 or 2 use red font for ^DT_ARME.

BDC_N10

Instruction: During the screening component, the respondent has stated they have felt dizzy or fainted previously during a blood draw. Probe and take the appropriate precautions.

• Press <1> to continue.
• 1 Continue
  (DK, RF not allowed)

BDC_Q21
I am going to do the blood draw.

Instruction: Explain the procedure to the respondent. Perform the blood draw on [the left arm/the right arm/either the left or the right arm].

•  
• 1 Continue
• (DK is not allowed)
• RF (Go to BDC_END)

BDC_D21

Content type - Note to data users:

• Tubes for blood collection are determined by the age of the respondent and whether he/she consented to blood and/or DNA storage.

BDC_N24

Instruction: Record which of the required tubes of blood were collected. Include only the collected tubes that apply.

Mark all that apply.

• 51 None of the required tubes (Go to BDC_N44)
• (DK is not allowed)
• RF (Go to BDC_END)

Content type - Note to data users:

• A dynamic list of blood collection tubes appears at this question based on the age of the respondent and whether he/she consented to blood and/or DNA storage.

BDC_N41

Instruction:

• Press <1> to print the blood collection tube labels.
• 1 Print the labels
• (DK, RF not allowed)

BDC_N42

Instruction: In the presence of the respondent, stick each label on the appropriate blood collection tube.

• Press <1> to continue.
• 1 Continue
• (DK, RF not allowed)

BDC_N43

Instruction: Record whether the respondent was seated or supine during the blood draw.

• 1 Seated
• 2 Supine
  (DK, RF not allowed)

BDC_C44

• If all of the required main tubes or sub tubes were collected, go to BDC_N51.
• Otherwise, go to BDC_N44.

BDC_N44

Instruction: Record the reason why all required tubes were not collected.

• 01 Respondent refused
• 02 Respondent fainted
• 03 Unable to find vein
• 04 Blood flow stopped
• 05 Physical limitation
• 06 Other - Specify (Go to BDC_S44)
• 07 No time
• 08 Respondent unable to continue for health reasons
• (DK, RF not allowed)

Go to BDC_C51

BDC_S44

(Record the reason why all required tubes were not collected.)

Instruction: Specify.

• (80 spaces)
• (DK, RF not allowed)

BDC_C51

• If PHI_R10 = DK, go to BDC_END.
• Otherwise, go to BDC_N51.

BDC_N51

Instruction: Record whether another staff member assisted with the blood draw.

• 1 Yes
• 2 No (Go to BDC_END)
• (DK, RF not allowed)

BDC_N52

Instruction: Record the HMSID of the staff member that assisted with the blood draw.

• (MIN: 1000)
• (MAX: 9995)
• (DK, RF not allowed)

BDC_END

Urine Collection 2 Component (UC2)

Overview: The Urine Collection 2 component is only administered if the respondent did not provide a sufficient volume of urine in the Urine Collection 1 component.

UC2_BEG

External variables required:

Variables taken from sample file:

• STAND: name of the city/town/village in which the clinic has been set up
• CLINICID: 8 digit respondent identifier

Variables assigned in Variable Creation:

• CurrentYear: numeric year during which clinic visit is taking place
• CurrentMonth: numeric month during which clinic visit is taking place
• CurrentDay: numeric day during which clinic visit is taking place
• SessionE: English text of when the clinic visit is taking place

Variables from previously completed blocks:

• RespondentName: name of respondent
• GenderE: English text for sex of respondent
• CON_AGE: age of respondent
• SCS_N12: visit type (3= clinic visit; 4= home visit)

UC2_N10

Instruction: Record whether the respondent provided a second urine sample.

• 1 Yes
• 2 No
• (DK, RF not allowed)

UC2_D10

Programmer:

• IF SCS_N12 = 4 THEN
  • UC2_D10 = EMPTY
• ELSE
• IF UC2_N10 = RESPONSE and UC2_D10 = EMPTY,
  • Set UC2_D10 = Current Time (in HH:MM:SS format)
• ENDIF

UC2_C10

• If UC2_N10 = 1, go to UC2_END.
• Otherwise, go to UC2_N30.

UC2_N30

Instruction: Record the reason why the respondent did not provide a urine sample.

1. Refusal
2. Unable to provide
3. Other - Specify (Go to UC2_S30)
   (DK, RF not allowed)

Go to UC2_END

UC2_S30

(Record the reason why the respondent did not provide a urine sample.)

Instruction: Specify the reason.

• (80 spaces)
• (DK, RF not allowed)

UC2_END

Report of Measurements Component (RM)

RM_BEG

External variables required:

Variables assigned in Variable Creation:

• CurrentYear: numeric year during which clinic visit is taking place
• CurrentMonth: numeric month during which clinic visit is taking place
• CurrentDay: numeric day during which clinic visit is taking place

Variables from previously completed blocks:

• RespondentName: name of respondent
• GenderE: English text for sex of respondent
• CON_AGE: age of respondent
• LNG_N11: respondent's preferred official language
• BPM_411A: blood pressure norms for respondents aged 18 or older
• BPM_412A: blood pressure norms for respondents aged less than 18
• OTM_N31: whether the right ear canal is obstructed
• OTM_N40: record of the otoscopic examination of the right ear
• OTM_N50: record of the amount pus/wax in the right ear
• OTM_N60: whether the left ear canal is obstructed
• OTM_N70: record of the otoscopic examination of the left ear
• OTM_N80: record of the amount pus/wax in the left ear
• SCS_N12: visit type (3= clinic visit; 4= home visit)
• BPM_D317: respondent's average systolic blood pressure
• BPM_D318: respondent's average diastolic blood pressure
• BPM_D319: respondent's average resting hearth rate
• HWM_Q11: standing height measurement in centimetres
• HWM_D11: standing height in inches
• HWM_Q12: sitting height measurement in centimetres
• HWM_D12: sitting height in inches
• HWM_Q13: weight measurement in kilograms
• HWM_D13: weight measurement in pounds
• HWM_Q14: waist circumference measurement in centimetres
• HWM_D14: waist circumference measurement in inches
• HWM_Q15: hip circumference measurement in centimetres
• HWM_D15: hip circumference measurement in inches
• HWM_D21 calculated body mass index
• HWM_D22: body mass index norms for respondents 18 or older
• HWM_D23: body mass index norms for respondents less than 18
• HWM_D25: waist to hip ratio
• PHC_Q11: whether the respondent is currently pregnant
• GSM_D51: total hang grip strength
• GSM_D52: calculated hand grip strength norms for respondents 15-69
• GSM_D53: calculated hand grip strength norms for respondents less than 15

RM_N90

Instruction: Press <1> to print the Report of Physical Measurements.

• 1 Print the report
• (DK, RF not allowed)

RM_D90

Programmer:

• IF SCS_N12 = 4 THEN
  • RM_D90 = EMPTY
• ELSE
• IF RM_N90 = 1 and RM_D90 = EMPTY,
  • Set RM_D90 = Current Time (in HH:MM:SS format)
• ENDIF

RM_END

Exit Component

Exit Component Introduction (ECI)

ECI_BEG

External variables required:

Variables taken from sample file:

• STAND: name of the city/town/village in which the clinic has been set up
• CLINICID: 8 digit respondent identifier

Variables assigned in Variable Creation:

• CurrentYear: numeric year during which clinic visit is taking place
• CurrentMonth: numeric month during which clinic visit is taking place
• CurrentDay: numeric day during which clinic visit is taking place
• SessionE: English text of when the clinic visit is taking place

Variables from previously completed blocks:

• RespondentName: name of respondent
• GenderE: English text for sex of respondent
• CON_AGE: age of respondent
• SCS_N12: visit type (3= clinic visit; 4= home visit)

ECI_Q01
Before you leave, we have a few administrative questions.

Instruction:

• Press <1> to continue.
• (DK, RF not allowed)

ECI_D01B

Programmer:

• IF SCS_N12 = 4 THEN
  • ECI_D01 = EMPTY
• ELSE
• IF ECI_Q01 = 1 and ECI_D01 = EMPTY,
  • Set ECI_D01 = Current Time (in HH:MM:SS format)
• ENDIF

ECI_END

Exit Consent Questions (ECQ)

ECQ_BEG

External variables required:

Variables taken from sample file:

• STAND: name of the city/town/village in which the clinic has been set up
• CLINICID: 8 digit respondent identifier
• CPROV: province of residencesst
• LNKFLG: flag indicating whether consent to link will be asked or whether a linkage text will be read (1 = linkage question; 2 = linkage statement)

Variables assigned in Variable Creation:

• CurrentYear: numeric year during which clinic visit is taking place
• CurrentMonth numeric month during which clinic visit is taking place
• CurrentDay: numeric day during which clinic visit is taking place
• SessionE: English text of when the clinic visit is taking place

Variables from previously completed blocks:

• RespondentName: name of respondent
• RespondentFirstName: first name of respondent
• GenderE: English text for sex of respondent
• CON_AGE: age of respondent
• DryRun: whether the case is a dry run case (1or 2= dryrun; 3= survey respondent)
• CON_SEX: sex of the respondent

ECQ_C11

• If DryRun in (1, 2)., go to ECQ_END.
• Otherwise, go to ECQ_D11A.

ECQ_D11A

• If CPROV = 10, DT_PROVINCEE = "Newfoundland and Labrador".
• If CPROV = 11, DT_PROVINCEE = "Prince Edward Island".
• If CPROV = 12, DT_PROVINCEE = "Nova Scotia".
• If CPROV = 13, DT_PROVINCEE = "New Brunswick".
• If CPROV = 24, DT_PROVINCEE = "Quebec".
• If CPROV = 35, DT_PROVINCEE = "Ontario".
• If CPROV = 46, DT_PROVINCEE = "Manitoba".
• If CPROV = 47, DT_PROVINCEE = "Saskatchewan".
• If CPROV = 48, DT_PROVINCEE = "Alberta".
• If CPROV = 59, DT_PROVINCEE = "British Columbia".
• If CPROV = 60, DT_PROVINCEE = "Yukon".
• If CPROV = 61, DT_PROVINCEE = "Northwest Territories".
• If CPROV = 62, DT_PROVINCEE = "Nunavut".

ECQ_D11B

• If CPROV < 60, DT_PROVTERR1 = "provincial".
• If CPROV < 60, DT_PROVTERRE = "province".
• Otherwise, DT_PROVTERR1 = "territorial".
• Otherwise, DT_PROVTERRE = "territory".

ECQ_D11C

• If CON_AGE > 13, DT_ECQ12E = "you".
• Otherwise, DT_ECQ12E = "^RespondentFirstName".

ECQ_D11D

• If CON_AGE > 13, DT_ECQ22E = "your".
• Otherwise, DT_ECQ22E = "^RespondentFirstName's".

ECQ_D11E

• If CON_AGE > 13, DT_ECQ14E = "Do you".
• Otherwise, DT_ECQ14E = "Does ^RespondentFirstName".

ECQ_D11F

• Not Applicable

ECQ_D11G

• If CON_AGE > 13, DT_ECQ16E = "your".
• Otherwise, if CON_SEX = 1, DT_ECQ16E = "his".
• Otherwise, if CON_SEX = 2, DT_ECQ16E = "her".

ECQ_Q12A
Statistics Canada may combine information about [you/RespondentFirstName] collected during this survey with information from other surveys or from administrative data sources.
The results will be used for statistical purposes only.
Do we have your permission to combine this information?

1. Yes (Go to ECQ_Q14)
2. No (Go to ECQ_D21)
   DK, RF (Go to ECQ_D21)

Help text:

• CHMS data could be combined with the respondent's information from:
  • the Provincial Ministry of Health;
  • health registries or other recognized health organizations.
• This would include information on the respondent's past and continuing use of:
  • services provided at hospitals, clinics and doctor's offices;
  • other health services provided by the province.

ECQ_Q14
Having a ^DT_PROVTERR1 health number will assist Statistics Canada in linking the survey data to the ^DT_PROVTERR1 health information.^DT_ECQ14E have a(n) ^DT_PROVINCEE health number?

• 1 Yes (Go to ECQ_Q16)
• 2 No
  DK, RF (Go to ECQ_D21)

ECQ_Q15
For which [province/territory] is [your/RespondentFirstName's] health number?

• 10 Newfoundland and Labrador
• 11 Prince Edward Island
• 12 Nova Scotia
• 13 New Brunswick
• 24 Quebec
• 35 Ontario
• 46 Manitoba
• 47 Saskatchewan
• 48 Alberta
• 59 British Columbia
• 60 Yukon
• 61 Northwest Territories
• 62 Nunavut
• 88 Does not have a [provincial/territorial] health number (Go to ECQ_D21)
  DK, RF (Go to ECQ_R21)

ECQ_Q16
What is [your/his/her] health number?

Instruction: Enter the respondent’s health number. Do not insert blanks, hyphens or commas between the numbers.

• (12 spaces)
• DK, RF (Go to ECQ_D21)

ECQ_N16

Instruction: Re-enter the health number.

• (12 spaces)
• DK, RF

ECQ_D21

• If ECQ_Q16 = RESPONSE and CON_AGE > 13, DT_ECQ21TEXTE = "Your name, address, telephone number and health number".
• Else if ECQ_Q16 <> RESPONSE and CON_AGE > 13, DT_ECQ21TEXTE = "Your name, address and telephone number".
• Else if ECQ_Q16 = RESPONSE and CON_AGE < 14, DT_ECQ21TEXTE = "^RespondentFirstName's name, address, telephone number and health number".
• Else if ECQ_Q16 <> RESPONSE and CON_AGE < 14, DT_ECQ21TEXTE = "^RespondentFirstName's name, address and telephone number".

ECQ_R21
To avoid duplication of surveys, Statistics Canada has signed agreements with Health Canada and the Public Health Agency of Canada to share the information collected during this survey. ^DT_ECQ21TEXTE will not be shared.

Instruction: Press <1> to continue.

ECQ_Q22
They have agreed to keep the information confidential and use it only for statistical purposes.
Do you agree to share [your/RespondentFirstName's] information with Health Canada and the Public Health Agency of Canada?

• 1 Yes
• 2 No
  DK, RF

ECQ_END

Contact (CONT)

CONT_BEG

External fields required:

Variables taken from sample file:

• STAND: name of the city/town/village in which the clinic has been set up
• CLINICID: 8 digit respondent identifier
• FLAGReconsent: 1 = reconsent question asked 2 = reconsent question not asked

Variables assigned in Variable Creation:

• CurrentYear: numeric year during which clinic visit is taking place
• CurrentMonth: numeric month during which clinic visit is taking place
• CurrentDay: numeric day during which clinic visit is taking place
• DryRun: indicator of whether the case is a dry run case
• SessionE: English text of when the clinic visit is taking place

Variables from previously completed blocks:

• RespondentName: first and last name of respondent
• GenderE: English text for sex of respondent
• CON_AGE: age of respondent
• CON_SEX: sex of respondent
•  

CONT_C01

• If DryRun in (1, 2), go to CONT_END.
• Otherwise, go to CONT_Q01.

CONT_Q01
We may want to contact your household in a number of years to ask about your participation in a follow-up to this survey. Do we have your permission to contact you?

• 1 Yes
• 2 No
  (DK is not allowed)
  RF

CONT_C03B

• If CONT_Q01 = 2 or RF, go to CONT_END.
• Otherwise, go to CONT_Q03.

Content type - Note to data users:

• If the respondent does not consent for Statistics Canada to contact their home to participate in a follow up to the CHMS (CONT_Q01=2 or RF), go to CONT_END.

CONT_Q03
In case you move or change telephone numbers, it would be helpful if you could provide the name, telephone number and address of a relative or friend who could help us to contact you.

Instruction: Press <1> to continue.

• 1 Continue
• (DK is not allowed)
• RF

CONT_C04

• If CONT_Q03 = RF, go to CONT_END.
• Otherwise, go to CONT_B05.

CONT_B05

• Call the Get Contact Name (GCN) block. See Appendix I.

Programmer:

• Pass the following parameters:
• DV_QTEXT_E = "I want to emphasize that we will contact this person only if we experience difficulty reaching you."

CONT_C05

• If CONT_B05.GCN_Q02 = 1, go to CONT_END.
• Otherwise, go to CONT_D05.

CONT_D05

Programmer:

• IF CONT_B05.GCN_FNAME = DK or RF AND CONT_B05.GCN_LNAME = DK or RF THEN
  • CONT1_NAMEE = "the person"
• ELSE IF CONT_B05.GCN_FNAME = DK or RF THEN
  • CONT1_NAMEE = CONT_B05.GCN_LNAME
• ELSE IF CONT_B05.GCN_LNAME = DK or RF THEN
  • CONT1_NAMEE = CONT_B05.GCN_FNAME
• ELSE
  • CONT1_NAMEE = CONT_B05.GCN_FNAME + CONT_B05.GCN_LNAME
• ENDIF

CONT_B06

• Call the Address block. See Appendix I.

Programmer:

• Pass the following parameters:
• DV_QTEXT_E = “What is the address for ^CONT1_NAMEE?”
• LISTINGADFLAG = 2 (No)
• NONCANADFLAG = 1 (Yes)

CONT_C07

• If CONT_B06.Province = 77 "Outside of Canada and U.S.A.", go to CONT_B08.
• Otherwise, go to CONT_B07.

CONT_B07

• Call the North American Telephone block (NATP). See Appendix I.
• Go to CONT_B09

Programmer:

• Pass the following parameters:
• DV_QTEXT_E = "What is the telephone number for ^CONT1_NAMEE, including the area code?"
• ASKEXT = 2 (No).

CONT_B08

• Call the Overseas Telephone block (OSTP). See Appendix I.

Programmer:

• Pass the following parameters:
• DV_QTEXT_E = "What is the telephone number for ^CONT1_NAMEE, including the area code?"

CONT_B09

• Call the Get Contact Name block (GCN). See Appendix I.

Programmer:

• Pass the following parameters:
• DV_QTEXT_E = "Is there someone else we could call to help us contact you? Again, we will contact this person only if we experience difficulty reaching you and then only to obtain the new address and telephone number."

CONT_C09

• If CONT_B09.GCN_Q02 = 1, go to CONT_END.
• Otherwise, go to CONT_D09.

CONT_D09

Programmer:

• IF CONT_B09.GCN_Q02 = DK or RF AND CONT_B09.GCN_LNAME = DK or RF THEN
  • CONT2_NAMEE = "the person"
• ELSE IF CONT_B09.GCN_FNAME = DK or RF THEN
  • CONT2_NAMEE = CONT_B09.GCN_LNAME
• ELSE IF CONT_B09.GCN_LNAME = DK or RF THEN
  • CONT2_NAMEE = CONT_B09.GCN_FNAME
• ELSE
  • CONT2_NAMEE = CONT_B09.GCN_FNAME + CONT_B09.GCN_LNAME
• ENDIF

CONT_B10

• Call the Address block. See Appendix I.

Programmer:

• Pass the following parameters:
• DV_QTEXT_E = “What is the address for ^CONT2_NAMEE?”
• LISTINGADFLAG = 2 (No)
• ONCANADFLAG = 1 (Yes)

CONT_C11

• If CONT_B10.Province = 77 "Outside of Canada and U.S.A.", go to CONT_B12.
• Otherwise, go to CONT_B11.

CONT_B11

• Call the North American Telephone block (NATP). See Appendix I.
• Go to CONT_END

Programmer:

• Pass the following parameters:
• DV_QTEXT_E = "What is the telephone number for ^CONT2_NAMEE, including the area code?"
• ASKEXT = 2 (No).

CONT_B12

• Call the Overseas Telephone block (OSTP). See Appendix I.

Programmer:

• Pass the following parameters:
• DV_QTEXT_E = "What is the telephone number for ^CONT2_NAMEE, including the area code?"

CONT_END

Clinic Sign-Out Component (CSO)

CSO_BEG

External variables required:

Variables taken from sample file:

• STAND: name of the city/town/village in which the clinic has been set up
• CLINICID: 8 digit respondent identifier

Variables assigned in Variable Creation:

• CurrentYear: numeric year during which clinic visit is taking place
• CurrentMonth: numeric month during which clinic visit is taking place
• CurrentDay: numeric day during which clinic visit is taking place
• SessionE: English text of when the clinic visit is taking place
• DryRun: indicator of whether the case is a dry run case

Variables output from previously completed blocks:

• RespondentName: name of respondent
• GenderE: English text for sex of respondent
• CON_AGE: age of respondent
• RespondentFirstName: respondent's preferred official language
• SCS_N12: visit type (3= clinic visit; 4= home visit)
• DT_REP11TEXTE: Dynamic text from REP block ("^RespondentFirstName’s"/”your”)
• RespondentName: first and last name of the respondent

CSO_D05

• If CON_AGE < 14 and CON_SEX = 1, DT_CSOR11E = "he".
• If CON_AGE < 14 and CON_SEX = 2, DT_CSOR11E = "she".
• Otherwise, DT_CSOR11E = "you".

CSO_R11A
Thank you for participating in the survey. Here is [RespondentFirstName’s/your] Report of physical measurements containing the results for some of the tests [he/she/you] performed today.

Instruction: Provide the respondent with his/her Report of physical measurements.

Briefly review the report with the respondent, identifying each section and explaining where the results and interpretations can be found.

• Press <1> to continue.

CSO_D11

Programmer:

• IF SCS_N12 = 4 THEN
  • CSO_D11 = EMPTY
• ELSE
• IF CSO_R11A = 1 and CSO_D11 = EMPTY,
  • Set CSO_D11 = Current Time (in HH:MM:SS format)
• ENDIF

CSO_R11B
Do you have any questions about this report? If you would like, a Health Measures Specialist can spend a few minutes reviewing the test results with you now.

Instruction: If a respondent has questions, ask a Health Measures Specialist to answer any questions about the test results.

• Press <1> to continue.

CSO_D12

• If DryRun in (1, 2), DT_CSO12TEXTE = "If you move, please inform us by phoning or e-mailing us".
• Otherwise, DT_CSO12TEXTE = "If you move, please inform us by e-mail or by returning this change of address card".

CSO_R12
We will send the final report of [RespondentFirstName’s/your] test results in 6 to 7 months. ^DT_CSO12TEXTE

Instruction: Press <1> to continue.

CSO_C21

• If DryRun in (1, 2), go to CSO_N23.
• Otherwise, go to CSO_N22.

CSO_N22

Instruction: Record whether RespondentName is to receive the standard reimbursement of $100.

• 1 Yes (Go to CSO_D23)
• 2 No
  (DK, RF not allowed)

CSO_N23

Instruction: Record the reimbursement amount.

• Amount (in dollars)
• (MIN: 0)
• (MAX: 300)
• (DK, RF not allowed)

CSO_D23

Programmer:

• IF CSO_N22 = 1 THEN
  • CSO_D23 = "100"
• ELSE
  • CSO_D23 = CSO_N23
• ENDIF

CSO_C24A

• If DryRun = 3, go to CSO_C24C.
• Otherwise, go to CSO_C24B.

CSO_C24B

• If (DryRun = 1 or 2) and CSO_D23 > 0, go to CSO_N24.
• Otherwise, go to CSO_END.

CSO_C24C

• If DryRun = 3 and CSO_D23 > 100, go to CSO_N25.
• Otherwise, go to CSO_D30.

CSO_N24

Instruction: Specify the reason why a reimbursement is being disbursed to a dry-run participant.

• (80 spaces)
• (DK, RF not allowed)

Go to CSO_D30

CSO_N25

Instruction: Specify the reason why a reimbursement in excess of $100 is being disbursed.

• (80 spaces)
• (DK, RF not allowed)

CSO_D30

• If CON_AGE > 13, DT_CSO30TEXTE = "my".
• Otherwise, DT_CSO30TEXTE = "^RespondentName’s".
• If CON_AGE < 14, DT_NAMECSO = "EMPTY".
• Otherwise, DT_NAMECSO = "^RespondentName".

CSO_N30

Instruction: Press <1> to print the Reimbursement form.

• 1 Print the form
• (DK, RF not allowed)

CSO_D31

• If CON_AGE > 13, DT_CSO31TEXT2E = "respondent".
• Otherwise, DT_CSO31TEXT2E = "parent or guardian".

CSO_R31
Before you leave, I would like to provide you with a reimbursement of the expenses for [RespondentFirstName’s/your] participation in the clinic portion of the survey. I need you to sign this form, which indicates that you received the reimbursement.

Instruction: Provide the [respondent/parent or guardian] with the Reimbursement Form. When the [respondent/parent or guardian] returns the form, check to ensure that all requested information has been filled in and is legible. Sign the form as the witness.

• Press <1> to continue.

CSO_END

Appendix 1

Date Block (APP1)

APP1_BEG
Date Block

DAY Instruction: Enter the day.

• Day
• (MIN: 1)
• (MAX: 31)

MONTH Instruction: Select the month.

• 01 January 07 July
• 02 February 08 August
• 03 March 09 September
• 04 April 10 October
• 05 May 11 November
• 06 June 12 December

YEAR Instruction: Enter a four-digit year.

• Year
• (MIN: 1925)
• (MAX: 2009)
• DATE_END

APP1_END

Address (AD)

AD_BEG

Import the following variables:

• DV_QTEXT_E (QuestionText)
• LISTINGADFLAG tYesNo
• NONCANADFLAG tYesNo

AD_Q01
^DV_QTEXT_E

Interviewer: Enter the civic number.

• If necessary, ask: (What is the civic number?)
  (5 spaces)
  DK, RF

AD_C01

• If DK or RF is entered and LISTINGADFLAG <> Yes, go to AD_N01.
• Otherwise, go to AD_Q02.

AD_N01

Interviewer: (^DV_QTEXT_E)

Do you wish to skip the remaining address fields?

• 1 Yes (Go to AD_END)
• 2 No
  (DK, RF not allowed)

Programmer:

• If "Yes" is selected, fill address fields with DK or RF (based on the response to AD_Q01) and go to AD_END.

AD_Q02
(^DV_QTEXT_E)

Interviewer: Enter the street name.

• If necessary, ask: (What is the street name?)
  (50 spaces)
  DK, RF

Programmer:

• Null is not allowed.

AD_Q03
(^DV_QTEXT_E)

Interviewer: Enter the apartment number.

• If necessary, ask: (What is the apartment number?)
  (5 spaces)
  DK, RF

AD_Q04
(^DV_QTEXT_E)

Interviewer: Enter the city, town, village or municipality.

• If necessary, ask: (What is the city, town, village or municipality?)
  (30 spaces)
  (DK, RF not allowed)

AD_D05

• If (LISTINGADFLAG = Yes and NONCANADFLAG = No) or (LISTINGADFLAG = No and NONCANADFLAG = No), DT_CLANOTEXT_E = "EMPTY".
• Otherwise, DT_CLANOTEXT_E = "If the address is outside Canada, press <Enter>".

AD_Q05
(^DV_QTEXT_E)

Interviewer: Enter the postal code.

• [EMPTY /If the address is outside Canada, press <Enter>]
• If necessary, ask: (What is the postal code?)
• (6 spaces)
• DK, RF (Go to AD_Q07)
• Go to AD_E05A

Programmer:

• The value "EMPTY" should go to AD_D07.

AD_D06

• If first character of the postal code is "A", DT_PROV_E = "Newfoundland and Labrador".
• If first character of the postal code is "B", DT_PROV_E = "Nova Scotia".
• If first character of the postal code is "C", DT_PROV_E = "Prince Edward Island".
• If first character of the postal code is "E", DT_PROV_E = "New Brunswick".
• If first character of the postal code is "G" or "H" or "J", DT_PROV_E = "Quebec".
• If first character of the postal code is "K" or "L" or "M" or "N" or "P", DT_PROV_E = "Ontario".
• If first character of the postal code is "R", DT_PROV_E = "Manitoba".
• If first character of the postal code is "S", DT_PROV_E = "Saskatchewan".
• If first character of the postal code is "T", DT_PROV_E = "Alberta".
• If first character of the postal code is "V", DT_PROV_E = "British Columbia".
• If first character of the postal code is "Y", DT_PROV_E = "Yukon".
• If first character of the postal code is "X", DT_PROV_E = "Nunavut, Northwest Territories".

AD_D06A

• If first character of the postal code is "Y" or "X ", DT_PROV_TERR_E = "territory".
• Otherwise, DT_PROV_TERR_E = "province".

AD_C06A

• If the first character of the postal code is "X", go to AD_D07.
• Otherwise, go to AD_Q06.

AD_Q06
(^DV_QTEXT_E)

Interviewer: Confirm that the ^DT_PROV_TERR_E is ^DT_PROV_E.

• If necessary, ask: (So the ^DT_PROV_TERR_E is ^DT_PROV_E?)
• 1 Yes (Go to AD_END)
• 2 No
  (DK, RF not allowed)

AD_D07

• If NONCANADFLAG = Yes, DT_USA_E = "U.S.A.".
  Otherwise, DT_USA_E = "" "".
• If NONCANADFLAG = Yes, DT_OUTSIDE_E = "Outside of Canada and U.S.A.".
  Otherwise, DT_OUTSIDE_E = "" "".

AD_Q07
(^DV_QTEXT_E)

Interviewer: Select the province or territory.

• If necessary, ask: (What is the province or territory?)
• 10 Newfoundland and Labrador
• 11 Prince Edward Island
• 12 Nova Scotia
• 13 New Brunswick
• 24 Quebec
• 35 Ontario
• 46 Manitoba
• 47 Saskatchewan
• 48 Alberta
• 59 British Columbia
• 60 Yukon
• 61 Northwest Territories
• 62 Nunavut
• 76 [U.S.A./" "]
• 77 [Outside of Canada and U.S.A./" "]
  (DK, RF not allowed)

AD_D07A

• If AD_Q07 = 60 or 61 or 62, DT_PROV_TERR2_E = "territory".
• Otherwise, DT_PROV_TERR2_E = "province".

AD_C08

• If 76 "U.S.A." is selected and NONCANADFLAG = Yes, go to AD_Q08.
• Otherwise, go to AD_END.

AD_Q08
(^DV_QTEXT_E)

Interviewer: Select the state.

• If necessary, ask: (What is the state?)
• 01 Alabama
• 02 Alaska
• 03 Arizona
• 04 Arkansas
• 05 California
• 06 Colorado
• 07 Connecticut
• 08 Delaware
• 09 District of Columbia
• 10 Florida
• 11 Georgia
• 12 Hawaii
• 13 Idaho
• 14 Illinois
• 15 Indiana
• 16 Iowa
• 17 Kansas
• 18 Kentucky
• 19 Louisiana
• 20 Maine
• 21 Maryland
• 22 Massachusetts
• 23 Michigan
• 24 Minnesota
• 25 Mississippi
• 26 Missouri
• 27 Montana
• 28 Nebraska
• 29 Nevada
• 30 New Hampshire
• 31 New Jersey
• 32 New Mexico
• 33 New York
• 34 North Carolina
• 35 North Dakota
• 36 Ohio
• 37 Oklahoma
• 38 Oregon
• 39 Pennsylvania
• 40 Rhode Island
• 41 South Carolina
• 42 South Dakota
• 43 Tennessee
• 44 Texas
• 45 Utah
• 46 Vermont
• 47 Virginia
• 48 Washington
• 49 West Virginia
• 50 Wisconsin
• 51 Wyoming
  (DK, RF not allowed)

AD_Q09
(^DV_QTEXT_E)

Interviewer: Enter only a US zip code.

• If necessary, ask: (What is the zip code?)
• (12 spaces)
• DK, RF (Go to AD_END)

AD_END

Get Contact Name (GCN)

GCN_BEG

Import the following variables:

• DV_QTEXT_E (Question text)

GCN_N01
^DV_QTEXT_E

Instruction: Enter the first name.

• (50 spaces)
• DK, RF (Go to GCN_Q02)
• Go to GCN_Q03

GCN_Q02
(^DV_QTEXT_E)

Instruction: Do you wish to skip the remaining contact fields?

• 1 Yes (Go to GCN_END)
• 2 No
• (DK, RF not allowed)

Programmer:

• If "Yes" is selected, fill contact fields with DK or RF (based on the response to GCN_Q01).

GCN_Q03
(^DV_QTEXT_E)

Instruction: Enter the last name.

• (50 spaces)
• DK, RF

GCN_END

North American Telephone (NATP)

Overview: The North American Telephone block is called from within other blocks. Only a telephone number is collected.

NATP_BEG

• Import the following variables:
• DV_QTEXT_E (Question Text)
• ASKEXT tYesNo

NATP_Q01
^DV_QTEXT_E

Interviewer: Enter the area code.

• If necessary, ask: (What is the area code?)
• Enter "000" if no telephone.
• (MIN: 0)
• (MAX: 9,999,995)
• DK, RF (Go to NATP_Q02)

NATP_C01

• If NATP_Q01 = "000", fill NATP_Q02 with "0000000", go to NATP_END.
• Otherwise, go to NATP_E01A.

NATP_Q02
(^DV_QTEXT_E)

Interviewer: Enter the telephone number.

• If necessary, ask: (What is the telephone number?)
• (MIN: 0)
• (MAX: 9999995)
• DK, RF (Go to NATP_END)

NATP_C03

• If NATP_Q02 = DK, RF or "0000000" or ASKEXT = No, go to NATP_END.
• Otherwise, go to NATP_Q03.

NATP_Q03
(^DV_QTEXT_E)

Interviewer: Enter the extension, if applicable.

• (6 spaces)
• DK, RF

Programmer:

• The extension field can be left empty.

NATP_END

Overseas Telephone (OSTP)

Overview: The Overseas Telephone block is called from within other blocks. Only a telephone number is collected.OSTP_BEG

Import the following variables:

• DV_QTEXT_E (Question Text)

OSTP_Q01
^DV_QTEXT_E

Interviewer: Enter the country code.

• If necessary, ask: (What is the country code?)
• Enter "000" if no telephone.
• (3 spaces)
• DK, RF (Go to OSTP_Q02)

OSTP_C01

• If OSTP_Q01 = "000", fill OSTP_Q02 with "0000" and OSTP_Q03 with "0000000", go to OSTP_END.
• Otherwise, go to OSTP_Q02.

OSTP_Q02
(^DV_QTEXT_E)

Interviewer: Enter the city code (if required).

• If necessary, ask: (What is the city code?)
• (4 spaces)
• DK, RF

OSTP_C02

• If OSTP_Q02 = "blank", go to OSTP_Q03.
• Otherwise, go to OSTP_Q03.

OSTP_Q03
(^DV_QTEXT_E)

Interviewer: Enter the telephone number.

• If necessary, ask: (What is the telephone number?)
• (8 spaces)
• DK, RF

OSTP_END

2014 to 2015
Clinic Questionnaire

Explanatory notes for this document
Respondent Verification Component
Respondent Verification (RVB)
Name Spelling Confirmation (NSC)
Sex Confirmation (SXC)
Confirmation of Birth Date (DDN)
Language Confirmation (LNG)
Consent Component
Consent (CON)
Report (REP)
Urgent Condition (URG)
Electronic Address (EA)
Urine Collection 1 Component (UC1)
Screening Component
Screening Component Introduction (SCI)
Adherence to Guidelines (ATG)
Physical and Health Conditions (PHC)
Hearing Restriction (HER)
Spirometry Questions (SPQ)
Spirometry Restriction (SPR)
Medications and Product Confirmation (MEDC)
Medication use for Clinic (MEUC)
Confirm Drug Product (CDP)
New Product Information (NPI)
New Product Information – Call block (NPC)
Other Reason for Screening Out (ORS)
Water Analysis Questions Component (WAQ)
Fish and Shellfish Consumption Component
Fish and Shellfish Consumption (FSF)
Detail Fish and Shellfish (DFS)
Noise Exposure Component
Noise Exposure Component Introduction (HCI)
Hearing Ability (HAB)
Noise Exposure (NEX)
Activity Detail (ACD)
Sun Exposure Component (SEB)
Skin Pigmentation Component
Skin Pigmentation Component Introduction (SKI)
Skin Pigmentation Measurement (SKM)
Skin Pigmentation Recording (SKR)
Anthropometric Component
Anthropometric Component Introduction (ACI)
Height and Weight Measurements (HWM)
Blood Pressure Component
Blood Pressure Measurement (BPM)
Blood Pressure Recording (BPR)
Activity Monitor Component (AM)
Indoor Air Sampler Component
Indoor Air Sampler (IAS)
Indoor Air Questions (IAQ)
Spirometry Measurement Component (SPM)
Hearing Component
Otoscopy Measurement (OTM)
Tympanometry Measurement (TYM)
Otoacoustic Emissions Measurement (OAE)
Audiometry Measurement (AUD)
Grip Strength Component
Grip Strength Component Introduction (GSI)
Grip Strength Measurement (GSM)
Phlebotomy Component
Phlebotomy Component Introduction (PHI)
Blood Collection (BDC)
Urine Collection 2 Component (UC2)
Report of Measurements Component (RM)
Exit Component
Exit Component Introduction (ECI)
Exit Consent Questions (ECQ)
Contact (CONT)
Clinic Sign-Out Component (CSO)
Appendix 1
Date Block (APP1)
Address (AD)
Get Contact Name (GCN)
North American Telephone (NATP)
Overseas Telephone (OSTP)

Explanatory notes for this document

1. Question text in bold font is read to the respondent. Text in normal font is not read to the respondent. Instructions to the person asking the questions or taking the measures are prefaced by the word "Instruction", and are not read aloud.
2. Question text in bold font enclosed by brackets () is read to the respondent at the discretion of the person asking the questions.
3. In this text, the use of the masculine is generic and applies to both men and women. Please note that during the actual clinic visit, the questions were personalized to be appropriate to the gender of the respondent.
4. Question text enclosed in square brackets [ ] is dynamic and in most cases will vary depending on the particular circumstances. The symbol ^ indicates that dynamic substitution will take place.
5. In this document, the flow direction from a given response is not provided when it is to the next immediate question.
6. For more detailed information on physical measures protocols, please contact Statistics Canada's National Contact Centre (toll-free 1-800-263-1136; 613-951-8116; infostats@statcan.gc.ca).

Respondent Verification Component

Respondent Verification (RVB)

RVB_BEG

External variables required:

Variables taken from sample file:

• STAND: name of the city/town/village in which the clinic has been set up
• CLINICID: 8 digit respondent identifier
• AWC_AGE: age of respondent
• AWC_YOB: year of birth of respondent
• AWC_MOB: month of birth of respondent
• AWC_DOB: day of birth of respondent
• RespondentName: name of respondent

Variables assigned in Variable Creation:

• CurrentYear: numeric year during which clinic visit is taking place
• CurrentMonth: numeric month during which clinic visit is taking place
• CurrentDay: numeric day during which clinic visit is taking place
• SessionE: English text of when the clinic visit is taking place
• ShortRespName: first 4 letters of LNAME plus first 3 letters of FNAME
• IntLangE: English text of language of application during the household interview (either English or French)
• GenderE: English text for sex of respondent
• SCS_N12: visit type (3= clinic visit; 4= home visit)

RVB_C11

• If SCS_N12 = 4, go to RVB_END.
• Otherwise, go to RVB_N11.

RVB_N11

Instruction: Press <1> to print the Participant's personal information form.

• 1 Print the form
• (DK, RF not allowed)

RVB_D11

Programmer:

• IF SCS_N12 = 4 THEN
  • RVB_D11 = EMPTY
• ELSE
  • IF RVB_N11 = 1 and RVB_D11 = EMPTY,
  • Set RVB_D11 = Current Time (in HH:MM:SS format).
• ENDIF

RVB_R11
Here is the first of several forms we will be asking you to complete. Please read it carefully and provide the information requested.

Instruction: Provide the respondent with the English/French double-sided Participant’s personal information form.

When the respondent returns the form, check to ensure that all requested information has been filled in and is legible.

• Press <1> to continue.

RVB_N12

Instruction: Press <1> to print the label with the respondent's CLINICID as a bar code identifier.

• Stick the first label onto a bracelet
• Attach the bracelet around the wrist of the respondent.

• 1 Print the label
• (DK, RF not allowed)

RVB_END

Name Spelling Confirmation (NSC)

NSC_BEG

External variables required:

Variables taken from sample file:

• STAND: name of the city/town/village in which the clinic has been set up
• CLINICID: 8 digit respondent identifier
• FNAME: first name of respondent
• LNAME: last name of respondent
• AWC_AGE: age of respondent

Variables assigned in Variable Creation:

• CurrentYear: numeric year during which clinic visit is taking place
• CurrentMonth: numeric month during which clinic visit is taking place
• CurrentDay: numeric day during which clinic visit is taking place
• SesscionE: English text of when the clinic visit is taking place
• RespondentName: name of respondent
• GenderE: English text for sex of respondent

NSC_C11

• If RespondentName = "EMPTY", go to NSC_N13.
• Otherwise, go to NSC_N11.

NSC_N11

Instruction: Record whether ^RespondentName's name is spelled correctly.

1. Yes (Go to NSC_D15)
2. No (DK, RF not allowed)

NSC_N12

Instruction: Record whether corrections are to be made to:

1. ...the first name only?
2. ...the last name only? (Go to NSC_N14)
3. ...both names?
   (DK, RF not allowed)

NSC_N13

Instruction: Enter the first name only.

• (25 spaces)
• (DK, RF not allowed)

NSC_C14

• If NSC_N12 = 1 (first name only), go to NSC_D15.
• Otherwise, go to NSC_N14.

NSC_N14

• Instruction: Enter the last name only.
• (25 spaces)
• (DK, RF not allowed)

NSC_D15

Programmer:

• IF NSC_N11 = 1 THEN
  • Set RespondentFirstName = FNAME
  • Set RespondentLastName = LNAME
  • Set RespondentName = FNAME + LNAME
    (separated by one space)
• ELSE IF NSC_N12 = 1 THEN
  • Set RespondentFirstName = NSC_N13
  • Set RespondentLastName = LNAME
  • Set RespondentName = NSC_N13 + LNAME
    (separated by one space)
• ELSE IF NSC_N12 = 2 THEN
  • Set RespondentFirstName = FNAME
  • Set RespondentLastName = NSC_N14
  • Set RespondentName = FNAME + NSC_N14
    (separated by one space)
• ELSE
  • Set RespondentFirstName = NSC_N13
  • Set RespondentLastName = NSC_N14
  • Set RespondentName = NSC_N13 + NSC_N14
    (separated by one space)
• ENDIF

NSC_END

Sex Confirmation (SXC)

SXC_BEG

External variables required:

Variables taken from sample file:

• STAND: name of the city/town/village in which the clinic has been set up
• CLINICID: 8 digit respondent identifier
• AWC_AGE: age of respondent
• SEX_Q01: sex of respondent

Variables assigned in Variable Creation:

• CurrentYear: numeric year during which clinic visit is taking place
• CurrentMonth: numeric month during which clinic visit is taking place
• CurrentDay: numeric day during which clinic visit is taking place
• SessionE: English text of when the clinic visit is taking place
• GenderE: English text for sex of respondent

Variables from previously completed blocks:

• RespondentName: name of respondent

SXC_C11

• If SEX_Q01 = EMPTY, go to SXC_N12.
• Otherwise, go to SXC_N11.

SXC_N11

Instruction: Record whether ^RespondentName's sex is correct.

1. Yes (Go to SXC_D13)
2. No (DK, RF not allowed)

SXC_N12

Instruction: Record ^RespondentName's sex.

1. Male
2. Female
   (DK, RF not allowed)

SXC_D13

Programmer:

• IF SXC_N11 = 1, THEN
  • IF SEX_Q01 = 1 THEN
    • CON_SEX = 1
    • GenderE = "Male"
  • ELSE
    • CON_SEX = 2
    • GenderE = "Female"
  • ENDIF
• ELSE
  • IF SXC_N12 = 1 THEN
    • CON_SEX = 1
    • GenderE = "Male"
  • ELSE
    • CON_SEX = 2
    • GenderE = "Female"
  • ENDIF
• ENDIF

SXC_END

Confirmation of Birth Date (DDN)

DDN_BEG

External variables required:

Variables taken from sample file:

• STAND: name of the city/town/village in which the clinic has been set up
• CLINICID: 8 digit respondent identifier
• AWC_DOB: day of birth of respondent
• AWC_MOB: month of birth of respondent
• AWC_YOB: year of birth of respondent
• AWC_AGE: age of respondent

Variables assigned in Variable Creation:

• CurrentYear: numeric year during which clinic visit is taking place
• CurrentMonth: numeric month during which clinic visit is taking place
• CurrentDay: numeric day during which clinic visit is taking place
• SessionE: English text of when the clinic visit is taking place
• ShortRespName: respondent short name

Variables from previously completed blocks:

• RespondentName: name of respondent
• GenderE: English text for sex of respondent
• CON_SEX: sex of respondent

Programmer:

• "Feedback" data represents information collected during the household interview (e.g., "Feedback date of birth" represents the date of birth provided by the respondent during the household interview).

DDN_C1

• If AWC_DOB, AWC_MOB or AWC_YOB is blank, DK or RF, or AWC_AGE is blank, go to DDN_B2.
• Otherwise, go to DDN_D1.

DDN_D1

• If AWC_MOB = 1, DT_MONTHOFBIRTHE = "January".
• If AWC_MOB = 2, DT_MONTHOFBIRTHE = "February".
• If AWC_MOB = 3, DT_MONTHOFBIRTHE = "March".
• If AWC_MOB = 4, DT_MONTHOFBIRTHE = "April".
• If AWC_MOB = 5, DT_MONTHOFBIRTHE = "May".
• If AWC_MOB = 6, DT_MONTHOFBIRTHE = "June".
• If AWC_MOB = 7, DT_MONTHOFBIRTHE = "July".
• If AWC_MOB = 8, DT_MONTHOFBIRTHE = "August".
• If AWC_MOB = 9, DT_MONTHOFBIRTHE = "September".
• If AWC_MOB = 10, DT_MONTHOFBIRTHE = "October".
• If AWC_MOB = 11, DT_MONTHOFBIRTHE = "November".
• If AWC_MOB = 12, DT_MONTHOFBIRTHE = "December".

DDN_N1

Instruction: Record whether ^RespondentName's date of birth is ^MonthOfBirthE ^AWC_DOB, ^AWC_YOB.

• 1 Yes (Go to DDN_D4)
• 2 No (DK, RF not allowed)

Content type - Note to data users:

• If the DOB is confirmed at DDN_N1, then the DOB values are entered into the DOB fields at DDN_B2 and age is calculated.

DDN_B2

Instruction: Record ^RespondentName's date of birth.

• Call the Date block. See Appendix I.

Content type - Note to data users:

• If Month of birth or Year of birth is not known or refused, respondent is flowed to DDN_N4 where he/she is asked his/her age.
• If Day of birth is not known or refused AND the current month is the same as the month of birth, then respondent is flowed to DDN_N4 where he/she is asked his/her age.
• If entered DOB is not different from the feedback DOB, then go to DDN_N4.
• Mulitple edits assure that the respondent is not less than 3 years of age or greater than 80 years of age.

DDN_Q3
I would like to confirm that your age is ^CalculatedAge.

Instruction: Date of birth is ^MonthOfBirthE ^DDN_B2.DATD, ^DDN_B2.DATY.

1. Yes (Go to DDN_E4)
2. No, return and correct date of birth (Go to DDN_B2)
3. No, collect age
   (DK, RF not allowed)

Programmer:

IF ^CalculatedAge < 3 or ^CalculatedAge > 80 display ^CalculatedAge in red font.

• IF DDN_B2.DATM = 1, THEN
  • MonthOfBirthE = "January"
• ELSE IF DDN_B2.DATM = 2, THEN
  • MonthOfBirthE = "February"
• ELSE IF DDN_B2.DATM = 3, THEN
  • MonthOfBirthE = "March"
• ELSE IF DDN_B2.DATM = 4, THEN
  • MonthOfBirthE = "April"
• ELSE IF DDN_B2.DATM = 5, THEN
  • MonthOfBirthE = "May"
• ELSE IF DDN_B2.DATM = 6, THEN
  • MonthOfBirthE = "June"
• ELSE IF DDN_B2.DATM = 7, THEN
  • MonthOfBirthE = "July"
• ELSE IF DDN_B2.DATM = 8, THEN
  • MonthOfBirthE = "August"
• ELSE IF DDN_B2.DATM = 9, THEN
  • MonthOfBirthE = "September"
• ELSE IF DDN_B2.DATM = 10, THEN
  • MonthOfBirthE = "October"
• ELSE IF DDN_B2.DATM = 11, THEN
  • MonthOfBirthE = "November"
• ELSE IF DDN_B2.DATM = 12, THEN
  • MonthOfBirthE = "December"
• ENDIF

Calculate the age using the entered date of birth, and pre-fill the question text with the result.

DDN_N4

Instruction: Record ^RespondentName's age.

• Age in years
• (MIN: 1)
• (MAX: 85)
• (DK, RF not allowed)

DDN_D4

Content type - Note to data users:

• The respondent's age in years (CON_AGE) and age in days (AGE_DAYS) are calculated using date of birth.

Programmer:

• IF DDN_N1 = 1 THEN
  • CON_DDN = AWC_MOB + AWC_DOB + AWC_YOB
  • CON_AGE = CalculatedAge
• ELSE IF DDN_B2.DATD = RESPONSE AND DDN_B2.DATM = RESPONSE AND DDN_B2.DATY = RESPONSE THEN
  • CON_DDN = DDN_B2.DATM + DDN_B2.DATD + DDN_B2.DATY
• ENDIF
• IF DDN_Q3 = 1 THEN
  • CON_AGE = CalculatedAge
• ELSE IF DDN_N4 = RESPONSE THEN
  • CON_AGE = DDN_N4
• ENDIF
• IF CON_DDN = RESPONSE THEN
  • AGE_DAYS = Age in days based on CON_DDN
• ELSE IF DDN_B2.DATM = RESPONSE AND DDN_B2.DATY = RESPONSE THEN
  • AGE_DAYS = Age in days based on DDN_B2.DATY + DDN_B2.DATM + 15
• ELSE
  • AGE_DAYS = EMPTY
• ENDIF

DDN_D6

Content type - Note to data users:

• The respondent's required minimum urine sample volume(DDN_D6) is calculated based on respondent age and randomly set sampling flags.

Programmer:

• IF CON_AGE <6 THEN
  • IF (BPAFLG = 1 or TRICFLG =1 or ARSCFLG = 1 or ORGPFLG = 1 or PARAFLG = 1) THEN
    • IF (BENZFLG = 1 or  PAHFLG = 1) THEN
      • DDN_D6 = 40.0 ml
    • ELSE
      • DDN_D6 = 30.0 ml
    • ENDIF
  • ELSE
    • IF (BENZFLG = 1 or  PAHFLG = 1) THEN
      • DDN_D6 = 30.0 ml
    • ELSE
      • DDN_D6 = 20.0 ml
    • ENDIF
  • ENDIF
• ELSE
  • IF (BPAFLG = 1 or TRICFLG =1 or ARSCFLG = 1 or ORGPFLG = 1 or PARAFLG = 1) THEN
    • IF (BENZFLG = 1 or  PAHFLG = 1) THEN
      • DDN_D6 = 50.0 ml
    • ELSE
      • DDN_D6 = 40.0 ml
    • ENDIF
  • ELSE
    • IF (BENZFLG = 1 or  PAHFLG = 1) THEN
      • DDN_D6 = 40.0 ml
    • ELSE
      • DDN_D6 = 30.0 ml
    • ENDIF
  • ENDIF
• ENDIF

DDN_N6

Instruction: Press <1> to print the labels with the respondent's short name.

• First label: Stick it onto the respondent's file folder.
• Second label: Staple it to the inside of the respondent's file folder.
• Third label: Stick it onto a urine sample container.

DO NOT give the container to the respondent until the Urine component has been generated (after CONSENT).

• 1 Print the labels
• (DK, RF not allowed)

DDN_END

Language Confirmation (LNG)

LNG_BEG

External variables required:

Variables taken from sample file:

• STAND: name of the city/town/village in which the clinic has been set up
• CLINICID: 8 digit respondent identifier

Variables assigned in Variable Creation:

• CurrentYear: numeric year during which clinic visit is taking place
• CurrentMonth: numeric month during which clinic visit is taking place
• CurrentDay: numeric day during which clinic visit is taking place
• SessionE: English text of when the clinic visit is taking place

Variables from previously completed blocks:

• RespondentName: name of respondent
• GenderE: English text for sex of respondent
• CON_AGE: age of respondent

LNG_N11

Instruction: Record ^RESPONDENTNAME's preferred official language.

• 1 English
• 2 French
• (DK, RF not allowed)

LNG_END
If necessary, change the application language to correspond to the response to LNG_N11.

Consent Component

Consent (CON)

CON_BEG

External variables required:

Variables taken from sample file:

• STAND: name of the city/town/village in which the clinic has been set up
• CLINICID: 8 digit respondent identifier
• STOREBLD: flag for whether storage is available for blood and urine samples
• STOREDNA: flag for whether storage is available for DNA samples

Variables assigned in Variable Creation:

• CurrentYear: numeric year during which clinic visit is taking place
• CurrentMonth: numeric month during which clinic visit is taking place
• CurrentDay: numeric day during which clinic visit is taking place
• DryRun: whether the case is a dry run case (1/2= dryrun; 3= survey respondent)
• SessionE: English text of when the clinic visit is taking place

Variables from previously completed blocks:

• RespondentFirstName: first name of respondent
• RespondentName: name of respondent
• GenderE: English text for sex of respondent
• CON_AGE: age of respondent
• LNG_N11: respondent's preferred official language
• SCS_N12: visit type (3= clinic visit; 4= home visit)

CON_C01

• If SCS_N12 = 4, go to CON_D01.
• Otherwise, go to CON_N01.

CON_N01

Instruction: Press <1> to print the Consent form(s).

• 1 Print the form(s)
• (DK, RF not allowed)

CON_D01

• If CON_AGE < 14, DT_CONINST1E = "the parent or guardian".
• Otherwise, DT_CONINST1E = "the respondent".
• If CON_AGE < 14, DT_CONINST3E = "^RespondentFirstName's".
• Otherwise, DT_CONINST3E = "his/her".

CON_Q11
Before we start the clinic tests, we need to ensure you have reviewed the Information and Consent Booklet that was given to you during the interview at your home. Did you have a chance to read that booklet?

Instruction: Show the respondent the Information and Consent Booklet.

• 1 Yes
• 2 No
• (DK, RF not allowed)

CON_D11

Programmer:

• IF SCS_N12 = 4 THEN
  • CON_D11 = EMPTY
• ELSE
  • IF CON_Q11 = RESPONSE and CON_D11 = EMPTY,
    • Set CON_D11 = Current Time (in HH:MM:SS format)
• ENDIF

CON_C12

• If CON_Q11 = 2, go to CON_R13.
• Otherwise, go to CON_R12

CON_R12
Do you have any questions about any of the information in the booklet or about the clinic portion of the survey?

Instruction: Answer any questions as thoroughly as possible.

• Press <1> to continue.
• Go to CON_R14

CON_R13
Here is a copy of the Information and Consent Booklet. Please take a few minutes to read through it. If you have any questions about the information in the booklet or the clinic tests, I can answer them for you.

Instruction: Hand the Information and Consent Booklet to the respondent and give him/her time to read through it (approximately 5 minutes).

• Press <1> to continue.

CON_R14
Here is the Consent form for participation in the clinic portion of the survey. Please read the form carefully and check either the "Yes" or "No" box for each item.

Instruction: Provide [the parent or guardian/the respondent] with the Consent form.

• Check to ensure that it has been completed correctly.
• Sign the form as the witness.
• Press <1> to continue.

CON_R15
I am now going to enter that information into our computer system. I may have some additional questions about your responses.

Instruction: Press <1> to continue.

CON_C15

• If CON_AGE > 13, go to CON_D16.
• Otherwise, go to CON_N15.

CON_N15

Instruction: Record whether a parent or guardian has consented to the respondent participating in the physical measure tests.

• 1 Yes
• 2 No
• (DK, RF not allowed)

Content type - Note to data users:

• If CON_N15 = 2, the clinic visit will not continue for that respondent.

CON_C16

• If CON_AGE < 6, go to CON_N21.
• Otherwise, go to CON_R16.

CON_R16
Your parent or guardian has said you can take part in the tests today. If you would like to participate we need you to write or print your name on this form.

Instruction: Provide the child with the Assent form.

• Check to ensure that it has been completed correctly.
• Sign the form as the witness.
• Press <1> to continue.

CON_D16

• If CON_AGE > 13, DT_CON16E = "consented".
• Otherwise, DT_CON16E = "assented".

CON_N16

Instruction: Record whether the respondent has [consented/assented] to participating in the physical measure tests.

• 1 Yes
• 2 No
• (DK, RF not allowed)

Content type - Note to data users:

• If CON_N16 = 2, the clinic visit will not continue for that respondent.

CON_N21

Instruction: Record whether [the parent or guardian/the respondent] has consented to receiving reports of [^RespondentFirstName's /his/her] test results.

• 1 Yes
• 2 No
• (DK, RF not allowed)

CON_D23

• If CON_AGE > 13, DT_CON4E = "your".
• Otherwise, DT_CON4E = "^RespondentFirstName's".

• If CON_AGE < 14, DT_CONREPE = "contaminants that might require".
• Otherwise, DT_CONREPE = "diseases and contaminants that might require".

• If CON_AGE < 14, DT_CONREP2E = "contaminants".
• Otherwise, DT_CONREP2E = "diseases and contaminants".

CON_N23

Instruction: Record whether [the parent or guardian/the respondent] has consented to allowing Statistics Canada to test [RespondentFirstName's/ his/her] blood and urine for ^DT_CONREPE mandatory reporting in his/her province of residence, and to contact him/her as well as the appropriate provincial authorities if the results are positive.

• 1 Yes
• 2 No
• (DK, RF not allowed)

CON_C23B

• If CON_N21 = 1 or CON_N23 = 2, go to CON_C23C.
• Otherwise, go to CON_R23.

CON_R23
You have indicated on the Consent form that you do not want to receive reports of [your/RespondentFirstName’s] test results. However, you have agreed that Statistics Canada can test [your/RespondentFirstName’s] blood and urine for reportable [diseases and contaminants that might require/contaminants]. I just want you to be aware that, by agreeing to have these tests done, you will receive the results if they are positive.

Instruction: Answer any questions as thoroughly as possible.

• Press <1> to continue.

CON_C23C

• If DRYRUN in (1,2), go to CON_END.
• Otherwise, go to CON_C24A.

CON_C24A

• If STOREBLD = 2, go to CON_C26.
• Otherwise, go to CON_C24B.

CON_C24B

• If CON_AGE > 13, go to CON_N25.
• Otherwise, go to CON_N24.

CON_N24

Instruction: Record whether a parent or guardian has consented to storage of the respondent's blood and urine for use in future health studies.

• 1 Yes
• 2 No
• (DK, RF not allowed)

Go to CON_END

CON_N25

Instruction: Record whether the respondent has agreed to storage of blood and urine for use in future health studies.

• 1 Yes
• 2 No
• (DK, RF not allowed)

CON_C26

• If CON_AGE < 14 or STOREDNA = 2, go to CON_END.
• Otherwise, go to CON_N26.

CON_N26

Instruction: Record whether the respondent has agreed to storage of DNA for use in future health studies.

• 1 Yes
• 2 No
• (DK, RF not allowed)

CON_END

Report (REP)

REP_BEG

External variables required:

Variables taken from sample file:

• STAND: name of the city/town/village in which the clinic has been set up
• CLINICID: 8 digit respondent identifier
• ERESFLG: Flag indicating if Electronic results is offered to respondents (1 = YES; 2 = NO)

Variables assigned in Variable Creation:

• CurrentYear: numeric year during which clinic visit is taking place
• CurrentMonth: numeric month during which clinic visit is taking place
• CurrentDay: numeric day during which clinic visit is taking place
• SessionE: English text of when the clinic visit is taking place
• MailAddress: mailing address of respondent

Variables from previously completed blocks:

• RespondentFirstName: first name of respondent
• RespondentName: first and last name of respondent
• GenderE: English text for sex of respondent
• CON_AGE: age of respondent
• LNG_N11: respondent's preferred official language
• CON_N15: yes/no indicator of whether a parent or guardian has consented to the respondent participating in the physical measure tests
• CON_N16: yes/no indicator of whether the respondent has consented to participating in the physical measure tests
• CON_N21: yes/no indicator of whether the respondent/parent/guardian has consented to receiving the test results

REP_C11A

• If CON_N15 = 2 or CON_N16 = 2, go to REP_END.
• Otherwise, go to REP_C11B.

REP_C11B

• If CON_N21 = 2, go to REP_C13.
• Otherwise, go to REP_D11.

REP_D11

• If CON_AGE < 14 and CON_SEX = 1, DT_VOSE = "his".
• If CON_AGE < 14 and CON_SEX = 2, DT_VOSE = "her".
• Otherwise, DT_VOSE = "your".

REP_R11
Today, at the end of the clinic visit, you will receive [RespondentFirstName’s/your ] Report of physical measurements containing the results that are immediately available. We will send the final report of [his/her/your ]^DT_VOSE remaining test results in 6 to 7 months.

Instruction: Press <1> to continue.

REP_C13

• If CON_AGE > 13, go to REP_C14.
• Otherwise, go to REP_N13.

REP_N13

Instruction: Record the name of the person who signed the Consent form.

• Enter the person's first and last name.
• (80 spaces)
• (DK, RF not allowed)

REP_C14

• If CON_N21 = 2, go to REP_C21.
• Otherwise, go to REP_C16.

REP_C16

• If ERESFLG=1, go to REP_Q16.
• Otherwise, go to REP_Q20.

Programmer:

• For CHMS cycle 4, the ERESFLG flag will always be set to 2 (electronic results will not be offered).

REP_Q20
We can send you the results by regular mail or by courier. Can we send you the final report by regular mail?

1. Yes (Go to REP_C21)
2. No
   (DK, RF not allowed)

REP_R21
We will send you the final report of test results by courier.

Instruction: Press <1> to continue.

REP_C21

• If no mailing address exists (i.e., the street and city fields are empty), go to REP_B22.
• Otherwise, go to REP_Q21.

REP_Q21
I would like to confirm your mailing address. Is it:
^MailAddress

• 1 Yes
• 2 No
• (DK, RF not allowed)

Programmer:

• If "Yes" is selected, copy the values from the displayed address into the respective REP_B22 address fields and go to REP_END.
• If "No" is selected, copy the values from the displayed address into the respective REP_B22 address fields and allow changes to the displayed address.

REP_B22

• Call the Address block. See Appendix I

Programmer:

• Pass the following parameters:
• DV_QTEXT_E = "What is your mailing address?"
• LISTINGADFLAG = 2 (No)
• NONCANADFLAG = 1 (Yes)

REP_END

Urgent Condition (URG)

URG_BEG

External variables required:

Variables taken from sample file:

• STAND: name of the city/town/village in which the clinic has been set up
• CLINICID: 8 digit respondent identifier
• TelephoneNumber1: First telephone number of the respondent
• TelephoneNumber2: Second telephone number of the respondent
• EMAILADDRESS: E-mail address of respondent or of parent/guardian (if less than 14 years old)

Variables assigned in Variable Creation:

• CurrentYear: numeric year during which clinic visit is taking place
• CurrentMonth: numeric month during which clinic visit is taking place
• CurrentDay: numeric day during which clinic visit is taking place
• SessionE: English text of when the clinic visit is taking place

Variables from previously completed blocks:

• RespondentFirstName: first name of respondent
• RespondentName: first and last name of respondent
• GenderE: English text for sex of respondent
• CON_AGE: age of respondent
• LNG_N11: respondent's preferred official language
• CON_N15: whether a parent or guardian has consented to the respondent participating in the physical measure tests
• CON_N16: whether the respondent has consented to participating in the physical measure tests

URG_C04

• If CON_N15 = 2 or CON_N16 = 2, go to URG_END.
• Otherwise, go to URG_C05.

URG_C05

• If TelephoneNumber1 = EMPTY and TelephoneNumber2 = EMPTY, go to URG_D10.
• Otherwise, go to URG_R06.

URG_R06
I would like to confirm the telephone numbers we have on file.

Instruction: Press <1> to continue.

URG_Q07
Is ^TelephoneNumber1 correct?

• 1 Yes (Go to URG_C08)
• 2 No (DK, RF not allowed)

Programmer:

• If "Yes" is selected, copy the values from the displayed telephone number into the respective URG_B07 phone number fields and go to URG_C08.

URG_B07

• Call the North American Telephone (NATP) block. See Appendix I.

Programmer:

• Pass the following parameters:
• DV_QTEXT_E = "What is the correct phone number?"
• ASKEXT = 2 (No).

URG_C08

• If TelephoneNumber2 = EMPTY, go to URG_D10.
• Otherwise, go to URG_Q09.

URG_Q09
Is ^TelephoneNumber2 correct?

• 1 Yes (Go to URG_C11)
• 2 No
• (DK, RF not allowed)

Programmer:

• If "Yes" is selected, copy the values from the displayed telephone number into the respective URG_B09 phone number fields and go to URG_C11.

URG_B09

• Call the North American Telephone (NATP) block. See Appendix I.

Programmer:

• Pass the following parameters:
• DV_QTEXT_E = "What is the correct phone number?"
• ASKEXT = 2 (No).

URG_C09

• If 1=1, go to URG_C11.
• Otherwise, go to URG_C11.

URG_D10

• If TelephoneNumber1 = EMPTY and TelephoneNumber2 = EMPTY, DT_URG10_TEXTE = "a".
• Otherwise, DT_URG10_TEXTE = "another".

URG_Q10
Is there [a/another] phone number that can be used to reach you?

• 1 Yes
• 2 No (Go to URG_C11)
  DK, RF (Go to URG_C11)

URG_B11
Call the North American Telephone (NATP) block. See Appendix I.

Programmer:

• Pass "What is it?" as parameter.

URG_C11

• If EMAILADDRESS = DK, RF or EMPTY, go to URG_Q11.
• Otherwise, go to URG_B12.

URG_Q11
Can you provide us with an e-mail address?

• 1 Yes
• 2 No (Go to URG_N13)
  DK, RF (Go to URG_N13)

URG_B12

• Call the Electronic Address block (EA)

Programmer:

• SPECRESPNAME = RespondentFirstName
• If CON_SEX = 1 then PROXYSEX = 1.
• If CON_SEX = 2 then PROXYSEX = 2.

URG_N13

Instruction: Is the respondent in a wheelchair?

• 1 Yes
• 2 No
  (DK, RF not allowed)

URG_C14

• If URG_N13 = 1, go to URG_Q14.
• Otherwise, go to URG_D20.

URG_Q14
The laboratories that analyse the urine samples require that these samples are provided without the use of a catheter. For this reason, we need to know if you use a catheter.

Instruction: Record if the respondent is using a catheter.

• 1 Yes
• 2 No
  DK, RF

URG_D20

Content type - Note to data users:

PROXYSEX is the gender of selected respondent and whether the interview is being conducted by proxy. PROXYSEX is set here as follows:

• 1 = male, non-proxy
• 2 = female, non-proxy
• 3 = male, proxy
• 4 = female, proxy

Programmer:

• IF CON_AGE > 11 THEN
  • IF CON_SEX = 1 THEN
    • PROXYSEX = 1
  • ELSE
    • PROXYSEX = 2
  • ENDIF
• ELSE
  • IF CON_SEX = 1 THEN
    • PROXYSEX = 3
  • ELSE
    • PROXYSEX = 4
  • ENDIF
• ENDIF

URG_END

Electronic Address (EA)

EA_BEG
Call block

External variables required:

Variables taken from sample file:

• EMAILADDRESS: specific respondent’s e-mail address (as provided in a previous interview or survey)

Variables from previously completed blocks

• SPECRESPFNAME: first name of selected respondent
• PROXYSEX: gender of selected respondent and whether the interview is being conducted by proxy
  • 1 = male, non-proxy
  • 2 = female, non-proxy
  • 3 = male, proxy
  • 4 = female, proxy

EA_C01

• If EMAILADDRESS = DK, RF or EMPTY, go to EA_Q02.
• Otherwise, go to EA_D01A.

EA_D01A

• Not Applicable

EA_D01B

• Not Applicable

EA_Q01
I would like to confirm your e-mail address.
Is it ^EMAILADDRESS?

Instruction: Read the e-mail address character by character.

1. Yes
2. No
   DK, RF (Go to EA_END)

Programmer:

• Pre-fill the question text with the appropriate respondent name and e-mail address.

EA_D02

Programmer:

• If EA_Q01 = 1, set EA_Q02 = ^EMAILADDRESS

EA_C02

• If EA_Q01 = 1 (Yes), go to EA_END.
• Otherwise, go to EA_Q02.

EA_Q02
What is your e-mail address?

Instruction: Ask about upper and lower case, special characters, etc.

• (80 spaces)
• DK, RF (Go to EA_END)

Help text:

• Email address must follow the format:  name@domain.type

  Name may contain only the following: letters (upper or lower case, no accents), numbers, or ! ' & . - + * $ % ^ _(no blank spaces)

  Domain may contain only:
  (a) sequences of 1-3 numbers with a period (.) between them (e.g. 123.53.233) OR
  (b) sequences of letters (upper or lower case, no accents) or numbers with a period (.) between each sequence; each sequence must contain at least one letter (e.g. statcan.gc)
  Optionally, domain may begin with the character [

  Type may contain only:
  (a) 1-3 numbers OR
  (b) 2-4 letters (e.g. com, org, net, ca)
  Optionally, type may end with the character ]

Programmer:

• Any lower case text characters typed into the field should NOT be converted to upper case text characters after <Enter> is pressed.

EA_Q03
I would like to confirm the e-mail address.
Is it ^EA_Q02?

Instruction: Read the e-mail address character by character.

1. Yes (Go to EA_END)
2. No
   DK, RF (Go to EA_END)

EA_END

Urine Collection 1 Component (UC1)

UC1_BEG

External variables required:

Variables taken from sample file:

• STAND: name of the city/town/village in which the clinic has been set up
• CLINICID: 8 digit respondent identifier

Variables assigned in Variable Creation:

• CurrentYear: numeric year during which clinic visit is taking place
• CurrentMonth: numeric month during which clinic visit is taking place
• CurrentDay: numeric day during which clinic visit is taking place
• SessionE: English text of when the clinic visit is taking place

Variables from previously completed blocks:

• RespondentName: name of respondent
• RespondentFirstName: first name of respondent
• GenderE: English text for sex of respondent
• CON_AGE: age of respondent
• SCS_N12: Visit type (3= clinic visit; 4= home visit)

UC1_D10A

• If CON_AGE < 6, DT_UC110E = "^RespondentFirstName".
• Otherwise, DT_UC110E = "you".

UC1_Q10
Now we would like [^RespondentFirstName/you] to provide a urine sample.

Instruction: Press <1> to continue

• 1 Continue
• (DK is not allowed)
• RF
• Go to UC1_D10B

UC1_D10B

Programmer:

• IF SCS_N12 = 4 THEN
  • UC1_D10B = EMPTY
• ELSE
  • IF (UC1_Q10 = 1 or RF) and UC1_D10B = EMPTY,
    • Set UC1_D10B = Current Time (in HH:MM:SS format)
• ENDIF

UC1_C20A

• If UC1_Q10 = RF, go to UC1_END.
• Otherwise, go to UC1_C20B.

UC1_C20B

• If CON_AGE < 6, go to UC1_R21.
• Otherwise, go to UC1_R20.

UC1_R20
Please use this container to collect the urine sample.

• You will need to remove the lid and place it on the shelf in the washroom with the inside facing up.
• Do not touch the inside of the container.
• Fill the container as full as possible and put the lid back on tightly.
• Once you are finished, please rinse and dry the exterior of the container. Wash your hands, place the container in the paper bag provided and bring it back to me.

Instruction: Demonstrate how to remove the lid using the example container and ensure the respondent understands what is meant by placing the lid on the shelf "with the inside facing up".

• Answer any questions as thoroughly as possible.
• Press <1> to continue.

UC1_C21

• If CON_AGE > 5, go to UC1_C30.
• Otherwise, go to UC1_R21.

UC1_R21
To collect urine samples from young children, we are using a special urine collection device that rests under the toilet seat.

• You will need to lift the toilet seat and install the collection device.
• Ensure it fits snugly in the front of the toilet with the edges resting over the lip of the bowl.
• Lower the toilet seat.

Instruction: Show the example urine collection device to the respondent's parent or guardian and demonstrate which end is the front.

• Instruct the parent or guardian to use the washroom in the reception area (the collection device does not fit the toilet in the second washroom).
• Answer any questions as thoroughly as possible.
• Press <1> to continue.

UC1_R22
To collect the urine, ensure ^RespondentFirstName is sitting on the toilet seat in such a way that the urine stream is collected in the device.

Try to collect as much urine as possible and avoid touching the inside of the collection device.

Instruction: Press <1> to continue.

UC1_R23
Once ^RespondentFirstName no longer requires your assistance:

• Remove the lid of the container and place it on the shelf in the washroom with the inside facing up.
• Over the toilet, pour the urine from the collection device into the container using the 'spout'.
• Fill the container as full as possible and put the lid back on tightly.
• Discard the collection device in the washroom garbage.
• Please rinse and dry the exterior of the container. Wash your hands, place the container in the paper bag provided and bring it back to me.

Instruction: Show the parent or guardian the spout used for pouring the urine.

Demonstrate how to remove the lid and pour the urine using the example container.

Ensure the parent or guardian understands what is meant by placing the lid on the shelf "with the inside facing up".

• Answer any questions as thoroughly as possible.
• Press <1> to continue.

UC1_C30

• If SCS_N12 = 4, go to UC1_N40.
• Otherwise, go to UC1_R30.

UC1_R30
In case you forget any of the collection procedures, there are step by step instructions posted in the washroom.

Instruction: Press <1> to continue.

UC1_N40

Instruction: Record whether the respondent provided a urine sample.

• 1 Yes
• 2 No (Go to UC1_N70)
• (DK, RF not allowed)

UC1_C42

• If SCS_N12 = 4, go to UC1_N42B.
• Otherwise, go to UC1_D42A.

UC1_N42B

Instruction: Enter the urine collection time (Please use a HH:MM format followed by "AM" or "PM").

• (MIN: 1)
• (MAX: 13)
• (DK, RF not allowed)

UC1_D42A

Programmer:

• IF SCS_N12 = 4,
  • Set UC1_D42A = UC1_N42B
• ELSE
  • IF UC1_N40 = 1 and UC1_D42A = EMPTY,
    • Set UC1_D42A = Current Time (in HH:MM:SS format)
• ENDIF

UC1_D42B

Programmer:

• Set UC1_D42B = current date

UC1_Q43
In order to complete an accurate analysis of the sample provided, we would like to know how long ago [^RespondentFirstName/you] urinated prior to providing this sample.

Instruction: Read categories to respondent.

1. Less than 1 hour ago
2. 1 to 2 hours ago
3. More than 2 hours ago
   DK
   (RF is not allowed)

UC1_N50

Instruction: The required urine volume can be found on the urine container label.

Did the respondent provide a urine sample of sufficient volume?

• 1 Yes (Go to UC1_END)
• 2 No (DK, RF not allowed)

UC1_R60
We did not obtain enough urine for the lab to run all the desired tests. I will prepare another urine container so that a second sample can be collected before the end of the clinic visit.

Instruction: Prepare a second urine container using the label stapled to the inside of the respondent's file folder.

• Using a Sharpie, write the number 2 in the upper right hand corner of the label.
• Provide the paper bag containing the second labelled urine container to the respondent.
• Press <1> to continue.
• Go to UC1_END

UC1_N70

Instruction: Record the reason why the respondent did not provide a urine sample.

• 1 Refusal
• 2 Unable to provide
• 3 Other - Specify (Go to UC1_S70)
• (DK, RF not allowed)
• Go to UC1_END

UC1_S70

• (Record the reason why the respondent did not provide a urine sample.)
• Instruction: Specify the reason.
• (80 spaces)
• (DK, RF not allowed)

UC1_END

Screening Component

Screening Component Introduction (SCI)

SCI_BEG

External variables required:

Variables taken from sample file:

• STAND: name of the city/town/village in which the clinic has been set up
• CLINICID: 8 digit respondent identifier

Variables assigned in Variable Creation:

• CurrentYear: numeric year during which clinic visit is taking place
• CurrentMonth: numeric month during which clinic visit is taking place
• CurrentDay: numeric day during which clinic visit is taking place
• SessionE: English text of when the clinic visit is taking place

Variables from previously completed blocks:

• RespondentName: name of respondent
• GenderE: English text for sex of respondent
• CON_AGE: age of respondent
• SCS_N12: Visit Type (3= clinic visit; 4= home visit)

SCI_D1A

• If CON_AGE < 14, DT_SCITEXTE = "Your parent or guardian may need to help you answer some of these questions".
• Otherwise, DT_SCITEXTE = "EMPTY".

SCI_R1
The following questions are asked to ensure that you are given all the tests for which you are eligible. Some questions may have been asked during the home interview, but we need to ensure that our information is up-to-date. We also need to know if any changes have occurred since the home interview.It is important to note that some medications and physical conditions may exclude you from certain tests.

Please answer to the best of your knowledge, as accurate information about you is important. [Your parent or guardian may need to help you answer some of these questions/EMPTY].

Instruction: Press <1> to continue.

SCI_D1B

Programmer:

• IF SCS_N12 = 4 THEN
  • SCI_D1B = EMPTY
• ELSE
  • IF SCI_R1 = 1 and SCI_D1B = EMPTY,
    • Set SCI_D1B = Current Time (in HH:MM:SS format)
• ENDIF

SCI_END

Adherence to Guidelines (ATG)

ATG_BEG

External variables required:

Variables taken from sample file:

• STAND: name of the city/town/village in which the clinic has been set up
• CLINICID: 8 digit respondent identifier
• SELFAST: whether selected to fast for 12 hours (1=fasting, 2=non-fasting)

Variables assigned in Variable Creation:

• CurrentYear: numeric year during which clinic visit is taking place
• CurrentMonth: numeric month during which clinic visit is taking place
• CurrentDay: numeric day during which clinic visit is taking place
• SessionE: English text of when the clinic visit is taking place

Variables from previously completed blocks:

• RespondentName: name of respondent
• GenderE: English text for sex of respondent
• CON_AGE: age of respondent
• SCS_N12: visit type (3= clinic visit; 4= home visit)

ATG_R11
At the time of the home interview, you were given a set of pre-testing guidelines. We will now review those guidelines.

Instruction: Press <1> to continue.

ATG_Q11
When did you last eat or drink anything other than water (e.g., coffee, tea, alcohol, juice or flavoured water)?

Instruction: Probe to determine what and how much the respondent ate or drank.

Enter the time (followed by "AM" or "PM") at which the respondent last ate or drank something that does not meet the phlebotomy fasting requirements.

• (MIN: 1.00)
• (MAX: 12.59)
• (DK, RF not allowed)

Help text: The respondent is still considered fasted if the following have been consumed within the indicated time-frame:

• Black coffee - up until the time of the appointment
• Coffee with milk/cream - up to 2 hours prior to the appointment
• Juice - up to 2 hours prior to the appointment
• Gum and candy are allowed - up until the time of the appointment

The respondent is not considered fasted if the following have been consumed within the past 10 hours.

• Liquids other than those indicated above, including
  • Milkshakes
  • Protein shakes
  • Meal replacements
  • Milk
  • Energy drinks
  • Any other beverages or supplements
• Any food

ATG_N11

Instruction: Confirm the date.

• 1 Yesterday
• 2 Today
• (DK, RF not allowed)

ATG_D11

• If ATG_N11 = 1, DT_ATGN11E = "yesterday".
• ELSE, DT_ATGN11E = "today".

ATG_C11

• If SCS_N12 = 3, go to ATG_D12.
• Otherwise, go to ATG_N12.

ATG_N12

Instruction: Enter the time (followed by "AM" or "PM") the fasting question (ATG_Q11) was asked to the respondent.

• (MIN: 1.00)
• (MAX: 12.59)
• (DK, RF not allowed)

ATG_D12

Content type - Note to data users:

• Fasting status (10 hr) is determined based on the fasting flag (SELFAST) and the responses to ATG_Q11 and ATG_N11 (if clinic visit) along with ATG_N12 (if home visit). ATG_D12=1 (fasted) and ATG_D12=2 (not fasted).

Programmer:

• IF SCS_N12 = 3 THEN
• IF SELFAST = 2 THEN
  • ATG_D12 = 2
• ELSE
  • IF ATG_N11 = 1 and the difference between CurrentDate-1/ATG_Q11 and CurrentDate/CurrentTime is 10 hours or more OR
    • ATG_N11 = 2 and difference between CurrentDate/ATG_Q11 and CurrentDate/CurrentTime is 10 hours or more THEN
    • ATG_D12 = 1
• ELSE
  • ATG_D12 = 2
• ENDIF
• ENDIF
• ELSE
  • IF SCS_N12 = 4 THEN
  • IF SELFAST = 2 THEN
    • ATG_D12 = 2
• ELSE
  • IF ATG_N11 = 1 and the difference between CurrentDate-1/ATG_Q11 and CurrentDate/ATG_N12 is 10 hours or more OR
    • ATG_N11 = 2 and difference between CurrentDate/ATG_Q11 and CurrentDate/ATG_N12 is 10 hours or more THEN
    • ATG_D12 = 1
• ELSE
  • ATG_D12 = 2
• ENDIF
• ENDIF
• ENDIF

ATG_C14A

• If CON_AGE < 6, go to ATG_Q41.
• Otherwise, go to ATG_C21.

ATG_C21

• If CON_AGE < 12, go to ATG_Q22.
• Otherwise, go to ATG_Q21.

ATG_Q21
Have you smoked cigarettes or used other tobacco or nicotine products during the past 2 hours?

• 1 Yes
• 2 No
• (DK, RF not allowed)

ATG_Q22
Have you consumed any caffeinated products (e.g., coffee, pop, energy drinks, tea or chocolate) during the past 2 hours?

• 1 Yes
• 2 No
• (DK, RF not allowed)

ATG_C31

• If CON_AGE < 12, go to ATG_Q41.
• Otherwise, go to ATG_Q31.

ATG_Q31
Have you consumed any alcohol during the past 6 hours?

• 1 Yes
• 2 No
• (DK, RF not allowed)

ATG_Q41
Have you exercised today for at least ten minutes at a time (e.g., running, moderate or vigorous walking, swimming, weight training)?

• 1 Yes
• 2 No (Go to ATG_Q50)
• (DK, RF not allowed)

ATG_Q43
How long has it been since you last exercised?

• 1 1 to less than 30 minutes ago
• 2 30 minutes to less than 1 hour ago
• 3 1 hour to less than 2 hours ago
• 4 More than 2 hours ago
• (DK, RF not allowed)

ATG_Q50
Have you listened to loud music today?

Instruction: Loud music is defined as:

A) A volume above 50% of the maximum volume level for a given audio device; or

B) Volume levels that prevent you from understanding someone speaking in a normal voice an arm's length away.

• 1 Yes
• 2 No
• (DK, RF not allowed)

ATG_Q51
In the past 24 hours, have you been exposed to loud noise without hearing protection? Examples of loud noise include power tools, farm machinery, guns, motorcycle riding at highway speed or any activity where you had to speak in a raised voice to be heard or communicate.

Instruction: A raised voice is defined as volume of speech between a normal voice and shouting.

• 1 Yes
• 2 No
• (DK, RF not allowed)

ATG_END

Physical and Health Conditions (PHC)

PHC_BEG

External variables required:

Variables taken from sample file:

• STAND: name of the city/town/village in which the clinic has been set up
• CLINICID: 8 digit respondent identifier
• PHCFLAG: whether or not the menstrual period questions need to be asked

Variables assigned in Variable Creation:

• CurrentYear: numeric year during which clinic visit is taking place
• CurrentMonth: numeric month during which clinic visit is taking place
• CurrentDay: numeric day during which clinic visit is taking place
• SessionE: English text of when the clinic visit is taking place
• Date2MonthsAgoE: the date two months ago in English
• TwoMonthsAgoDay: the day of the date two months ago
• TwoMonthsAgoMonth: the month of the date two months ago
• TwoMonthsAgoYear: the year of the date two months ago

Variables from previously completed blocks:

• RespondentName: name of respondent
• GenderE: English text for sex of respondent
• CON_SEX: sex of respondent
• CON_AGE: age of respondent

PHC_R11
I am now going to ask you about your current health and physical condition.

Instruction: Press <1> to continue.

PHC_C11A

• If CON_SEX = 1, go to PHC_Q41.
• Otherwise, go to PHC_C11B.

PHC_C11B

• If CON_AGE < 14 or > 59, go to PHC_C13A.
• Otherwise, go to PHC_Q11.

PHC_Q11
Are you currently pregnant?

• 1 Yes (Go to PHC_Q12)
• 2 No
• DK
• (RF is not allowed)

Go to PHC_C13A

PHC_Q12
In what week are you?

• Week
• (MIN: 1)
• (MAX: 45)
• DK, RF

PHC_C13A

• If PHCFLAG = 2, go to PHC_Q41.
• Otherwise, go to PHC_C13B.

Content type - Note to data users:

• For cycle 4 PHCFLAG will always be set to 1 (menstrual cycle questions will be asked).

PHC_C13B

• If (PHC_Q11 = 2 or DK and CON_AGE = 14 to 59) or CON_AGE = 12 or 13, go to PHC_Q13.
• Otherwise, go to PHC_Q41.

PHC_Q13
Have you had a menstrual period in the past 6 months?

• 1 Yes (Go to PHC_Q14)
• 2 No
• DK, RF

Go to PHC_Q41

PHC_Q14
Is your menstrual cycle regular? Here, "regular" is defined as having a menstrual period every 20 to 36 days.

• 1 Yes (Go to PHC_Q15)
• 2 No
• DK, RF

Go to PHC_Q41

PHC_Q15
What is the length of your typical menstrual cycle, that is, from day 1 of the last menstrual period to day 1 of the next?

Instruction: A menstrual cycle represents the number of days between two menstruations. Record the duration of the respondent's typical menstrual cycle in days.

• Days
• (MIN: 1)
• (MAX: 97)
• DK, RF

PHC_B16

• Call the Date block. See Appendix I

Content type - Note to data users:

• Hard edits are in place to ensure that data is not recorded if the respondent does not have regular menstrual periods (20-26 days) or has not had a menstrual period in the past 6 months.

Programmer:

• Pass "When was the first day of your last menstrual period? Instruction: If the respondent is unable to indicate the first day of her last menstrual period but is able to estimate the week in which her last menstrual period occurred, then choose the date as being the Monday of that week." as parameter.

PHC_Q41
Do you have any acute conditions, for example a sprained wrist, flu or other infection? An acute condition develops suddenly and is short-term.

• 1 Yes
• 2 No (Go to PHC_Q43)
• (DK, RF not allowed)

PHC_N41

Instruction: What type(s) of acute condition(s) does the respondent have?

Mark all that apply.

• 1 Bone, joint or muscle problem
• 2 Flu or other infection
• 3 Medical procedure (recovery)
• 4 Other health problem
• 6 Fever
• (DK, RF not allowed)

Go to PHC_N42

PHC_N42

Instruction: From which test(s) should the respondent be excluded because of this condition?

Probe to determine the seriousness of the condition.

Mark all that apply.

• 05 Activity monitor
• 06 Spirometry
• 08 Grip strength
• 12 None
• 14 Hearing
• 15 Skin Pigmentation
• (DK, RF not allowed)

PHC_Q43
Do you have a chronic condition, for example arthritis, heart condition, multiple sclerosis, or colostomy bag that may prevent you from participating in any of the tests today? A chronic condition develops slowly and is long lasting.

Instruction: Show the laminated card with pictures of each test to the respondent.

• 1 Yes
• 2 No (Go to PHC_Q51)
• (DK, RF not allowed)

PHC_N43

Instruction: What type(s) of chronic condition(s) does the respondent have?

Mark all that apply.

1. Bone, joint or muscle problem
2. Cardiovascular condition
3. Respiratory condition
4. Physically impaired
5. Other health problem
6. (DK, RF not allowed)

PHC_N44

Instruction: From which test(s) should the respondent be excluded because of this condition?

Probe to determine the seriousness of the condition.

Mark all that apply.

• 05 Activity monitor
• 06 Spirometry
• 08 Grip strength
• 12 None
• 14 Hearing
• 15 Skin Pigmentation
• (DK, RF not allowed)

PHC_Q51
Do you have a clotting condition such as haemophilia or von Willebrand disease?

• 1 Yes
• 2 No
• (DK, RF not allowed)

PHC_Q52
Have you received chemotherapy in the past four weeks?

• 1 Yes
• 2 No
• (DK, RF not allowed)

PHC_Q53
In the past 2 months, that is, from ^Date2MonthsAgoE to today, did you receive a blood transfusion?

• 1 Yes
• 2 No
• DK, RF

PHC_Q54
In the past 2 months, did you donate blood?

• 1 Yes
• 2 No (Go to PHC_Q56)
• DK, RF (Go to PHC_Q56)

Go to PHC_B55

PHC_B55

• Call the Date block. See Appendix I

Programmer:

• Pass "What was the date when you last donated blood?" as parameter.

PHC_Q56
Have you ever felt dizzy or fainted during a blood draw?

• 1 Yes
• 2 No
• (DK, RF not allowed)

PHC_C57

• If CON_AGE < 19, go to PHC_C57B.
• Otherwise, go to PHC_Q57A.

PHC_Q57A
Have you ever had a mastectomy?

Instruction: A mastectomy involves removal of the breast tissue, the underlying muscle tissue, and lymph nodes of the underarm.

1. Yes
2. No (Go to PHC_Q58)
   (DK, RF not allowed)

PHC_Q57B
On which side?

1. Right
2. Left
3. Both
   (DK, RF not allowed)

PHC_C57B

• If CON_AGE < 6, go to PHC_END.
• Otherwise, go to PHC_Q58.

PHC_Q58
Is your doctor currently prescribing drugs (for example, water pills) for your blood pressure or a heart condition?

1. Yes
2. No (Go to PHC_END)
   (DK, RF not allowed)

PHC_Q59
For which condition(s) are you taking the drugs?

Instruction: Mark all that apply.

• 01 High blood pressure
• 02 Low blood pressure
• 03 Angina
• 04 Previous heart attack
• 05 Aneurysm
• 06 Arrhythmia
• 07 Other heart condition
• 08 Other medical condition
• DK, RF

PHC_C59

• If PHC_Q59 in (7, 8), go to PHC_S59.
• Otherwise, go to PHC_END.

PHC_S59
Instruction: Specify.

• (80 spaces)
• (DK, RF not allowed)

PHC_END

Hearing Restriction (HER)

HER_BEG

External variables required:

Variables taken from sample file:

• STAND: name of the city/town/village in which the clinic has been set up
• CLINICID: 8 digit respondent identifier

Variables assigned in Variable Creation:

• CurrentYear: numeric year during which clinic visit is taking place
• CurrentMonth: numeric month during which clinic visit is taking place
• CurrentDay: numeric day during which clinic visit is taking place
• SessionE: English text of when the clinic visit is taking place

Variables from previously completed blocks:

• RespondentName: name of respondent
• GenderE: English text for sex of respondent
• CON_AGE: age of respondent

HER_R10
The next set of questions concern your hearing health.

Instruction: Press <1> to continue.

HER_Q10
When was the last time you had your hearing tested?

Instruction: A hearing test is conducted to evaluate a person's ability to hear different frequencies of sound, from very high (for example, the highest note on a piano) to very low (for example, the call of an owl). The subject of a hearing test is asked to wear headphones or earphones and then listens to different sounds played in random order. The subject is asked to raise his or her hand or press a button when a sound is played. Depending on surrounding noise levels, a hearing test can be performed in a soundproof booth or in a quiet room.

Read categories to respondent.

1. Less than a year ago
2. 1 to less than 5 years ago
3. 5 to less than 10 years ago
4. 10 or more years ago
5. Never (Go to HER_Q30)
   DK, RF

HER_Q20
Has a health professional ever diagnosed you with a hearing problem?

• 1 Yes
• 2 No
• DK, RF

HER_Q30
Have you had any surgery performed on the inside of your ear in the past three months?

• 1 Yes
• 2 No (Go to HER_Q40)
• (DK, RF not allowed)

HER_Q31
On which ear(s)?

• 1 Right
• 2 Left
• 3 Both
• (DK, RF not allowed)

HER_Q40
Do you currently have an ear infection or pain in your ear(s)?

• 1 Yes
• 2 No (Go to HER_Q50)
• (DK, RF not allowed)

HER_Q41
In which ear(s)?

• 1 Right
• 2 Left
• 3 Both
• (DK, RF not allowed)

HER_Q50
Do you have a cochlear implant?

Instruction: A cochlear implant (bionic ear) is a small, electronic device that is surgically placed (implanted) within the inner ear to help to provide a sense of sound to a person who is profoundly deaf or severely hard-of-hearing.

• 1 Yes
• 2 No (Go to HER_D52)
• (DK, RF not allowed)

HER_Q51
In which ear(s)?

• 1 Right
• 2 Left
• 3 Both
• (DK, RF not allowed)

HER_C52

• If HER_Q51 = 3, go to HER_END.
• Otherwise, go to HER_D52.

HER_D52

• If HER_Q51 = 1, DT_HER52TEXTE = "Do you have a hearing aid for your left ear?".
• If HER_Q51 = 2, DT_HER52TEXTE = "Do you have a hearing aid for your right ear?".
• Otherwise, DT_HER52TEXTE = "Do you have a hearing aid?".

HER_Q52
[Do you have a hearing aid for your left ear?/Do you have a hearing aid for your right ear?/Do you have a hearing aid?]

• 1 Yes
• 2 No (Go to HER_D54)
• (DK, RF not allowed)

HER_C53

• If HER_Q50 = 2, go to HER_Q53.
• Otherwise, go to HER_D54.

HER_Q53
In which ear(s)?

1. Right
2. Left
3. Both
   (DK, RF not allowed)

HER_D54

Programmer:

• IF HER_Q53 = 1,
  • HER_D54 = 1
  • ELSE IF HER_Q53 = 2
    • HER_D54 = 2
  • ELSE IF HER_Q53 = 3
    • HER_D54 = 3
  • ELSE IF (HER_Q51 = 1 AND HER_Q52 = 1)
    • HER_D54 = 2
  • ELSE IF (HER_Q51 = 2 AND HER_Q52 = 1)
    • HER_D54 = 1
• ENDIF

HER_END

Spirometry Questions (SPQ)

SPQ_BEG

External variables required:

Variables taken from sample file:

• STAND: name of the city/town/village in which the clinic has been set up
• CLINICID: 8 digit respondent identifier

Variables assigned in Variable Creation:

• CurrentYear: numeric year during which clinic visit is taking place
• CurrentMonth: numeric month during which clinic visit is taking place
• CurrentDay: numeric day during which clinic visit is taking place
• SessionE: English text of when the clinic visit is taking place

Variables from previously completed blocks:

• RespondentFirstName: first name of respondent
• RespondentName: name of respondent
• GenderE: English text for sex of respondent
• CON_SEX: sex of respondent
• CON_AGE: age of respondent

SPQ_C01

• If CON_AGE < 6, go to SPQ_END.
• Otherwise, go to SPQ_C11.

SPQ_C11

• If CON_AGE > 12, go to SPQ_R21.
• Otherwise, go to SPQ_R11.

SPQ_R11
The next set of questions is related to the health of ^RespondentFirstName's lungs.

Instruction: Ask the questions of the parent or guardian of the respondent.

• Press <1> to continue.

SPQ_Q11
Has your child ever had wheezing or whistling in the chest at any time in the past?

• 1 Yes
• 2 No (Go to SPQ_Q16)
• (DK, RF not allowed)

SPQ_Q12
Has your child had wheezing or whistling in the chest in the last 12 months?

• 1 Yes
• 2 No (Go to SPQ_Q16)
• (DK, RF not allowed)

SPQ_Q13
How many attacks of wheezing has your child had in the last 12 months?

Instruction: Read categories to the parent or guardian of the respondent.

1. 1 to 3 attacks
2. 4 to 12 attacks
3. More than 12 attacks
   (DK, RF not allowed)

SPQ_Q14
In the last 12 months, how often, on average, has your child's sleep been disturbed due to wheezing?

Instruction: Read categories to the parent or guardian of the respondent.

1. Never woken with wheezing
2. Less than one night per week
3. One or more nights per week
   (DK, RF not allowed)

SPQ_Q15
In the last 12 months, has wheezing ever been severe enough to limit your child's speech to only one or two words at a time between breaths?

• 1 Yes
• 2 No
• (DK, RF not allowed)

SPQ_Q16
In the last 12 months, has your child's chest sounded wheezy during or after exercise?

• 1 Yes
• 2 No
• (DK, RF not allowed)

SPQ_Q17
In the last 12 months, has your child had a dry cough at night, apart from a cough associated with a cold or a chest infection?

• 1 Yes
• 2 No
• (DK, RF not allowed)

Go to SPQ_END

SPQ_R21
The next set of questions is related to the health of your lungs.

Instruction: Press <1> to continue.

SPQ_Q21
Do you cough regularly?

• 1 Yes
• 2 No
• (DK, RF not allowed)

SPQ_Q22
Do you cough up phlegm regularly?

• 1 Yes
• 2 No
• (DK, RF not allowed)

SPQ_Q23
Do even simple chores make you short of breath?

• 1 Yes
• 2 No
• (DK, RF not allowed)

SPQ_Q24
Do you wheeze when you exert yourself, or at night?

• 1 Yes
• 2 No
• (DK, RF not allowed)

SPQ_Q25
Do you get frequent colds that persist longer than those of other people you know?

Instruction: Select "yes" only if respondent meets both conditions (i.e., colds are both frequent and persist longer than those of other people).

• 1 Yes
• 2 No
• (DK, RF not allowed)

SPQ_END

Spirometry Restriction (SPR)

SPR_BEG

External variables required:

Variables taken from sample file:

• STAND: name of the city/town/village in which the clinic has been set up
• CLINICID: 8 digit respondent identifier

Variables assigned in Variable Creation:

• CurrentYear: numeric year during which clinic visit is taking place
• CurrentMonth: numeric month during which clinic visit is taking place
• CurrentDay: numeric day during which clinic visit is taking place
• SessionE: English text of when the clinic visit is taking place

Variables from previously completed blocks:

• RespondentName: name of respondent
• GenderE: English text for sex of respondent
• CON_AGE: age of respondent

SPR_C11A

• If CON_AGE < 6, go to SPR_END.
• Otherwise, go to SPR_C11B.

SPR_C11B

• If PHC_Q11 = 1 and PHC_Q12 = RESPONSE and PHC_Q12 > 27, go to SPR_END.
• Otherwise, go to SPR_C11C.

SPR_C11C

• If PHC_N42 = 6, go to SPR_END.
• Otherwise, go to SPR_C11D.

SPR_C11D

• If PHC_N44 = 6, go to SPR_END.
• Otherwise, go to SPR_R11.

SPR_R11
I also need to ask a few health related questions to make sure you are able to do the lung function test today.

Instruction: Press <1> to continue.

SPR_Q11
Have you had a heart attack within the past 3 months?

• 1 Yes (Go to SPR_END)
• 2 No
• (DK, RF not allowed)

SPR_Q12
Have you had major surgery on your chest or abdomen in the past 3 months?

• 1 Yes (Go to SPR_END)
• 2 No
• (DK, RF not allowed)

SPR_Q13
Have you had eye surgery in the past 6 weeks?

• 1 Yes (Go to SPR_END)
• 2 No
• (DK, RF not allowed)

SPR_END

Medications and Product Confirmation (MEDC)

Overview: Up to 45 medications (both prescription and non prescription) entered at the household interview will be confirmed at the clinic in MEDC.

MEDC_BEG

External fields required:

Variables taken from sample file:

• STAND: name of the city/town/village in which the clinic has been set up
• CLINICID: 8 digit respondent identifier
• MEU_B11[i].DV_PIN: Product Identification Number (DIN, DIN-HM, NPN or EN) of the ith prescription medication from the household interview, i = 1 to 45.
• MEU_B11[i].DV_Product_name: Name of the ith prescription medication from the household interview, i = 1 to 45.
• MEU_B11[i].DV_Short_form: Code for the form of ith prescription medication from the household interview, i = 1 to 45 (used to derive dynamic text for take/use).
• 01 = Tablet/pill/capsule
• 02 = Lozenge
• 03 = Chew/gummy
• 04 = Globule
• 05 = Drop
• 06 = Tincture
• 07 = Liquid/solution
• 08 = Suspension
• 09 = Cream/ointment/gel/lotion
• 10 = Packet/sachet
• 11 = Powder
• 12 = Granule
• 13 = Spray/aerosol
• 14 = Patch
• 15 = Kit
• 16 = Suppository
• 50 = Other
• MEU_B11[i].NPI_N05: Indicator of whether there is an ith prescription medication from the household interview, i = 1 to 45.
• If MEU_B11[i].NPI_N05 = 1 or 2, there is an ith prescription medication. Otherwise, there are no more prescription medications
• MEU_B25[j].DV_PIN: Product Identification Number (DIN, DIN-HM, NPN or EN) of the jth over-the-counter or other health product from the household interview, j = 1 to 45.
• MEU_B25[j].DV_Product_name: Name of the jth over-the-counter or health product from the household interview, j = 1 to 45.
• MEU_B25[j].DV_Short_form: Code for the form of the jth over-the-counter or health product from the household interview, j = 1 to 45 (used to derive dynamic text for take/use).
• 01 = Tablet/pill/capsule
• 02 = Lozenge
• 03 = Chew/gummy
• 04 = Globule
• 05 = Drop
• 06 = Tincture
• 07 = Liquid/solution
• 08 = Suspension
• 09 = Cream/ointment/gel/lotion
• 10 = Packet/sachet
• 11 = Powder
• 12 = Granule
• 13 = Spray/aerosol
• 14 = Patch
• 15 = Kit
• 16 = Suppository
• 50 = Other
• MEU_B25[j].NPI_N05: Indicator of whether there is a jth over-the-counter or other health product from the household interview, j = 1 to 45. If MEU_B25[j].NPI_N05 = 1 or 2, there is a jth over-the-counter or other health product. Otherwise, there are no more over-the-counter or other health products

Variables assigned in Variable Creation:

• CurrentYear: numeric year during which clinic visit is taking place
• CurrentMonth: numeric month during which clinic visit is taking place
• CurrentDay: numeric day during which clinic visit is taking place
• SessionE: English text of when the clinic visit is taking place

Variables from previously completed blocks:

• RespondentName: name of respondent
• GenderE: English text for sex of respondent
• CON_AGE: age of respondent
• CON_SEX: sex of respondent
• ProxySex: gender of selected respondent and whether the interview is being conducted by proxy

MEDC_C100A

• If MEU_B11[1].NPI_N05 = 1 or 2 or MEU_B25[1].NPI_N05 = 1 or 2 , go to MEDC_D100A.
• Otherwise, go to MEDC_B300.MEDC_D100ANot Applicable

MEDC_R100
Now I'd like to confirm your use of prescription and over-the-counter medications and other health products, including natural health products.

Instruction: Press <1> to continue.

MEDC_C100B

• If MEU_B11[n].NPI_N05 = 1 or 2, go to MEDC_C100C.
• Otherwise, go to MEDC_C200A.

MEDC_C100C

• If MEU_B11[n].DV_Product_Name = RESPONSE, go to MEDC_D100B.
• Otherwise, go to MEDC_C100B.

MEDC_D100B

Programmer:

• If MEU_B11[n].DV_Short_form = 9, 13,14, 15 or 16 THEN set
  • DT_TAKE1E = "used"
  • DT_TAKE2E = "using"
• ELSE
  • DT_TAKE1E = "took"
  • DT_TAKE2E = "taking"
• ENDIF

MEDC_B101

• Call the Confirm Drug Product (CDP) block

Programmer:

• Pass "DT_QuestionE = During the interview in your home, it was reported that you were ^DT_TAKE2E ^DV_PRODUCT_NAME. When was the last time that you ^DT_TAKE1E this medication?" as parameter for the 1st product and every other multiple of 5.
• Pass "DT_QuestionE = When was the last time that you ^DT_TAKE1E ^DV_PRODUCT_NAME?" as parameter for all other products.

MEDC_C200A

• If MEU_B25[n].NPI_N05 = 1 or 2, go to MEDC_C200B.
• Otherwise, go to MEDC_B300.

MEDC_C200B

• If MEU_B25[n].DV_PRODUCT_NAME = RESPONSE, go to MEDC_D200.
• Otherwise, go to MEDC_C200A.

MEDC_D200

Programmer:

• If MEU_B25[n].DV_Short_form = 9, 13,14, 15 or 16 THEN set
  • DT_TAKE1E = "used"
  • DT_TAKE2E = "using"
• ELSE
  • DT_TAKE1E = "took"
  • DT_TAKE2E = "taking"
• ENDIF

MEDC_B201

• Call the Confirm Drug Product (CDP) block

Programmer:

• Pass "DT_QuestionE = During the interview in your home, it was reported that you were ^DT_TAKE2E ^DV_Product_name. When was the last time that you ^DT_TAKE1E this product? " as parameter for the 1st product and every other multiple of 5.
• Pass "DT_QuestionE = When was the last time that you ^DT_TAKE1E ^DV_Product_name? " as parameter for all other products.

MEDC_B300

• Call the Medication Use for clinic (MEUC) block

MEDC_C411A

• If CON_AGE < 6, go to MEDC_END.
• Otherwise, go to MEDC_C411B.

MEDC_C411B

• If CON_AGE < 14, go to MEDC_C511.
• Otherwise, go to MEDC_R411.

MEDC_R411
Now I am going to ask you a question about your use of other substances such as performance enhancing or recreational drugs. We ask this question because these drugs can affect the results of the physical and biological measures that we will be taking today. You can be assured that anything you say will remain confidential and that your answer will not screen you out of any tests.

Instruction: Press <1> to continue.

MEDC_Q411
In the past week have you used any performance enhancing or recreational drugs such as steroids, marijuana or cocaine?

• 1 Yes
• 2 No
• DK, RF

MEDC_C511

• If MEU_B11[1].NPI_N05 = (EMPTY) and
• MEDC_B300. MEUC_Q02 <> 1 and
• MEU_B25[1].NPI_N05 = (EMPTY) and
• MEDC_B300.MEUC_Q22 <> 1, go to MEDC_END.
• Otherwise, go to MEDC_N611.

MEDC_N611

Instruction: From which tests should the respondent be excluded because of medication use?

• 1 Spirometry
• 6 None
• (DK, RF not allowed)

Programmer:

• Display a list of the confirmed and new prescription drugs immediately below the question header.
• If any drugs are to be displayed, include a title as follows:
• Medications currently being taken

MEDC_END

Confirm Drug Product (CDP)

CDP_BEG

External variables required:

• Proxysex
• DT_QuestionE: English question text
• DT_TAKE1E: English text for "used/took"
• DV_Product_name: Name of product
• DV_PIN: Product Identification Number (DIN, DIN-HM, NPN or EN) from NPI block

CDP_Q1
^DT_QUESTIONE
(The response categories are today, yesterday, within the last week, within the last month or more than one month ago.)

1. Today
2. Yesterday
3. Within the last week
4. Within the last month
5. More than one month ago
6. Never ^DT_TAKE1E the product
7. DK, RF

CDP_END

Medication use for Clinic (MEUC)

MEUC_BEG

External variables required:

Variables from previously completed blocks:

• PROXYSEX: gender of selected respondent and whether the interview is being conducted by proxy
• CON_SEX: sex of respondent
• CON_AGE : age of respondent
• RespondentFirstname: first name of respondent
• DV_PIN: Product Identification Number (DIN, DIN-HM, NPN or EN) from NPI block

Content type - Note to data users:

• Information on up to 15 new prescription, over-the-counter and other health products, taken or used in the past month is collected in MEUC. First, information (collected in the NPI block) on prescription medications is captured, followed by over-the-counter and other health products. Look-up databases are used to identify the products. Products containing ingredients of particular interest have been pre-flagged on these databases (FollowUpFlag = 1). For these products, additional questions are administered to collect information on the quantity and frequency of use. If more that 15 new medications have been taken during the past month, then the respondent is asked to state the number of additional medications he/she takes.

Programmer:

• Set DT_DateLastMonthE = English text of date one month ago.

MEUC_D02A

• If any of MEDC_B101[n].CDP_Q1 = 1, 2, 3, 4 or 5, DT_OTHER1 = "other ".
• Otherwise, DT_OTHER1 = "EMPTY".

MEUC_D02B

• If CON_SEX = 1 and CON_AGE > 13, DT_MEUTEXT2E = "antibiotics and nicotine patches".
• Otherwise, if CON_SEX = 2 and CON_AGE > 13, DT_MEUTEXT2E = "antibiotics, nicotine patches and birth control pills, patches or injections".
• Otherwise, DT_MEUTEXT2E = "antibiotics and asthma medication".

MEUC_Q02
In the past month, that is, from ^DT_DATELASTMONTHE to today, have you taken or used any [other /EMPTY]medications that have been prescribed or administered by a health professional such as a doctor or dentist? This includes such things as insulin, [antibiotics and nicotine patches/antibiotics, nicotine patches and birth control pills, patches or injections/antibiotics and asthma medication].

Instruction: This question applies only to medications taken or used within the past month. Medications that have been prescribed but not taken or used within this period of time (e.g., Epi-pen) should not be captured.

• 1 Yes
• 2 No (Go to MEUC_Q22)
• DK, RF (Go to MEUC_Q22)

MEUC_B11

• Call the New product information (NPI) block

Content type - Note to data users:

• The NPI block is called once for each prescription medication, up to a maximum of 15 times.

MEUC_C11

• If the number of products captured is less than 15, go to MEUC_N11.
• Otherwise, go to MEUC_Q15.

MEUC_N11

Instruction: Do you have another prescription medication to capture?

• 1 Yes (Go to MEUC_B11)
• 2 No
• (DK is not allowed)
• RF (Go to MEUC_Q22)

MEUC_Q12
Have you taken or used any other prescription medications in the past month? Please include any prescription creams, injections or patches.

• 1 Yes (Go to MEUC_B11)
• 2 No
• DK, RF

Go to MEUC_Q22

Content type - Note to data users:

• MEUC_Q15 to MEUC_Q21 are asked only if more than 15 additional prescription medications have been taken or used in the past month.

MEUC_Q15
How many other prescription medications have you taken or used in the past month? Please include any prescription creams, injections or patches.

• (MIN: 0)
• (MAX: 95)
• DK, RF

MEUC_D19

• If any of MEDC_B201[n].CDP_Q1 = 1, 2, 3, 4, or 5 , DT_OTHER2 = "other".
• Otherwise, DT_OTHER2 = "EMPTY".

MEUC_Q20
Have you taken or used any [other/EMPTY]over-the-counter medications or other health products, including natural health products in the past month?

Over-the-counter medications could include such things as pain killers, antacids, allergy pills and hydrocortisone creams. Examples of health products include vitamins, minerals, amino acids, probiotics, fish oils and other oils, herbal remedies and homeopathic preparations.

Instruction: This question applies only to products taken or used within the past month. Products that have not been taken or used within this period of time should not be captured.

• 1 Yes (Go to MEUC_Q21)
• 2 No
• DK, RF

Go to MEUC_END

MEUC_Q21
How many [other/EMPTY]over-the-counter medications or other health products have you taken or used in the past month?

• (MIN: 1)
• (MAX: 95)
• DK, RF

Go to MEUC_END

MEUC_Q22
Have you taken or used any [other/EMPTY] over-the-counter medications or other health products, including natural health products, in the past month, that is, from ^DT_DATELASTMONTHE to today.

Over-the-counter medications could include such things as pain killers, antacids, allergy pills and hydrocortisone creams. Examples of health products include vitamins, minerals, amino acids, probiotics, fish oils and other oils, herbal remedies and homeopathic preparations.

Instruction: Has the respondent taken or used any over-the-counter medications or other health products in the past month?

This question applies only to products taken or used within the past month. Products that have not been taken or used within this period of time should not be captured.

• 1 Yes
• 2 No (Go to MEUC_END)
• DK, RF (Go to MEUC_END)

MEUC_B25

• Call the New Drug Product (NPI) block

Content type - Note to data users:

• The NPI block is called once for each over-the-counter medication or other health product, up to a maximum of 15 products in total (including prescription medications).

MEUC_C26

• If the number of products (combined) captured is less than 15, go to MEUC_N26.
• Otherwise, go to MEUC_Q29.

MEUC_N26

Instruction: Do you have another over-the-counter medication or health product to capture?

• 1 Yes (Go to MEUC_B25)
• 2 No
• (DK is not allowed)
• RF (Go to MEUC_END)

MEUC_Q27
Have you taken or used any other over-the-counter medications or health products in the past month? Please include any solutions, powders, creams or pastes.

• 1 Yes (Go to MEUC_B25)
• 2 No
• DK, RF

Go to MEUC_END

Content type - Note to data users:

• MEUC_Q29 is asked only if more than 15 additional products in total, including prescription medications, over-the-counter medications and other health products, have been taken or used in the past month.

MEUC_Q29
How many other over-the-counter medications or health products have you taken or used in the past month? Please include any solutions, powders, creams or pastes.

• (MIN: 0)
• (MAX: 95)
• DK, RF

MEUC_END

New Product Information (NPI)

NPI_BEG

External variables required:

• MEUC_Q22: whether respondent taken or used any over-the-counter medications or health products
• ProxySex: gender of selected respondent and whether the interview is being conducted by proxy
• FollowUpFlag: 0 or 1
• CON_AGE: age of respondent

NPI_N05

Instruction: Is a product identification number available for the product (e.g., DIN, DIN-HM, NPN, EN)?

• 1 Yes
• 2 No (Go to NPI_N15)
• (DK, RF not allowed)

NPI_N07

Instruction: Record the product identification number from the bottle, tube or box. Include all leading zeros.

• (8 spaces)

Content type - Note to data users:

• A search is performed based on the Product Identification Number. This could be a Drug Identification Number (DIN); Natural Product Number (NPN); Homeopathic Medicine Number (DIN_HM); or Exemption Number (EN).

NPI_C08

• If Blaise search does not find an exact match, go to NPI_N11.
• Otherwise, go to NPI_N08.

NPI_N08

• Instruction: Select the correct product.
• (DK, RF not allowed)

Programmer:

• List records with an exact match on PIN as response categories. The default 'Go to' for these responses should be NPI_D25.
• Please add the response category 'None of the above' as the last response category. The "Go to" for this category should be NPI_N11.
• Don't know and Refusal are not allowed.
• Display the following variables: Pk, product_name, product_strength and form.

NPI_N11

Instruction: Is ^NPI_N07 the correct product identification number?

• 1 Yes (Go to NPI_D18A)
• 2 No (Go to NPI_N05)
• (DK, RF not allowed)

NPI_N15

Instruction: Why is a product identification number not available for the product?

• 1 Container not available
• 2 No product identification number
• (DK, RF not allowed)

NPI_D15

If NPI_N15 = 1 and MEUC_Q22 = EMPTY, DT_NPI15E = "To search for this product I will need some of the following information:

• Product name: for example, Accutane, Alesse 21 or Ventolin.
• Product form: for example, pill, powder, liquid or cream.
• Manufacturer: for example, Roche, Pfizer or GlaxoSmithKline.".

Else If NPI_N15 = 1 and MEUC_Q22 = RESPONSE , DT_NPI15E = "To search for this product, I will need some of the following information:

• Product name: for example, Children's Tylenol^® Cold and Cough Nighttime.
• Product form: for example, pill, powder, liquid or cream.
• Manufacturer: for example, Bayer, Jamieson or Sisu.".

Otherwise, DT_NPI15E = "EMPTY".

Content type - Note to data users:

• If a product identification number is not available, MedSearch can be used to search for the medication.
• The MedSearch tool uses a look-up database to search for prescription medications, over-the-counter medications and other health products based on product name, manufacturer, active ingredients, route of administration, form and/or product strength.

NPI_Q16
^DT_NPIN15E

Instruction: Use the MedSearch tool to find the product.

• Press <1> to continue.
• 1 Continue
• (DK, RF not allowed)

NPI_N17

Instruction: Was an exact product match found?

• 1 Yes
• 2 No (Go to NPI_D18A)
• (DK, RF not allowed)

NPI_Q17A

• Product identification number: ^DV_PIN
• Product name: ^DV_PRODUCT_NAME
• Form: ^DV_FORME
• Strength: ^DT_STRENGTH
• Route of administration: ^DT_ROUTEE

Instruction: Confirm whether the information displayed is correct.

• 1 Yes (Go to NPI_D25)
• 2 No
• (DK, RF not allowed)

NPI_N17B

Instruction: Do you want to search for the product again?

• 1 Yes (Go to NPI_D15)
• 2 No
• (DK, RF not allowed)

NPI_D18A

• If MEUC_Q22 = EMPTY, DT_NAMEEXAMPLEE = "For example, Accutane, Alesse 21 or Ventolin.".
• Otherwise, DT_NAMEEXAMPLEE = "For example, Children's Tylenol^® Cold and Cough Nighttime.".

Content type - Note to data users:

• If a product cannot be found in the database search at NPI_N07 or NPI_N17, information about the product is entered at NPI_Q18 to NPI_Q25.

NPI_Q18
(What is the name of this product? [For example, Accutane, Alesse 21 or Ventolin./For example, Children's Tylenol^® Cold and Cough Nighttime.])

Instruction: Capture the information from the product container, if it is available. Otherwise, ask the respondent to provide the information, as accurately as possible.

• (80 spaces)
• DK, RF (Go to NPI_END)

NPI_C19

• If NPI_N15 = 1, go to NPI_Q20.
• Otherwise, go to NPI_D19.

NPI_D19

• If MEUC_Q22 = EMPTY, DT_COMPANYEXAMPLEE = "For example, Roche, Pfizer, GlaxoSmithKline.".
• Otherwise, DT_COMPANYEXAMPLEE = "For example, Bayer, Jamieson or Sisu.".

NPI_Q19
What company information is found on the product container?
[For example, Roche, Pfizer, GlaxoSmithKline./For example, Bayer, Jamieson or Sisu.]

Instruction: Capture all the company names from the product container. This could include: the manufacturer, the importer and/or the company for which this product was manufactured. If there is no company information on the container, enter <Don't know>.

• (80 spaces)
• DK, RF

NPI_Q20
(What is the form of this product? For example, is it a pill, powder, liquid or cream?)

Instruction: Capture the information from the product container, if it is available. Otherwise, ask the respondent to provide the information, as accurately as possible.

Select the product form.

• 01 Tablet / pill / capsule
• 02 Lozenge
• 03 Chew / gummy
• 04 Globule
• 05 Drop
• 06 Tincture
• 07 Liquid / solution
• 08 Suspension
• 09 Cream / ointment / gel / lotion
• 10 Packet / sachet
• 11 Powder
• 12 Granule
• 13 Spray / aerosol
• 14 Patch
• 15 Kit
• 16 Suppository
• 50 Other - Specify (Go to NPI_S20)
• DK, RF

Go to NPI_D20

NPI_S20
(What is the form of this product? For example, is it a pill, powder, liquid or cream?)

Instruction: Specify.

• (80 spaces)
• (DK, RF not allowed)

NPI_D20

• If NPI_Q20 = 50, DT_FORME = "NPI_S20".
• Otherwise, if NPI_Q20 = DK, RF, DT_FORME = "EMPTY".
• Otherwise, DT_FORME = "English text of category selected at NPI_Q20".

NPI_Q21
(What is the strength of this product, for example, 250mg, 1%, 1000 international units?)

Instruction: Capture the information from the product container, if it is available. Otherwise, ask the respondent to provide the information, as accurately as possible.

• (80 spaces)
• DK, RF

NPI_Q22
(How is this product administered? For example, is it inhaled, swallowed, dissolved beneath the tongue or applied to the skin?)

Instruction: Capture the information from the product container, if it is available. Otherwise, ask the respondent to provide the information as accurately as possible.

Select the route of administration of the product.

• 01 Oral
• 02 Sublingual (under tongue)
• 03 Buccal (inside of cheek)
• 04 Dental (teeth or gums)
• 05 By inhalation
• 06 Nasal (nose)
• 07 Ophthalmic (eyeball)
• 08 Otic (ear)
• 09 Topical (applied to skin)
• 10 Transdermal (absorbed through skin)
• 11 By injection
• 12 Rectal
• 13 Vaginal
• 50 Other - Specify (Go to NPI_S22)
• DK, RF

Go to NPI_D25

NPI_S22
(How is this product administered? For example, is it inhaled, swallowed, dissolved beneath the tongue or applied to the skin?)

Instruction: Specify.

• (80 spaces)
• (DK, RF not allowed)

Go to NPI_D25

NPI_D25

• If DV_Short_form = 9, 13,14, 15 or 16 then set:, DT_TAKE1E = "used".
• Else, DT_TAKE1E = "took".
• If DV_Short_form = 9, 13,14, 15 or 16 then set:, DT_TAKE2E = "using".
• Else, DT_TAKE2E = "taking".
• If DV_Short_form = 9, 13,14, 15 or 16 then set:, DT_TAKE3E = "use".
• Else, DT_TAKE3E = "take".

NPI_Q25
When was the last time that you [used/took] this product?

(The response categories are today, yesterday, within the last week or within the last month.)

1. Today
2. Yesterday
3. Within the last week
4. Within the last month
5. More than one month ago (Go to NPI_END)
6. DK, RF (Go to NPI_END)

NPI_C25

• If FollowUpFlag = 1 (administer follow-up questions), go to NPI_D26.
• Otherwise, go to NPI_END.

Content type - Note to data users:

• The next questions are only asked for products found on the look-up database that contain ingredients of particular interest.

NPI_D26

Content type - Note to data users:

• DT_NPC_TEXT1E is created and passed to NPC. This text string contains examples of possible units of measure based on the form of the product.

NPI_B26

• Call the New Product Information – Call block (NPC).

Programmer:

• Pass DT_NPC_TEXT1E, DT_NPC_TEXT1E and available choices for NPC_N12) as a parameter.

NPI_D59

• If MEUC_Q22 = 1, DT_SPRODE = "this or a similar product".
• Otherwise, DT_SPRODE = "this product".

NPI_D60

• If NPI_Q25 = 1 or 2, DT_NPITEXT5E = "For how long have you been [using/taking] [this or a similar product/this product]? (^DV_PRODUCT_NAME)".
• Otherwise, DT_NPITEXT5E = "For how long did you ^DT_TAKE3E [this or a similar product/this product]? (^DV_PRODUCT_NAME)".

NPI_D62

• If MEUC_Q22 = EMPTY, DT_NPITEXT7E = "Consider a change in prescription (e.g., a change in medication company or dosage) to be a stop in medication use.
• Do not consider a short break in the use of prescribed medication (e.g., temporarily ran out of medication or forgot to take a dose) to be a stop in medication use.
• For prescription medication used on an as-needed basis (e.g., medicated cream for a reoccurring condition), only include the period when it was last used.".
• Otherwise, DT_NPITEXT7E = "A similar product could be a different company name (e.g., Jamieson Vitamin C^® vs. Flintstones Vitamin C^®) or a different form (e.g., tablet vs. liquid).
• Do not consider a short break in the use of a product (e.g., temporarily ran out of a vitamin supplement or forgot to take a dose) to be a stop in product use.
• For over-the-counter medication used on an as-needed basis (e.g., medication for a cold or headache), only include the period when it was last used ".

NPI_Q63
[For how long have you been [using/taking] [this or a similar product/this product]?/For how long did you [use/take] [this or a similar product/this product]?] (^DV_PRODUCT_NAME)

(If you stopped [using/taking] it at some point, only include the most recent period of use.)

Instruction: Enter time only.

• ^DT_NPITEXT7E
• (MIN: 0)
• (MAX: 500)
• DK (Go to NPI_Q65)
• RF (Go to NPI_END)

NPI_N64

Instruction: Select the reporting period.

1. Days
2. Weeks
3. Months
4. Years
5. (DK, RF not allowed)

NPI_Q65
In the past month, on how many days did you [use/take] this product (^DT_PRODUCT_NAME)?

Instruction: Enter number of days.

If the medication was used every day for the past month, enter "31".

• (MIN: 1)
• (MAX: 31)
• DK, RF

NPI_END

New Product Information – Call block (NPC)

NPC_BEG

External variables required:

• DT_NPC_TEXT1E: example text in English
• DV_PRODUCT_NAME: product name
• DT_Take1E: English text fill for "used/took"
• DT_Take3E: English text fill for "use/take"

NPC_Q10
On the days that you [used/took] this product, how many times did you usually [use/take] it in a single day?

Instruction: Record the number of times per day.

• (MIN: 1)
• (MAX: 100)
• DK, RF (Go to NPC_END)

NPC_Q11
How much did you usually [use/take] each time you [used/took] it?

Instruction: Enter the quantity only.

• (MIN: 0.01)
• (MAX: 99,995.00)
• DK, RF (Go to NPC_END)

NPC_D11A

• If NPC_Q10 = 1, DT_TIMESE = "time".
• Otherwise, DT_TIMESE = "times".

NPC_N12

Instruction: Select the unit of measure.

• 01 Tablets / pills / capsules
• 02 Lozenges
• 03 Chews / gummies
• 04 Millilitres (mL)
• 05 Milligrams (mg)
• 06 Grams (g)
• 07 Tablespoons (Tbsp)
• 08 Teaspoons (tsp)
• 09 Capfuls
• 10 Scoops
• 11 Packets / sachets
• 12 Drops
• 13 Sprays
• 14 Doses
• 15 Vials
• 16 Units
• 50 Other - Specify (Go to NPC_S12)
• DK, RF (Go to NPC_END)

Go to NPC_D12

NPC_S12
(Select the unit of measure.)

Instruction: Specify.

• (80 spaces)
• (DK, RF not allowed)

NPC_D12

• If NPC_N12 = 01, DT_UNITE = "tablet(s)".
• If NPC_N12 = 02, DT_UNITE = "lozenge(s)".
• If NPC_N12 = 03, DT_UNITE = "chew(s)".
• If NPC_N12 = 04, DT_UNITE = "millilitre(s)".
• If NPC_N12 = 05, DT_UNITE = "milligram(s)".
• If NPC_N12 = 06, DT_UNITE = "gram(s)".
• If NPC_N12 = 07, DT_UNITE = "tablespoon(s)".
• If NPC_N12 = 08, DT_UNITE = "teaspoon(s)".
• If NPC_N12 = 09, DT_UNITE = "capful(s)".
• If NPC_N12 = 10, DT_UNITE = "scoop(s)".
• If NPC_N12 = 11, DT_UNITE = "packet(s)".
• If NPC_N12 = 12, DT_UNITE = "drop(s)".
• If NPC_N12 = 13, DT_UNITE = "spray(s)".
• If NPC_N12 = 14, DT_UNITE = "dose(s)".
• If NPC_N12 = 15, DT_UNITE = "vial(s)".
• If NPC_N12 = 16, DT_UNITE = "unit(s)".
• If NPC_N12 = 50, DT_UNITE = "^NPC_S12".

NPC_Q14
So you [used/took] ^NPC_Q11 ^DT_UNITE ^NPC_Q10 [time/times] each day you [used/took] this product (^DV_PRODUCT_NAME). Is that correct?

• 1 Yes
• 2 No (Go to NPC_Q10)
• (DK, RF not allowed)

NPC_END

Other Reason for Screening Out (ORS)

ORS_BEG

External variables required:

Variables taken from sample file:

• STAND: name of the city/town/village in which the clinic has been set up
• CLINICID: 8 digit respondent identifier

Variables assigned in Variable Creation:

• CurrentYear: numeric year during which clinic visit is taking place
• CurrentMonth: numeric month during which clinic visit is taking place
• CurrentDay: numeric day during which clinic visit is taking place
• SessionE: English text of when the clinic visit is taking place

Variables from previously completed blocks:

• RespondentName: name of respondent
• GenderE: English text for sex of respondent
• CON_AGE: age of respondent

ORS_Q1
Other than what you have already mentioned, are there any other reasons you should not participate in one or more of the physical tests?

• 1 Yes
• 2 No
• DK, RF

ORS_C1

• If CON_AGE < 6, go to ORS_N7.
• Otherwise, go to ORS_N1.

ORS_N1

Instruction: Is there any other reason why the respondent should not perform the Grip Strength test?

• 1 Yes
• 2 No (Go to ORS_N2)
• (DK, RF not allowed)

ORS_S1

Instruction: Specify the reason.

• (80 spaces)
• (DK, RF not allowed)

ORS_N2

Instruction: Is there any other reason why the respondent should not perform the Spirometry test?

• 1 Yes
• 2 No (Go to ORS_N7)
• (DK, RF not allowed)

ORS_S2

Instruction: Specify the reason.

• (80 spaces)
• (DK, RF not allowed)

ORS_N7

Instruction: Is there any other reason why the respondent should not perform the Hearing tests?

• 1 Yes
• 2 No (Go to ORS_N8)
• (DK, RF not allowed)

ORS_S7

Instruction: Specify the reason.

• (80 spaces)
• (DK, RF not allowed)

ORS_N8

Instruction: Is there any other reason why the respondent should not perform the skin pigmentation measurements?

• 1 Yes
• 2 No (Go to ORS_END)
• (DK, RF not allowed)

ORS_S8

Instruction: Specify the reason.

• (80 spaces)
• (DK, RF not allowed)

ORS_END

Water Analysis Questions Component (WAQ) (ORS)

WAQ_BEG

External variables required:

Variables taken from sample file:

• STAND: name of the city/town/village in which the clinic has been set up
• CLINICID:8 digit respondent identifier

Variables assigned in Variable Creation:

• CurrentYear: numeric year during which clinic visit is taking place
• CurrentMonth: numeric month during which clinic visit is taking place
• CurrentDay: numeric day during which clinic visit is taking place
• SessionE: English text of when the clinic visit is taking place
• RespondentName: name of respondent
• GenderE: English text for sex of respondent

Variables from previously completed blocks:

• BVOCFLG: tap water subsampling flag (blood)
• UFLUFLG: tap water subsampling flag (urine)
• SCS_N12: Visit type (3= clinic visit; 4= home visit)
• RespondentName: name of respondent
• GenderE: English text for sex of respondent
• CON_AGE: age of respondent

WAQ_D01

• If BVOCFLG=1 and UFLUFLG=1, DT_WAQTEXT1E = "blood and urine".
• If BVOCFLG=1 and UFLUFLG=2, DT_WAQTEXT1E = "blood".
• If BVOCFLG=2 and UFLUFLG=1, DT_WAQTEXT1E = "urine".

WAQ_R01
Now I am going to ask you some questions about behaviours and habits to help us better understand your [blood and urine/blood/urine] test results. These questions are related to your household tap water analysis.

Instruction: Press <1> to continue.

Programmer:

• Allow 'DK' as a response category.

WAQ_C01

• If WAQ_R01 = DK, go to WAQ_N60.
• Otherwise, go to WAQ_D02.

WAQ_D02

Programmer:

• IF SCS_N12 = 4 THEN
  • WAQ_D02 = EMPTY
• ELSE
  • IF WAQ_R01 = 1 and WAQ_D02 = EMPTY,
    • Set WAQ_D02 = Current Time (in HH:MM:SS format)
• ENDIF

WAQ_C02

• If BVOCFLG = 1, go to WAQ_Q02.
  Otherwise, go to WAQ_C04A.

WAQ_Q02
When did you last spend time in a swimming pool, in a hot tub, or in a steam room?

Instruction: Include steam rooms but do not include saunas. Steam rooms contain hot mist created by a steam generator, and are made of materials such as ceramic tile that can contain the moisture. The humidity in a steam room can build to almost 100%. Saunas use dry heat (stones placed on some kind of heater) and are usually wood-lined with wood benches. Although steam may be produced by pouring water on the stones, the steam in a sauna quickly dissipates. Saunas are maintained at a much higher temperature than steam rooms.

Read categories to respondent.

1. Less than 6 hours ago
2. 6 to less than 12 hours ago
3. 12 to less than 24 hours ago
4. 24 or more hours ago
   DK, RF

WAQ_Q03
When did you last take a hot shower, for 5 minutes or longer, or a hot bath, for twenty minutes or longer?

Instruction: Include warm baths or showers, but do not include cold baths or showers.

1. Less than 6 hours ago
2. 6 to less than 12 hours ago
3. 12 to less than 24 hours ago
4. 24 or more hours ago
   DK, RF

WAQ_C04A

• If UFLUFLG=1, go to WAQ_C04B.
• Otherwise, go to WAQ_END.

WAQ_C04B

• If CON_AGE < 6, go to WAQ_Q08.
• Otherwise, go to WAQ_Q04.

WAQ_Q04
How often do you drink black, white or green tea? Examples of black tea include Orange Pekoe, Earl Grey and English Breakfast. Please do not include herbal teas.

Instruction: Include decaffeinated tea. Include iced tea if it was made from hot steeped black, white or green tea (in tea bags or in loose leaf form). Do not include pre-prepared powdered, bottled or canned iced tea.

Enter frequency only.

• Times
• (MIN: 0)
• (MAX: 365)
• DK, RF
• Go to WAQ_Q08)

WAQ_C05

• If WAQ_Q04=0, go to WAQ_Q08.
• Otherwise, go to WAQ_N05A.

WAQ_N05A

Instruction: Select the reporting period.

1. Per day
2. Per week
3. Per month
4. Per year
   (DK, RF not allowed)

WAQ_Q06
When you drink black, white or green tea, how much do you usually drink in cups? A cup is equivalent to the size of a measuring cup: 250ml or 8oz.

Instruction: Read categories to respondent.

1. Less than 1 cup
2. 1 to less than 2 cups
3. 2 or more cups
   DK, RF

WAQ_Q07
When did you last drink black, white or green tea?

Instruction: Read categories to respondent.

1. Less than 6 hours ago
2. 6 to less than 12 hours ago
3. 12 to less than 24 hours ago
4. 24 or more hours ago
   DK, RF

WAQ_Q08
When did you last receive fluoride treatments at the dentist?

Instruction: A fluoride treatment may take the form of a rinse, varnish, gel or foam. Varnishes are painted on the teeth; foams are put into a mouth guard, which is applied to the teeth for 1 to 4 minutes; gels can be painted on or applied via a mouth guard. After a fluoride treatment, the patient is asked to refrain from eating, drinking and smoking for 30 minutes.

Read answer categories to respondent.

1. Less than 3 months ago
2. 3 to less than 6 months ago
3. 6 to less than 9 months ago
4. 9 to less than 12 months ago
5. 12 or more months ago
6. Never
   DK, RF

WAQ_Q09
Do you use fluoride-containing products at home, such as toothpaste, mouthwash, or 24-hour fluoride treatment?

• 1 Yes
• 2 No (Go to WAQ_END)
• DK, RF (Go to WAQ_END)

WAQ_Q10
When was the last time you used one of these products?

Instruction: Read categories to respondent.

1. Less than 6 hours ago
2. 6 to less than 12 hours ago
3. 12 to less than 24 hours ago
4. 24 or more hours ago
   DK, RF
   
   Go to WAQ_END

WAQ_N60

Instruction: Why was the component not fully completed?

• 01 Respondent unable to continue for health reasons
• 06 No time
• 20 Other - Specify
• (DK, RF not allowed)

Go to WAQ_END

WAQ_S60
(Why was the component not fully completed?)

Instruction: Specify.

• (80 spaces)
• (DK, RF not allowed)

WAQ_END

Fish and Shellfish Consumption Component

Fish and Shellfish Consumption (FSF)

FSF_BEG

External variables required:

Variables taken from sample file:

• STAND: name of the city/town/village in which the clinic has been set up
• CLINICID: 8 digit respondent identifier

Variables assigned in Variable Creation:

• CurrentYear: numeric year during which clinic visit is taking place
• CurrentMonth: numeric month during which clinic visit is taking place
• CurrentDay: numeric day during which clinic visit is taking place
• SessionE: English text of when the clinic visit is taking place
• DateLastMonthE: English text of month of date one month before the clinic visit

Variables from previously completed blocks:

• RespondentName: name of respondent
• CON_SEX: sex of respondent
• GenderE: English text for sex of respondent
• CON_AGE: age of respondent
• SCS_N12: Visit type (3= clinic visit; 4= home visit)

FSF_R10
Now a few questions about your consumption of shellfish over the past month. Think about all the shellfish you ate, both meals and snacks, at home and away from home. Include fresh, frozen and canned shellfish.

Instruction: Press <1> to continue.

Programmer:

• Allow ‘DK’ as a response category.

FSF_C10

• If FSF_R10 = DK, go to FSF_N70.
• Otherwise, go to FSF_D10.

FSF_D10

Programmer:

• IF SCS_N12 = 4 THEN
  • FSF_D10 = EMPTY
• ELSE
  • IF FSF_R10 = 1 and FSF_D10 = "EMPTY" THEN
    • SET FSF_D10 = Current Time (in HH:MM:SS format)
• ENDIF

FSF_Q10
Have you eaten any of the following shellfish over the past month, that is, from ^DateLastMonthE to today?

Instruction: The term "shellfish" refers to a type of mollusc/crustacean. It does not include "saltwater fish" which are covered in the next question.

Read categories to respondent. Mark all that apply.

• 01 Lobster
• 02 Shrimp
• 03 Mussels
• 04 Scallops
• 05 Oysters
• 06 Squid or calamari
• 07 Clams
• 08 Crab
• 09 Surimi or imitation crab
• 10 Any other shellfish (Go to FSF_S10V)
• 11 No shellfish
• DK
• RF (Go to FSF_END)

Go to FSF_C11

FSF_S10V
What other shellfish did you consume?

Instruction: Enter one shellfish only.

• (80 spaces)
• DK, RF (Go to FSF_C11)

FSF_Q10X
Over the past month, did you consume any other shellfish?

• 1 Yes
• 2 No (Go to FSF_C11) DK, RF (Go to FSF_C11)

FSF_S10X
What other shellfish did you consume?

Instruction: Enter one shellfish only.

• (80 spaces)
• DK, RF (Go to FSF_C11)

FSF_Q10Y
Over the past month, did you consume any other shellfish?

• 1 Yes
• 2 No (Go to FSF_C11)
• DK, RF (Go to FSF_C11)

FSF_S10Y
What other shellfish did you consume?

Instruction: Enter one shellfish only.

• (80 spaces)
• DK, RF

FSF_C11

• If FSF_Q10 = 11 or DK, go to FSF_R24.
• Otherwise, go to FSF_C12.

FSF_C12

• If FSF_Q10 = 1, go to FSF_B12.
• Otherwise, go to FSF_C13.

Content type - Note to data users:

• For each shellfish identified at FSF_Q10, the Detail Fish and Shellfish block is called to quantify the number of times the shellfish was consumed in the past month. This block will also be called up to 3 times for any other shellfish that is specified at FSF_S10V, FSF_S10X, and FSF_S10Y.

FSF_B12

• Call the Detail Fish and Shellfish (DFS) block.

Programmer:

• Pass DT_QuestionE = "lobster" as parameter.

FSF_C13

• If FSF_Q10 = 2, go to FSF_B13.
• Otherwise, go to FSF_C14.

FSF_B13

• Call the Detail Fish and Shellfish (DFS) block.

Programmer:

• Pass DT_QuestionE = "shrimp" as parameter.

FSF_C14

• If FSF_Q10 = 3, go to FSF_B14.
• Otherwise, go to FSF_C15.

FSF_B14

• Call the Detail Fish and Shellfish (DFS) block.

Programmer:

• Pass DT_QuestionE = "mussels" as parameter.

FSF_C15

• If FSF_Q10 = 4, go to FSF_B15.
• Otherwise, go to FSF_C16.

FSF_B15

• Call the Detail Fish and Shellfish (DFS) block.

Programmer:

• Pass DT_QuestionE = "scallops" as parameter.

FSF_C16

• If FSF_Q10 = 5, go to FSF_B16.
• Otherwise, go to FSF_C17.

FSF_B16

• Call the Detail Fish and Shellfish (DFS) block.

Programmer:

• Pass DT_QuestionE = "oysters" as parameter.

FSF_C17

• If FSF_Q10 = 6, go to FSF_B17.
• Otherwise, go to FSF_C18.

FSF_B17

• Call the Detail Fish and Shellfish (DFS) block.

Programmer:

• Pass DT_QuestionE = "squid or calamari" as parameter.

FSF_C18

• If FSF_Q10 = 7, go to FSF_B18.
• Otherwise, go to FSF_C19.

FSF_B18

• Call the Detail Fish and Shellfish (DFS) block.

Programmer:

• Pass DT_QuestionE = "clams" as parameter.

FSF_C19

• If FSF_Q10 = 8, go to FSF_B19.
• Otherwise, go to FSF_C20.

FSF_B19

• Call the Detail Fish and Shellfish (DFS) block.

Programmer:

• Pass DT_QuestionE = "crab" as parameter.

FSF_C20

• If FSF_Q10 = 9, go to FSF_B20.
• Otherwise, go to FSF_C21.

FSF_B20

• Call the Detail Fish and Shellfish (DFS) block.

Programmer:

• Pass DT_QuestionE = "surimi or imitation crab" as parameter.

FSF_C21

• If FSF_S10V = RESPONSE and <> DK, RF, go to FSF_B21.
• Otherwise, go to FSF_C22.

FSF_B21

• Call the Detail Fish and Shellfish (DFS) block.

Programmer:

• Pass DT_QuestionE = "^FSF_S10V" as parameter.

FSF_C22

• If FSF_S10X = RESPONSE and <> DK, RF, go to FSF_B22.
• Otherwise, go to FSF_C23.

FSF_B22

• Call the Detail Fish and Shellfish (DFS) block.

Programmer:

• Pass DT_QuestionE = "^FSF_S10X" as parameter.

FSF_C23

• If FSF_S10Y = RESPONSE and <> DK,RF, go to FSF_B23.
• Otherwise, go to FSF_R24.

FSF_B23

• Call the Detail Fish and Shellfish (DFS) block.

Programmer:

• Pass DT_QuestionE = "^FSF_S10Y" as parameter.

FSF_R24
Now, think about all salt and freshwater fish you ate, both meals and snacks, at home and away from home. Include fresh, frozen and canned fish of all types, as well as the fish in fish and chips.

Instruction: Press <1> to continue.

FSF_Q24
Have you eaten any of the following fish over the past month, that is, from ^DateLastMonthE to today?

Instruction: The term "saltwater fish" does not include "shellfish", which were asked about in the previous question.

If respondent is unsure of the type of cod they have eaten, choose "Atlantic cod".

Read categories to respondent. Mark all that apply.

• 01 Fish Sticks
• 02 Tuna in a can or pouch
• 03 Tuna (fresh or frozen)
• 04 Salmon in a can or pouch
• 05 Salmon - fresh, frozen or smoked
• 06 Smelt
• 07 Shark
• 08 Marlin
• 09 Swordfish
• 10 Halibut
• 11 Rainbow Trout
• 12 Atlantic cod
• 13 Mackerel
• 14 Herring
• 15 Sardines
• 16 Sole, flounder or plaice
• 17 Haddock
• 18 Tilapia
• 19 Any other fish (Go to FSF_S24V)
• 20 No fish
• 21 Sablefish or black cod
• DK, RF

Go to FSF_C24A

FSF_S24V
What other fish did you consume?

Instruction: Enter one type of fish only.

• (80 spaces)
• DK, RF (Go to FSF_C24A)

FSF_Q24X
In the past month, did you consume any other fish?

• 1 Yes
• 2 No (Go to FSF_C24A)
• DK, RF (Go to FSF_C24A)

FSF_S24X
What other fish did you consume?

Instruction: Enter one type of fish only.

• (80 spaces)
• DK, RF (Go to FSF_C24A)

FSF_Q24Y
In the past month, did you consume any other fish?

• 1 Yes
• 2 No (Go to FSF_C24A)
• DK, RF (Go to FSF_C24A)

FSF_S24Y
What other fish did you consume?

Instruction: Enter one type of fish only.

• (80 spaces)
• DK, RF

FSF_C24A

• If FSF_Q24 = 20, DK or RF, go to FSF_END.
• Otherwise, go to FSF_C24.

FSF_C24

• If FSF_Q24 = 1, go to FSF_B24.
• Otherwise, go to FSF_C25A.

Content type - Note to data users:

• For each fish identified at FSF_Q24, the Detail Fish and Shellfish block is called to quantify the number of times the fish was consumed in the past month. This block will also be called up to 3 times for any other fish that is specified at FSF_S24V, FSF_S24X, and FSF_S24Y.

FSF_B24

• Call the Detail Fish and Shellfish (DFS) block.

Programmer:

• Pass DT_QuestionE = "fish sticks" as parameter.

FSF_C25A

• If FSF_Q24 = 2, go to FSF_Q25.
• Otherwise, go to FSF_C26.

FSF_Q25
Over the past month, when you ate tuna in a can or pouch, was it:

Instruction: Read categories to respondent.

1. ...light (flaked or chunk) tuna?
2. ...white (solid) tuna? (Go to FSF_C25B)
3. ...both?
   DK, RF (Go to FSF_C25C)

FSF_B25A

• Call the Detail Fish and Shellfish (DFS) block.

Programmer:

• Pass DT_QuestionE = "light (flaked or chunk) tuna in a can or pouch" as parameter.

FSF_C25B

• If FSF_Q25 = 2 or 3, go to FSF_B25B.
• Otherwise, go to FSF_C25C.

FSF_B25B

• Call the Detail Fish and Shellfish (DFS) block.

Programmer:

• Pass DT_QuestionE = "white (solid) tuna in a can or pouch" as parameter.

FSF_C25C

• If FSF_Q25 = DK or RF, go to FSF_B25C.
• Otherwise, go to FSF_C26.

FSF_B25C

• Call the Detail Fish and Shellfish (DFS) block.

Programmer:

• Pass DT_QuestionE = "tuna in a can or pouch" as parameter.

FSF_C26

• If FSF_Q24 = 3, go to FSF_B26.
• Otherwise, go to FSF_C27.

FSF_B26

• Call the Detail Fish and Shellfish (DFS) block.

Programmer:

• Pass DT_QuestionE = "tuna (fresh or frozen)" as parameter.

FSF_C27

• If FSF_Q24 = 4, go to FSF_B27.
• Otherwise, go to FSF_C28.

FSF_B27

• Call the Detail Fish and Shellfish (DFS) block.

Programmer:

• Pass DT_QuestionE = "salmon in a can or pouch" as parameter.

FSF_C28

• If FSF_Q24 = 5, go to FSF_B28.
• Otherwise, go to FSF_C29.

FSF_B28

• Call the Detail Fish and Shellfish (DFS) block.

Programmer:

• Pass DT_QuestionE = "salmon - fresh, frozen or smoked" as parameter.

FSF_C29

• If FSF_Q24 = 6, go to FSF_B29.
• Otherwise, go to FSF_C30.

FSF_B29

• Call the Detail Fish and Shellfish (DFS) block.

Programmer:

• Pass DT_QuestionE = "smelt" as parameter.

FSF_C30

• If FSF_Q24 = 7, go to FSF_B30.
• Otherwise, go to FSF_C31.

FSF_B30

• Call the Detail Fish and Shellfish (DFS) block.

Programmer:

• Pass DT_QuestionE = "shark" as parameter.

FSF_C31

• If FSF_Q24 = 8, go to FSF_B31.
• Otherwise, go to FSF_C32.

FSF_B31

• Call the Detail Fish and Shellfish (DFS) block.

Programmer:

• Pass DT_QuestionE = "marlin" as parameter.

FSF_C32

• If FSF_Q24 = 9, go to FSF_B32.
• Otherwise, go to FSF_C33.

FSF_B32

• Call the Detail Fish and Shellfish (DFS) block.

Programmer:

• Pass DT_QuestionE = "swordfish" as parameter.

FSF_C33

• If FSF_Q24 = 10, go to FSF_B33.
• Otherwise, go to FSF_C34.

FSF_B33

• Call the Detail Fish and Shellfish (DFS) block.

Programmer:

• Pass DT_QuestionE = "halibut" as parameter.

FSF_C34

• If FSF_Q24 = 11, go to FSF_B34.
• Otherwise, go to FSF_C35.

FSF_B34

• Call the Detail Fish and Shellfish (DFS) block.

Programmer:

• Pass DT_QuestionE = "rainbow trout" as parameter.

FSF_C35

• If FSF_Q24 = 12, go to FSF_B35.
• Otherwise, go to FSF_C36.

FSF_B35

• Call the Detail Fish and Shellfish (DFS) block.

Programmer:

• Pass DT_QuestionE = "Atlantic cod" as parameter.

FSF_C36

• If FSF_Q24 = 13, go to FSF_B36.
• Otherwise, go to FSF_C37.

FSF_B36

• Call the Detail Fish and Shellfish (DFS) block.

Programmer:

• Pass DT_QuestionE = "mackerel" as parameter.

FSF_C37

• If FSF_Q24 = 14, go to FSF_B37.
• Otherwise, go to FSF_C38.

FSF_B37

• Call the Detail Fish and Shellfish (DFS) block.

Programmer:

• Pass DT_QuestionE = "herring" as parameter.

FSF_C38

• If FSF_Q24 = 15, go to FSF_B38.
• Otherwise, go to FSF_C39.

FSF_B38

• Call the Detail Fish and Shellfish (DFS) block.

Programmer:

• Pass DT_QuestionE = "sardines" as parameter.

FSF_C39

• If FSF_Q24 = 16, go to FSF_B39.
• Otherwise, go to FSF_C40.

FSF_B39

• Call the Detail Fish and Shellfish (DFS) block.

Programmer:

• Pass DT_QuestionE = "sole, flounder or plaice" as parameter.

FSF_C40

• If FSF_Q24 = 17, go to FSF_B40.
• Otherwise, go to FSF_C41.

FSF_B40

• Call the Detail Fish and Shellfish (DFS) block.

Programmer:

• Pass DT_QuestionE = "haddock" as parameter.

FSF_C41

• If FSF_Q24 = 18, go to FSF_B41.
• Otherwise, go to FSF_C41B.

FSF_B41

• Call the Detail Fish and Shellfish (DFS) block.

Programmer:

• Pass DT_QuestionE = "tilapia" as parameter.

FSF_C41B

• If FSF_Q24 = 21, go to FSF_B41B.
• Otherwise, go to FSF_C42.

FSF_B41B

• Call the Detail Fish and Shellfish (DFS) block.

Programmer:

• Pass DT_QuestionE = "sablefish or black cod" as parameter.

FSF_C42

• If FSF_S24V = RESPONSE and <> DK,RF, go to FSF_B42.
• Otherwise, go to FSF_C43.

FSF_B42

• Call the Detail Fish and Shellfish (DFS) block.

Programmer:

• Pass DT_QuestionE = "^FSF_S24V" as parameter.

FSF_C43

• If FSF_S24X = RESPONSE and <> DK,RF, go to FSF_B43.
• Otherwise, go to FSF_C44.

FSF_B43

• Call the Detail Fish and Shellfish (DFS) block.

Programmer:

• Pass DT_QuestionE = "^FSF_S24X" as parameter.

FSF_C44

• If FSF_S24Y = RESPONSE and <> DK,RF, go to FSF_B44.
• Otherwise, go to FSF_END.

FSF_B44

• Call the Detail Fish and Shellfish (DFS) block.

Programmer:

• Pass DT_QuestionE = "^FSF_S24Y" as parameter.

FSF_C69

• If 1 = 1, go to FSF_END.
• Otherwise, go to FSF_END.

FSF_N70

Instruction: Why was the component not fully completed?

• 01 Respondent unable to continue for health reasons
• 06 No time
• 20 Other - Specify
• (DK, RF not allowed)

Go to FSF_END

FSF_S70
(Why was the component not fully completed?)

Instruction: Specify the reason.

• (80 spaces)
• (DK, RF not allowed)

FSF_END

Detail Fish and Shellfish (DFS)

DFS_BEG

External variables required:

Variables taken from sample file:

• STAND: name of the city/town/village in which the clinic has been set up
• CLINICID: 8 digit respondent identifier

Variables assigned in Variable Creation:

• CurrentYear: numeric year during which clinic visit is taking place
• CurrentMonth: numeric month during which clinic visit is taking place
• CurrentDay: numeric day during which clinic visit is taking place
• SessionE: English text of when the clinic visit is taking place

Variables from previously completed blocks:

• RespondentName: name of respondent
• CON_SEX: sex of respondent
• GenderE: English text for sex of respondent
• CON_AGE: age of respondent
• DT_QuestionE: English question text

DFS_Q11
Over the past month, how many times did you eat:...
^DT_QUESTIONE?

• Times
• (MIN: 1)
• (MAX: 95)
• DK, RF (Go to DFS_END)

DFS_N11

Instruction: Select the reporting period.

1. Per month
2. Per week
3. Per day
   (DK, RF not allowed)

DFS_END

Noise Exposure Component

Noise Exposure Component Introduction (HCI)

HCI_BEG

List external fields required:

Variables taken from sample file:

• STAND: name of the city/town/village in which the clinic has been set up
• CLINICID:8 digit respondent identifier
• CON_AGE:age of respondent

Variables assigned in Variable Creation:

• CurrentYear: numeric year during which clinic visit is taking place
• CurrentMonth: numeric month during which clinic visit is taking place
• CurrentDay: numeric day during which clinic visit is taking place
• SessionE: English text of when the clinic visit is taking place
• RespondentName: name of respondent
• GenderE: English text for sex of respondent

Variables from previously completed blocks:

• RespondentName: Name of respondent
• CON_AGE: age of respondent
• HER_Q41: Whether respondent has ear infection
• HER_Q51: Whether respondent has cochlear implant
• PHC_N42: Whether the respondent should be excluded from the block because of an acute condition
• PHC_N44: Whether the respondent should be excluded from the block because of an chronic condition
• ORS_N7:Whether the respondent should be excluded from the block for a other reason
• SCS_N12: Visit type (3= clinic visit; 4= home visit)

HCI_D01

• If PHC_N42 = 14 or PHC_N44 = 14 or HER_Q41 = 3 or HER_Q50 = 1 or ORS_N7 = 1 or SCS_N12 = 4, DT_HCITEXT1E = "EMPTY
• Otherwise, DT_HCITEXT1E = "This information will help us better understand the results from your hearing tests".

HCI_R01
Now we are going to ask you questions about your day-to-day hearing health and your exposure to noise. [EMPTY/ This information will help us better understand the results from your hearing tests.]

Instruction: Press <1> to continue.

Programmer:

• Allow 'DK' as a response category.
• If HCI_R01 = DK, go to HCI_END.
• Otherwise, go to HCI_D02.

HCI_D02

Programmer:

• IF SCS_N12 = 4 THEN
  • HCI_D02 = EMPTY
• ELSE
  • IF HCI_R01 = 1 and HCI_D02 = "EMPTY" THEN
    • SET HCI_D02 = Current Time (in HH:MM:SS format)
• ENDIF

HCI_END

Hearing Ability (HAB)

HAB_BEG

List external fields required:

Variables taken from sample file:

• STAND: name of the city/town/village in which the clinic has been set up
• CLINICID:8 digit respondent identifier

Variables assigned in Variable Creation:

• CurrentYear: numeric year during which clinic visit is taking place
• CurrentMonth: numeric month during which clinic visit is taking place
• CurrentDay: numeric day during which clinic visit is taking place
• SessionE: English text of when the clinic visit is taking place

Variables from previously completed blocks:

• RespondentName: name of respondent
• CON_AGE: age of respondent
• CON_SEX: sex of respondent
• GenderE: English text for sex of respondent
• HER_Q52: whether respondent has a hearing aid
• HCI_R01: hearing questionnaire introduction

HAB_C05

• If HCI_R01 = DK, go to HAB_END.
• Otherwise, go to HAB_D07.

HAB_D07

• If HER_Q52 = 1, DT_HETEXT1E = "without a hearing aid".
• Otherwise, DT_HETEXT1E = "EMPTY".

HAB_Q07
Are you usually able to hear what is said in a group conversation with at least 3 other people [without a hearing aid/EMPTY]?

• 1 Yes (Go to HAB_END)
• 2 No
• DK, RF (Go to HAB_END)

HAB_C08

• If HER_Q52=1, go to HAB_Q08.
• Otherwise, go to HAB_Q09.

HAB_Q08
Are you usually able to hear what is said in a group conversation with at least 3 other people with a hearing aid?

• 1 Yes (Go to HAB_Q10)
• 2 No
• DK, RF

HAB_Q09
Are you able to hear at all?

• 1 Yes
• 2 No (Go to HAB_END)
• DK, RF (Go to HAB_END)

HAB_Q10
Are you usually able to hear what is said in a conversation with one other person in a quiet room[ without a hearing aid/EMPTY]?

• 1 Yes (Go to HAB_END)
• 2 No
• DK, RF (Go to HAB_END)

HAB_C11

• If HER_Q52=1, go to HAB_Q11.
• Otherwise, go to HAB_END.

HAB_Q11
Are you usually able to hear what is said in a conversation with one other person in a quiet room with a hearing aid?

• 1 Yes
• 2 No
• DK, RF

HAB_END

Noise Exposure (NEX)

NEX_BEG

List external fields required:

Variables taken from sample file:

• STAND: name of the city/town/village in which the clinic has been set up
• CLINICID: 8 digit respondent identifier

Variables assigned in Variable Creation:

• CurrentYear: numeric year during which clinic visit is taking place
• CurrentMonth: numeric month during which clinic visit is taking place
• CurrentDay: numeric day during which clinic visit is taking place
• SessionE: English text of when the clinic visit is taking place

Variables from previously completed blocks:

• RespondentName: Name of respondent
• GenderE: English text for sex of respondent
• CON_AGE: age of respondent
• CON_SEX: sex of respondent
• HCI_R01: hearing questionnaire introduction

NEX_C01A

• If HCI_R01 = DK, go to NEX_N70.
• Otherwise, go to NEX_C01.

NEX_C01

• If CON_AGE < 16, go to NEX_D07.
• Otherwise, go to NEX_Q01.

NEX_Q01
At any time in your life, have you worked in a noisy environment? By noisy, I mean so loud that you and your co-workers had to speak in a raised voice to be understood by or communicate with someone standing an arm's length away.

Instruction: A raised voice is a volume of speech between a normal voice and shouting. Include unpaid work.

• 1 Yes
• 2 No (Go to NEX_D07)
• DK, RF (Go to NEX_D07)

NEX_Q02
For how long did you work in a noisy environment?

Instruction: Read categories to respondent.

1. Less than 12 months
2. 1 to less than 5 years
3. 5 to less than 10 years
4. 10 or more years
   DK, RF

NEX_Q03
What was the source of the loud noise?

Instruction: Read categories to respondent. Mark all that apply.

1. Machinery such as bulldozers, backhoes or sawmill equipment
2. Modes of transportation such as trains, airplanes, cars or trucks
3. Munitions such as guns or canons
4. Music, for example, at a concert or other amplified music
5. People
6. Other
   DK, RF

NEX_Q04
Are you currently working in a noisy environment?

• 1 Yes
• 2 No
• DK, RF

NEX_D05

• If NEX_Q04 = 1, DT_NEXTEXT5E = "do".
• Otherwise, DT_NEXTEXT5E = "did".

NEX_Q05
How often [do/did] you use hearing protection at work when in a noisy area?

Instruction: Read categories to respondent.

• 1 Always
• 2 Often
• 3 Sometimes
• 4 Rarely
• 5 Never
• DK, RF

NEX_D06

• If NEX_Q04 = 1, DT_NEXTEXT6E = "Are".
• Otherwise, DT_NEXTEXT6E = "Were".

NEX_Q06
[Are/Were] you required to wear hearing protection at work?

Instruction: If the respondent did not have an employer (e.g., was self-employed), select <Not applicable>.

• 1 Yes
• 2 No
• 3 Not applicable
• DK, RF

NEX_D07

• If CON_AGE < 16, DT_NEXTEXTR07E = "By".
• Otherwise, DT_NEXTEXTR07E = "Again, by".

NEX_R07
Now I would like to ask you about your exposure to specific sources of loud noise during the past year.

[By/Again, by] loud I mean where you would have had to speak in a raised voice to be understood by or communicate with someone standing an arm's length away.

Instruction: Press <1> to continue.

NEX_Q07
Within the past 12 months, have you been exposed to noise from any of the following? Please include activities that took place at work, at school or during your leisure time.

... loud power tools such as circular saws, grinders, belt sanders or hammer drills?

• 1 Yes
• 2 No
• DK, RF

NEX_Q08
Within the past 12 months, have you been exposed to noise from any of the following? Please include activities that took place at work, at school or during your leisure time.

... loud heavy industrial, farming or construction equipment such as bulldozers, gas turbines or large compressors?

• 1 Yes
• 2 No
• DK, RF

NEX_Q09
Within the past 12 months, have you been exposed to noise from any of the following? Please include activities that took place at work, at school or during your leisure time.

... loud hand-held gasoline engines such as gas-powered chainsaws, hedge trimmers or leaf blowers? Please do not include lawn mowers.

Instruction: Hand held gasoline engines do not include electric items.

• 1 Yes
• 2 No
• DK, RF

NEX_Q10
Within the past 12 months, have you been exposed to noise from any of the following? Please include activities that took place at work, at school or during your leisure time.

... motorcycles or snowmobiles driven at highway speed?

Instruction: Highway speed is defined as speeds at or above 80 km/h.

• 1 Yes
• 2 No
• DK, RF

NEX_Q11
Within the past 12 months, have you been exposed to noise from any of the following? Please include activities that took place at work, at school or during your leisure time.

... loud sporting or entertainment events such as hockey, rodeo or demolition derby? Please do not include music events.

• 1 Yes
• 2 No
• DK, RF

NEX_Q12
Within the past 12 months, have you been exposed to noise from any of the following? Please include activities that took place at work, at school or during your leisure time.

... loud amplified music such as at concerts or nightclubs or as a member of a band?

• 1 Yes
• DK, RF

NEX_Q13
Within the past 12 months, have you been exposed to noise from any of the following? Please include activities that took place at work, at school or during your leisure time.

... other types of loud music without the use of headphones or earbuds, for example, a home or car stereo?

Instruction: Loud music is defined as a volume at or above three quarters the maximum volume level for a given audio device.

• 1 Yes
• 2 No
• DK, RF

NEX_C14

• If CON_AGE < 12, go to NEX_C15.
• Otherwise, go to NEX_Q14.

NEX_Q14
Within the past 12 months, have you been exposed to noise from any of the following? Please include activities that took place at work, at school or during your leisure time.

...firearms, for example guns?

• 1 Yes
• 2 No
• DK, RF

Content type - Note to data users:

• For each positive response to NEX_Q07-NEX_Q13, the Activity Details block is called to quantify the frequency and duration of the specific noise exposure in the past 12 months and whether or not hearing protection was worn (NEX_C15 through NEX_B21).

NEX_C15

• If NEX_Q07 = 1, go to NEX_B15.
• Otherwise, go to NEX_C16.

NEX_B15

• Call the Activity Details (ACD) block.

Programmer:

• Pass "DT_QuestionE = During the past 12 months, how often were you exposed to noise from loud power tools?" as parameter.

NEX_C16

• If NEX_Q08 = 1, go to NEX_B16.
• Otherwise, go to NEX_C17.

NEX_B16

• Call the Activity Details (ACD) block.

Programmer:

• Pass "DT_QuestionE = During the past 12 months, how often were you exposed to noise from loud heavy industrial, farming or construction equipment?" as parameter.

NEX_C17

• If NEX_Q09 = 1, go to NEX_B17.
• Otherwise, go to NEX_C18.

NEX_B17

• Call the Activity Details (ACD) block.

Programmer:

• Pass "DT_QuestionE = During the past 12 months, how often were you exposed to loud noise from hand-held gasoline engines?" as parameter.

NEX_C18

• If NEX_Q10 = 1, go to NEX_B18.
• Otherwise, go to NEX_C19.

NEX_B18

• Call the Activity Details (ACD) block.

Programmer:

• Pass "DT_QuestionE = During the past 12 months, how often were you exposed to noise from motorcycles or snowmobiles driven at highway speeds?" as parameter.

NEX_C19

• If NEX_Q11 = 1, go to NEX_B19.
• Otherwise, go to NEX_C20.

NEX_B19

• Call the Activity Details (ACD) block.

Programmer:

• Pass "DT_QuestionE = During the past 12 months, how often did you attend loud sporting or entertainment events? Please do not include music events." as parameter.

NEX_C20

• If NEX_Q12 = 1, go to NEX_B20.
• Otherwise, go to NEX_C21.

NEX_B20

• Call the Activity Details (ACD) block.

Programmer:

• Pass "DT_QuestionE = During the past 12 months, how often were you exposed to loud amplified music such as at concerts or nightclubs or as a member of a band?" as parameter.

NEX_C21

• If NEX_Q13 = 1, go to NEX_B21.
• Otherwise, go to NEX_C22.

NEX_B21

• Call the Activity Details (ACD) block.

Programmer:

• Pass "DT_QuestionE = During the past 12 months, how often did you listen to other types of loud music without the use of headphones or earbuds?" as parameter.

NEX_C22

• If NEX_Q14 = 1, go to NEX_Q23.
• Otherwise, go to NEX_R25.

NEX_Q23
In the past 12 months, how many times have you fired, or been exposed to noise from the shot of a gun or firearm?

Instruction: Read categories to respondent.

1. 1 to 19 times
2. 20 to 99 times
3. 100 to 9999 times
4. 10,000 times or more
   DK, RF (Go to NEX_R25)

NEX_Q24
How often did you wear hearing protection?

Instruction: Read categories to respondent.

1. Always
2. Often
3. Sometimes
4. Rarely
5. Never
   DK, RF

NEX_R25
The next few questions concern your use of headphones or earbuds to listen to music, movies, or other types of audio. Examples of audio devices that you may have listened to using headphones or earbuds include mp3 players, iPods, cell phones, stereo systems, televisions or computers.

Instruction: Press <1> to continue.

NEX_Q25
In the past 12 months have you listened to audio devices using headphones or earbuds?

• 1 Yes
• 2 No (Go to NEX_R40)
• DK, RF (Go to NEX_R40)

NEX_Q26
On average, in the past 12 months, how many hours per week did you usually listen to music, movies or other types of audio using headphones or earbuds?

Instruction: If respondent answers in hours and minutes, enter the number of hours on this screen and the number of minutes on the next screen. If respondent answers in minutes only, enter 0 hours on this screen and number of minutes on the next screen.

You may enter the answer either per week or per day.

• Hours
• (MIN: 0)
• (MAX: 168)
• DK, RF (Go to NEX_Q27)

NEX_N26A

Instruction: Enter number of minutes.

• Minutes
• (MIN: 0)
• (MAX: 960)
  DK, RF

NEX_C26

• If NEX_Q26 = 0 and NEX_N26A = 0, go to NEX_R40.
• Otherwise, if NEX_Q26 = 0 and NEX_N26A = DK or RF, go to NEX_Q27.
• Otherwise, go to NEX_N26B.

NEX_N26B

Instruction: Select the reporting period.

• 1 Per day
• 2 Per week
• (DK, RF not allowed)

NEX_Q27
Is the volume level usually at or above three quarters of the maximum volume?

• 1 Yes
• 2 No
• DK, RF

NEX_Q28
Is the volume usually so loud that someone standing an arm's length away would have to speak in a raised voice for you to understand what they were saying?

Instruction: A raised voice is a volume of speech between a normal voice and shouting.

• 1 Yes
• 2 No
• DK, RF

NEX_C29

• If (NEX_Q27 = 2, DK or RF) and (NEX_Q28 = 2, DK or RF), go to NEX_R40.
• Otherwise, go to NEX_D29.

NEX_D29

• If NEX_Q27 = 1 and NEX_Q28 = 1, DT_NEXTEXT29E = "at or above three quarters of the maximum volume or so loud that someone standing an arm's length away would have to speak in a raised voice for you to understand what they were saying".
• If NEX_Q27 = 1 and NEX_Q28 < > 1, DT_NEXTEXT29E = "at or above three quarters of the maximum volume".
• If NEX_Q27 < > 1 and NEX_Q28 = 1, DT_NEXTEXT29E = "so loud that someone standing an arm's length away would have to speak in a raised voice for you to understand what they were saying".

NEX_Q29
How many hours per week do you usually listen to audio devices, using headphones or earbuds, at a volume that is ^DT_NEXTEST29E?

Instruction: If respondent answers in hours and minutes, enter the number of hours on this screen and the number of minutes on the next screen. If respondent answers in minutes only, enter 0 hours on this screen and number of minutes on the next screen.

You may enter the answer either per week or per day.

• Hours
• (MIN: 0)
• (MAX: 168)
• DK, RF (Go to NEX_Q30)

NEX_N29A

Instruction: Enter number of minutes.

• Minutes
• (MIN: 0)
• (MAX: 960)
• DK, RF

NEX_C29A

• If NEX_Q29 = 0 and NEX_N29A = DK or RF, go to NEX_Q30.
• Otherwise, go to NEX_N29B.

NEX_N29B

Instruction: Select the reporting period.

• 1 Per day
• 2 Per week
• (DK, RF not allowed)

NEX_D29E

• If NEX_N26B = 1, DV_PERWKFCTR26 = 7
• Otherwise, DV_PERWKFCTR26 = 1
• If NEX_N29B = 1, DV_PERWKFCTR29 = 7
• Otherwise, DV_PERWKFCTR29 = 1

NEX_Q30
For how long has this been your usual listening volume?

Instruction: Enter amount only.

• Amount
• (MIN: 1)
• (MAX: 995)
• DK, RF (Go to NEX_R40)

NEX_N30

Instruction: Select the reporting period.

1. Days
2. Weeks
3. Months
4. Years
   (DK, RF not allowed)

NEX_R40
Now I'd like to ask you about tinnitus. Tinnitus is the presence of hissing, buzzing, ringing, rushing or roaring sounds in your ears when there is no other sound around you.

Instruction: Press <1> to continue.

NEX_Q40
Have you ever experienced tinnitus?

• 1 Yes
• 2 No (Go to NEX_END)
• DK, RF (Go to NEX_END)

NEX_Q41
When was the last time you experienced these sounds in your ears? Was it... ?

Instruction: Read categories to respondent.

1. Within the last 7 days
2. 8 days to less than 1 month ago (Go to NEX_Q43)
3. 1 month to less than 6 months ago (Go to NEX_D45)
4. 6 months to less than 1 year ago (Go to NEX_D45)
5. 1 year ago or more (Go to NEX_END)
   DK, RF (Go to NEX_END)

NEX_Q42
Are you experiencing these sounds right now?

• 1 Yes
• 2 No
• DK, RF

NEX_Q43
When it is quiet, do you experience these sounds in your ears... ?

Instruction: Read categories to respondent.

1. Always
2. Often
3. Sometimes (Go to NEX_D45)
4. Rarely (Go to NEX_D45)
5. Never (Go to NEX_D45)
   DK, RF

NEX_Q44
For how long have you had this?

Instruction: Enter amount only.

• (MIN: 1)
• (MAX: 995)
• DK, RF (Go to NEX_D45)

NEX_N44

Instruction: Select the reporting period.

1. Days
2. Weeks
3. Months
4. Years
   (DK, RF not allowed)

NEX_D45

• If NEX_Q42 = 1, DT_NEXTEXT45AE = "Does".
• Otherwise, DT_NEXTEXT45AE = "Did".
• If NEX_Q42 = 1 , DT_NEXTEXT45BE = "does".
• Otherwise, DT_NEXTEXT45BE = "did".

NEX_Q45
[Does/Did] this bother you? For example, [does/did] it affect your sleep, concentration or mood?

• 1 Yes
• 2 No
• DK, RF

NEX_C46

• If CON_AGE < 10, go to NEX_END.
• Otherwise, go to NEX_D46.

NEX_D46

• If NEX_Q43 = 1 and [(NEX_Q44 => 6 and NEX_N44 = 3) or NEX_N44 = 4], DT_NEXTINNITUSE = "were they louder or more pronounced".
• Otherwise, DT_NEXTINNITUSE = "did they occur".

NEX_C47

• If NEX_Q25 = 1, go to NEX_Q47.
• Otherwise, go to NEX_C48.

NEX_Q47
In the past 12 months, when you experienced these noises in your ears, [were they louder or more pronounced/did they occur] ...

...after using headphones or earbuds to listen to audio devices such as an mp3 player, iPod, cell phone, stereo system, television or computer?

• 1 Yes
• 2 No
• DK, RF

NEX_C48

• If NEX_Q12 = 1, go to NEX_Q48.
• Otherwise, go to NEX_C49.

NEX_Q48
(In the past 12 months, when you experienced these noises in your ears, [were they louder or more pronounced/did they occur] ...)

...after being exposed to loud amplified music such as at a concert, nightclub or as a member of a band?

• 1 Yes
• 2 No
• DK, RF

NEX_C49

• If NEX_Q11 = 1, go to NEX_Q49.
• Otherwise, go to NEX_C50.

NEX_Q49
(In the past 12 months, when you experienced these noises in your ears, [were they louder or more pronounced/did they occur] ...)

...after being at a loud sporting or entertainment event?

• 1 Yes
• 2 No
• DK, RF

NEX_C50

• If NEX_Q07 = 1, go to NEX_Q50.
• Otherwise, go to NEX_C51.

NEX_Q50
(In the past 12 months, when you experienced these noises in your ears, [were they louder or more pronounced/did they occur] ...)

...after being exposed to noise from loud power tools (for example, circular saw, grinder, belt sander or hammer drill)?

• 1 Yes
• 2 No
• DK, RF

NEX_C51

• If NEX_Q14 = 1, go to NEX_Q51.
• Otherwise, go to NEX_D52.

NEX_Q51
(In the past 12 months, when you experienced these noises in your ears, [were they louder or more pronounced/did they occur] ...)

...after being exposed to noise from firearms or guns?

• 1 Yes
• 2 No
• DK, RF

NEX_D52

• If NEX_Q07 = 1 or NEX_Q11 = 1 or NEX_Q12 = 1 or NEX_Q14 = 1 or NEX_Q25 = 1, DT_NEXTEXT52E = "any other".
• Otherwise, DT_NEXTEXT52E = "any".

NEX_Q52
(In the past 12 months, when you experienced these noises in your ears, [were they louder or more pronounced/did they occur] ...)

... in [any other/any] specific circumstances?

• 1 Yes (Go to NEX_S52)
• 2 No (Go to NEX_END)
• DK, RF (Go to NEX_END)

NEX_S52

Instruction: Specify.

• (80 spaces)
• DK, RF

Go to NEX_END

NEX_N70

Instruction: Why was the component not fully completed?

• 01 Respondent unable to continue for health reasons
• 06 No time
• 20 Other - Specify
• (DK, RF not allowed)

Go to NEX_END

NEX_S70
(Why was the component not fully completed?)

Instruction: Specify.

• (80 spaces)
• DK, RF

NEX_END

Activity Detail (ACD)

ACD_BEG

• External variables required:
• QuestionE: English question text

ACD_Q11
^QuestionE

The answer categories are number of times per day, per week, per month or per year.

Instruction: Enter frequency only.

• (MIN: 1)
• (MAX: 995)
• DK, RF (Go to ACD_END)

ACD_N11

Instruction: The reference period for this question is the past 12 months. Report seasonal activities as number of times per year.

Select the reporting period.

1. Per day
2. Per week
3. Per month
4. Per year
   (DK, RF not allowed)

ACD_Q12
How much time did you typically spend on each occasion?

Instruction: Read categories to respondent.

1. Less than 10 minutes
2. 10 to less than 30 minutes
3. 30 minutes to less than 1½ hours
4. 1½ hours to less than 5 hours
5. 5 hours or more
   DK, RF

ACD_Q13
How often did you wear hearing protection?

Instruction: Read categories to respondent.

1. Always
2. Often
3. Sometimes
4. Rarely
5. Never
   DK, RF

ACD_END

Sun Exposure Component (SEB)

SEB_BEG

Variables taken from sample file:

• STAND: name of the city/town/village in which the clinic has been set up
• CLINICID:8 digit respondent identifier

Variables assigned in Variable Creation:

• CurrentYear: numeric year during which clinic visit is taking place
• CurrentMonth: numeric month during which clinic visit is taking place
• CurrentDay: numeric day during which clinic visit is taking place
• SessionE: English text of when the clinic visit is taking place
• Date2MonthsAgoE

Variables from previously completed blocks:

• RespondentName: name of respondent
• CON_AGE: age of respondent
• CON_SEX: sex of respondent
• GenderE: English text for sex of respondent
• SCS_N12: visit type (3= clinic visit; 4= home visit)

SEB_R01A
In order to better understand the relationship between sun exposure and vitamin D, we will be asking you questions about behaviours and habits that affect your body's ability to create vitamin D. Please answer the following questions as accurately as possible.

Instruction: Press <1> to continue.

Programmer:

• Allow ‘DK’ as a response category.

SEB_C01A

• If SEB_R01A = DK, go to SEB_N60.
• Otherwise, go to SEB_D01A.

SEB_D01A

Programmer:

• IF SCS_N12 = 4 THEN
  • SEB_D01A = EMPTY
• ELSE
  • IF SEB_R01A = 1 and SEB_D01A = EMPTY THEN
    • SET SEB_D01A = Current Time (in HH:MM:SS format)
• ENDIF

SEB_D01B

• If CurrentMonth = 10, 11, 12, 01, 02, 03 or 04, DT_SEBMONTHE = "this past May to September".
• If CurrentMonth = 08 or 09, DT_SEBMONTHE = "the months of May to ^CURRENTMONTHE this year".
• If CurrentMonth = 05, 06 or 07, DT_SEBMONTHE = "the months of May to September last year".

SEB_R01B
The next few questions concern time spent in the sun. Think about [this past May to September/the months of May to ^CURRENTMONTHE this year/the months of May to September last year].

Instruction: Press <1> to continue.

SEB_D01C

• If CON_AGE=3 to 6, DT_SEBTEXT2E = " or daycare".
• Otherwise, DT_SEBTEXT2E = "EMPTY".

SEB_C01

• If CON_AGE=3 to 11 , go to SEB_Q01.
• Otherwise, go to SEB_Q02.

SEB_Q01
Did you attend school[ or daycare/EMPTY] at any time during these months?

• 1 Yes (Go to SEB_D03A)
• 2 No (Go to SEB_Q13A)
• DK, RF (Go to SEB_Q13A)

SEB_Q02
Did you do any of the following during these months:

- work at a job?

- work at a business?

- attend school?

• 1 Yes
• 2 No (Go to SEB_Q13A)
• DK, RF (Go to SEB_Q13A)

SEB_D03A

• If CON_AGE > 11, DT_SEBTEXT3E = " work or".
• Otherwise, DT_SEBTEXT3E = "EMPTY".

SEB_D03B

• Not Applicable

SEB_Q03
During these months, how much time did you spend in the sun between 10 a.m. and 4 p.m., on a typical day at [work or/EMPTY] school[ or daycare/EMPTY]?

Instruction: Read categories to respondent.

1. Less than 5 minutes (Go to SEB_Q13A)
2. 5 to less than 30 minutes
3. 30 minutes to less than 1 hour
4. 1 hour to less than 2 hours
5. 2 hours or more
   DK, RF (Go to SEB_Q13A)

SEB_D04

• If CON_SEX=1, DT_SEBTEXT5E = "EMPTY".
• Otherwise, DT_SEBTEXT5E = ", veil".

SEB_Q04
When you were exposed to the sun during these hours on a day at[ work or/EMPTY] school[ or daycare/EMPTY], how often did you wear something on your head that shaded your face, ears or neck, for example, a cap[EMPTY/, veil] or sunhat?

Instruction: Read categories to respondent.

1. Always (Go to SEB_Q06)
2. Often
3. Sometimes
4. Rarely
5. Never
   DK, RF

SEB_Q05
Please identify whether the following areas of skin were typically covered or uncovered when you were out in the sun:

Face, ears or neck

Instruction: The reference period for these questions is [this past May to September/the months of May to ^CURRENTMONTHE this year/the months of May to September last year], between the hours of 10 a.m. and 4 p.m.

1. Covered
2. Uncovered
   DK, RF

SEB_Q06
Please identify whether the following areas of skin were typically covered or uncovered when you were out in the sun:

Hands

1. Covered
2. Uncovered
   DK, RF

SEB_Q07
Please identify whether the following areas of skin were typically covered or uncovered when you were out in the sun:

Arms

1. Covered
2. Uncovered
   DK, RF

SEB_Q08
Please identify whether the following areas of skin were typically covered or uncovered when you were out in the sun:

Legs

1. Covered
2. Uncovered
   DK, RF

SEB_Q09
Please identify whether the following areas of skin were typically covered or uncovered when you were out in the sun:

Feet

1. Covered
2. Uncovered
   DK, RF

SEB_Q10
Please identify whether the following areas of skin were typically covered or uncovered when you were out in the sun:

Other (for example, shoulders or back)

1. Covered
2. Uncovered
   DK, RF

SEB_Q11
How often did you usually use sunscreen...

...on your face, ears or neck?

Instruction: The reference period for these questions is [this past May to September/the months of May to ^CURRENTMONTHE this year/the months of May to September last year], between the hours of 10 a.m. and 4 p.m.

Read categories to respondent.

1. Always
2. Often
3. Sometimes
4. Rarely
5. Never
   DK, RF

SEB_Q12A
How often did you usually use sunscreen...

...on other areas (for example, hands, arms or legs)?

1. Always
2. Often
3. Sometimes
4. Rarely
5. Never
   DK, RF

SEB_Q13A
Again, please think about [this past May to September/the months of May to ^CURRENTMONTHE this year/the months of May to September last year]. During these months, how much time did you spend in the sun between 10 a.m. and 4 p.m. on a typical day when not at[ work or/EMPTY] school[ or daycare/EMPTY]?

Instruction: If the respondent was never in the sun during these hours, select <1> 'Less than 5 minutes'.

Read categories to respondent.

1. Less than 5 minutes (Go to SEB_Q23)
2. 5 to less than 30 minutes
3. 30 minutes to less than 1 hour
4. 1 hour to less than 2 hours
5. 2 hours or more
   DK, RF (Go to SEB_Q23)

SEB_Q14
When you were exposed to the sun during these hours on a day when you were not at[ work or/EMPTY] school[ or daycare/EMPTY], how often did you wear something on your head that shaded your face, ears or neck, for example, a cap[EMPTY/, veil] or sunhat?

Instruction: Read categories to respondent.

1. Always (Go to SEB_Q16)
2. Often
3. Sometimes
4. Rarely
5. Never
   DK, RF

SEB_Q15
Please identify whether the following areas of skin were typically covered or uncovered when you were out in the sun:

Face, ears or neck

Instruction: The reference period for these questions is [this past May to September/the months of May to ^CURRENTMONTHE this year/the months of May to September last year], between the hours of 10 a.m. and 4 p.m.

1. Covered
2. Uncovered
   DK, RF

SEB_Q16
Please identify whether the following areas of skin were typically covered or uncovered when you were out in the sun:

Hands

1. Covered
2. Uncovered
   DK, RF

SEB_Q17
Please identify whether the following areas of skin were typically covered or uncovered when you were out in the sun:

Arms

1. Covered
2. Uncovered
   DK, RF

SEB_Q18
Please identify whether the following areas of skin were typically covered or uncovered when you were out in the sun:

Legs

1. Covered
2. Uncovered
   DK, RF

SEB_Q19
Please identify whether the following areas of skin were typically covered or uncovered when you were out in the sun:

Feet

1. Covered
2. Uncovered
   DK, RF

SEB_Q20
Please identify whether the following areas of skin were typically covered or uncovered when you were out in the sun:

Other (for example, shoulders or back)

1. Covered
2. Uncovered
   DK, RF

SEB_Q21
How often did you usually use sunscreen...

...on your face, ears or neck?

Instruction: The reference period for these questions is [this past May to September/the months of May to ^CURRENTMONTHE this year/the months of May to September last year], between the hours of 10 a.m. and 4 p.m.

Read categories to respondent.

1. Always
2. Often
3. Sometimes
4. Rarely
5. Never
   DK, RF

SEB_Q22
How often did you usually use sunscreen...

...on other areas (for example, hands, arms or legs)?

1. Always
2. Often
3. Sometimes
4. Rarely
5. Never
   DK, RF

SEB_Q23
In the past 2 months, that is, from ^Date2MonthsAgoE to yesterday, have you traveled to a warm, sunny climate?

1. Yes
2. No (Go to SEB_C35)
   DK, RF (Go to SEB_C35)

SEB_Q24
How long were you there?

Instruction: Enter amount only.

• Amount
• (MIN: 1)
• (MAX: 61)
• DK, RF (Go to SEB_Q25)

SEB_N24

Instruction: Select the reporting period.

1. Days
2. Weeks
3. Months
4. Years
   (DK, RF not allowed)

SEB_Q25
While you were in this warm, sunny climate...

...how much time did you typically spend in the sun between 10 a.m. and 4 p.m.?

1. Less than 5 minutes (Go to SEB_C35)
2. 5 to less than 30 minutes
3. 30 minutes to less than 1 hour
4. 1 hour to less than 2 hours
5. 2 hours or more
   DK, RF (Go to SEB_C35)

SEB_Q26
While you were in this warm, sunny climate…

...during these hours, how often did you wear something on your head that shaded your face, ears or neck, for example, a cap [EMPTY/, veil] or sunhat?

1. Always (Go to SEB_Q28)
2. Often
3. Sometimes
4. Rarely
5. Never
   DK, RF

SEB_Q27
Please identify whether the following areas of skin were typically covered or uncovered when you were out in the sun:

Face, ears or neck

Instruction: The reference period for these questions is between the hours of 10 a.m. and 4 p.m.

1. Covered
2. Uncovered
   DK, RF

SEB_Q28
Please identify whether the following areas of skin were typically covered or uncovered when you were out in the sun:

Hands

1. Covered
2. Uncovered
   DK, RF

SEB_Q29
Please identify whether the following areas of skin were typically covered or uncovered when you were out in the sun:

Arms

1. Covered
2. Uncovered
   DK, RF

SEB_Q30
Please identify whether the following areas of skin were typically covered or uncovered when you were out in the sun:

Legs

1. Covered
2. Uncovered
   DK, RF

SEB_Q31
Please identify whether the following areas of skin were typically covered or uncovered when you were out in the sun:

Feet

1. Covered
2. Uncovered
   DK, RF

SEB_Q32
Please identify whether the following areas of skin were typically covered or uncovered when you were out in the sun:

Other (for example, shoulders or back)

1. Covered
2. Uncovered
   DK, RF

SEB_Q33
How often did you usually use sunscreen...

...on your face, ears or neck?

Instruction: Read categories to respondent. The reference period for these questions is between the hours of 10 a.m. and 4 p.m.

1. Always
2. Often
3. Sometimes
4. Rarely
5. Never
   DK, RF

SEB_Q34
How often did you usually use sunscreen...

...on other areas (for example, hands, arms or legs)?

1. Always
2. Often
3. Sometimes
4. Rarely
5. Never
   DK, RF

SEB_C35

• If CON_AGE < 12, go to SEB_END.
• Otherwise, go to SEB_R35.

SEB_R35
The following questions are about your use of tanning equipment.

Instruction: Press <1> to continue.

SEB_Q35
In the past 12 months, have you used a tanning bed or booth with tanning lamps?

1. Yes
2. No (Go to SEB_END)
   DK, RF (Go to SEB_END)

SEB_Q36
How often?

Instruction: Enter amount only.

• Times
• (MIN: 1)
• (MAX: 365)
  DK, RF (Go to SEB_Q37)

SEB_N36

Instruction: Select the reporting period.

1. Per day
2. Per week
3. Per month
4. Per year
   (DK, RF not allowed)

SEB_Q37
Have you used a tanning bed or booth with tanning lamps in the past 2 months, that is, from ^Date2MonthsAgoE to today?

1. Yes
2. No
   DK, RF (Go to SEB_END)

SEB_Q38
During which months do you typically use a tanning bed or booth?

Instruction: Mark all that apply.

• 01 January
• 02 February
• 03 March
• 04 April
• 05 May
• 06 June
• 07 July
• 08 August
• 09 September
• 10 October
• 11 November
• 12 December
• 13 All months
• DK, RF

Go to SEB_END

SEB_N60

Instruction: Why was the component not fully completed?

• 01 Respondent unable to continue for health reasons
• 06 No time
• 20 Other - Specify (Go to SEB_S60)
• (DK, RF not allowed)

Go to SEB_END

SEB_S60
(Why was the component not fully completed?)

Instruction: Specify the reason.

• (80 spaces)
• (DK, RF not allowed)

SEB_END

Skin Pigmentation Component

Skin Pigmentation Component Introduction (SKI)

SKI_BEG

External variables required:

Variables taken from sample file:

• STAND: name of the city/town/village in which the clinic has been set up
• CLINICID: 8 digit respondent identifier

Variables assigned in Variable Creation:

• CurrentYear: numeric year during which clinic visit is taking place
• CurrentMonth: numeric month during which clinic visit is taking place
• CurrentDay: numeric day during which clinic visit is taking place
• SessionE: English text of when the clinic visit is taking place

Variables from previously completed blocks:

• RespondentName: name of respondent
• GenderE: English text for sex of respondent
• CON_AGE: age of respondent
• SCS_N12: visit type (3= clinic visit; 4= home visit)

SKI_Q01
To better understand the relationship between skin colour, sun exposure and vitamin D, I will be measuring your skin pigmentation. To do this, I will gently hold a light sensor against your skin in order to measure the amount and type of light reflected by your skin.

Let me show you how it feels on your hand.

Instruction: Show the spectrophotometer to the respondent and demonstrate the technique on the back of the respondent's hand.

Press <1> to continue.

• 1 Continue
• DK (Go to SKI_END)
• (RF is not allowed)

SKI_D01

Programmer:

• IF SCS_N12 = 4 THEN
  • SKI_D01 = EMPTY
• ELSE
  • IF SKI_R01 = 1 and SKI_D01 = EMPTY,
  • SET SKI_D01 = Current Time (in HH:MM:SS format)
• ENDIF

SKI_R02
I will be measuring skin pigmentation at two sites: the back of the hand and the inside of the upper arm. At each site I will take 3 or 4 measurements.

The measurement must be taken directly against the skin (so I may need you to adjust your clothing slightly to have access to the sites).

Before I begin I will need to examine your hand(s) and arm(s) to determine if an accurate measurement can be taken. (Please remove your long sleeved clothing.)

Instruction: If the respondent is unwilling to remove long sleeved clothing, ask him/her to roll his/her sleeve(s) up to the shoulder or to put on a short sleeved gown.

Examine the respondent's right/left hand(s) and arm(s) to determine if an accurate skin pigmentation measurement can be taken.

• Press <1> to continue.
• DK and RF are not allowed.

SKI_N04

Instruction: Record which arm will be used for the inner arm skin pigmentation measurement.

• 1 Right (Go to SKI_N06)
• 2 Left (Go to SKI_N06)
• 3 None
  (DK, RF not allowed)

SKI_N05

Instruction: Why will an inner arm measurement not be taken?

Mark all that apply.

• 1 Measurement site is covered (e.g., cast, dressing)
• 2 Altered skin pigmentation (e.g., tattoo, scar, mole)
• 3 Blanching of skin due to restrictive clothing
• 4 Respondent refused
• 5 Other - Specify (Go to SKI_S05)
  (DK, RF not allowed)

Go to SKI_N06

SKI_S05

Instruction: Specify the reason.

• (80 spaces)
• (DK, RF not allowed)

SKI_N06

Instruction: Record which hand will be used for the hand skin pigmentation measurement:

• 1 Right (Go to SKI_C07)
• 2 Left (Go to SKI_C07)
• 3 None
  (DK, RF not allowed)

SKI_N07

Instruction: Why will a hand measurement not be taken?

Mark all that apply.

• 1 Measurement site is covered (e.g., cast, dressing)
• 2 Altered skin pigmentation (e.g., tattoo, scar, mole)
• 3 Blanching of skin due to restrictive clothing
• 4 Respondent refused
• 5 Other - Specify (Go to SKI_S07)
  (DK, RF not allowed)

Go to SKI_C07

SKI_S07

Instruction: Specify the reason.

• (80 spaces)
• (DK, RF not allowed)

SKI_C07

• If SKI_N04 = 3 and SKI_N06 = 3, go to SKI_R08.
• Otherwise, go to SKI_C08.

SKI_R08
Unfortunately I will not be able to take an accurate measurement of your skin pigmentation today.

Instruction: Answer any questions about why an accurate skin pigmentation measurement cannot be collected.

• Press <1> to continue.

Go to SKI_END

SKI_C08

• If CON_AGE < 12, go to SKI_END.
• Otherwise, go to SKI_R09.

SKI_R09
Now I am going to ask you questions about sunless tanning products. This information will help us better understand the results from your skin pigmentation measure.

Instruction: Press <1> to continue.

SKI_D09

Programmer:

• ^DT_Date10DaysAgoE = English text of date 10 days ago.

SKI_Q09
In the past 10 days, that is, from ^Date10DaysAgoE to today, have you used sunless tanning products such as creams or lotions, or received a spray-on or mist tan?

Instruction: Do not include cosmetic products like blush or bronzing powders.

• 1 Yes
• 2 No (Go to SKI_END)
  DK, RF (Go to SKI_END)

SKI_Q10
Was it applied to the back of your hands?

• 1 Yes
• 2 No
  DK, RF

SKI_Q11
Was it applied to your inner arms between the elbow and armpit?

• 1 Yes
• 2 No
  DK, RF

SKI_END

Skin Pigmentation Measurement (SKM)

SKM_BEG

External variables required:

Variables taken from sample file:

• STAND: name of the city/town/village in which the clinic has been set up
• CLINICID: 8 digit respondent identifier

Variables assigned in Variable Creation:

• CurrentYear: numeric year during which clinic visit is taking place
• CurrentMonth: numeric month during which clinic visit is taking place
• CurrentDay: numeric day during which clinic visit is taking place
• SessionE: English text of when the clinic visit is taking place

Variables from previously completed blocks:

• RespondentName: name of respondent
• GenderE: English text for sex of respondent
• CON_AGE: age of respondent
• SKI_N04: indicates arm for measurement
• SKI_N06: indicates hand for measurement

SKM_C10A

• If SKI_Q01 = DK, go to SKM_N220.
• Otherwise, go to SKM_C10B.

SKM_C10B

• If SKI_N04 =3 and SKI_N06 = 3, go to SKM_END.
• Otherwise, go to SKM_D10A.

SKM_D10A

• If SKI_N04 = 1 and SKI_N06 = 1, DT_SKMR10_TEXTE = "your right inner arm and right hand".
• If SKI_N04 = 2 and SKI_N06 = 2, DT_SKMR10_TEXTE = "your left inner arm and left hand".
• If SKI_N04 = 1 and SKI_N06 = 2, DT_SKMR10_TEXTE = "your right inner arm and left hand".
• If SKI_N04 = 2 and SKI_N06 = 1, DT_SKMR10_TEXTE = "your left inner arm and right hand".
• If SKI_N04 = 1 and SKI_N06 = 3, DT_SKMR10_TEXTE = "your right inner arm ".
• If SKI_N04 = 2 and SKI_N06 = 3, DT_SKMR10_TEXTE = "your left inner arm".
• If SKI_N04 = 3 and SKI_N06 = 1, DT_SKMR10_TEXTE = "your right hand".
• If SKI_N04 = 3 and SKI_N06 = 2, DT_SKMR10_TEXTE = "your left hand".

SKM_D10B

• If SKI_N04 = 1 and SKI_N06 = 3 or SKI_N04 = 2 and SKI_N06 = 3 or SKI_N04 = 3 and SKI_N06 = 1 or SKI_N04 = 3 and SKI_N06 = 2, DT_SKMD10B_TEXTE = "the".
• otherwise, DT_SKMD10B_TEXTE = "each"

SKM_D10C

• If SKI_N04 = 1 and SKI_N06 = 3 or SKI_N04 = 2 and SKI_N06 = 3 or SKI_N04 = 3 and SKI_N06 = 1 or SKI_N04 = 3 and SKI_N06 = 2, DT_SKMD10C_TEXTE = "it".
• Otherwise, DT_SKMD10C_TEXTE = "them".

SKM_R10
Now I am going to take a skin pigmentation measurement on ^DT_SKMR10_TEXTE. First, I need to mark the location of [the/each] measurement using this washable marker. When I am finished, I'll remove [it/them] with a wipe.

Instruction: Mark all locations.

• Press <1> to continue.

SKM_C20

• If SKI_N04 = 3 (No inner arm measurement), go to SKM_C130.
• Otherwise, go to SKM_N20.

SKM_N20

Instruction: Record how the inner arm skin pigmentation data will be captured.

• 1 Electronically
• 2 Electronic data captured manually (Go to SKM_C110)
  (DK, RF not allowed)

SKM_N21

Instruction: Press < ON/MEASURES > to take the first inner arm skin pigmentation measurement.

• Press < 1 > to continue
• DK, RF (Go to SKM_C130)

SKM_N21A

Instruction: Press <1> to save the measurements in Blaise.

• 1 Save the measurements
• (DK, RF not allowed)

SKM_N21B

Instruction: Check the skin pigmentation data.

• 1 Accept the measurements
• 2 Reject the measurements (Go to SKM_B110)
• (DK, RF not allowed)

SKM_N22

Instruction: Press < ON/MEASURES > to take the second inner arm skin pigmentation measurement.

• Press < 1 > to continue.
• 1 Continue
• DK, RF (Go to SKM_C130)

SKM_N22A

Instruction: Press <1> to save the measurements in Blaise.

• 1 Save the measurements
• (DK, RF not allowed)

SKM_N22B

Instruction: Check the skin pigmentation data.

• 1 Accept the measurements
• 2 Reject the measurements (Go to SKM_B111)
• (DK, RF not allowed)

SKM_N23

Instruction: Press < ON/MEASURES > to take the third inner arm skin pigmentation measurement.

• Press < 1 > to continue.
• 1 Continue
• DK, RF (Go to SKM_C130)

SKM_N23A

Instruction: Press <1> to save the measurements in Blaise.

• 1 Save the measurements
• (DK, RF not allowed)

SKM_N23B

Instruction: Check the skin pigmentation data.

• 1 Accept the measurements
• 2 Reject the measurements (Go to SKM_B112)
• (DK, RF not allowed)

SKM_D24

Programmer:

• If the difference between any two of SKM_B110.SKR_N1A, SKM_B111.SKR_N1A, SKM_B112.SKR_N1A is > 10 units, OR
• If the difference between any two of SKM_B110.SKR_N2A, SKM_B111.SKR_N2A, SKM_B112.SKR_N2A is > 10 units,
• Go to SKM_N24.
• Otherwise, go to SKM_C130.

SKM_N24

Instruction: Press < ON/MEASURES > to take the fourth inner arm skin pigmentation measurement.

• Press < 1 > to continue.
• 1 Continue
• DK, RF (Go to SKM_C130)

SKM_N24A

Instruction: Press <1> to save the measurements in Blaise.

• 1 Save the measurements
• (DK, RF not allowed)

SKM_N24B

Instruction: Check the skin pigmentation data.

• 1 Accept the measurements
• 2 Reject the measurements (Go to SKM_B113)
• (DK, RF not allowed)

SKM_C110

• If SKM_N20 = 1 (electronically), go to SKM_C130.
• Otherwise, go to SKM_B110.

SKM_B110

• Call the Skin Pigmentation Recording (SKR) Block.

Programmer:

• Pass ^DT_SKR_TEXTE1 = "first" and ^DT_SKR_TEXTE2 = "inner arm" as a parameters.

SKM_C111

• If SKM_B110.SKR_N1A = DK or RF, go to SKM_C130.
• Otherwise, go to SKM_N111.

SKM_N111

Instruction: Check the skin pigmentation data.

• 1 Accept the measurements
• 2 Reject the measurements (Go to SKM_B110)
• (DK, RF not allowed)

SKM_B111

• Call the Skin Pigmentation Recording (SKR) Block.

Programmer:

• Pass ^DT_SKR_TEXTE1 = "second" and ^DT_SKR_TEXTE2 = "inner arm" as a parameters.

SKM_C112

• If SKM_B111.SKR_N1A = DK or RF, go to SKM_C130.
• Otherwise, go to SKM_N112.

SKM_N112

Instruction: Check the skin pigmentation data.

• 1 Accept the measurements
• 2 Reject the measurements (Go to SKM_B111)
• (DK, RF not allowed)

SKM_B112

• Call the Skin Pigmentation Recording (SKR) Block.

SKM_C113

• If SKM_B112.SKR_N1A = DK or RF, go to SKM_C130.
• Otherwise, go to SKM_N113.

SKM_N113

Instruction: Check the skin pigmentation data.

• 1 Accept the measurements
• 2 Reject the measurements (Go to SKM_B112)
• (DK, RF not allowed)

SKM_D113

Programmer:

• If the difference between any two of SKM_B110.SKR_N1A, SKM_B111.SKR_N1A, SKM_B112.SKR_N1A is > 10 units, OR
• If the difference between any two of SKM_B110.SKR_N2A, SKM_B111.SKR_N2A, SKM_B112.SKR_N2A is > 10 units,
• go to SKM_B113
• Otherwise, go to SKM_C130

SKM_B113

• Call the Skin Pigmentation Recording (SKR) Block.

SKM_C114

• If SKM_B113.SKR_N1A = DK or RF, go to SKM_C130.
• Otherwise, go to SKM_N114.

SKM_N114

Instruction: Check the skin pigmentation data.

• 1 Accept the measurements
• 2 Reject the measurements (Go to SKM_B113)
• (DK, RF not allowed)

SKM_C130

• If SKI_N06 = 3 (No hand measurement), go to SKM_C220.
• Otherwise, go to SKM_N131.

SKM_N131

Instruction: Record how the hand skin pigmentation data will be captured.

• 1 Electronically
• 2 Electronic data captured manually (Go to SKM_C210)
• (DK, RF not allowed)

SKM_N132

Instruction: Press < ON/MEASURES > to take the first hand skin pigmentation measurement.

• Press < 1 > to continue.
• 1 Continue
• DK, RF (Go to SKM_C220)

SKM_N132A

Instruction: Press <1> to save the measurements in Blaise.

• 1 Save the measurements
• (DK, RF not allowed)

SKM_N132B

Instruction: Check the skin pigmentation data.

• 1 Accept the measurements
• 2 Reject the measurements (Go to SKM_B210)
• (DK, RF not allowed)

SKM_N133

Instruction: Press < ON/MEASURES > to take the second hand skin pigmentation measurement.

• Press < 1 > to continue
• 1 Continue
• DK, RF (Go to SKM_C220)

SKM_N133A

Instruction: Press <1> to save the measurements in Blaise.

• 1 Save the measurements
• (DK, RF not allowed)

SKM_N133B

Instruction: Check the skin pigmentation data.

• 1 Accept the measurements
• 2 Reject the measurements (Go to SKM_B211)
• (DK, RF not allowed)

SKM_N134

Instruction: Press < ON/MEASURES > to take the third hand skin pigmentation measurement.

• Press < 1 > to continue.
• 1 Continue
• DK, RF (Go to SKM_C220)

SKM_N134A

Instruction: Press <1> to save the measurements in Blaise.

• 1 Save the measurements
• (DK, RF not allowed)

SKM_N134B

Instruction: Check the skin pigmentation data.

• 1 Accept the measurements
• 2 Reject the measurements (Go to SKM_B212)
• (DK, RF not allowed)

SKM_D135

Programmer:

• If the difference between any two of SKM_B210.SKR_N1A, SKM_B211.SKR_N1A, SKM_B212.SKR_N1A is > 10 units, OR
• If the difference between any two of SKM_B210.SKR_N2A, SKM_B211.SKR_N2A, SKM_B212.SKR_N2A is > 10 units,
• go to SKM_N136.
• Otherwise, go to SKM_C210

SKM_N136

Instruction: Press < ON/MEASURES > to take the fourth hand skin pigmentation measurement.

• Press < 1 > to continue.
• 1 Continue
• DK, RF (Go to SKM_C220)

SKM_N136A

Instruction: Press <1> to save the measurements in Blaise.

• 1 Save the measurements
• (DK, RF not allowed)

SKM_N136B

Instruction: Check the skin pigmentation data.

• 1 Accept the measurements
• 2 Reject the measurements (Go to SKM_B213)
• (DK, RF not allowed)

SKM_C210

• If SKM_N131 = 1 (Electronically), go to SKM_C220.
• Otherwise, go to SKM_B210.

SKM_B210

• Call the Skin Pigmentation Recording (SKR) Block.

Programmer:

• Pass ^DT_SKR_TEXTE1 = "first" and ^DT_SKR_TEXTE2 = "hand" as a parameters.

SKM_C211

• If SKM_B210.SKR_N1A = DK or RF, go to SKM_C220.
• Otherwise, go to SKM_N211.

SKM_N211

Instruction: Check the skin pigmentation data.

• 1 Accept the measurements
• 2 Reject the measurements (Go to SKM_B210)
• (DK, RF not allowed)

SKM_B211

• Call the Skin Pigmentation Recording (SKR) Block.

Programmer:

• Pass ^DT_SKR_TEXTE1 = "second" and ^DT_SKR_TEXTE2 = "hand" as a parameters.

SKM_C212

• If SKM_B211.SKR_N1A = DK or RF, go to SKM_C220.
• Otherwise, go to SKM_N212.

SKM_N212

Instruction: Check the skin pigmentation data.

• 1 Accept the measurements
• 2 Reject the measurements (Go to SKM_B211)
• (DK, RF not allowed)

SKM_B212

• Call the Skin Pigmentation Recording (SKR) Block.

Programmer:

• Pass ^DT_SKR_TEXTE1 = "third" and ^DT_SKR_TEXTE2 = "hand" as a parameters.

SKM_C213

• If SKM_B212.SKR_N1A = DK or RF, go to SKM_C220.
• Otherwise, go to SKM_N213.

SKM_N213

Instruction: Check the skin pigmentation data.

• 1 Accept the measurements
• 2 Reject the measurements (Go to SKM_B212)
• (DK, RF not allowed)

SKM_D213

Programmer:

• If the difference between any two of SKM_B210.SKR_N1A, SKM_B211.SKR_N1A, SKM_B212.SKR_N1A is > 10 units, OR
• If the difference between any two of SKM_B210.SKR_N2A, SKM_B211.SKR_N2A, SKM_B212.SKR_N2A is > 10 units,
• go to SKM_B213.
• Otherwise, go to SKM_C220

SKM_B213

• Call the Skin Pigmentation Recording (SKR) Block.

SKM_C214

• If SKM_B213.SKR_N1A = DK or RF, go to SKM_C220.
• Otherwise, go to SKM_N214.

SKM_N214

Instruction: Check the skin pigmentation data.

• 1 Accept the measurements
• 2 Reject the measurements (Go to SKM_B213)
• (DK, RF not allowed)

SKM_C220

• If SKM_N21 = DK or SKM_N22 = DK or SKM_N23 = DK or SKM_N24 = DK or SKM_B110. SKR_N1A = DK or SKM_B111. SKR_N1A = DK, or SKM_B112. SKR_N1A = DK, or SKM_B113. SKR_N1A = DK, or SKM_N132 = DK or SKM_N133= DK or SKM_N134 = DK or SKM_N136 = DK or SKM_B210.SKR_N1A = DK or SKM_B211.SKR_N1A = DK or SKM_B212.SKR_N1A = DK or SKM_B213.SKR_N1A = DK, go to SKM_N220.
• Otherwise, go to SKM_END.

SKM_N220

Instruction: Why was the component not fully completed?

• 01 Respondent unable to continue for health reasons
• 02 Respondent unable to understand technique / Health Measures Specialist unable to adapt coaching
• 04 Equipment problem / technical difficulty
• 05 Respondent's mental condition
• 06 No time
• 20 Other - Specify (Go to SKM_S220)
• (DK, RF not allowed)

Go to SKM_END

SKM_S220

• (Why was the component not fully completed?)
• Instruction: Specify.
• (80 spaces)
• (DK, RF not allowed)

SKM_END

Skin Pigmentation Recording (SKR)

SKR_BEG

Import the following variables:

• DT_SKR_TEXTE1
• DT_SKR_TEXTE2

SKR_N1A

Instruction: Record the ^DT_SKR_TEXTE1 ^DT_SKR_TEXTE2 Erythema measurement.

• (MIN: ­240)
• (MAX: 240)
• DK, RF

SKR_N1B

Instruction: Re-enter the ^DT_SKR_TEXTE1 ^DT_SKR_TEXTE2 Erythema measurement.

• (MIN: ­240)
• (MAX: 240)
• DK, RF

SKR_C1

• If SKR_N1A = RF or DK, go to SKR_END.
• Otherwise, go to SKR_N2A.

SKR_N2A

Instruction: Record the ^DT_SKR_TEXTE1 ^DT_SKR_TEXTE2 Melanin measurement.

• (MIN: 0)
• (MAX: 240)
• (DK, RF not allowed)

SKR_N2B

Instruction: Re-enter the ^DT_SKR_TEXTE1 ^DT_SKR_TEXTE2 Melanin measurement.

• (MIN: 0)
• (MAX: 240)
• (DK, RF not allowed)

SKR_N3A

Instruction: Record the ^DT_SKR_TEXTE1 ^DT_SKR_TEXTE2 L* measurement.

• (MIN: 0)
• (MAX: 100)
• (DK, RF not allowed)

SKR_N3B

Instruction: Re-enter the ^DT_SKR_TEXTE1 ^DT_SKR_TEXTE2 L* measurement.

• (MIN: 0)
• (MAX: 100)
• (DK, RF not allowed)

SKR_N4A

Instruction: Record the ^DT_SKR_TEXTE1 ^DT_SKR_TEXTE2 a* measurement.

• (MIN: ­120)
• (MAX: 120)
• (DK, RF not allowed)

SKR_N4B

Instruction: Re-enter the ^DT_SKR_TEXTE1 ^DT_SKR_TEXTE2 a* measurement.

• (MIN: ­120)
• (MAX: 120)
• (DK, RF not allowed)

SKR_N5A

Instruction: Record the ^DT_SKR_TEXTE1 ^DT_SKR_TEXTE2 b* measurement.

• (MIN: ­120)
• (MAX: 120)
• (DK, RF not allowed)

SKR_N5B

Instruction: Re-enter the ^DT_SKR_TEXTE1 ^DT_SKR_TEXTE2 b* measurement.

• (MIN: ­120)
• (MAX: 120)
• (DK, RF not allowed)

SKR_END

Anthropometric Component

Anthropometric Component Introduction (ACI)

ACI_BEG

External variables required:

Variables taken from sample file:

• STAND: name of the city/town/village in which the clinic has been set up
• CLINICID: 8 digit respondent identifier

Variables assigned in Variable Creation:

• CurrentYear: numeric year during which clinic visit is taking place
• CurrentMonth: numeric month during which clinic visit is taking place
• CurrentDay: numeric day during which clinic visit is taking place
• SessionE: English text of when the clinic visit is taking place

Variables from previously completed blocks:

• RespondentName: name of respondent
• GenderE: English text for sex of respondent
• CON_AGE: age of respondent
• ANCREP: whether an anthropometric replicate has been assigned
• SCS_N12: Visit Type (3= clinic visit; 4= home visit)

ACI_C01A

• If ANCREP=1, go to ACI_R01.
• Otherwise, go to ACI_R02.

ACI_R01
You have been randomly selected to repeat the anthropometric component where we take body measurements such as your height and weight. You did nothing wrong when these measurements were taken earlier. We repeat these measurements with about 1 out of every 10 participants as a way to ensure consistency of the results.

Do you have any questions?

Instruction: Accompany the respondent to the waiting room and ask him/her to have a seat. Inform the respondent that an HMS will arrive shortly to complete the replicate anthropometric component.

Inform the next available HMS that a respondent has been selected for a replicate and is sitting in the waiting area. Ensure you mention the name of the selected respondent as there may be several respondents in the waiting room.

• Press <1> to continue.

Programmer:

• Allow ‘DK’ as a response category.

ACI_C01B

• If ACI_R01 = DK, go to ACI_END.
• Otherwise, go to ACI_D02.

ACI_R02
Next will be a series of body measurements.

Instruction: Press <1> to continue.

Programmer:

• Allow ‘DK’ as a response category.

ACI_C02

• If ACI_R02 = DK, go to ACI_END.
• Otherwise, go to ACI_D02.

ACI_D02

Programmer:

• IF SCS_N12 = 4 THEN
  • ACI_D02 = EMPTY
• ELSE
  • IF ACI_R02 = 1 and ACI_D02 = EMPTY THEN
    • Set ACI_D02 = Current Time (in HH:MM:SS format)
  • ELSE IF ACI_R01 = 1 THEN
    • Set ACI_D02 = Current Time (in HH:MM:SS format)
  • ENDIF
• ENDIF

ACI_END

Height and Weight Measurements (HWM)

HWM_BEG

External variables required:

Variables taken from sample file:

• STAND: name of the city/town/village in which the clinic has been set up
• CLINICID: 8 digit respondent identifier

Variables assigned in Variable Creation:

• CurrentYear: numeric year during which clinic visit is taking place
• CurrentMonth: numeric month during which clinic visit is taking place
• CurrentDay: numeric day during which clinic visit is taking place
• SessionE: English text of when the clinic visit is taking place

Variables from previously completed blocks:

• RespondentName: name of respondent
• CON_SEX: sex of respondent
• GenderE: English text for sex of respondent
• CON_AGE: age of respondent
• PHC_Q11: whether the respondent is pregnant
• PHC_Q12: number of weeks of pregnancy
• ACI_R01: anthropometry component replicate introduction
• ACI_R02: anthropometry component introduction

HWM_C10

• If ACI_R01 = DK or ACI_R02 = DK, go to HWM_N60.
• Otherwise, go to HWM_R11.

HWM_R11
I'm going to start by measuring how tall you are. Please remove your shoes and stand with your feet together and your heels, buttocks, back, and head in contact with the measuring device. Look straight ahead and stand as tall as possible.

Now, take a deep breath in and hold it.

Instruction: Ensure the respondent's head is in the Frankfort plane and all hair ties or ornaments (e.g., buns, braids, clips) have been removed.

Take the measurement while the breath is being held.

• Press <1> to continue

HWM_N11

Instruction: Record how the data will be captured.

• 1 Electronically
• 2 Manually with a portable device (Go to HWM_N11B)
• 3 Self-report (Go to HWM_N11B)
• 4 Electronic data entered manually
• (DK, RF not allowed)

HWM_N11A

Instruction: Ensure that the stadiometer is set to millimeters (mm).

Press the "Send" button on the left side of the digital display box or the "Data" button on the SPC (send to PC) device.

• (MIN: 770.00)
• (MAX: 2070.90)
• (DK, RF not allowed)

HWM_C11

• If HWM_N11 = 4, go to HWM_N11D.
• Otherwise, go to HWM_D11.

HWM_N11B

Instruction: Record the standing height in centimetres.

• (MIN: 19.00)
• (MAX: 207.60)
• DK, RF (Go to HWM_D11)

HWM_N11C

Instruction: Re-enter the standing height in centimetres.

• (MIN: 19.00)
• (MAX: 207.60)
• DK, RF

Go to HWM_D11

HWM_N11D

Instruction: Re-enter the standing height in millimeters.

• Millimeters
• (MIN: 770.00)
• (MAX: 2070.90)
• DK, RF

HWM_D11

Programmer:

• Set standing height in centimeters and derive standing height in inches (HWM_D11).
• IF HWM_N11 = 1 or 4 THEN
  • HWM_Q11 = Round((HWM_N11A / 10), .01)
• ELSE
  • HWM_Q11 = HWM_N11B
• ENDIF

• IF HWM_Q11 = RESPONSE THEN
  • HWM_D11 = Round((HWM_Q11 * 0.3937), .1)
• ENDIF

HWM_C11A

• If HWM_Q11 = DK, go to HWM_S11.
• Otherwise, go to HWM_C11B.

HWM_S11

Instruction: Specify the reason why the measurement could not be taken.

• (80 spaces)
• (DK, RF not allowed)

HWM_C11B

• If HWM_N11 = 3, go to HWM_R13.
• Otherwise, go to HWM_R12.

HWM_R12
Next, I'd like you to sit on this box so that I can measure how tall you are when you are sitting. Sit with your back and head against the measuring device. Put your hands on your lap and keep your legs still. Look straight ahead and sit up as straight as possible.

Now, take a deep breath in and hold it.

Instruction: Ensure the respondent's head is in the Frankfort plane.

Ensure the respondent does not contract the gluteal muscles nor push with the legs.

Take the measurement while the breath is being held.

• Press <1> to continue.

HWM_C12A

• If HWM_N11 = 1 or 4, go to HWM_N12A.
• Otherwise, go to HWM_N12B.

HWM_N12A

Instruction: Ensure that the stadiometer is set to millimetres (mm). Press the "Send" button on the left side of the digital display box or the "Data" button on the SPC (send to PC) device.

• (MIN: 770.00)
• (MAX : 2070.90)
• DK, RF (Go to HWM_D12)

HWM_C12B

• If HWM_N11 = 4, go to HWM_N12D.
• Otherwise, go to HWM_D12.

HWM_N12B

Instruction: Record the sitting height in centimetres.

• (MIN: 73.00)
• (MAX: 207.60)
• DK, RF (Go to HWM_D12)

HWM_N12C

Instruction: Re-enter the sitting height in centimetres.

• (MIN: 73.00)
• (MAX: 207.60)
• DK, RF

Go to HWM_D12

HWM_N12D

Instruction: Re-enter the sitting height in millimeters.

• (MIN: 770.00)
• (MAX: 2070.90)
• DK, RF

HWM_D12

Programmer:

• Set sitting height in centimeters and derive sitting height in inches (HWM_D12).
• IF HWM_N11 = 1 or 4 THEN
  • IF HWM_N12A = RESPONSE THEN
    • HWM_Q12 = Round(((HWM_N12A / 10) - 73), .01)
  • ELSE
    • HWM_Q12 = HWM_N12A
  • ENDIF
• ELSE
  • IF HWM_N12B = RESPONSE THEN
    • HWM_Q12 = (HWM_N12B - 73)
  • ELSE
    • HWM_Q12 = HWM_N12B
  • ENDIF
• ELSE
  • IF HWM_Q12 = RESPONSE THEN
    • HWM_D12 = Round((HWM_Q12 * 0.3937), .1)
• ENDIF

HWM_C12C

• If HWM_Q12 = DK, go to HWM_S12.
• Otherwise, go to HWM_R13.

HWM_S12

Instruction: Specify the reason why the measurement could not be taken.

• (80 spaces)
• (DK, RF not allowed)

HWM_R13
Next I'm going to measure how much you weigh. Please empty your pockets, remove all heavy accessories, step onto the centre of the scale and face me. Keep your hands at your sides and look straight ahead.

Instruction: Ensure the respondent has on only minimal clothing (no shoes), has nothing in his/her pockets and has removed all heavy accessories (e.g., a watch, belt, pair of glasses).

• Press <1> to continue.

HWM_N13

Instruction: Record how the data will be captured.

1. Electronically
2. Manually with a portable device (Go to HWM_N13B)
3. Self-report (Go to HWM_N13B)
4. Electronic data entered manually (Go to HWM_N13B)
   (DK, RF not allowed)

HWM_N13A

Instruction: Ensure the scale is set to kilograms (kg).

• Press <Print> on the scale.
• Press <1> to save the measurement in Blaise.
• 1 Save the measurement
• (DK, RF not allowed)

HWM_R13A

Instruction: Check the data returned from the scale.

• Press <1> to continue.
• Go to HWM_C14A

HWM_N13B

Instruction: When the measurement is stable, record the weight in kilograms.

• (MIN: 0.5)
• (MAX: 500.0)
• DK, RF (Go to HWM_D13)

HWM_N13C

Instruction: Re-enter the weight in kilograms.

• (MIN: 0.5)
• (MAX: 500.0)
• DK, RF

HWM_D13

Programmer:

• Set weight in kilograms and derive weight in pounds (HWM_D13).
• IF HWM_N13 = 1 THEN
  • HWM_Q13 = HWM_N13A
• ELSE
  • HWM_Q13 = HWM_N13B
• ENDIF

• IF HWM_Q13 = RESPONSE THEN
  • HWM_D13 = Round((HWM_Q13 * 2.205), .1)
• ENDIF

HWM_C13

• If HWM_Q13 = DK, go to HWM_S13.
• Otherwise, go to HWM_C14A.

HWM_S13

Instruction: Specify the reason why the measurement could not be taken.

• (80 spaces)
• (DK, RF not allowed)

HWM_C14A

• If PHC_Q11 = 1, go to HWM_C20.
• Otherwise, go to HWM_R14.

HWM_R14
Now I'm going to measure your waist circumference. Please stand up straight with your arms hanging loosely at your sides, and breathe normally. I may need to move your clothing slightly because the measurement has to be taken directly on the skin. In order to ensure I have the correct position, I am going to feel for certain landmarks and make a few small marks on your skin with a washable marker where the tape measure is to go. When I'm done, I'll remove them with a wipe.

Instruction: Landmark both sides.

• Read the measurement at the right side of the body.
• Take the measurement at the end of a normal expiration.
• Press <1> to continue.

HWM_N14A

Instruction: Record the waist circumference in centimetres.

• (MIN: 0.1)
• (MAX: 305.0)
• DK, RF (Go to HWM_D14)

HWM_N14B

Instruction: Re-enter the waist circumference in centimetres.

• (MIN: 0.1)
• (MAX: 305.0)
• DK, RF

HWM_D14

Programmer:

• Set waist circumference in centimeters and derive waist circumference in inches (HWM_D14).
• HWM_Q14 = HWM_N14A
• IF HWM_Q14 = RESPONSE THEN
  • HWM_D14 = Round((HWM_Q14 * 0.3937), .1)
• ENDIF

HWM_C14B

• If HWM_Q14 = DK, go to HWM_S14.
• Otherwise, go to HWM_R15.

HWM_S14

Instruction: Specify the reason why the measurement could not be taken.

• (80 spaces)
• (DK, RF not allowed)

HWM_R15
Now I'm going to measure your hip circumference. Please stand up straight with your feet together, your arms hanging loosely at your sides, and breathe normally. I may need to move your clothing slightly to ensure the measurement is accurate.

Instruction: Read the measurement at the right side of the body.

• Press <1> to continue.

HWM_N15A

Instruction: Record the hip circumference in centimetres.

• (MIN: 0.1)
• (MAX: 305.0)
• DK, RF (Go to HWM_D15)

HWM_N15B

Instruction: Re-enter the hip circumference in centimetres.

• (MIN: 0.1)
• (MAX: 305.1)
• DK, RF

HWM_D15

Programmer:

• Set hip circumference in centimeters and derive hip circumference in inches (HWM_D15).
• HWM_Q15 = HWM_N15A

• IF HWM_Q15 = RESPONSE THEN
  • HWM_D15 = Round((HWM_Q15 * 0.3937), .1)
• ENDIF

HWM_C15

• If HWM_Q15 = DK, go to HWM_S15.
• Otherwise, go to HWM_D20.

HWM_S15

Instruction: Specify the reason why the measurement could not be taken.

• (80 spaces)
• (DK, RF not allowed)

HWM_C20

• If ANCREP = 1, go to HWM_D21.
• Otherwise, go to HWM_D20.

HWM_D20

• If PHC_Q11=1, DT_HWMTEXT20E = "EMPTY".
• Otherwise, DT_HWMTEXT20E = "In case you are selected, I will now erase the marks I put on your skin to ensure that they do not influence a possible second set of measurements.".
• If PHC_Q11=1, DT_HWMINT20E = "EMPTY".
• Otherwise, DT_HWMINT20E = "Use a wipe to wash off all marks on the respondent's skin.".

HWM_R20
At the end of the appointment, we may need to repeat the measurements I have just completed. The computer randomly selects people to be re-measured for quality control purposes. [EMPTY/In case you are selected, I will now erase the marks I put on your skin to ensure that they do not influence a possible second set of measurements.]

Instruction: Press <1> to continue.

[EMPTY/Use a wipe to wash off all marks on the respondent's skin.]

HWM_D21

Programmer:

• Calculate the body mass index.

HWM_D22

Programmer:

• Calculate the body mass index norms for respondents 18 or older.

HWM_D23

Programmer:

• Calculate the body mass index norms for respondents less than 18.

HWM_D24

Programmer:

• Calculate the waist circumference norms for respondents 15 - 69.

HWM_D25

Programmer:

• Calculate the waist-to-hip ratio.

HWM_C59

• If 1 = 1, go to HWM_END.
• Otherwise, go to HWM_END.

HWM_N60

Instruction: Why was the component not fully completed?

• 01 Respondent unable to continue for health reasons
• 06 No time
• 20 Other - Specify
• (DK, RF not allowed)

Go to HWM_END

HWM_S60
(Why was the component not fully completed?)

Instruction: Specify.

• (80 spaces)
• (DK, RF not allowed)

HWM_END

Blood Pressure Component

Blood Pressure Measurement (BPM)

BPM_BEG

External variables required:

Variables taken from sample file:

• STAND: name of the city/town/village in which the clinic has been set up
• CLINICID: 8 digit respondent identifier

Variables assigned in Variable Creation:

• CurrentYear: numeric year during which clinic visit is taking place
• CurrentMonth: numeric month during which clinic visit is taking place
• CurrentDay: numeric day during which clinic visit is taking place
• SessionE: English text of when the clinic visit is taking place

Variables from previously completed blocks:

• RespondentName: name of respondent
• CON_SEX: sex of respondent
• GenderE: English text for sex of respondent
• CON_AGE: age of respondent
• HWM_Q11: standing height (in centimetres)
• SCS_N12: visit type (3= clinic visit; 4= home visit)
• PHC_Q57B: indicator of which side the respondent has had a mastectomy

BPM_N101

Instruction: Record how the first set of data will be captured.

• 1 Electronically (BpTRU)
• 3 BpTRU data entered manually (Go to BPM_B110)
  DK (Go to BPM_N600)
• (RF is not allowed)

Programmer:

• If BPM_N101= 3 is selected, please do not pre-fill the values with previous data.

BPM_D101

Programmer:

• IF SCS_N12 = 4 THEN
  • BPM_D101 = EMPTY
• ELSE
  • If BPM_N101 = RESPONSE and BPM_D101 = EMPTY,
  • Set BPM_D101 = Current Time (in HH:MM:SS format)
• ENDIF

BPM_D101B

• If PHC_Q57B = 1, DT_ARME = "left".
• Otherwise, DT_ARME = "right".

BPM_Q101A
Now I will take your blood pressure and heart rate using an automated blood pressure cuff. During this test you will need to sit up straight with your feet flat on the floor, your back against the back rest of the chair, and your [left/right] arm on the table.

Instruction:

- Ensure the BpTRU is communicating with Health Listener

- Set the BpTRU to cycle 1 (1 - minute intervals)

- Turn the BpTRU away from the respondent.

• Press <1> to continue.
• 1 Continue
• (DK is not allowed)
• RF (Go to BPM_END)

BPM_D102B

• If CON_AGE < 14, DT_BPM102TEXTE = "The cuff will fill with air and it will squeeze your arm a little. It will do this 6 times. During the test you cannot talk. You need to sit really still and keep both feet flat on the floor. You should stay relaxed to ensure we get good results. Before we start, I will leave you alone to sit and relax for 5 minutes. I will then come back to start the machine. It is very important that we don’t talk until the test is done.".
• Otherwise, DT_BPM102TEXTE = "The cuff will inflate automatically once every minute, applying pressure to your arm. A total of 6 measures will be taken. I will stay in the room for the first measurement then I will leave the room. Although I will not be present during the test, should you require assistance, I will be just outside the room. You should not move or talk during the test, and you need to keep both feet flat on the floor. It is important that you stay relaxed to ensure we get good results. Before we begin, I will leave you alone to sit and relax for 5 minutes. I will then return to start the machine. I ask that you do not talk when I return to take the first measurement.".

BPM_Q102
^DT_BPM102TEXTE.

Do you have any questions before we begin?

Instruction: Answer any questions as thoroughly as possible.

• Select the appropriate cuff size by using the range indicated on the inside of the cuff.
• Secure the cuff on the respondent's [left/right] arm.
• Ensure respondent is in the correct position (palm down, feet flat, arm and back rested, relaxed).
• Start the stopwatch to return to the room after 5 minutes.
• After the 5-minute rest period, return to the room and press the <Start> button on the BpTRU.
• Stay in the room for the first measure and write down the result.
• Press CTL-ALT-DELETE and then ENTER to lock the computer before leaving the room.
• Press <1> to continue.
• 1 Continue
• (DK, RF not allowed)

PM_N105

Instruction: Press <1> to save the measurements in Blaise.

• 1 Save the measurements (Go to BPM_D160A)
• (DK, RF not allowed)

BPM_B110

• Call the Blood Pressure Recording (BPR) block.

BPM_C111

• If BPM_B110.BPR_N1A = RF, go to BPM_END.
• Otherwise, go to BPM_B111.

BPM_C112

• If BPM_B111.BPR_N1A = RF, go to BPM_N160.
• Otherwise, go to BPM_B121.

BPM_B111

• Call the Blood Pressure Recording (BPR) block.

BPM_B121

• Call the Blood Pressure Recording (BPR) block.

BPM_B131

• Call the Blood Pressure Recording (BPR) block.

BPM_B141

• Call the Blood Pressure Recording (BPR) block.

BPM_B151

• Call the Blood Pressure Recording (BPR) block.

BPM_D160A

Programmer:

• IF any three of (BPM_B111.BPR_N4, BPM_B121.BPR_N4, BPM_B131.BPR_N4, BPM_B141.BPR_N4 and BPM_B151.BPR_N4) or (BPM_B111.DT_BPR_N4, BPM_B121. DT_BPR_N4, BPM_B131. DT_BPR_N4, BPM_B141. DT_BPR_N4 and BPM_B151. DT_BPR_N4) = RESPONSE THEN
  • BPM_D160A = 1
• ENDIF

BPM_D160B

• If BPM_N105 = 1, DT_BPM160INSTE = "Press <Clear> on the BPTru screen.".
• Otherwise, DT_BPM160INSTE = "EMPTY".

BPM_N160

Instruction: Check the blood pressure and heart rate data.

• [Press <Clear> on the BPTru screen./EMPTY]
• Accept the measurements
• Re-do the measurements
• (DK, RF not allowed)

Help text:

• Select "Re-do the measurements" if the blood pressure measurements are invalid. For example:
• There was a noteworthy distraction or noise in the room while the measurement was being taken (e.g., something fell from a shelf or desk, likely startling the respondent); or
• The protocol was not respected (e.g., the respondent is not in the correct position, moves or talks during the measurements).
• The measurements were stopped before obtaining three or more valid measures (e.g., error code 6)

BPM_C161A

• If (BPM_N101=1 and BPM_Q101A=1) or BPM_N101=3, go to BPM_N161.
• Otherwise, go to BPM_C161B.

BPM_N161

Instruction: Was anyone in the room with the respondent (e.g., HMS, parent or guardian) when the blood pressure measurements were taken?

• 1 Yes
• 2 No
  (DK, RF not allowed)

BPM_C161

• If BPM_N160 = 2, go to BPM_C201.
• Otherwise, go to BPM_D161.

BPM_D161

Programmer:

• Calculate the first average systolic blood pressure.

BPM_D162

Programmer:

• Calculate the first average diastolic blood pressure.

BPM_D163

Programmer:

• Calculate the first average resting heart rate.

BPM_C164

• If BPM_D160A = 1, go to BPM_N201.
• Otherwise, go to BPM_D402.

BPM_N201

Instruction: Record how the second set of data will be captured.

• 1 Electronically (BpTRU)
• 3 BpTRU data entered manually (Go to BPM_B210)
  (DK, RF not allowed)

BPM_Q201
There were too many errors with that set of measurements, so we have to do the test again. I will retake your blood pressure and heart rate. Remember, you should not move or talk during the test, and you need to keep both feet flat on the floor. It's important that you stay relaxed to ensure we get good results.

Instruction:

• Ensure the BpTRU is communicating with Health Listener.
• Set the BpTRU to cycle 1.
• Turn the BpTRU away from the respondent.
• Answer any questions as thoroughly as possible.
• Select the appropriate cuff size by using the range indicated on the inside of the cuff.
• Secure the cuff on the respondent's [left/right] arm.
• Ensure respondent is in the correct position (palm down, feet flat, arm and back rested, relaxed).
• Start the BpTRU.
• Stay in the room for the first measure and write down the result.
• Press CTL-ALT-DELETE and then ENTER to lock the computer before leaving the room.

• Press <1> to continue.
• (DK is not allowed)
• RF (Go to BPM_D402)

BPM_N205

Instruction: Press <1> to save the measurements in Blaise.

• 1 Save the measurements (Go to BPM_D260A)
• (DK, RF not allowed)

BPM_B210

• Call the Blood Pressure Recording (BPR) block.

BPM_C211

• If BPM_B210.BPR_N1A = RF, go to BPM_D402.
• Otherwise, go to BPM_B211.

BPM_B211

• Call the Blood Pressure Recording (BPR) block.

BPM_B221

• Call the Blood Pressure Recording (BPR) block.

BPM_B231

• Call the Blood Pressure Recording (BPR) block.

BPM_B241

• Call the Blood Pressure Recording (BPR) block.

BPM_B251

• Call the Blood Pressure Recording (BPR) block.

BPM_D260A

Programmer:

• If any three of (BPM_B211.BPR_N4, BPM_B221.BPR_N4, BPM_B231.BPR_N4, BPM_B241.BPR_N4 and BPM_B251.BPR_N4) or (BPM_B211.DT_BPR_N4, BPM_B221. DT_BPR_N4, BPM_B231. DT_BPR_N4, BPM_B241. DT_BPR_N4 and BPM_B251. DT_BPR_N4) = RESPONSE THEN
  • BPM_D260A = 1
• ENDIF

BPM_D260B

• If BPM_N205 = 1, DT_BPM260INSTE = "Press <Clear> on the BPTru screen.".
• Otherwise, DT_BPM260INSTE = "EMPTY".

BPM_N260

Instruction: Check the blood pressure and heart rate data.

[Press <Clear> on the BPTru screen./EMPTY]

• 1 Accept the measurements
• 2 Reject the measurements
  (DK, RF not allowed)

Help text:

Select "Reject the measurements" if the blood pressure measurements are invalid. For example:

• There was a noteworthy distraction or noise in the room while the measurement was being taken (e.g., something fell from a shelf or desk, likely startling the respondent);
• The protocol was not respected (e.g., the respondent is not in the correct position, moves or talks during the measurements).

BPM_N261

Instruction: Was anyone in the room with the respondent (e.g., HMS, parent or guardian) when the blood pressure measurements were taken?

• 1 Yes
• 2 No
• (DK, RF not allowed)

BPM_C261B

• If BPM_N260 = 2, go to BPM_D402.
• Otherwise, go to BPM_D261. BPM_D261

Programmer:

• Calculate the second average systolic blood pressure.

BPM_D262

Programmer:

• Calculate the second average diastolic blood pressure.

BPM_D263

Programmer:

• Calculate the second average resting heart rate.

BPM_D402

Content type - Note to data users:

• If two sets of blood pressure measurements are taken, the set with the greatest number of valid measurements is used to set the final resting blood pressure and heart rate results.

Programmer:

• IF BPM_D260A = 1 or BPM_D261 = EMPTY OR 999 THEN
• IF BPM_D160A = 1 or BPM_D161 = EMPTY OR 999 THEN
• IF BPM_D261 = RESPONSE AND BPM_D262 = RESPONSE AND BPM_D263 = RESPONSE THEN
• IF BPM_D161 = RESPONSE AND BPM_D162 = RESPONSE AND BPM_D163 = RESPONSE THEN
• IF second set has more valid measures than first set* THEN
  • BPM_D314 = BPM_D261
  • BPM_D315 = BPM_D262
  • BPM_D316 = BPM_D263
• ELSE
  • BPM_D314 = BPM_D161
  • BPM_D315 = BPM_D162
  • BPM_D316 = BPM_D163
• ENDIF
• ELSE
  • BPM_D314 = BPM_D261
  • BPM_D315 = BPM_D262
  • BPM_D316 = BPM_D263
• ENDIF
• ELSE
  • IF BPM_D161 = RESPONSE AND BPM_D162 = RESPONSE AND BPM_D163 = RESPONSE THEN
    • BPM_D314 = BPM_D161
    • BPM_D315 = BPM_D162
    • BPM_D316 = BPM_D163
  • ELSE
    • BPM_D314 = EMPTY
    • BPM_D315 = EMPTY
    • BPM_D316 = EMPTY
  • ENDIF
  • ENDIF
  • ELSE
    • BPM_D314 = BPM_D161
    • BPM_D315 = BPM_D162
    • BPM_D316 = BPM_D163
  • ENDIF
  • ELSE
    • IF BPM_D160A = 1 or BPM_D161 = EMPTY OR 999 THEN
      • BPM_D314 = BPM_D261
      • BPM_D315 = BPM_D262
      • BPM_D316 = BPM_D263
    • ELSE
      • BPM_D314 = BPM_D161
      • BPM_D315 = BPM_D162
      • BPM_D316 = BPM_D163
  • ENDIF
• ENDIF

* a valid measure within a set has N1A = RESPONSE and N2A = RESPONSE and N3A = RESPONSE

BPM_D403

Programmer:

• BPM_D317 = BPM_D314
• BPM_D318 = BPM_D315
• BPM_D319 = BPM_D316

BPM_D411A

Programmer:

• Calculate the blood pressure norms for respondents 18 or older.

BPM_C411

• If BPM_D411A = RESPONSE and BPM_D411A > 2, go to BPM_D411B.
• Otherwise, go to BPM_D412A.

BPM_D411B

• If BPM_D411A = 3, DT_BPM411TEXTE = "above the acceptable range".
• If BPM_D411A = 4, DT_BPM411TEXTE = "moderately high".
• If BPM_D411A = 5, DT_BPM411TEXTE = "high".
• If BPM_D411A = 6, DT_BPM411TEXTE = "very high".

• If BPM_D411A = 6, DT_BPM411TEXT2E = "Your average blood pressure today was ^BPM_D317 / ^BPM_D318 mmHg, which means your blood pressure is very high. You should see a doctor or clinic today, or go to a hospital emergency room, to have your blood pressure re-checked.
  Because of these results, we will not continue with your clinic visit.".
• Otherwise, DT_BPM411TEXT2E = "EMPTY".
• If BPM_D411A = 6, DT_BPM411INSTE = "
  • Answer any questions as thoroughly as possible
  • Skip each of the remaining components by entering “DK” at the first question and selecting “Respondent unable to continue for health reasons”
  • Sign the blood pressure reporting letter and ensure that the exit and sign-out components are completed as soon as possible.".
• Otherwise, DT_BPM411INSTE = "The respondent's average blood pressure was ^BPM_D317 / ^BPM_D318 mmHg, which means their blood pressure is ^DT_BPM411TEXTE. A blood pressure reporting letter will be generated at the end of the clinic visit.".

BPM_R411
^DT_BPM411TEXT2E

Instruction: ^DT_BPM411INSTE

• Go to BPM_END

BPM_D412A

Programmer:

• Calculate the blood pressure norms for respondents less than 18.
• See the DV "include" file.

BPM_C412

• If BPM_D412A = RESPONSE and BPM_D412A > 2, go to BPM_D412B.
• Otherwise, go to BPM_C599.

BPM_D412B

• If BPM_D412A = 4, DT_BPM412TEXTE = "Your average blood pressure today was ^BPM_D317 / ^BPM_D318 mmHg, this means your blood pressure is very high. You should see a doctor or clinic today, or go to a hospital emergency room, to have your blood pressure re-checked.
  Because of these results we will not continue with your clinic visit.".
• Otherwise, DT_BPM412TEXTE = "EMPTY".
• If BPM_D412A = 4, DT_BPM412INSTE = "
  • Answer any questions as thoroughly as possible
  • Skip each of the remaining components by entering “DK” at the first question and selecting "Respondent unable to continue for health reasons"
  • Sign the blood pressure reporting letter and ensure that the exit and sign-out components are completed as soon as possible.".
• Otherwise, DT_BPM412INSTE = "The respondent's average blood pressure was ^BPM_D317 / ^BPM_D318 mmHg, this means their blood pressure was high. A blood pressure reporting letter will be generated at the end of the clinic visit.".

BPM_R412
^DT_BPM412TEXTE

Instruction: ^DT_BPM412INSTE

• Press <1> to continue.
• Go to BPM_END

BPM_C599

• If BPM_D317 = RESPONSE, go to BPM_END.
• Otherwise, go to BPM_N600.

BPM_N600

Instruction: Why was the component not fully completed?

• 01 Respondent unable to continue for health reasons
• 02 Respondent unable to understand technique / Health Measures Specialist unable to adapt coaching
• 03 Respondent refuses to continue
• 04 Equipment problem / technical difficulty
• 05 Respondent’s mental condition
• 06 No time
• 20 Other - Specify (Go to BPM_S600)
• (DK, RF not allowed)

Go to BPM_END

BPM_S600
(Why was the component not fully completed?)

Instruction: Specify.

• (80 spaces)
• (DK, RF not allowed)

BPM_END

Blood Pressure Recording (BPR)

BPR_BEG

External variables required:

• BPM_N101: record how the data will be captured.
  BPM_N201: record how the data will be captured.

BPR_N1A

Instruction: Record the systolic blood pressure measurement.

• Systolic blood pressure (in mmHg)
• (MIN: 30)
• (MAX: 300)
• DK, RF

BPR_N1B

Instruction: Re-enter the systolic blood pressure measurement.

• (MIN: 30)
• (MAX: 300)
• DK, RF

BPR_C2

• If BPR_N1A = RF, go to BPR_END.
• Otherwise, go to BPR_N2A.

BPR_N2A

Instruction: Record the diastolic blood pressure measurement.

• Diastolic blood pressure (in mmHg)
• (MIN: 30)
• (MAX: 200)
• DK
• (RF is not allowed)

BPR_N2B

Instruction: Re-enter the diastolic blood pressure measurement.

• (MIN: 30)
• (MAX: 200)
• DK
• (RF is not allowed)

BPR_N3A

Instruction: Record the heart rate.

• Heart rate (in beats per minute)
• (MIN: 30)
• (MAX: 200)
• DK
• (RF is not allowed)

BPR_N3B

Instruction: Re-enter the heart rate.

• (MIN: 30)
• (MAX: 200)
• DK
• (RF is not allowed)

BPR_C4

• If BPR_N1A = DK or BPR_N2A = DK, go to BPR_N4.
• Otherwise, go to BPR_END.

BPR_N4

Instruction: Record the reason why the measurement could not be taken. Mark all that apply.

• 00 Too few pulses detected
• 01 Excessive motion artifacts
• 06 Deflation too fast
• 08 Low pulse amplitude
• 20 Indeterminate systolic blood pressure
• 21 Indeterminate diastolic blood pressure
• 23 Systolic blood pressure under-range
• 24 Diastolic blood pressure under-range
• 25 Systolic blood pressure over-range
• 26 Diastolic blood pressure over-range
• 88 Other - Specify (Go to BPR_S5)
• (DK, RF not allowed)

BPR_C5

• If BPR_N4 = 88, go to BPR_S5.
• Otherwise, go to BPR_END.

BPR_S5

(Record the reason why the measurement could not be taken.)

Instruction: Specify.

• (80 spaces)
• (DK, RF not allowed)

BPR_END

Activity Monitor Component (AM)

AM_BEG

External variables required:

Variables taken from sample file:

• STAND: name of the city/town/village in which the clinic has been set up
• CLINICID: 8 digit respondent identifier

Variables assigned in Variable Creation:

• CurrentYear: numeric year during which clinic visit is taking place
• CurrentMonth: numeric month during which clinic visit is taking place
• CurrentDay: numeric day during which clinic visit is taking place
• SessionE: English text of when the clinic visit is taking place
• DateMailBackE: English text of date 8 days after the clinic visit

Variables output from Clinic Shell:

• DateMailBackE: English text of date 8 days after the clinic visit

Variables from previously completed blocks:

• RespondentName: name of respondent
• GenderE: English text for sex of respondent
• CON_AGE: age of respondent
• IAS_N32: the waybill number of the postage-paid envelope
• SCS_N12: Visit type (3= clinic visit; 4= home visit)

AM_N11

Instruction: Record whether an activity monitor is available.

• 1 Yes
• 2 No (Go to AM_END)
• DK (Go to AM_N90)
• (RF is not allowed)

AM_D11

Programmer:

• IF SCS_N12 = 4 THEN
  • AM_D11 = EMPTY
• ELSE
  • IF AM_N11 = RESPONSE and AM_D11 = EMPTY,
    • Set AM_D11 = Current Time (in HH:MM:SS format)
• ENDIF

AM_R11
It is crucial to obtain information about Canadians' daily activity patterns. As a result, this survey will be measuring your daily activity patterns over a 7 day period. In order to do this, we would like you to wear an activity monitor for the next 7 days.

An activity monitor is a small battery-operated electronic device that is worn on a belt around the waist, on the right hip bone. The monitor records all daily activities as electronic signals. It is pre-programmed to start recording tomorrow morning, there is no activation required and it does not need to be turned on or off.

Instruction: Hold up the activity monitor (on the belt) for display.

• Press <1> to continue.

AM_Q11
The activity monitor is to be worn for the next 7 days and mailed back after the 7 days are over. Do you have any questions before we proceed?

Instruction: Answer any questions as thoroughly as possible.Press <1> to continue.

• 1 Continue (Go to AM_R21)
• (DK is not allowed)
• RF

AM_N12

Instruction: Record the reason why the respondent is not willing to wear an activity monitor for the next 7 days.

• 01 Burden
• 02 Invasive
• 03 Aesthetics
• 04 Away during the collection period
• 05 Anticipating change in normal activity
• 06 Sick or laid up
• 07 Worried about losing or damaging the device
• 08 Other - Specify (Go to AM_S12)
• (DK, RF not allowed)

Go to AM_END

AM_S12

(Record the reason why the respondent is not willing to wear an activity monitor for the next 7 days.)

Instruction: Specify the reason.

• (80 spaces)
• (DK, RF not allowed)

Go to AM_END

AM_R21
We ask that you start wearing this monitor as soon as you wake up tomorrow morning and that you keep wearing it for 7 full days.

• Place it on your right hip bone with the arrow pointing up and the belt snug.
• You can wear it over or under your clothes.
• It is important that you put on the activity monitor as soon as you wake up in the morning and take it off only when going to bed at night. We do not want to miss a step!
• Since the device is waterproof please wear it all day long without interruption (when showering, swimming, taking a nap, etc.).

Please do not alter your usual physical activity behaviour, since we are interested in your normal activity level.

Instruction: Assist the respondent in putting the belt on. Check to ensure the belt fits snugly around the waist and that the activity monitor is positioned on the right hip bone with the arrow pointing up.

Write the respondent's initials on the belt if more than one member of the same household will receive a monitor.

• Press <1> to continue.

AM_N21

Instruction: Record whether the respondent took an activity monitor.

• 1 Yes (Go to AM_N31A)
• 2 No
• (DK, RF not allowed)

AM_N22

Instruction: Record the reason why the respondent did not take an activity monitor.

• 01 Burden
• 02 Invasive
• 03 Aesthetics
• 04 Away during the collection period
• 05 Anticipating change in normal activity
• 06 Sick or laid up
• 07 Worried about losing or damaging the device
• 08 Other - Specify (Go to AM_S22)
• (DK, RF not allowed)

Go to AM_END

AM_S22

(Record the reason why the respondent did not take an activity monitor.)

Instruction: Specify.

• (80 spaces)
• (DK, RF not allowed)

Go to AM_END

AM_N31A

Instruction: To log in the serial number of the activity monitor, scan the bar code on the monitor.

• (7 spaces)
• (DK, RF not allowed)

AM_N31B

Instruction: Re-scan the bar code on the activity monitor.

• (7 spaces)
• (DK, RF not allowed)

AM_N32

Instruction: To log in the waybill number of the postage-paid envelope, scan the bar code on the envelope.

• (13 spaces)
• (DK, RF not allowed)

AM_R33
On the morning of ^DateMailBackE, please put the activity monitor into this postage-paid envelope and put the envelope into any Canada Post mailbox. Full descriptions of what the activity monitor is, what it measures, how it works, and why it is important are included on the information sheet in the envelope. Should you have any questions or concerns, you will find a toll free number on this sheet.

Instruction: Give the postage-paid envelope (addressed to Statistics Canada), the monitor and the information sheet to the respondent.

Ensure they do not confuse this material with the Indoor Air Sampler material.Inform the respondent that he/she will receive a reminder call to ensure he/she has started to wear the monitor and another call to remind him/her to return it.

• Press <1> to continue.

Go to AM_END

AM_N90

Instruction: Why was the component not fully completed?

• 01 Respondent unable to continue for health reasons
• 02 Respondent unable to understand technique / Health Measures Specialist unable to adapt coaching
• 04 Equipment problem / technical difficulty
• 05 Respondent's mental condition
• 06 No time
• 20 Other - Specify (Go to AM_S90)
• (DK, RF not allowed)

Go to AM_END

AM_S90
(Why was the component not fully completed?)

Instruction: Specify the reason.

• (80 spaces)
• (DK, RF not allowed)

AM_END

Indoor Air Sampler Component

Indoor Air Sampler (IAS)

Overview: The indoor air sampler measurement is only administered to one person per household. In households with two selected respondents, the IAS block is administered to the first respondent that begins the clinic visit.

IAS_BEG

External variables required:

Variables taken from sample file:

• STAND: name of the city/town/village in which the clinic has been set up
• CLINICID: 8 digit respondent identifier
• REPLICID: 8 digit replicate identifier
• IASPCT: selection percentage for an Indoor Air replicate

Variables assigned in Variable Creation:

• CurrentYear: numeric year during which clinic visit is taking place
• CurrentMonth: numeric month during which clinic visit is taking place
• CurrentDay: numeric day during which clinic visit is taking place
• SessionE: English text of when the clinic visit is taking place

Variables output from Clinic Shell:

• DateMailBackE: English text of date 8 days after the clinic visit

Variables from previously completed blocks:

• RespondentName: name of respondent
• CON_SEX: sex of respondent
• GenderE: English text for sex of respondent
• CON_AGE: age of respondent
• AM_N32: the waybill number of the postage-paid envelope
• SCS_N12: visit type (3= clinic visit; 4= home visit)

IAS_N11

Instruction: Record whether an indoor air sampler is available.

• 1 Yes
• 2 No
• DK (Go to IAS_N90)
• (RF is not allowed)

IAS_D11

Programmer:

• IF SCS_N12 = 4 THEN
  • IAS_D11 = EMPTY
• ELSE
  • IF IAS_N11 = RESPONSE and IAS_D11 = EMPTY,
    • Set IAS_D11 = Current Time (in HH:MM:SS format)
• ENDIF

IAS_C11

• If IAS_N11 = 2, go to IAS_END.
• Otherwise, go to IAS_R11.

IAS_R11
As part of this survey we will be assessing the air in your home. To do this, we would like you to bring this indoor air sampler home and place it in your living or family room for the next 7 days.

An indoor air sampler is a small tubular device that collects air from your home. Specifically, the sampler will measure a number of substances that may be present in the air of your household, such as benzene, methane and ethanol. The indoor air sampler is quite easy to use.

It is important for us to collect this information because it will allow us to establish national baselines for indoor air concentrations of substances that could affect the health of Canadians.

Instruction: Hold up the sampler for display.

• Press <1> to continue.
• DK, RF not allowed.

IAS_Q11
The indoor air sampler should be placed in your home for the next 7 days and mailed back after the 7 days are over. Do you have any questions before we proceed?

Instruction: Answer any questions as thoroughly as possible. If the respondent is not available to mail back the sampler at the end of the 7 days, it can be mailed backed a few days earlier or later. The sampler must be set up for at least 4 days, to a maximum of 9 days before being sent back. Do not provide the sampler if these conditions cannot be met.

• Press <1> to continue. (Go to IAS_R21)
• (DK is not allowed)
• RF (Go to IAS_N12)

IAS_N12

Instruction: Record the reason why the respondent is not willing to take an indoor air sampler to place in their home for the next 7 days.

1. Burden
2. Invasive
3. Away during the collection period
4. Worried about losing or damaging the device
5. Other - Specify (Go to IAS_S12)
6. (DK, RF not allowed)

Go to IAS_END

IAS_S12
(Record the reason why the respondent is not willing to take an indoor air sampler to place in their home for the next 7 days.)

Instruction: Specify the reason.

• (80 spaces)
• (DK, RF not allowed)

Go to IAS_END

IAS_R21
In this postage-paid envelope, you will find: An aluminium container with:

• A brass tube with a round clip-on white cap
• A grey metal cap with mesh screen
• A small pencil

I will now go through the detailed instructions with you.

Instruction: Ensure respondent has entire contents of the indoor air sampler envelope. Go through and demonstrate each step of the instruction sheet carefully with the respondent.

• Press <1> to continue.
• DK, RF not allowed

IAS_N21

Instruction: Record whether the respondent took an indoor air sampler.

• 1 Yes (Go to IAS_N31A)
• 2 No
• (DK, RF not allowed)

IAS_N22

Instruction: Record the reason why the respondent did not take an indoor air sampler.

1. Burden
2. Invasive
3. Away during the collection period
4. Worried about losing or damaging the device
5. Other - Specify (Go to IAS_S22)
   (DK, RF not allowed)

Go to IAS_END

IAS_S22
(Record the reason why the respondent did not take an indoor air sampler.)

Instruction: Specify the reason.

• (80 spaces)
• (DK, RF not allowed)

Go to IAS_END

IAS_N31A

Instruction: Press <1> to print the label with the respondent's CLINIC ID.

Stick the label to the aluminium container with the indoor air sampler.

• 1 Print the label
• (DK, RF not allowed)

IAS_N31B

Instruction: To log in the serial number of the indoor air sampler, scan the sampler ID bar code on the aluminium container.

• (8 spaces)
• (DK, RF not allowed)

IAS_N31C

Instruction: Re-scan the sampler ID bar code on the aluminium container.

• (8 spaces)
• (DK, RF not allowed)

IAS_N32

Instruction: To log in the waybill number of the postage-paid envelope, scan the bar code on the envelope.

• (13 spaces)
• (DK, RF not allowed)

IAS_R71
On the morning of ^DateMailBackE please put the aluminium container with the sampler inside into this postage-paid envelope and put the envelope into any Canada Post mailbox. Please remember to refer to the information sheet under the section: "What to do at the end of the 7 days".Should you have any questions or concerns, you will find a toll free number on this sheet.

Instruction: Give the postage-paid envelope (addressed to CASSEN Testing Laboratories), the container with sampler and the information sheet to the respondent. Ensure they do not confuse this material with the Activity Monitor material.

Inform the respondent that they will receive a reminder call to ensure they have set up the sampler and another call to remind them to return it.

• Press <1> to continue.
• DK, RF not allowed

Go to IAS_END

IAS_N90

Instruction: Why was the component not fully completed?

• 01 Respondent unable to continue for health reasons
• 02 Respondent unable to understand technique / Health Measures Specialist unable to adapt coaching
• 04 Equipment problem / technical difficulty
• 05 Respondent's mental condition
• 06 No time
• 20 Other - Specify (Go to IAS_S90)
• (DK, RF not allowed)

Go to IAS_END

IAS_S90
(Why was the component not fully completed?)

Instruction: Specify.

• (80 spaces)
• (DK, RF not allowed)

IAS_END

Indoor Air Questions (IAQ)

IAQ_BEG

External variables required:

Variables taken from sample file:

• STAND: name of the city/town/village in which the clinic has been set up
• CLINICID: 8 digit respondent identifier
• DW_Q01: type of dwelling that the respondent lives in, collected when the method of interview is by telephone
• DW_N02: type of dwelling that the respondent lives in, collected when the method of Interview is personal
• DW_S02: Other - Specify response for type of dwelling that the respondent lives in

Variables assigned in Variable Creation:

• CurrentYear: numeric year during which clinic visit is taking place
• CurrentMonth: numeric month during which clinic visit is taking place
• CurrentDay: numeric day during which clinic visit is taking place
• SessionE: English text of when the clinic visit is taking place

Variables output from Clinic Shell:

• Date1WeekAgoE: English text of date one week before the clinic visit
• DateLastMonthE: English text of date one month before the clinic visit
• Date6MonthsAgoE: English text of date six months before the clinic visit

Variables from previously completed blocks:

• RespondentName: name of respondent
• CON_SEX: sex of respondent
• GenderE: English text for sex of respondent
• CON_AGE: age of respondent
• IAS_N21: whether respondent took an indoor air sampler

IAQ_C01

• If IAS_N21 = 1, go to IAQ_R01.
• Otherwise, go to IAQ_END.

IAQ_R01
Now I'm going to ask you some questions about your home and the environment around your home.

Instruction: Press <1> to continue.

IAQ_C02

• If DW_Q01 <> RESPONSE and DW_N02 <> RESPONSE, go to IAQ_Q03.
• Otherwise, go to IAQ_D02A.

IAQ_D02A

Programmer:

• IF DW_Q01 = 10 THEN
  • DT_IAQ02TextE = DW_S02
  • DT_IAQ02TextF = DW_S02
• ELSE
  • IF DW_N02 = 10 THEN<
    • DT_IAQ02TextE = DW_S02
    • DT_IAQ02TextF = DW_S02
• ENDIF

IAQ_D02B

• If DW_Q01 = 1 or DW_N02 = 1, DT_IAQ02TEXTE = "single detached home".
• If DW_Q01 = 2 or DW_N02 = 2, DT_IAQ02TEXTE = "double".
• If DW_Q01 = 3 or DW_N02 = 3, DT_IAQ02TEXTE = "row house or terrace home".
• If DW_Q01 = 4 or DW_N02 = 4, DT_IAQ02TEXTE = "duplex".
• If DW_Q01 = 5 or DW_N02 = 5, DT_IAQ02TEXTE = "low-rise apartment of fewer than 5 stories or a flat".
• If DW_Q01 = 6 or DW_N02 = 6, DT_IAQ02TEXTE = "high-rise apartment of 5 stories or more".
• If DW_Q01 = 7 or DW_N02 = 7, DT_IAQ02TEXTE = "institution".
• If DW_Q01 = 8 or DW_N02 = 8, DT_IAQ02TEXTE = "hotel; rooming/lodging house; camp".
• If DW_Q01 = 9 or DW_N02 = 9, DT_IAQ02TEXTE = "mobile home".

IAQ_Q02
It was recorded during the household interview that you live in a(n) ^DT_IAQ02TEXTE. Is this correct?

• 1 Yes (Go to IAQ_D04)
• 2 No
• (DK, RF not allowed)

IAQ_Q03
What type of dwelling do you live in? Is it a... ?

Instruction: Read categories to respondent.

• 01 Single detached
• 02 Double
• 03 Row or terrace
• 04 Duplex
• 05 Low-rise apartment of fewer than 5 stories or a flat
• 06 High-rise apartment of 5 stories or more
• 07 Institution
• 08 Hotel; rooming/lodging house; camp
• 09 Mobile home
• 10 Other - Specify (Go to IAQ_S03)
• DK, RF

Go to IAQ_D04

IAQ_S03
(What type of dwelling do you live in? Is it a... ?)

Instruction: Specify.

• (80 spaces)
• (DK, RF not allowed)

IAQ_D04

Content type - Note to data users:

• IAQ_D04 (dwelling type) is set based on IAQ_Q02 (dwelling type confirmation from home interview) or IAQ_Q03 (response to dwelling type question during the clinic visit)

Programmer:

• IF IAQ_Q02 = 1
  • IF DW_N02 = RESPONSE THEN
    • IAQ_D04 = DW_N02
  • ELSE
    • IAQ_D04 = DW_Q01
  • ENDIF
• ELSE
  • IAQ_D04 = IAQ_Q03
• ENDIF

IAQ_Q04
How old is your home? Is it...?

Instruction: Read categories to respondent. If necessary state: If you do not know the exact age, please provide an estimate.

1. Less than 10 years old
2. 10 years old to less than 20
3. 20 years old to less than 30
4. 30 years old to less than 40
5. 40 years old to less than 50
6. 50 or more years old
7. DK, RF

IAQ_Q05
How long have you lived in your home?

Instruction: Minimum is 0; maximum is ^CON_AGE.
If less than one year enter "0".

• Years
• (MIN: 0)
• (MAX: 79)
• DK, RF

Content type - Note to data users:

• A hard edit will ensure that the age of the home is always greater or equal to the length of time the respondent has lived in his/her home.

IAQ_Q06
Excluding the basement and garage, what is the approximate area of your home in square feet or square metres? Would you say it is...?

Instruction: Read categories to respondent.

1. 600 sq. ft (55 square metres) or less
2. 601 to 1,000 sq. ft (56 to 95 square metres)
3. 1,001 to 2,000 sq. ft (96 to 185 square metres)
4. 2,001 to 3,000 sq. ft (186 to 280 square metres)
5. 3,001 to 4,000 sq. ft (281 to 371 square metres)
6. 4,001 sq. ft (372 square metres) or more
   DK, RF

IAQ_Q07
What is the main source of heat in your home?

Instruction: If the respondent reports the distribution method of the heat (e.g., hot water), probe to determine the original source of the heat (e.g., the means of heating the water such as an oil or gas furnace). Mark all that apply.

• 1 Oil furnace
• 2 Gas furnace
• 3 Electric heat
• 4 Wood-burning stove
• 5 Wood-burning fireplace
• 6 Gas fireplace
• 7 Other - Specify (Go to IAQ_S07)
• DK, RF

Go to IAQ_C11

IAQ_S07
(What is the main source of heat in your home?)

Instruction: Specify.

• (80 spaces)
• (DK, RF not allowed)

IAQ_C11

• If IAQ_D04 = 5, 6 or 7 (dwelling is low-rise apartment, high-rise apartment or institution), go to IAQ_Q14.
• Otherwise, go to IAQ_Q11.

IAQ_Q11
Do you have a garage on your property?

Instruction: Do not include carports.

• 1 Yes
• 2 No (Go to IAQ_Q15)
• (DK is not allowed)
• RF (Go to IAQ_Q15)

IAQ_C12A

• If IAQ_Q11 = 1, go to IAQ_Q12.
• Otherwise, go to IAQ_C12B.

IAQ_C12B

• If (IAQ_D04 = 1, 2, 3, 4, 9 (single detached, double, row or terrace, duplex or mobile home) and IAQ_Q11 = 2 or RF), go to IAQ_Q15.
• Otherwise, go to IAQ_C12C.

IAQ_C12C

• If (IAQ_D04 = 8, 10, DK, RF (hotel; rooming/lodging house; camp, other - specify, don’t know or refuse) and IAQ_Q11 = 2 or RF), go to IAQ_Q14.
• Otherwise, go to IAQ_Q12.

IAQ_Q12
Is it a... ?

Instruction: Read categories to respondent.

If respondent has more than one garage, ask about the garage situated closest to the home.

1. Detached garage
2. Attached garage without a connecting door to your home
3. Attached garage with a connecting door to your home
   DK, RF

IAQ_Q13
In the past month, that is from ^DateLastMonthE until today, how often has a car, truck, or other vehicle been parked in this garage after being used?

Instruction: Read categories to respondent.

1. More than 5 times a week
2. 1 to 5 times a week
3. Less than once a week
4. Never
   DK, RF

IAQ_C14

• If IAQ_Q11 = 1, go to IAQ_Q15.
• Otherwise, go to IAQ_Q14.

IAQ_Q14
Does your building have any of the following parking facilities?

Instruction: Read categories to respondent. Mark all that apply.

1. Indoor or underground parking lot
2. Outdoor or partially enclosed parking lot
3. Neither
   DK, RF

IAQ_Q15
In the past month, that is from ^DateLastMonthE until today, have you or anyone else ever smelled fumes in your home from cars, trucks or other vehicles?

Instruction: These fumes could come from a garage, driveway, parking lot, the street, etc.

• 1 Yes
• 2 No (Go to IAQ_Q17)
• DK, RF (Go to IAQ_Q17)

IAQ_Q16
How often were these fumes smelt?

Instruction: Read categories to respondent.

1. More than 5 times a week
2. 1 to 5 times a week
3. Less than once a week
   DK, RF

IAQ_Q17
In the past month, have you had a major home renovation such as finishing of the basement, painting walls or windows, changing floors/ceilings or upgrading a kitchen or bathroom?

Instruction: Do not include home renovations that took place more than one month ago or that will occur during the collection period.

• 1 Yes
• 2 No
• DK, RF

IAQ_Q18
In the past month, have new carpeting or rugs been installed in your home?

• 1 Yes
• 2 No
• DK, RF

IAQ_Q19
In the past week, that is from ^Date1WeekAgoE to today, which of the following products did you or anyone else use inside your home? Do not include products used in your garage or outside of your home.

Instruction: Read categories to respondent. Mark all that apply.

• 01 Gasoline or gasoline-powered devices
• 02 Kerosene
• 03 Moth balls or moth crystals
• 04 Oil-based (alkyd) paints
• 05 Latex paint
• 06 Paint remover
• 07 Solvents (e.g., Varsol, paint thinners)
• 08 Oil based (alkyd) wood stains
• 09 Latex wood stains
• 10 Candles
• 11 Paints, type unknown
• 12 Wood stains, type unknown
• 13 None
• DK, RF

Help text: The following products should be included in the corresponding response category:

• 01 Gasoline or gasoline-powered devices: devices working with lighter fuel
• 05 Latex paint: water based paint
• 10 Candles: candles on a birthday cake
• 11 Paints, type unknown: acrylic paint

The following products should not be included in the corresponding response category:

• Finger paints for kids
• Nail polish remover
• Incense

IAQ_Q20
On a typical day over the past week, did you normally open windows or doors to get fresh air into your home?

• 1 Yes
• 2 No
• DK, RF

IAQ_Q21
In the past 6 months, that is from ^Date6MonthsAgoE to today, how often did you or anyone else in your home bring home clothing or any other items from the dry cleaners?

Instruction: Read categories to respondent.

1. More than once a week
2. About once a week
3. Less than once a week
4. Never
   DK, RF

IAQ_END

Spirometry Measurement Component (SPM)

SPM_BEG

External fields required:

Variables taken from sample file:

• STAND: name of the city/town/village in which the clinic has been set up
• CLINICID: 8 digit respondent identifier
• SDC_Q36: respondent's racial background is Aboriginal
• SDC_Q38A: respondent's racial background is White
• SDC_Q38B: respondent's racial background is South Asian
• SDC_Q38C: respondent's racial background is Chinese
• SDC_Q38D: respondent's racial background is Black
• SDC_Q38E: respondent's racial background is Filipino
• SDC_Q38F: respondent's racial background is Latin American
• SDC_Q38G: respondent's racial background is Arab
• SDC_Q38H: respondent's racial background is Southeast Asian
• SDC_Q38I: respondent's racial background is West Asian
• SDC_Q38J: respondent's racial background is Korean
• SDC_Q38K: respondent's racial background is Japanese
• SDC_Q38L: respondent's racial background is Other
• SDC_S38: Other - Specify for respondent's racial background

Variables assigned in Variable Creation:

• CurrentYear: numeric year during which clinic visit is taking place
• CurrentMonth: numeric month during which clinic visit is taking place
• CurrentDay: numeric day during which clinic visit is taking place
• SessionE: English text of when the clinic visit is taking place

Variables from previously completed blocks:

• RespondentFirstName: first name of respondent
• RespondentLastName: last name of respondent
• RespondentName: name of respondent
• CON_SEX: sex of respondent
• GenderE: English text for sex of respondent
• CON_DDN: date of birth of respondent (in YYYYMMDD format)
• CON_AGE: age of respondent
• HWM_D11: height of respondent in inches
• SCS_N12: visit type (3= clinic visit; 4= home visit)

SPM_D011

Content type - Note to data users:

• If the respondent's date of birth is not available, it will be estimated by subtracting the respondent's age from the current year (Using January 1st as the reference date).

SPM_Q021
Now we will be doing a test to measure your lung function. The results of this test greatly depend on your effort; so, to get good results we really need you to give 100%.

Instruction: Press <1> to continue.

• 1 Continue
• DK (Go to SPM_N901)
• RF (Go to SPM_END)

SPM_D021

Programmer:

• IF SCS_N12 = 4 THEN
  • SPM_D021 = EMPTY
• ELSE
• IF SPM_Q021 = 1 or RF and SPM_D021 = EMPTY,
  • Set SPM_D021 = Current Time (in HH:MM:SS format)
• ENDIF

SPM_R022
First I need to enter some information into our computer system to prepare the test. This will only take a few minutes.

Instruction: Press <1> to continue.

SPM_D022A

• If SDC_Q36 = 1, DT_RBE1 = "Aboriginal".
• If SDC_Q38A = 1, DT_RBE2 = "White".
• If SDC_Q38B = 1, DT_RBE3 = "South Asian ".
• If SDC_Q38C = 1, DT_RBE4 = "Chinese".
• If SDC_Q38D = 1, DT_RBE5 = "Black".
• If SDC_Q38E = 1, DT_RBE6 = "Filipino".
• If SDC_Q38F = 1, DT_RBE7 = "Latin American".
• If SDC_Q38G = 1, DT_RBE8 = "Arab".
• If SDC_Q38H = 1, DT_RBE9 = "Southeast Asian".
• If SDC_Q38I = 1, DT_RBE10 = "West Asian".
• If SDC_Q38J = 1, DT_RBE11 = "Korean".
• If SDC_Q38K = 1, DT_RBE12 = "Japanese".
• If SDC_Q38L = 1, DT_RBE13 = "^SDC_S38".

SPM_D022B

Programmer:

^DT_SPM022TextE = DT_RBE1 + DT_RBE2 + DT_RBE3 + DT_RBE4 + DT_RBE5 + DT_RBE6 + DT_RBE7 + DT_RBE8 + DT_RBE9 + DT_RBE10 + DT_RBE11 + DT_RBE12 + DT_RBE13 (separated by slashes)

SPM_D022C

• If SDC_Q36=1 or SDC_Q38A=1 or SDC_Q38G=1, DT_RACEWE = "White".
• If SDC_Q38D=1, DT_RACEBE = "Black".
• If SDC_Q38F=1, DT_RACEHE = "Hispanic".
• If SDC_Q38B=1 or SDC_Q38C=1 or SDC_Q38E=1 or SDC_Q38H=1 or SDC_Q38I=1 or SDC_Q38J=1 or SDC_Q38K=1, DT_RACEAE = "Asian".
• If SDC_Q38L=1, DT_RACEOE = "Other".

Programmer:

• ^DT_RACEADJE = [White] or [Black] or [Hispanic] or [Asian] or [Other]

SPM_D022D

• If ^DT_RACEADJE = more than 1 race adjustment category, DT_PGTEXT1E = " either".
• Otherwise, DT_PGTEXT1E = "EMPTY".
• If ^DT_RACEADJE = more than 1 race adjustment category, DT_PGTEXT2E = " based on the respondent's morphology".
• Otherwise, DT_PGTEXT2E = "EMPTY".

SPM_N022

Instruction: The racial background reported during the household interview is ^DT_SPM022TEXTE. Based on this information you should pick [ either/EMPTY] the ^DT_RACEADJE race adjustment category[ based on the respondent's morphology/EMPTY].

Record the appropriate race adjustment for the respondent.

• 1 White
• 2 Black
• 3 Hispanic
• 4 Asian
• 5 Other
• (DK, RF not allowed)

Content type - Note to data users:

• Using the information collected from the household interview, the health measures specialist (HMS) is prompted to select one race adjustment category. If more than one race adjustment category is possible, the HMS will decide based on the respondent's morphology.

SPM_C022

• If Edit = Suppressed, go to SPM_N022B.
• Otherwise, go to SPM_D023.

Content type - Note to data users:

• If a race adjustment category different from that which was prompted at SPM_N022 is selected then go to SPM_022B.
• Otherwise, go to SPM_D023.

SPM_N022B

Instruction: Why was ^SPM_N022 selected as the race adjustment category?

1. Morphology does not match race adjustment category
2. No reported racial background during household interview
3. Incomplete/incorrect racial background from household interview
4. Other - Specify (Go to SPM_S022B)
   (DK, RF not allowed)

Go to SPM_D023

SPM_S022B

Instruction: Specify.

• (80 spaces)
• (DK, RF not allowed)

SPM_D023

• If CON_SEX = 1, DT_SPM_SEX = "M".
• If CON_SEX = 2, DT_SPM_SEX = "F".

SPM_N023

Instruction: Check the data to be sent to the spirometry software.

• Press <1> to transmit the data.
• Press <2> to retransmit the data.
• 1 Transmit the data
• 2 Retransmit the data
• (DK, RF not allowed)

SPM_D024

Programmer:

• IF CON_AGE < 8 THEN
  • SPM024Text1 = "Corey 1976"
• IF SPM_N022 = 1 THEN
  • SPM024Text2 = "W H U"
• ELSE IF SPM_N022 = 2 THEN
  • SPM024Text2 = "B A"
• ELSE IF SPM_N022 = 3 THEN
  • SPM024Text2 = "W H U"
• ELSE IF SPM_N022 = 4 THEN
  • SPM024Text2 = "B A"
• ELSE
  • SPM024Text2 = "W H U"
• ENDIF
• ELSE
  • SPM024Text1 = "Hankinson (NHANES III)"
• IF SPM_N022 = 1 THEN
  • SPM024Text2 = "Caucasian"
• ELSE IF SPM_N022 = 2 THEN
  • SPM024Text2 = "African-American"
• ELSE IF SPM_N022 = 3 THEN
  • SPM024Text2 = "Mexican-American"
• ELSE IF SPM_N022 = 4 THEN
  • SPM024Text2 = "Other - Asian"
• ELSE
  • SPM024Text2 = "Other - Unknown"
• ENDIF
• ENDIF

SPM_R024

Instruction: Open the KoKo software.Follow the instructions on importing and retrieving respondent information.

In the KoKo patient information screen, choose "^SPM024Text1" for "Predicteds" and "^SPM024Text2" for "Ethnic Group".

• Press <1> to continue.

SPM_Q031
During the test, you will wear this clip on your nose and place this mouthpiece in your mouth. Your lips and teeth should be nice and tight around the mouthpiece, so that no air escapes. Once you have the mouthpiece in your mouth, you will follow a few easy steps.

1. First, you are going to breathe normally.
2. Next, I'm going to tell you to take a big breath in! I want you to fill up your lungs with as much air as possible, and as quickly as possible.
3. As soon as you've filled your lungs, I'm going to tell you to blow the air out as fast, as hard, and for as long as possible. Don't hold your breath at all; you need to blow it out as quickly as possible.
4. After that, I'm going to tell you to keep blowing, keep blowing, keep blowing! Even if you think no more air is coming out, keep blowing because there may be a little bit left and we want to get it all out.
5. When you've finished blowing out, I'm going to tell you to take a big breath in again, just like the first one.
6. Finally, you can remove the mouthpiece from your mouth and take the nose clip off of your nose.

Instruction: Demonstrate the test from start to finish, as realistically as possible.

• Press <1> to continue.
• 1 Continue
• (DK is not allowed)
• RF (Go to SPM_END)

SPM_Q032
I'll tell you exactly what to do and when to do it. All you need to do is listen to my instructions and give me your best effort.

We will repeat this test a few times to ensure that we get your best effort.

Do you have any questions before we begin?

Instruction: Answer any questions as thoroughly as possible.

• Press <1> to continue.
• 1 Continue
• (DK is not allowed)
• RF (Go to SPM_END)

SPM_Q033
Please sit up straight in your chair and keep both feet flat on the floor.

Instruction: Press <1> to continue.

• 1 Continue
• (DK is not allowed)
• RF (Go to SPM_END)

SPM_R033

Instruction: Common verbal cues

1. "Take a few normal breaths."
2. "Big breath in!"
3. "Blow!"
4. "Keep blowing, keep blowing, keep blowing..."
5. "Big breath in!"

Instruction: Go to the KoKo software.

Follow the instructions for performing the test.

• Press <1> to continue.

SPM_R100

Instruction: Ensure the spirometry test results have been saved in the KoKo software and the .SER file has been transferred from the KoKo software to the clinic server.

• Press <1> to continue.

SPM_N800

Instruction: Record how many trials were performed and saved.

• 1 0
• 2 1 or 2
• 3 3 or more
• (DK, RF not allowed)

SPM_C800

• If SPM_N800 = 1 or 2, go to SPM_N901.
• Otherwise, go to SPM_N900.

SPM_N900

Instruction: Record whether this test meets the American Thoracic Society (ATS) criteria.

• 1 Yes
• 2 No
• (DK, RF not allowed)

SPM_C901

• If SPM_N900 = RESPONSE, go to SPM_END.
• Otherwise, go to SPM_N901.

SPM_N901

Instruction: Why was the component not fully completed?

1. Respondent unable to continue for health reasons
2. Respondent unable to understand technique / Health Measures Specialist unable to adapt coaching
3. Respondent refuses to continue
4. Equipment problem / technical difficulty
5. Respondent's mental condition
6. Other - Specify (Go to SPM_S901)
7. No time
   (DK, RF not allowed)

Go to SPM_END

SPM_S901
(Why was the component not fully completed?)

Instruction: Specify.

• (80 spaces)
• (DK, RF not allowed)

SPM_END

Hearing Component

Otoscopy Measurement (OTM)

OTM_BEG

External variables required:

Variables taken from sample file:

• STAND: name of the city/town/village in which the clinic has been set up
• CLINICID: 8 digit respondent identifier

Variables assigned in Variable Creation:

• CurrentYear: numeric year during which clinic visit is taking place
• CurrentMonth: numeric month during which clinic visit is taking place
• CurrentDay: numeric day during which clinic visit is taking place
• SessionE: English text of when the clinic visit is taking place

Variables from previously completed blocks:

• RespondentName: name of respondent
• GenderE: English text for sex of respondent
• CON_AGE: age of respondent
• HER_Q40: whether the respondent has an ear infection or pain in ears
• HER_Q41: whether the respondent has acute infection/pain (in right, left or both ears)
• HER_Q52: whether the respondent has a hearing aid
• HER_Q53: whether the respondent has hearing aid (in right, left or both ears)

OTM_D10

• If HER_Q41 = 1, DT_OTMTEXT1E = "left ear".
• Else If HER_Q41 = 2, DT_OTMTEXT1E = "right ear".
• Otherwise, DT_OTMTEXT1E = "ears, one at a time".
• If HER_Q41 = 1 or 2, DT_OTMTEXT4E = "ear".
• Otherwise, DT_OTMTEXT4E = "ears".

OTM_R10
Now we will be doing a series of tests to measure your hearing. I'm going to start by doing a visual inspection of your [ear/ears]. To do this, I will gently place an otoscope in your [left ear/right ear/ears, one at the time] and record my observations.

Instruction: Show the otoscope to the respondent.

• Press <1> to continue.

Programmer:

• Use red font for dynamic text DT_OTMTEXT4E
• Allow ‘DK’ as a response category

OTM_C11

• If OTM_R10 = DK, go to OTM_N90.
• Otherwise, go to OTM_D11.

OTM_D11

Programmer:

• IF OTM_R10 = 1 and OTM_D11 = EMPTY,
  • Set OTM_D11 = Current Time (in HH :MM :SS format).
• ENDIF

OTM_Q20
I would like you to sit in this chair with your hands on your lap, sitting up straight and facing forward. Please sit as still as you can. This will only take a few seconds.

Instruction: Select the appropriately sized speculum and place it on the otoscope. Ensure the respondent is sitting still in the correct position and any glasses, hair ties or ornaments, hats or chewing gum that may interfere with otoscopic examination have been removed.

• Press <1> to continue.
• 1 Continue
• (DK is not allowed)
• RF (Go to OTM_END)

OTM_C30A

• If HER_Q52 = 1, go to OTM_D30.
• Otherwise, go to OTM_C30E.

OTM_D30

• If HER_Q53 = 1 or 2, DT_OTMTEXT2E = "aid".
• If HER_Q53 = 3 , DT_OTMTEXT2E = "aids".

OTM_Q30
Before we start, I would like to ask you to please remove your hearing [aid/aids].

Instruction: If the respondent cannot remove his or her own hearing [aid/aids] (or is not accompanied by a parent or guardian who can assist), press <F5> to refuse.

• Press <1> to continue.
• 1 Continue (Go to OTM_C30E)
• (DK is not allowed)
  RF (Go to OTM_C30B)

OTM_C30B

• If HER_Q53 = 1, go to OTM_C60A.
• Otherwise, go to OTM_C30C.

OTM_C30C

• If HER_Q53 = 2, go to OTM_C30E.
• Otherwise, go to OTM_C30D.

OTM_C30D

• If HER_Q53 = 3, go to OTM_END.
• Otherwise, go to OTM_C30E.

OTM_C30E

• If HER_Q41 = 1 , go to OTM_C60A.
• Otherwise, go to OTM_N31.

OTM_N31

Instruction: Is the entrance to the right ear canal completely obstructed?

• 1 Yes (Go to OTM_C60A)
• 2 No
• (DK, RF not allowed)

OTM_N40

Instruction: Perform otoscopic examination of the right ear. Record the presence of any of the following in the right ear. Mark all that apply.

1. Blood
2. Pus / Wax
3. Foreign object
4. Pressure equalization tube
5. Narrow, collapsible ear canal
6. Other - Specify (Go to OTM_S40)
7. None
   (DK is not allowed)
   RF (Go to OTM_C60A)

Go to OTM_C50

OTM_S40

Instruction: Specify the observed abnormality.

• (80 spaces)
• (DK, RF not allowed)

OTM_C50

• If OTM_N40 = 2, go to OTM_N50.
• Otherwise, go to OTM_C60A.

OTM_N50

Instruction: Record the amount of pus / wax in the right ear.

1. Normal
2. Excessive
3. Impacted
   (DK, RF not allowed)

OTM_C60A

• If OTM_Q30 = RF and HER_Q53 = 2, go to OTM_END.
• Otherwise, go to OTM_C60B.

OTM_C60B

• If HER_Q41 = 2, go to OTM_END.
• Otherwise, go to OTM_N60.

OTM_N60

Instruction: Is the entrance to the left ear canal completely obstructed?

• 1 Yes (Go to OTM_END)
• 2 No
• (DK, RF not allowed)

OTM_N70

Instruction: Perform otoscopic examination of the left ear. Record the presence of any of the following in the left ear.

Mark all that apply.

1. Blood
2. Pus / Wax
3. Foreign object
4. Pressure equalization tube
5. Narrow, collapsible ear canal
6. Other - Specify (Go to OTM_S70)
7. None
   (DK is not allowed)
   RF (Go to OTM_END)

Go to OTM_C80

OTM_S70

Instruction: Specify the observed abnormality.

• (80 spaces)
• (DK, RF not allowed)

OTM_C80

• If OTM_N70 = 2, go to OTM_N80.
• Otherwise, go to OTM_END.

OTM_N80

Instruction: Record the amount of pus / wax in the left ear.

1. Normal
2. Excessive
3. Impacted
   (DK, RF not allowed)

Go to OTM_END

OTM_N90

Instruction: Why was the component not fully completed?

• 01 Respondent unable to continue for health reasons
• 02 Respondent unable to understand technique / Health Measures Specialist unable to adapt coaching
• 04 Equipment problem / technical difficulty
• 05 Respondent's mental condition
• 06 No time
• 20 Other - Specify (Go to OTM_S90)
  (DK, RF not allowed)

Go to OTM_END

OTM_S90
(Why was the component not fully completed?)

Instruction: Specify.

• (80 spaces)
• (DK, RF not allowed)

OTM_END

Tympanometry Measurement (TYM)

TYM_BEG

External variables required:

Variables taken from sample file:

• STAND: name of the city/town/village in which the clinic has been set up
• CLINICID: 8 digit respondent identifier

Variables assigned in Variable Creation:

• CurrentYear: numeric year during which clinic visit is taking place
• CurrentMonth: numeric month during which clinic visit is taking place
• CurrentDay: numeric day during which clinic visit is taking place
• SessionE: English text of when the clinic visit is taking place

Variables from previously completed blocks:

• RespondentName: name of respondent
• GenderE: English text for sex of respondent
• CON_AGE: age of respondent
• HER_Q31: whether the respondent had an ear surgery (right, left or both ears)
• HER_Q41: whether the respondent has acute infection /pain in (right, left or both ears)
• HER_Q53: whether the respondent has hearing aid (right, left or both ears)
• OTM_N31: whether the respondent has occluded right ear
• OTM_N60: whether the respondent has occluded left ear
• OTN_N40: record of the otoscopic examination of the right ear
• OTM_N70: record of the otoscopic examination of the left ear
• OTM_N50: record of the amount pus/wax in the right ear
• OTM_N80: record of the amount pus/wax in the left ear
• OTM_Q30: if the respondent refused removing his or her hearing aid(s)
• OTM_Q20: whether the respondent started otoscopy measurements
• OTM_R10: introduction to the otoscopy measurement

TYM_C10

• If (OTM_Q20 = RF) or HER_Q31 = 3 or (OTM_N31 = 1 and OTM_N60 = 1) or ((OTM_N40 in (1, 3, 6 or RF) and OTM_N70 in (1, 3, 6 or RF)) or (OTM_N50 = 3 and OTM_N80 = 3) or (OTM_Q30 = RF and HER_Q53 = 3) or OTM_R10 = DK, go to TYM_END.
• Otherwise, go to TYM_D11.

Content type - Note to data users:

• If the respondent did not complete otoscopy, had surgery in both ears, had occlusions in both ears, had blood, a foreign object or another object/substance in both ears, had impacted wax in both ears or was unwilling to remove his/her hearing aids from both ears, then the tympanometry test is not completed.

TYM_D11

Content type - Note to data users:

• If the respondent has an occlusion in the right ear, has acute pain or infection in the right ear, has had surgery in the right ear, has blood, a foreign object or another object/substance in the right ear, has impacted wax in the right ear, or is unwilling to remove his/her hearing aid from the right ear, then REFLAG is set to 1.

Programmer:

• IF ((HER_Q31 = 1 or HER_Q41 = 1 or OTM_N31 = 1 or OTM_N40 in (1,3,6 or RF) or OTM_N50 = 3) or (OTM_Q30 = RF and HER_Q53 = 1)), set REFLAG = 1
• Otherwise, set REFLAG = 2

TYM_D12

Content type - Note to data users:

• If the respondent has an occlusion in the left ear, has acute pain or infection in the left ear, has had surgery in the left ear, has blood, a foreign object or another object/substance in the left ear, has impacted wax in the left ear, or is unwilling to remove his/her hearing aid from the left ear, then LEFLAG is set to 1.

Programmer:

• IF ((HER_Q31 = 2 or HER_Q41 = 2 or OTM_N60 = 1 or OTM_N70 in (1,3,6 or RF) or OTM_N80 = 3) or (OTM_Q30 = RF and HER_Q53 = 2)), set LEFLAG = 1
• Otherwise, set LEFLAG = 2

TYM_C13

• If REFLAG = 1 and LEFLAG = 1, go to TYM_END.
• Otherwise, go to TYM_D13.

TYM_D13

• If REFLAG=2 and LEFLAG = 2, DT_TYMSIDEE = "ears, one at a time".
• Else If REFLAG =1 and LEFLAG = 2 , DT_TYMSIDEE = "left ear".
• Otherwise (if REFLAG = 2 and LEFLAG =1), DT_TYMSIDEE = "right ear".
• If REFLAG=2 and LEFLAG = 2, DT_TYMDRUME = "eardrums".
• Otherwise, DT_TYMDRUME = "eardrum".

TYM_R20
This tympanometry test will measure the flexibility of your [eardrums/eardrum]. I will place a probe in your [ears, one at a time/left ear/right ear]. You will hear a soft humming sound and feel a gentle pressure when I take the measurement.

Instruction:

• Show the tympanometer to the respondent.
• Select the appropriate ear tip and slip it onto the nose cone of the probe.
• Press <1> to continue.

Programmer:

• Allow ‘DK’ as a response category

TYM_C20

• If TYM_R20 = DK, go to TYM_N56.
• Otherwise, go to TYM_Q21.

TYM_Q21
I would like you to sit in this chair with your hands on your lap, sitting up straight and facing forward. Please sit as still as you can. This will only take a few seconds.

Instruction:

• Turn the device on.
• Select the Tympanometry only mode by pressing the "Tymp" button on the front panel.
• Ensure the respondent is sitting still in the correct position.
• Press <1> to continue.
• 1 Continue
• (DK is not allowed)
• RF (Go to TYM_END)

TYM_C30

• If REFLAG = 1, go to TYM_C40.
• Otherwise, go to TYM_N30.

TYM_N30

Instruction: Perform measurement on the right ear.

• Select the right ear by pressing the "R" button.
• Make sure that the green light on the probe is blinking.
• Put the probe in the respondent's right ear, applying a gentle pressure to maintain a tight seal.
• As soon as a good seal is obtained, the blinking green light will change to a steady glow.
• Remain steady while the test is in progress.
• Once the test is over, all lights on the probe will be turned off and the test results can be viewed on the instrument display.

• Press <1> to continue.
• 1 Continue
• (DK, RF not allowed)

Help text:

• Green light: Still blinking - seal has not been obtained to initiate the test sequence.
• Orange light: The ear canal is not properly sealed and a large pressure leak exists.
• Yellow light: The probe tip is occluded with ear wax or you are pressing the tip of the probe against the ear canal wall causing an occlusion.

TYM_N31

Instruction:

Capture the results of the right ear.

• Press <1> to continue.
• 1 Continue
• (DK is not allowed)
• RF (Go to TYM_C40)

TYM_N32A

Instruction: Record the canal volume (ECV cm3) for the right ear.

• (MIN: 0.0)
• (MAX: 5.0)
• DK
• (RF is not allowed)

TYM_N32B

Instruction: Re-enter the canal volume (ECV cm3) for the right ear.

• (MIN: 0.0)
• (MAX: 5.0)
• DK
• (RF is not allowed)

TYM_C33

• If TYM_N32A = DK, go to TYM_C40.
• Otherwise, go to TYM_N33A.

TYM_N33A

Instruction: Record whether a no peak message, " NP", was displayed for the compliance peak (PEAK cm3) value for the right ear.

• 1 Yes (Go to TYM_D33)
• 2 No
• (DK, RF not allowed)

TYM_N33B

Instruction: Record the compliance peak value (PEAK cm3) for the right ear.

• (MIN: 0.0)
• (MAX: 5.0)
• (DK, RF not allowed)

TYM_N33C

Instruction: Re-enter the compliance peak value (PEAK cm3) for the right ear.

• (MIN: 0.0)
• (MAX: 5.0)
• DK, RF not allowed)

TYM_D33

• If TYM_N33A = 1 then , DV_TYMN33 = "NP"
• Otherwise, DV_TYMN33 = "TYM_N33B"

TYM_N34A

Instruction: Record whether a no peak message, "NP", was displayed for the pressure peak (PEAK daPa) value for the right ear.

• 1 Yes (Go to TYM_D34)
• 2 No
• (DK, RF not allowed)

TYM_N34B

Instruction: Record the pressure peak value (PEAK daPa) for the right ear.

• daPa
• (MIN: -400)
• (MAX: 200)
• (DK, RF not allowed)

TYM_N34C

Instruction: Re-enter the pressure peak value (PEAK daPa) for the right ear.

• cm3
• (MIN: -400)
• (MAX: 200)
• (DK, RF not allowed)

TYM_D34

• If TYM_N34A = 1 then , DV_TYMN34 = "NP"
• Otherwise, DV_TYMN34 = "TYM_N34B"

TYM_N35

Instruction: Check the tympanometry data.

1. Accept the measurements
2. Reject the measurements (Go to TYM_N32A)
   (DK, RF not allowed)

TYM_D35

• If TYM_N32A in (0.2 to 2.0 cm3) and TYM_N33B in (0.2 to 1.8 cm3) and TYM_N34B in (-150 to 100 daPa), DV_TYMD35 = 1 (pass).
• Else, DV_TYMD35 = 2 (refer).

TYM_C40

• If LEFLAG = 1 and TYM_N32A = DK, go to TYM_C56
• Else if LEFLAG = 1 and TYM_N32A = (0.0 to 5.0) or "EMPTY", go to TYM_END.
• Otherwise, go to TYM_N50.

TYM_N50

Instruction: Perform measurement on the left ear.

• Select the left ear by pressing the "L" button.
• Make sure that the green light on the probe is blinking.
• Put the probe in the respondent's left ear, applying a gentle pressure to maintain a tight seal.
• As soon as a good seal is obtained, the blinking green light will change to a steady glow.
• Remain steady while the test is in progress.
• Once the test is over, all lights on the probe will be turned off and the test results can be viewed on the instrument display.

• Press <1> to continue.
• 1 Continue
• (DK, RF not allowed)

Help text:

• Green light: Still blinking - seal has not been obtained to initiate the test sequence.
• Orange light: The ear canal is not properly sealed and a large pressure leak exists.
• Yellow light: The probe tip is occluded with ear wax or you are pressing the tip of the probe against the ear canal wall causing an occlusion.

TYM_N51

Instruction: Capture the results of the left ear.

• Press <1> to continue.
• 1 Continue
• (DK is not allowed)
• RF (Go to TYM_C56)

TYM_N52A

Instruction: Record the canal volume (ECV cm3) for the left ear.

• (MIN: 0.0)
• (MAX: 5.0)
• DK
• (RF is not allowed)

TYM_N52B

Instruction: Re-enter the canal volume (ECV cm3) for the left ear.

• (MIN: 0.0)
• (MAX: 5.0)
• DK
• (RF is not allowed)

TYM_C53

• If TYM_N52A = DK, go to TYM_C56.
• Otherwise, go to TYM_N53A.

TYM_N53A

Instruction: Record whether a no peak message, NP, was displayed for the compliance peak (PEAK cm3) value for the left ear.

• 1 Yes (Go to TYM_D53)
• 2 No
• (DK, RF not allowed)

TYM_N53B

Instruction: Record the compliance peak value (PEAK cm3) for the left ear.

• (MIN: 0.0)
• (MAX: 5.0)
• (DK, RF not allowed)

TYM_N53C

Instruction: Re-enter the compliance peak value (PEAK cm3) for the left ear.

• (MIN: 0.0)
• (MAX: 5.0)
• (DK, RF not allowed)

TYM_D53

• If TYM_N53A = 1 then , DV_TYMN53 = "NP"
• Otherwise, DV_TYMN53 = "TYM_N53B"

TYM_N54A

Instruction: Record whether a no peak message, "NP", was displayed for the pressure peak (PEAK daPa) value for the left ear.

• 1 Yes (Go to TYM_D54)
• 2 No
• (DK, RF not allowed)

TYM_N54B

Instruction: Record the pressure peak value (PEAK daPa) for the left ear.

• daPa
• (MIN: -400)
• (MAX: 200)
• (DK, RF not allowed)

TYM_N54C

Instruction: Re-enter the pressure peak value (PEAK daPa) for the left ear.

• cm3
• (MIN: -400)
• (MAX: 200)
• (DK, RF not allowed)

TYM_D54

• If TYM_N54A = 1 then , DV_TYMN54 = "NP"
• Otherwise, DV_TYMN54 = "TYM_N54B"

TYM_N55

Instruction: Check the tympanometry data.

1. Accept the measurements
2. Reject the measurements (Go to TYM_N52A)
   (DK, RF not allowed)

TYM_D55

• If TYM_N52A in (0.2 to 2.0 cm3) and TYM_N53B in (0.2 to 1.8 cm3) and TYM_N54B in (-150 to 100 daPa), DV_TYMD55 = 1 (pass).
• Else, DV_TYMD55 = 2 (refer).TYM_C56If TYM_N32A = DK or TYM_N52A = DK, go to TYM_N56.
• Otherwise, go to TYM_END.

TYM_N56

Instruction: Why was the component not fully completed?

• 01 Respondent unable to continue for health reasons
• 02 Respondent unable to understand technique / Health Measures Specialist unable to adapt coaching
• 04 Equipment problem / technical difficulty
• 05 Respondent's mental condition
• 06 No time
• 20 Other - Specify (Go to TYM_S56)
• (DK, RF not allowed)

Go to TYM_END

TYM_S56
(Why was the component not fully completed?)

Instruction: Specify.

• (80 spaces)
• (DK, RF not allowed)

TYM_END

Otoacoustic Emissions Measurement (OAE)

OAE_BEG

External variables required:

Variables taken from sample file:

• STAND: name of the city/town/village in which the clinic has been set up
• CLINICID: 8 digit respondent identifier
• SITE: site number

Variables assigned in Variable Creation:

• CurrentYear: numeric year during which clinic visit is taking place
• CurrentMonth: numeric month during which clinic visit is taking place
• CurrentDay: numeric day during which clinic visit is taking place
• SessionE: English text of when the clinic visit is taking place

Variables from previously completed blocks:

• RespondentFirstName: first name of respondent
• RespondentLastName: last name of respondent
• GenderE: English text for sex of respondent
• CON_AGE: age of respondent
• PROXYSEX: gender of targeted respondent
• HER_Q41: whether the respondent has acute infection /pain in (right, left or both ears)
• HER_Q53: whether the respondent has hearing aid (right, left or both ears)
• OTM_Q20: whether the respondent started the otoscopy measurements
• OTM_N31: whether the respondent has occluded right ear
• OTM_N60: whether the respondent has occluded left ear
• OTM_N40: record of the otoscopic examination of the right ear
• OTM_N70: record of the otoscopic examination of the left ear
• OTM_N50: record of the amount of pus/wax in the right ear
• OTM_N80: record of the amount of pus/wax in the left ear
• OTM_Q30: if the respondent refused removing his or her hearing aid(s)
• OTM_R10: introduction to the otoscopy measurement

OAE_C10

• If (OTM_Q20 = RF) or (OTM_N31=1 and OTM_N60 = 1) or (OTM_N40 IN (1, 3, 6 or RF) and OTM_N70 IN (1, 3, 6 or RF)) or (OTM_N50 = 3 and OTM_N80 = 3) or (OTM_Q30 = RF and HER_Q53 = 3) or OTM_R10 = DK, go to OAE_END.
• Otherwise, go to OAE_D10.

Content type - Note to data users:

• If the respondent did not complete otoscopy, had occlusions in both ears, had blood, a foreign object or another object/substance in both ears, had impacted wax in both ears, or is unwilling to remove his/her hearing aids from both ears, then the otoacoustic emissions test is not completed.

OAE_D10

Content type - Note to data users:

• If the respondent has acute pain or infection in the right ear, an occlusion in the right ear, has blood, a foreign object or another object/substance in the right ear, has impacted wax in the right ear, is unwilling to remove his/her hearing aid from the right ear, or refuses to continue with otoscopy on the right ear, then REFLAG is set to 1.

Programmer:

• IF ((HER_Q41 = 1 or OTM_N31 = 1 or OTM_N40 in (1,3,6 or RF) or OTM_N50 = 3) or (OTM_Q30 = RF and HER_Q53 = 1)), set REFLAG = 1
• Otherwise, set REFLAG = 2

OAE_D11

Content type - Note to data users:

• If the respondent has acute pain or infection in the left ear, an occlusion in the left ear, has blood, a foreign object or another object/substance in the left ear, has impacted wax in the left ear, is unwilling to remove his/her hearing aid from the left ear, or refuses to continue with otoscopy on the left ear, then LEFLAG is set to 1.

Programmer:

• IF ((HER_Q41 = 2 or OTM_N60 = 1 or OTM_N70 in (1, 3, 6 or RF) or OTM_N80 = 3) or (OTM_Q30 = RF and HER_Q53 = 2)), set LEFLAG = 1
• Otherwise, set LEFLAG = 2

OAE_C11

• If REFLAG = 1 and LEFLAG = 1, go to OAE_END.
• Otherwise, go to OAE_D12.

OAE_D12

• If REFLAG = 2, DT_RIGHTEARE = "Right ear ".
• Otherwise, DT_RIGHTEARE = "EMPTY".
• If LEFLAG = 2, DT_LEFTEARE = "Left ear".
• Otherwise, DT_LEFTEARE = "EMPTY".

OAE_D14

• If REFLAG = 2 and LEFLAG = 2, DT_OAESIDEE = "ears, one at a time".
• If REFLAG = 1 and LEFLAG = 2, DT_OAESIDEE = "left ear".
• If REFLAG = 2 and LEFLAG = 1, DT_OAESIDEE = "right ear".

OAE_Q15
This otoacoustic emissions test will measure how well your inner ear is working. I will place a probe in your [ears, one at a time/left ear/right ear]. You may hear a series of different pitched tones and faint sounds when I take the measurement.

During this test you will sit in the sound booth.

Instruction: Press <1> to continue.

• 1 Continue
• DK (Go to OAE_N47)
• RF (Go to OAE_END)

OAE_R16
First, I will need to enter some information into our computer system to prepare the test. This will only take a few minutes.

Instruction: Press <1> to continue.

OAE_N17

Instruction: Check the data to be sent to the OtoAccess software.

• Press <1> to transmit the data.
• 1 Transmit the data
• (DK, RF not allowed)

OAE_N18

Instruction: Open the OtoAccess software.

Follow the instructions on importing and retrieving respondent information.

• Press <1> to continue.
• 1 Continue
• (DK, RF not allowed)

OAE_Q30
I will now ask you to sit in the sound booth so that I can take the measurement.

Again, during the test I would like you to sit up straight, and remain as still as you can. This will only take a few minutes.

Do you have any questions before we start the test?

Instruction:

• Show the probe, ear tip and the sound booth to the respondent.
• Answer any questions as thoroughly as possible.
• Select the appropriate ear tip and slip it onto the nose cone of the probe.
• Insert the probe into the respondent's ear to obtain a seal that is flush with the ear canal.
• Press <1> to continue.
• 1 Continue
• (DK is not allowed)
• RF (Go to OAE_END)

OAE_N35

Instruction: Perform the measurement on the [Right ear/(and) Left ear].

Ensure that the sound meter readout is below 55 dB before and during the test.

• Press <1> to continue.
• 1 Continue
• (DK, RF not allowed)

OAE_N40

Instruction: Ensure the test results have been saved in the OtoAccess software and the respondent's .xml file has been transferred from the OtoAccess software to the clinic server.

• Press <1> to continue.
• 1 Continue
  (DK, RF not allowed)

OAE_C40

• If REFLAG = 2, go to OAE_N41.
• Otherwise, go to OAE_C45.

OAE_N41

Instruction: Was a successful test completed and saved for the right ear?

• 1 Yes
• 2 No
  (DK, RF not allowed)

OAE_C45

• If LEFLAG = 2, go to OAE_N45.
• Otherwise, go to OAE_N46.

OAE_N45

Instruction: Was a successful test completed and saved for the left ear?

• 1 Yes
• 2 No
• (DK, RF not allowed)

OAE_N46

Instruction: Record whether the maximum recommended sound level inside the booth (55 dB) was exceeded at any point during the test.

• 1 Yes
• 2 No
• (DK, RF not allowed)

OAE_C46

• If OAE_N41 = 2 or OAE _N45 = 2, go to OAE_N47.
• Otherwise, go to OAE_END.

OAE_N47

Instruction: Why was the component not fully completed?

• 01 Respondent unable to continue for health reasons
• 02 Respondent unable to understand technique / Health Measures Specialist unable to adapt coaching
• 03 Respondent refuses to continue
• 04 Equipment problem / technical difficulty
• 05 Respondent's mental condition
• 06 No time
• 20 Other - Specify (Go to OAE_S47)
• (DK, RF not allowed)

Go to OAE_END

OAE_S47
(Why was the component not fully completed?)

Instruction: Specify.

• (80 spaces)
• (DK, RF not allowed)

OAE_END

Audiometry Measurement (AUD)

AUD_BEG

External fields required:

Variables taken from sample file:

• STAND: name of the city/town/village in which the clinic has been set up
• CLINICID: 8 digit respondent identifier
• SITE: site number

Variables assigned in Variable Creation:

• CurrentYear: numeric year during which clinic visit is taking place
• CurrentMonth: numeric month during which clinic visit is taking place
• CurrentDay: numeric day during which clinic visit is taking place
• SessionE: English text of when the clinic visit is taking place

Variables from previously completed blocks:

• RespondentName: name of respondent
• RespondentLastName: Last name of the respondent
• RespondentFirstName: First name of the respondent
• GenderE: English text for sex of respondent
• CON_AGE: age of respondent
• HER_Q40: whether the respondent has an ear infection or pain in ears
• HER_Q41: whether the respondent has an acute infection/pain (in right,left or both ears)
• HER_Q52: whether the respondent has a hearing aid
• HER_Q53: whether the respondent has a hearing aid (in right,left or both ears)
• OTM_Q30: if the respondent refused removing his or her hearing aid(s)
• OTM_N31: whether the respondent has occluded right ear
• OTM_N40: record of the otoscopic examination of the right ear
• OTM_N50: record of the amount of pus/wax in the right ear
• OTM_N60: whether the respondent has occluded left ear
• OTM_N70: record of the otoscopic examination of the left ear
• OTM_N80: record of the amount of pus/wax in the left ear
• OTO.Outcome: Otoscopy outcome code
• OAE.Outcome: DPOAE outcome code

AUD_C10

• If CON_AGE < 6 or (OTO.Outcome = 79 or 80) or (OTM_Q30 = RF and HER_Q53 = 3), go to AUD_END.
• Otherwise, go to AUD_D10.

Content type - Note to data users:

• If the respondent is less than 6 years of age, or refuses to remove hearing aids from both ears, or if the component outcome code for the otoscopy measurement is set to not done (79) or refusal (80), then the audiometry test is not completed.

AUD_D10

Content type - Note to data users:

• If the respondent has acute pain or infection in the right ear, an occlusion in the right ear, has blood, a foreign object or another object/substance in the right ear along with a narrow/collapsible ear canal, has excessing or impacted wax in the right ear along with a narrow/collapsible ear canal, is unwilling to remove his/her hearing aid from the right ear, or refuses to continue with otoscopy on the right ear, then REFLAG is set to 1.

Programmer:

• IF HER_Q41 = 1 or OTM_N31 = 1 or [OTM_N40 in (1,3,6) and OTM_N40 = 5] or [OTM_N50 in (2,3) and OTM_N40 = 5] or [OTM_Q30 = RF and HER_Q53 = 1] , or OTM_N40 = RF, set REFLAG = 1
• Otherwise, set REFLAG = 2

AUD_D11

Content type - Note to data users:

• If the respondent has acute pain or infection in the left ear, an occlusion in the left ear, has blood, a foreign object or another object/substance in the left ear along with a narrow/collapsible ear canal, has excessing or impacted wax in the left ear along with a narrow/collapsible ear canal, is unwilling to remove his/her hearing aid from the left ear, or refuses to continue with otoscopy on the left ear, then LEFLAG is set to 1.

Programmer:

• IF HER_Q41 = 2 or OTM_N60 = 1 or [OTM_N70 in (1,3,6) and OTM_N70 = 5] or [OTM_N80 in (2,3) and OTM_N70 = 5] or [OTM_Q30 = RF and HER_Q53 = 2], or OTM_N70 = RF, set LEFLAG = 1
• Otherwise, set LEFLAG = 2AUD_C11 If REFLAG = 1 and LEFLAG = 1, go to AUD_END.
• Otherwise, go to AUD_D13A.

Content type - Note to data users:

• The type of earphones to be used for the audiometry test is derived at AUD_D13A, AUD_D13B, and AUD_D13C, based on the otoscopy observations from the right and left ear (responses to OTM_N40 and OTM_N70).

AUD_D13A

Programmer:

• IF REFLAG = 1 go to AUD_D13B ELSE
  • IF OTM_N40 in (1, 3, 6) or OTM_N50 in (2,3), THEN
    • set AUD_D13A = 3 (supra-aural headphones only)
  • ELSE IF OTM_N40 = 5 THEN
    • set AUD_D13A = 2 (insert earphones only)
  • ELSE
    • set AUD_D13A = 1 (insert or supra-aural)
  • ENDIF
• ENDIF

AUD_D13B

Programmer:

• IF LEFLAG = 1 go to AUD_D13C ELSE
  • IF OTM_N70 in (1, 3, 6) or OTM_N80 in (2,3), THEN
    • set AUD_D13B = 3 (supra-aural headphones only)
  • ELSE IF OTM_N70 = 5 THEN
    • set AUD_D13B = 2 (insert earphones only)
  • ELSE
    • set AUD_D13B = 1 (insert or supra-aural)
  • ENDIF
• ENDIF

AUD_D13C

Programmer:

• IF AUD_D13A = AUD_D13B THEN
  • AUDEFLAG = AUD_D13A
• ELSE IF AUD_D13A = EMPTY THEN
  • AUDEFLAG = AUD_D13B
• ELSE IF AUD_D13B = EMPTY THEN
  • AUDEFLAG = AUD_D13A
• ELSE IF AUD_D13A = 1 THEN
  • AUDEFLAG = AUD_D13B
• ELSE IF AUD_D13B = 1 THEN
  • AUDEFLAG = AUD_D13A
• ELSE IF AUD_D13A and AUD_D13B in (2, 3) THEN
  • AUDEFLAG = 3
• ENDIF

AUD_D13D

Programmer:

• IF (AUD_D13A = 2 and AUD_D13B = 3) THEN
  • reset REFLAG = 1
• ELSE IF (AUD_D13A = 3 and AUD_D13B = 2) THEN
  • reset LEFLAG = 1
• ENDIF
• ENDIF

AUD_D16

• If AUDEFLAG in (1,2) , DT_AUDTEXT1E = "earphones".
• Otherwise, DT_AUDTEXT1E = "headphones".
• If AUDEFLAG in (1,2) , DT_AUDTEXT2E = "in".
• Otherwise, DT_AUDTEXT2E = "over".
• If AUDEFLAG in (1,2) , DT_AUDTEXT3E = "insert earphones".
• Otherwise, DT_AUDTEXT3E = "supra-aural headphones".

AUD_Q18
This audiometry test will measure your hearing sensitivity. This test needs to be done in the sound booth.

Instruction: Press <1> to continue.

• 1 Continue
• DK (Go to AUD_N36)
• RF (Go to AUD_END)

AUD_D19

Programmer:

• IF AUD_Q18 = 1 and AUD_D19 = EMPTY,
  • Set AUD_D19 = Current Time (in HH :MM :SS format).
• ENDIF

AUD_Q20
For this test, I will place [earphones/headphones] [in/over] your ears and ask you to press a button every time you hear a sound.

Instruction: Press <1> to continue.

• Press <1> to continue.
• 1 Continue (Go to AUD_R22)
• (DK is not allowed)
• RF

AUD_C20

• If AUDEFLAG = 1, go to AUD_Q21.
• Otherwise, go to AUD_END.

AUD_Q21
If you are uncomfortable using insert earphones, we can use headphones instead. Would you then be willing to try this test?

• 1 Yes
• 2 No (Go to AUD_END)
• (DK, RF not allowed)

AUD_R22
First, I need to enter some information into our computer system in order to prepare the test. This will only take a few minutes.

Instruction: Press <1> to continue.

AUD_N22

Instruction: Check the data to be sent to the Audiometry software.

• Press <1> to transmit the data.
• 1 Transmit the data
• (DK, RF not allowed)

AUD_N23

Instruction: Open the Audiometry software (CCA-100).

• Follow the instructions on importing and retrieving respondent information.
• Press the "Examiner" button and choose your identification number.
• Press "Language" and choose a language for the instructions.
• 1 Continue
• (DK, RF not allowed)

AUD_R24
For the test, I will ask you to sit up straight holding the button in front of you. You will need to press the button whenever you hear a sound, no matter how faint. Press the button only once and release it quickly. The test will begin after a series of pre-recorded instructions and I will give you a "thumbs up" to let you know the test is about to start. Do you have any questions before we begin?

Instruction: Answer any questions as thoroughly as possible.

• Press <1> to continue.

AUD_D25A

• If AUDEFLAG in (1,2) and AUD_Q20 is not RF, DT_AUDTEXT4E = "earphones in".
• Otherwise, DT_AUDTEXT4E = "headphones over".
• If AUDEFLAG in (1,2) and AUD_Q20 is not RF, DT_AUDTEXT5E = "earphones".
• Otherwise, DT_AUDTEXT5E = "headphones".

AUD_D25B

• If AUDEFLAG = 3 , DT_AUDTEXT25AE = "Only supra-aural headphones can be used for this test.".
• If AUDEFLAG = 2 , DT_AUDTEXT25AE = "Only insert earphones can be used for this test.".
• Otherwise, DT_AUDTEXT25AE = "Either insert earphones or supra-aural headphones can be used for this test.".

AUD_Q25
I am now going to place the [earphones in/headphones over] your ears.

When the test is over I will help you remove them to make sure the equipment is not damaged.Remember to stay as still as possible throughout the test, since noise or movement can interfere with the test.

Instruction:

• Show the [earphones/headphones] and the response button to the respondent.
• Ensure any glasses, hair ties or ornaments, hats or chewing gum that may interfere with the examination have been removed.
• ^DT_AUDTEXT25AE
• Complete the audiometry test on the:
  • [right ear/EMPTY]
  • [left ear/EMPTY]
• Ensure that the correct cords are plugged into the audiometer before starting the test.

• Press <1> to continue.
• 1 Continue
• (DK is not allowed)
• RF (Go to AUD_END)

AUD_D25C

• If REFLAG = 2, DT_RIGHTEARE = "right ear".
• Otherwise, DT_RIGHTEARE = "EMPTY".
• If LEFLAG = 2, DT_LEFTEARE = "left ear".
• Otherwise, DT_LEFTEARE = "EMPTY".

AUD_C26

• If AUDEFLAG = 3 or if (AUD_Q20 = RF and AUD_Q21 = 1), go to AUD_N27.
• Otherwise, go to AUD_N26.

AUD_N26

Instruction: Confirm that insert earphones will be used for the test.

• 1 Yes (Go to AUD_D28)
• 2 No
• (DK, RF not allowed)

AUD_C27

• If AUDEFLAG = 2, go to AUD_N36.
• Otherwise, go to AUD_N27.

AUD_N27

Instruction: Confirm that supra-aural headphones will be used for the test.

• 1 Yes
• 2 No (Go to AUD_N36)
• (DK, RF not allowed)

AUD_D28

• If AUD_N26=1 , DT_AUDTEXT29E = "green curve".
• If AUD_N27=1 , DT_AUDTEXT29E = "red curve".

AUD_N29

Instruction:

• Perform the test on the [right ear/EMPTY] and [left ear/EMPTY].
• Give a ''thumbs-up'' to the respondent when test is ready to start.
• Play the instructions for the audiometry test.
• Ensure that the sound meter readout is below the [green curve/red curve] before and during the test.

• 1 Continue
• (DK is not allowed)
• RF (Go to AUD_END)

AUD_N30

Instruction: Ensure the test results have been saved in the CCA-100 software and the respondent's .asc file has been transferred from the software to the clinic server.

• Press <1> to continue.
• 1 Continue
• (DK, RF not allowed)

AUD_C30

• If REFLAG = 2 , go to AUD_N31.
• Otherwise, go to AUD_C32.

AUD_N31

Instruction: Record if the test was performed on the right ear.

• 1 Yes
• 2 No
• (DK, RF not allowed)

AUD_C32

• If LEFLAG = 2, go to AUD_N32.
• Otherwise, go to AUD_C33.

AUD_N32

Instruction: Record if the test was performed on the left ear.

• 1 Yes
• 2 No
• (DK, RF not allowed)

AUD_C33

• If AUD_N31 = 1 or AUD_N32 = 1, go to AUD_N33.
• Otherwise, go to AUD_N36.

AUD_N33

Instruction: Rate the test reliability.

1. 3 error codes or more
2. 1-2 error codes
3. No error codes
   (DK, RF not allowed)

AUD_N34

Instruction: Record how the test was administered.

1. Automatic Mode
2. Manual Mode
3. Both
   (DK, RF not allowed)

AUD_N35

Instruction: Record whether the sound level meter exceeded the peak noise threshold ([green curve/red curve]) during the test.

• 1 Yes
• 2 No
  (DK, RF not allowed)

AUD_C36

• If (AUD_N31 = 1 or EMPTY) and (AUD_N32 = 1 or EMPTY), go to AUD_END.
• Otherwise, go to AUD_N36.

AUD_N36

Instruction: Why was the component not fully completed?

• 01 Respondent unable to continue for health reasons
• 02 Respondent unable to understand technique / Health Measures Specialist unable to adapt coaching
• 03 Respondent refuses to continue
• 04 Equipment problem / technical difficulty
• 05 Respondent's mental condition
• 06 No time
• 20 Other - Specify (Go to AUD_S36)
• (DK, RF not allowed)

Go to AUD_END

AUD_S36
(Why was the component not fully completed?)

Instruction: Specify.

• (80 spaces)
• (DK, RF not allowed)

AUD_END

Grip Strength Component

Grip Strength Component Introduction (GSI)

GSI_BEG

External variables required:

Variables taken from sample file:

• STAND: name of the city/town/village in which the clinic has been set up
• CLINICID: 8 digit respondent identifier

Variables assigned in Variable Creation:

• CurrentYear: numeric year during which clinic visit is taking place
• CurrentMonth: numeric month during which clinic visit is taking place
• CurrentDay: numeric day during which clinic visit is taking place
• SessionE: English text of when the clinic visit is taking place

Variables from previously completed blocks:

• RespondentName: name of respondent
• GenderE: English text for sex of respondent
• CON_AGE: age of respondent
• SCS_N12: visit type (3= clinic visit; 4= home visit)

GSI_R1
Next I am going to measure your upper body strength with a hand grip dynamometer. You will perform this test twice on each hand, alternating each time. When performing the test, hold your hand away from your body and squeeze the handle as hard as you can, blowing out while you squeeze.

Instruction: Demonstrate the procedure while explaining the technique.

• Press <1> to continue.

Programmer:

• Allow ‘DK’ as a response category.

GSI_C1

• If GSI_R1 = DK, go to GSI_END.
• Otherwise, go to GSI_D1.

GSI_D1

Programmer:

• IF SCS_N12 = 4 THEN
  • GSI_D1 = EMPTY
• ELSE
• IF GSI_R1 = 1 and GSI_D1 = EMPTY,
  • Set GSI_D1 = Current Time (in HH:MM:SS format)
• ENDIF

GSI_R2
Hold the handle so that the 2nd joint of your fingers fits comfortably under the handle; we can adjust the size if necessary. Remember, hold your arm straight and away from your body and squeeze the handle as hard as you can, blowing out while you squeeze.

Instruction: Ensure respondent has removed all rings or hand jewellery.

• Press <1> to continue.

GSI_END

Grip Strength Measurement (GSM)

GSM_BEG

External variables required:

Variables taken from sample file:

• STAND: name of the city/town/village in which the clinic has been set up
• CLINICID: 8 digit respondent identifier

Variables assigned in Variable Creation:

• CurrentYear: numeric year during which clinic visit is taking place
• CurrentMonth: numeric month during which clinic visit is taking place
• CurrentDay: numeric day during which clinic visit is taking place
• SessionE: English text of when the clinic visit is taking place

Variables from previously completed blocks:

• RespondentName: name of respondent
• GenderE: English text for sex of respondent
• CON_AGE: age of respondent
• GSI_R1: grip strength introduction

GSM_C10

• If GSI_R1 = DK, go to GSM_N60.
• Otherwise, go to GSM_N11A.

GSM_N11A

Instruction: Record the first grip strength measurement for the right hand to the nearest kilogram (kg).

• Right hand grip strength (in kg)
• (MIN: 1)
• (MAX: 100)
• DK, RF

GSM_N11B

Instruction: Re-enter the first grip strength measurement for the right hand to the nearest kilogram (kg).

• Right hand grip strength (in kg)
• (MIN: 1)
• (MAX: 100)
• DK, RF

GSM_C11B

• If GSM_N11A = RF, go to GSM_END.
• Otherwise, go to GSM_N12A.

GSM_N12A

Instruction: Record the first grip strength measurement for the left hand to the nearest kilogram (kg).

• Left hand grip strength (in kg)
• (MIN: 1)
• (MAX: 100)
• DK, RF

GSM_N12B

Instruction: Re-enter the first grip strength measurement for the left hand to the nearest kilogram (kg).

• Left hand grip strength (in kg)
• (MIN: 1)
• (MAX: 100)
• DK, RF

GSM_N21A

Instruction: Record the second grip strength measurement for the right hand to the nearest kilogram (kg).

• Right hand grip strength (in kg)
• (MIN: 1)
• (MAX: 100)
• DK, RF

GSM_N21B

Instruction: Re-enter the second grip strength measurement for the right hand to the nearest kilogram (kg).

• Right hand grip strength (in kg)
• (MIN: 1)
• (MAX: 100)
• DK, RF

GSM_N22A

Instruction: Record the second grip strength measurement for the left hand to the nearest kilogram (kg).

• Left hand grip strength (in kg)
• (MIN: 1)
• (MAX: 100)
• DK, RF

GSM_N22B

Instruction: Re-enter the second grip strength measurement for the left hand to the nearest kilogram (kg).

• Left hand grip strength (in kg)
• (MIN: 1)
• (MAX: 100)
• DK, RF

GSM_D51

Programmer:

• Calculate the total hand grip strength.

GSM_D52

Programmer:

• Calculate the grip strength norms for respondents 15 - 69.

GSM_D53

Programmer:

• Calculate the grip strength norms for respondents less than 15.

GSM_C59

• If (GSM_N11A = NONRESPONSE and GSM_N21A = NONRESPONSE) or (GSM_N12A = NONRESPONSE and GSM_N22A = NONRESPONSE), go to GSM_N60.
• Otherwise, go to GSM_END.

GSM_N60

Instruction: Why was the component not fully completed?

• 01 Respondent unable to continue for health reasons
• 02 Respondent unable to understand technique / Health Measures Specialist unable to adapt coaching
• 03 Respondent refuses to continue
• 04 Equipment problem / technical difficulty
• 05 Respondent’s mental condition
• 06 No time
• 20 Other - Specify (Go to GSM_S60)
• (DK, RF not allowed)

Go to GSM_END

GSM_S60
(Why was the component not fully completed?)

Instruction: Specify.

• (80 spaces)
• (DK, RF not allowed)

GSM_END

Phlebotomy Component

Phlebotomy Component Introduction (PHI)

PHI_BEG

External variables required:

Variables taken from sample file:

• STAND: name of the city/town/village in which the clinic has been set up
• CLINICID: 8 digit respondent identifier
• SELFAST: whether selected to fast for 12 hours (1=fasting, 2=non-fasting)

Variables assigned in Variable Creation:

• CurrentYear: numeric year during which clinic visit is taking place
• CurrentMonth: numeric month during which clinic visit is taking place
• CurrentDay: numeric day during which clinic visit is taking place
• SessionE: English text of when the clinic visit is taking place

Variables from previously completed blocks:

• RespondentName: name of respondent
• GenderE: English text for sex of respondent
• CON_AGE: age of respondent
• ATG_Q11: time when the respondent last ate/drank
• ATG_N11: date when the respondent last ate/drank
• DT_ATGN11E: English text for reported fasting date
• ATG_D12: whether the respondent has fasted for at least 10 hours
• SCS_N12 : visit type (3= clinic visit; 4= home visit)

PHI_R10
Hi, my name is.... Please have a seat on the chair because I need to ask you a few questions before we begin.

Instruction: Press <1> to continue.

Programmer:

• Allow ‘DK’ as a response category
• If PHI_R10 = DK, go to PHI_END.
• Otherwise, go to PHI_D10.

PHI_D10

Programmer:

• IF SCS_N12 = 4 THEN
  • PHI_D10 = EMPTY
• ELSE
• IF PHI_R10 = 1 and PHI_D10 = EMPTY,
  • Set PHI_D10 = Current Time (in HH:MM:SS format)
• ENDIF

PHI_Q11
I need to confirm your fasting status. When did you last eat or drink anything other than water (e.g., coffee, tea, alcohol, juice or flavoured water)?

The respondent reported last eating or drinking at ^ATG_Q11 ^DT_ATGN11E.

Instruction: Probe to determine the date and time at which the respondent last ate or drank something that does not meet the phlebotomy fasting requirements.

Record whether the fasting time and date recorded during the screening component are correct.

• 1 Yes (Go to PHI_D12)
• 2 No
• (DK, RF not allowed)

Help text: The respondent is still considered fasted if the following have been consumed within the indicated time-frame:

• Black coffee - up until the time of the appointment
• Coffee with milk/cream - up to 2 hours prior to the appointment
• Juice - up to 2 hours prior to the appointment
• Gum and candy are allowed - up until the time of the appointment

The respondent is not considered fasted if the following have been consumed within the past 10 hours.

• Liquids other than those indicated above, including
  • Milkshakes
  • Protein shakes
  • Meal replacements
  • Milk
  • Energy drinks
  • Any other beverages or supplements
• Any food

PHI_N11

Instruction: Enter the time (followed by "AM" or "PM") at which the respondent last ate or drank something that does not meet the phlebotomy fasting requirements.

• (MIN: 1)
• (MAX: 13)
• (DK, RF not allowed)

PHI_N12A

Instruction: Confirm the date.

• 1 Yesterday
• 2 Today
• (DK, RF not allowed)

PHI_C12

• If SCS_N12 = 3, go to PHI_D12.
• Otherwise, go to PHI_N12B.

PHI_N12B

Instruction: Enter the time (followed by "AM" or "PM") the fasting question (PHI_N11) was asked to the respondent.

• (MIN: 1)
• (MAX: 13)
• (DK, RF not allowed)

PHI_D12

Content type - Note to data users:

• Fasting status (10 hr) is confirmed based on the fasting flag (SELFAST) and the responses to PHI_Q11 and PHI_N11 (if clinic visit) along with PHI_N12B (if home visit). PHI_D12 = 1 (fasted) and PHI_D12 = 2 (not fasted).

Programmer:

• IF SCS_N12 = 3 THEN
  • IF SELFAST = 2 THEN
    • PHI_D12 = 2
  • ELSE IF (PHI_Q11 = 1 and ATG_D12 = 1) OR (PHI_Q11 = 1 and ATG_N11 = 1 and the difference between CurrentDate-1/ATG_Q11 and CurrentDate/CurrentTime is 10 hours or more) OR(PHI_Q11 = 1 and ATG_N11 = 2 and the difference between CurrentDate/ATG_Q11 and CurrentDate/CurrentTime is 10 hours or more) OR(PHI_Q11 = 2 and PHI_N12A = 1 and the difference between CurrentDate-1/PHI_N11 and CurrentDate/CurrentTime is 10 hours or more) OR(PHI_Q11 = 2 and PHI_N12A = 2 and the difference between CurrentDate/PHI_N11 and CurrentDate/CurrentTime is 10 hours or more) THEN
    • PHI_D12 = 1
  • ELSE
    • PHI_D12 = 2
  • ENDIF
• ELSE IF SCS_N12 = 4 THEN
  • IF SELFAST = 2 THEN
    • PHI_D12 = 2
  • ELSE IF (PHI_Q11 = 1 and ATG_D12 = 1) OR (PHI_Q11 = 1 and ATG_N11 = 1 and the difference between CurrentDate-1/ATG_Q11 and CurrentDate/PHI_N12B is 10 hours or more) OR(PHI_Q11 = 1 and ATG_N11 = 2 and the difference between CurrentDate/ATG_Q11 and CurrentDate/PHI_N12B is 10 hours or more) OR(PHI_Q11 = 2 and PHI_N12A = 1 and the difference between CurrentDate-1/PHI_N11 and CurrentDate/PHI_N12B is 10 hours or more) OR(PHI_Q11 = 2 and PHI_N12A = 2 and the difference between CurrentDate/PHI_N11 and CurrentDate/PHI_N12B is 10 hours or more) THEN
    • PHI_D12 = 1
  • ELSE
    • PHI_D12 = 2
  • ENDIF
• ENDIF

PHI_D13

• If ATG_D12 = 1 or PHI_D12 = 1, DT_ATGFASTE = "fasted".
• Otherwise, DT_ATGFASTE = "non-fasted".

PHI_END

Blood Collection (BDC)

BDC_BEG

External variables required:

Variables taken from sample file:

• STAND: name of the city/town/village in which the clinic has been set up
• CLINICID: 8 digit respondent identifier
•  

Variables assigned in Variable Creation:

• DryRun: whether the case is a dry run case
• CurrentYear: numeric year during which clinic visit is taking place
• CurrentMonth: numeric month during which clinic visit is taking place
• CurrentDay: numeric day during which clinic visit is taking place
• SessionE: English text of when the clinic visit is taking place

Variables from previously completed blocks:

• RespondentName: name of respondent
• CON_AGE: age of respondent
• CON_SEX: sex of respondent
• GenderE: English text for sex of respondent
• CON_N24 : whether the respondent's parent or guardian provided consent for blood and urine storage
• CON_N25 : whether the respondent provided consent for blood and urine storage
• CON_N26: whether the respondent provided consent for DNA storage
• BVOCFLG: Blood  VOC subsampling flag
• OMEGFLG: Fatty acids subsampling flag
• PHC_Q56: whether the respondent felt dizzy or fainted previously during a blood draw
• PHI_D12: whether respondent has fasted for at least 10 hours (1 = fasted; 2 = non-fasted)
• PHI_R10: introduction to the phlebotomy component
• PHC_Q57B: indicator of which side the respondent has had a mastectomy (1=right, 2=left, 3=both)

BDC_C9

• If PHI_R10 = DK, go to BDC_N44.
• Otherwise, go to BDC_C10.

BDC_C10

• If PHC_Q56 = 1, go to BDC_N10.
• Otherwise, go to BDC_Q21.

BDC_D10

• If PHC_N57B=1, DT_ARME = "the left arm".
• If PHC_N57B=2, DT_ARME = "the right arm".
• Otherwise, DT_ARME = "either the left or the right arm ".

Programmer:

• If PHC_N57B= 1 or 2 use red font for ^DT_ARME.

BDC_N10

Instruction: During the screening component, the respondent has stated they have felt dizzy or fainted previously during a blood draw. Probe and take the appropriate precautions.

• Press <1> to continue.
• 1 Continue
  (DK, RF not allowed)

BDC_Q21
I am going to do the blood draw.

Instruction: Explain the procedure to the respondent. Perform the blood draw on [the left arm/the right arm/either the left or the right arm].

•  
• 1 Continue
• (DK is not allowed)
• RF (Go to BDC_END)

BDC_D21

Content type - Note to data users:

• Tubes for blood collection are determined by the age of the respondent and whether he/she consented to blood and/or DNA storage.

BDC_N24

Instruction: Record which of the required tubes of blood were collected. Include only the collected tubes that apply.

Mark all that apply.

• 51 None of the required tubes (Go to BDC_N44)
• (DK is not allowed)
• RF (Go to BDC_END)

Content type - Note to data users:

• A dynamic list of blood collection tubes appears at this question based on the age of the respondent and whether he/she consented to blood and/or DNA storage.

BDC_N41

Instruction:

• Press <1> to print the blood collection tube labels.
• 1 Print the labels
• (DK, RF not allowed)

BDC_N42

Instruction: In the presence of the respondent, stick each label on the appropriate blood collection tube.

• Press <1> to continue.
• 1 Continue
• (DK, RF not allowed)

BDC_N43

Instruction: Record whether the respondent was seated or supine during the blood draw.

• 1 Seated
• 2 Supine
  (DK, RF not allowed)

BDC_C44

• If all of the required main tubes or sub tubes were collected, go to BDC_N51.
• Otherwise, go to BDC_N44.

BDC_N44

Instruction: Record the reason why all required tubes were not collected.

• 01 Respondent refused
• 02 Respondent fainted
• 03 Unable to find vein
• 04 Blood flow stopped
• 05 Physical limitation
• 06 Other - Specify (Go to BDC_S44)
• 07 No time
• 08 Respondent unable to continue for health reasons
• (DK, RF not allowed)

Go to BDC_C51

BDC_S44

(Record the reason why all required tubes were not collected.)

Instruction: Specify.

• (80 spaces)
• (DK, RF not allowed)

BDC_C51

• If PHI_R10 = DK, go to BDC_END.
• Otherwise, go to BDC_N51.

BDC_N51

Instruction: Record whether another staff member assisted with the blood draw.

• 1 Yes
• 2 No (Go to BDC_END)
• (DK, RF not allowed)

BDC_N52

Instruction: Record the HMSID of the staff member that assisted with the blood draw.

• (MIN: 1000)
• (MAX: 9995)
• (DK, RF not allowed)

BDC_END

Urine Collection 2 Component (UC2)

Overview: The Urine Collection 2 component is only administered if the respondent did not provide a sufficient volume of urine in the Urine Collection 1 component.

UC2_BEG

External variables required:

Variables taken from sample file:

• STAND: name of the city/town/village in which the clinic has been set up
• CLINICID: 8 digit respondent identifier

Variables assigned in Variable Creation:

• CurrentYear: numeric year during which clinic visit is taking place
• CurrentMonth: numeric month during which clinic visit is taking place
• CurrentDay: numeric day during which clinic visit is taking place
• SessionE: English text of when the clinic visit is taking place

Variables from previously completed blocks:

• RespondentName: name of respondent
• GenderE: English text for sex of respondent
• CON_AGE: age of respondent
• SCS_N12: visit type (3= clinic visit; 4= home visit)

UC2_N10

Instruction: Record whether the respondent provided a second urine sample.

• 1 Yes
• 2 No
• (DK, RF not allowed)

UC2_D10

Programmer:

• IF SCS_N12 = 4 THEN
  • UC2_D10 = EMPTY
• ELSE
• IF UC2_N10 = RESPONSE and UC2_D10 = EMPTY,
  • Set UC2_D10 = Current Time (in HH:MM:SS format)
• ENDIF

UC2_C10

• If UC2_N10 = 1, go to UC2_END.
• Otherwise, go to UC2_N30.

UC2_N30

Instruction: Record the reason why the respondent did not provide a urine sample.

1. Refusal
2. Unable to provide
3. Other - Specify (Go to UC2_S30)
   (DK, RF not allowed)

Go to UC2_END

UC2_S30

(Record the reason why the respondent did not provide a urine sample.)

Instruction: Specify the reason.

• (80 spaces)
• (DK, RF not allowed)

UC2_END

Report of Measurements Component (RM)

RM_BEG

External variables required:

Variables assigned in Variable Creation:

• CurrentYear: numeric year during which clinic visit is taking place
• CurrentMonth: numeric month during which clinic visit is taking place
• CurrentDay: numeric day during which clinic visit is taking place

Variables from previously completed blocks:

• RespondentName: name of respondent
• GenderE: English text for sex of respondent
• CON_AGE: age of respondent
• LNG_N11: respondent's preferred official language
• BPM_411A: blood pressure norms for respondents aged 18 or older
• BPM_412A: blood pressure norms for respondents aged less than 18
• OTM_N31: whether the right ear canal is obstructed
• OTM_N40: record of the otoscopic examination of the right ear
• OTM_N50: record of the amount pus/wax in the right ear
• OTM_N60: whether the left ear canal is obstructed
• OTM_N70: record of the otoscopic examination of the left ear
• OTM_N80: record of the amount pus/wax in the left ear
• SCS_N12: visit type (3= clinic visit; 4= home visit)
• BPM_D317: respondent's average systolic blood pressure
• BPM_D318: respondent's average diastolic blood pressure
• BPM_D319: respondent's average resting hearth rate
• HWM_Q11: standing height measurement in centimetres
• HWM_D11: standing height in inches
• HWM_Q12: sitting height measurement in centimetres
• HWM_D12: sitting height in inches
• HWM_Q13: weight measurement in kilograms
• HWM_D13: weight measurement in pounds
• HWM_Q14: waist circumference measurement in centimetres
• HWM_D14: waist circumference measurement in inches
• HWM_Q15: hip circumference measurement in centimetres
• HWM_D15: hip circumference measurement in inches
• HWM_D21 calculated body mass index
• HWM_D22: body mass index norms for respondents 18 or older
• HWM_D23: body mass index norms for respondents less than 18
• HWM_D25: waist to hip ratio
• PHC_Q11: whether the respondent is currently pregnant
• GSM_D51: total hang grip strength
• GSM_D52: calculated hand grip strength norms for respondents 15-69
• GSM_D53: calculated hand grip strength norms for respondents less than 15

RM_N90

Instruction: Press <1> to print the Report of Physical Measurements.

• 1 Print the report
• (DK, RF not allowed)

RM_D90

Programmer:

• IF SCS_N12 = 4 THEN
  • RM_D90 = EMPTY
• ELSE
• IF RM_N90 = 1 and RM_D90 = EMPTY,
  • Set RM_D90 = Current Time (in HH:MM:SS format)
• ENDIF

RM_END

Exit Component

Exit Component Introduction (ECI)

ECI_BEG

External variables required:

Variables taken from sample file:

• STAND: name of the city/town/village in which the clinic has been set up
• CLINICID: 8 digit respondent identifier

Variables assigned in Variable Creation:

• CurrentYear: numeric year during which clinic visit is taking place
• CurrentMonth: numeric month during which clinic visit is taking place
• CurrentDay: numeric day during which clinic visit is taking place
• SessionE: English text of when the clinic visit is taking place

Variables from previously completed blocks:

• RespondentName: name of respondent
• GenderE: English text for sex of respondent
• CON_AGE: age of respondent
• SCS_N12: visit type (3= clinic visit; 4= home visit)

ECI_Q01
Before you leave, we have a few administrative questions.

Instruction:

• Press <1> to continue.
• (DK, RF not allowed)

ECI_D01B

Programmer:

• IF SCS_N12 = 4 THEN
  • ECI_D01 = EMPTY
• ELSE
• IF ECI_Q01 = 1 and ECI_D01 = EMPTY,
  • Set ECI_D01 = Current Time (in HH:MM:SS format)
• ENDIF

ECI_END

Exit Consent Questions (ECQ)

ECQ_BEG

External variables required:

Variables taken from sample file:

• STAND: name of the city/town/village in which the clinic has been set up
• CLINICID: 8 digit respondent identifier
• CPROV: province of residencesst
• LNKFLG: flag indicating whether consent to link will be asked or whether a linkage text will be read (1 = linkage question; 2 = linkage statement)

Variables assigned in Variable Creation:

• CurrentYear: numeric year during which clinic visit is taking place
• CurrentMonth numeric month during which clinic visit is taking place
• CurrentDay: numeric day during which clinic visit is taking place
• SessionE: English text of when the clinic visit is taking place

Variables from previously completed blocks:

• RespondentName: name of respondent
• RespondentFirstName: first name of respondent
• GenderE: English text for sex of respondent
• CON_AGE: age of respondent
• DryRun: whether the case is a dry run case (1or 2= dryrun; 3= survey respondent)
• CON_SEX: sex of the respondent

ECQ_C11

• If DryRun in (1, 2)., go to ECQ_END.
• Otherwise, go to ECQ_D11A.

ECQ_D11A

• If CPROV = 10, DT_PROVINCEE = "Newfoundland and Labrador".
• If CPROV = 11, DT_PROVINCEE = "Prince Edward Island".
• If CPROV = 12, DT_PROVINCEE = "Nova Scotia".
• If CPROV = 13, DT_PROVINCEE = "New Brunswick".
• If CPROV = 24, DT_PROVINCEE = "Quebec".
• If CPROV = 35, DT_PROVINCEE = "Ontario".
• If CPROV = 46, DT_PROVINCEE = "Manitoba".
• If CPROV = 47, DT_PROVINCEE = "Saskatchewan".
• If CPROV = 48, DT_PROVINCEE = "Alberta".
• If CPROV = 59, DT_PROVINCEE = "British Columbia".
• If CPROV = 60, DT_PROVINCEE = "Yukon".
• If CPROV = 61, DT_PROVINCEE = "Northwest Territories".
• If CPROV = 62, DT_PROVINCEE = "Nunavut".

ECQ_D11B

• If CPROV < 60, DT_PROVTERR1 = "provincial".
• If CPROV < 60, DT_PROVTERRE = "province".
• Otherwise, DT_PROVTERR1 = "territorial".
• Otherwise, DT_PROVTERRE = "territory".

ECQ_D11C

• If CON_AGE > 13, DT_ECQ12E = "you".
• Otherwise, DT_ECQ12E = "^RespondentFirstName".

ECQ_D11D

• If CON_AGE > 13, DT_ECQ22E = "your".
• Otherwise, DT_ECQ22E = "^RespondentFirstName's".

ECQ_D11E

• If CON_AGE > 13, DT_ECQ14E = "Do you".
• Otherwise, DT_ECQ14E = "Does ^RespondentFirstName".

ECQ_D11F

• Not Applicable

ECQ_D11G

• If CON_AGE > 13, DT_ECQ16E = "your".
• Otherwise, if CON_SEX = 1, DT_ECQ16E = "his".
• Otherwise, if CON_SEX = 2, DT_ECQ16E = "her".

ECQ_Q12A
Statistics Canada may combine information about [you/RespondentFirstName] collected during this survey with information from other surveys or from administrative data sources.
The results will be used for statistical purposes only.
Do we have your permission to combine this information?

1. Yes (Go to ECQ_Q14)
2. No (Go to ECQ_D21)
   DK, RF (Go to ECQ_D21)

Help text:

• CHMS data could be combined with the respondent's information from:
  • the Provincial Ministry of Health;
  • health registries or other recognized health organizations.
• This would include information on the respondent's past and continuing use of:
  • services provided at hospitals, clinics and doctor's offices;
  • other health services provided by the province.

ECQ_Q14
Having a ^DT_PROVTERR1 health number will assist Statistics Canada in linking the survey data to the ^DT_PROVTERR1 health information.^DT_ECQ14E have a(n) ^DT_PROVINCEE health number?

• 1 Yes (Go to ECQ_Q16)
• 2 No
  DK, RF (Go to ECQ_D21)

ECQ_Q15
For which [province/territory] is [your/RespondentFirstName's] health number?

• 10 Newfoundland and Labrador
• 11 Prince Edward Island
• 12 Nova Scotia
• 13 New Brunswick
• 24 Quebec
• 35 Ontario
• 46 Manitoba
• 47 Saskatchewan
• 48 Alberta
• 59 British Columbia
• 60 Yukon
• 61 Northwest Territories
• 62 Nunavut
• 88 Does not have a [provincial/territorial] health number (Go to ECQ_D21)
  DK, RF (Go to ECQ_R21)

ECQ_Q16
What is [your/his/her] health number?

Instruction: Enter the respondent’s health number. Do not insert blanks, hyphens or commas between the numbers.

• (12 spaces)
• DK, RF (Go to ECQ_D21)

ECQ_N16

Instruction: Re-enter the health number.

• (12 spaces)
• DK, RF

ECQ_D21

• If ECQ_Q16 = RESPONSE and CON_AGE > 13, DT_ECQ21TEXTE = "Your name, address, telephone number and health number".
• Else if ECQ_Q16 <> RESPONSE and CON_AGE > 13, DT_ECQ21TEXTE = "Your name, address and telephone number".
• Else if ECQ_Q16 = RESPONSE and CON_AGE < 14, DT_ECQ21TEXTE = "^RespondentFirstName's name, address, telephone number and health number".
• Else if ECQ_Q16 <> RESPONSE and CON_AGE < 14, DT_ECQ21TEXTE = "^RespondentFirstName's name, address and telephone number".

ECQ_R21
To avoid duplication of surveys, Statistics Canada has signed agreements with Health Canada and the Public Health Agency of Canada to share the information collected during this survey. ^DT_ECQ21TEXTE will not be shared.

Instruction: Press <1> to continue.

ECQ_Q22
They have agreed to keep the information confidential and use it only for statistical purposes.
Do you agree to share [your/RespondentFirstName's] information with Health Canada and the Public Health Agency of Canada?

• 1 Yes
• 2 No
  DK, RF

ECQ_END

Contact (CONT)

CONT_BEG

External fields required:

Variables taken from sample file:

• STAND: name of the city/town/village in which the clinic has been set up
• CLINICID: 8 digit respondent identifier
• FLAGReconsent: 1 = reconsent question asked 2 = reconsent question not asked

Variables assigned in Variable Creation:

• CurrentYear: numeric year during which clinic visit is taking place
• CurrentMonth: numeric month during which clinic visit is taking place
• CurrentDay: numeric day during which clinic visit is taking place
• DryRun: indicator of whether the case is a dry run case
• SessionE: English text of when the clinic visit is taking place

Variables from previously completed blocks:

• RespondentName: first and last name of respondent
• GenderE: English text for sex of respondent
• CON_AGE: age of respondent
• CON_SEX: sex of respondent
•  

CONT_C01

• If DryRun in (1, 2), go to CONT_END.
• Otherwise, go to CONT_Q01.

CONT_Q01
We may want to contact your household in a number of years to ask about your participation in a follow-up to this survey. Do we have your permission to contact you?

• 1 Yes
• 2 No
  (DK is not allowed)
  RF

CONT_C03B

• If CONT_Q01 = 2 or RF, go to CONT_END.
• Otherwise, go to CONT_Q03.

Content type - Note to data users:

• If the respondent does not consent for Statistics Canada to contact their home to participate in a follow up to the CHMS (CONT_Q01=2 or RF), go to CONT_END.

CONT_Q03
In case you move or change telephone numbers, it would be helpful if you could provide the name, telephone number and address of a relative or friend who could help us to contact you.

Instruction: Press <1> to continue.

• 1 Continue
• (DK is not allowed)
• RF

CONT_C04

• If CONT_Q03 = RF, go to CONT_END.
• Otherwise, go to CONT_B05.

CONT_B05

• Call the Get Contact Name (GCN) block. See Appendix I.

Programmer:

• Pass the following parameters:
• DV_QTEXT_E = "I want to emphasize that we will contact this person only if we experience difficulty reaching you."

CONT_C05

• If CONT_B05.GCN_Q02 = 1, go to CONT_END.
• Otherwise, go to CONT_D05.

CONT_D05

Programmer:

• IF CONT_B05.GCN_FNAME = DK or RF AND CONT_B05.GCN_LNAME = DK or RF THEN
  • CONT1_NAMEE = "the person"
• ELSE IF CONT_B05.GCN_FNAME = DK or RF THEN
  • CONT1_NAMEE = CONT_B05.GCN_LNAME
• ELSE IF CONT_B05.GCN_LNAME = DK or RF THEN
  • CONT1_NAMEE = CONT_B05.GCN_FNAME
• ELSE
  • CONT1_NAMEE = CONT_B05.GCN_FNAME + CONT_B05.GCN_LNAME
• ENDIF

CONT_B06

• Call the Address block. See Appendix I.

Programmer:

• Pass the following parameters:
• DV_QTEXT_E = “What is the address for ^CONT1_NAMEE?”
• LISTINGADFLAG = 2 (No)
• NONCANADFLAG = 1 (Yes)

CONT_C07

• If CONT_B06.Province = 77 "Outside of Canada and U.S.A.", go to CONT_B08.
• Otherwise, go to CONT_B07.

CONT_B07

• Call the North American Telephone block (NATP). See Appendix I.
• Go to CONT_B09

Programmer:

• Pass the following parameters:
• DV_QTEXT_E = "What is the telephone number for ^CONT1_NAMEE, including the area code?"
• ASKEXT = 2 (No).

CONT_B08

• Call the Overseas Telephone block (OSTP). See Appendix I.

Programmer:

• Pass the following parameters:
• DV_QTEXT_E = "What is the telephone number for ^CONT1_NAMEE, including the area code?"

CONT_B09

• Call the Get Contact Name block (GCN). See Appendix I.

Programmer:

• Pass the following parameters:
• DV_QTEXT_E = "Is there someone else we could call to help us contact you? Again, we will contact this person only if we experience difficulty reaching you and then only to obtain the new address and telephone number."

CONT_C09

• If CONT_B09.GCN_Q02 = 1, go to CONT_END.
• Otherwise, go to CONT_D09.

CONT_D09

Programmer:

• IF CONT_B09.GCN_Q02 = DK or RF AND CONT_B09.GCN_LNAME = DK or RF THEN
  • CONT2_NAMEE = "the person"
• ELSE IF CONT_B09.GCN_FNAME = DK or RF THEN
  • CONT2_NAMEE = CONT_B09.GCN_LNAME
• ELSE IF CONT_B09.GCN_LNAME = DK or RF THEN
  • CONT2_NAMEE = CONT_B09.GCN_FNAME
• ELSE
  • CONT2_NAMEE = CONT_B09.GCN_FNAME + CONT_B09.GCN_LNAME
• ENDIF

CONT_B10

• Call the Address block. See Appendix I.

Programmer:

• Pass the following parameters:
• DV_QTEXT_E = “What is the address for ^CONT2_NAMEE?”
• LISTINGADFLAG = 2 (No)
• ONCANADFLAG = 1 (Yes)

CONT_C11

• If CONT_B10.Province = 77 "Outside of Canada and U.S.A.", go to CONT_B12.
• Otherwise, go to CONT_B11.

CONT_B11

• Call the North American Telephone block (NATP). See Appendix I.
• Go to CONT_END

Programmer:

• Pass the following parameters:
• DV_QTEXT_E = "What is the telephone number for ^CONT2_NAMEE, including the area code?"
• ASKEXT = 2 (No).

CONT_B12

• Call the Overseas Telephone block (OSTP). See Appendix I.

Programmer:

• Pass the following parameters:
• DV_QTEXT_E = "What is the telephone number for ^CONT2_NAMEE, including the area code?"

CONT_END

Clinic Sign-Out Component (CSO)

CSO_BEG

External variables required:

Variables taken from sample file:

• STAND: name of the city/town/village in which the clinic has been set up
• CLINICID: 8 digit respondent identifier

Variables assigned in Variable Creation:

• CurrentYear: numeric year during which clinic visit is taking place
• CurrentMonth: numeric month during which clinic visit is taking place
• CurrentDay: numeric day during which clinic visit is taking place
• SessionE: English text of when the clinic visit is taking place
• DryRun: indicator of whether the case is a dry run case

Variables output from previously completed blocks:

• RespondentName: name of respondent
• GenderE: English text for sex of respondent
• CON_AGE: age of respondent
• RespondentFirstName: respondent's preferred official language
• SCS_N12: visit type (3= clinic visit; 4= home visit)
• DT_REP11TEXTE: Dynamic text from REP block ("^RespondentFirstName’s"/”your”)
• RespondentName: first and last name of the respondent

CSO_D05

• If CON_AGE < 14 and CON_SEX = 1, DT_CSOR11E = "he".
• If CON_AGE < 14 and CON_SEX = 2, DT_CSOR11E = "she".
• Otherwise, DT_CSOR11E = "you".

CSO_R11A
Thank you for participating in the survey. Here is [RespondentFirstName’s/your] Report of physical measurements containing the results for some of the tests [he/she/you] performed today.

Instruction: Provide the respondent with his/her Report of physical measurements.

Briefly review the report with the respondent, identifying each section and explaining where the results and interpretations can be found.

• Press <1> to continue.

CSO_D11

Programmer:

• IF SCS_N12 = 4 THEN
  • CSO_D11 = EMPTY
• ELSE
• IF CSO_R11A = 1 and CSO_D11 = EMPTY,
  • Set CSO_D11 = Current Time (in HH:MM:SS format)
• ENDIF

CSO_R11B
Do you have any questions about this report? If you would like, a Health Measures Specialist can spend a few minutes reviewing the test results with you now.

Instruction: If a respondent has questions, ask a Health Measures Specialist to answer any questions about the test results.

• Press <1> to continue.

CSO_D12

• If DryRun in (1, 2), DT_CSO12TEXTE = "If you move, please inform us by phoning or e-mailing us".
• Otherwise, DT_CSO12TEXTE = "If you move, please inform us by e-mail or by returning this change of address card".

CSO_R12
We will send the final report of [RespondentFirstName’s/your] test results in 6 to 7 months. ^DT_CSO12TEXTE

Instruction: Press <1> to continue.

CSO_C21

• If DryRun in (1, 2), go to CSO_N23.
• Otherwise, go to CSO_N22.

CSO_N22

Instruction: Record whether RespondentName is to receive the standard reimbursement of $100.

• 1 Yes (Go to CSO_D23)
• 2 No
  (DK, RF not allowed)

CSO_N23

Instruction: Record the reimbursement amount.

• Amount (in dollars)
• (MIN: 0)
• (MAX: 300)
• (DK, RF not allowed)

CSO_D23

Programmer:

• IF CSO_N22 = 1 THEN
  • CSO_D23 = "100"
• ELSE
  • CSO_D23 = CSO_N23
• ENDIF

CSO_C24A

• If DryRun = 3, go to CSO_C24C.
• Otherwise, go to CSO_C24B.

CSO_C24B

• If (DryRun = 1 or 2) and CSO_D23 > 0, go to CSO_N24.
• Otherwise, go to CSO_END.

CSO_C24C

• If DryRun = 3 and CSO_D23 > 100, go to CSO_N25.
• Otherwise, go to CSO_D30.

CSO_N24

Instruction: Specify the reason why a reimbursement is being disbursed to a dry-run participant.

• (80 spaces)
• (DK, RF not allowed)

Go to CSO_D30

CSO_N25

Instruction: Specify the reason why a reimbursement in excess of $100 is being disbursed.

• (80 spaces)
• (DK, RF not allowed)

CSO_D30

• If CON_AGE > 13, DT_CSO30TEXTE = "my".
• Otherwise, DT_CSO30TEXTE = "^RespondentName’s".
• If CON_AGE < 14, DT_NAMECSO = "EMPTY".
• Otherwise, DT_NAMECSO = "^RespondentName".

CSO_N30

Instruction: Press <1> to print the Reimbursement form.

• 1 Print the form
• (DK, RF not allowed)

CSO_D31

• If CON_AGE > 13, DT_CSO31TEXT2E = "respondent".
• Otherwise, DT_CSO31TEXT2E = "parent or guardian".

CSO_R31
Before you leave, I would like to provide you with a reimbursement of the expenses for [RespondentFirstName’s/your] participation in the clinic portion of the survey. I need you to sign this form, which indicates that you received the reimbursement.

Instruction: Provide the [respondent/parent or guardian] with the Reimbursement Form. When the [respondent/parent or guardian] returns the form, check to ensure that all requested information has been filled in and is legible. Sign the form as the witness.

• Press <1> to continue.

CSO_END

Appendix 1

Date Block (APP1)

APP1_BEG
Date Block

DAY Instruction: Enter the day.

• Day
• (MIN: 1)
• (MAX: 31)

MONTH Instruction: Select the month.

• 01 January 07 July
• 02 February 08 August
• 03 March 09 September
• 04 April 10 October
• 05 May 11 November
• 06 June 12 December

YEAR Instruction: Enter a four-digit year.

• Year
• (MIN: 1925)
• (MAX: 2009)
• DATE_END

APP1_END

Address (AD)

AD_BEG

Import the following variables:

• DV_QTEXT_E (QuestionText)
• LISTINGADFLAG tYesNo
• NONCANADFLAG tYesNo

AD_Q01
^DV_QTEXT_E

Interviewer: Enter the civic number.

• If necessary, ask: (What is the civic number?)
  (5 spaces)
  DK, RF

AD_C01

• If DK or RF is entered and LISTINGADFLAG <> Yes, go to AD_N01.
• Otherwise, go to AD_Q02.

AD_N01

Interviewer: (^DV_QTEXT_E)

Do you wish to skip the remaining address fields?

• 1 Yes (Go to AD_END)
• 2 No
  (DK, RF not allowed)

Programmer:

• If "Yes" is selected, fill address fields with DK or RF (based on the response to AD_Q01) and go to AD_END.

AD_Q02
(^DV_QTEXT_E)

Interviewer: Enter the street name.

• If necessary, ask: (What is the street name?)
  (50 spaces)
  DK, RF

Programmer:

• Null is not allowed.

AD_Q03
(^DV_QTEXT_E)

Interviewer: Enter the apartment number.

• If necessary, ask: (What is the apartment number?)
  (5 spaces)
  DK, RF

AD_Q04
(^DV_QTEXT_E)

Interviewer: Enter the city, town, village or municipality.

• If necessary, ask: (What is the city, town, village or municipality?)
  (30 spaces)
  (DK, RF not allowed)

AD_D05

• If (LISTINGADFLAG = Yes and NONCANADFLAG = No) or (LISTINGADFLAG = No and NONCANADFLAG = No), DT_CLANOTEXT_E = "EMPTY".
• Otherwise, DT_CLANOTEXT_E = "If the address is outside Canada, press <Enter>".

AD_Q05
(^DV_QTEXT_E)

Interviewer: Enter the postal code.

• [EMPTY /If the address is outside Canada, press <Enter>]
• If necessary, ask: (What is the postal code?)
• (6 spaces)
• DK, RF (Go to AD_Q07)
• Go to AD_E05A

Programmer:

• The value "EMPTY" should go to AD_D07.

AD_D06

• If first character of the postal code is "A", DT_PROV_E = "Newfoundland and Labrador".
• If first character of the postal code is "B", DT_PROV_E = "Nova Scotia".
• If first character of the postal code is "C", DT_PROV_E = "Prince Edward Island".
• If first character of the postal code is "E", DT_PROV_E = "New Brunswick".
• If first character of the postal code is "G" or "H" or "J", DT_PROV_E = "Quebec".
• If first character of the postal code is "K" or "L" or "M" or "N" or "P", DT_PROV_E = "Ontario".
• If first character of the postal code is "R", DT_PROV_E = "Manitoba".
• If first character of the postal code is "S", DT_PROV_E = "Saskatchewan".
• If first character of the postal code is "T", DT_PROV_E = "Alberta".
• If first character of the postal code is "V", DT_PROV_E = "British Columbia".
• If first character of the postal code is "Y", DT_PROV_E = "Yukon".
• If first character of the postal code is "X", DT_PROV_E = "Nunavut, Northwest Territories".

AD_D06A

• If first character of the postal code is "Y" or "X ", DT_PROV_TERR_E = "territory".
• Otherwise, DT_PROV_TERR_E = "province".

AD_C06A

• If the first character of the postal code is "X", go to AD_D07.
• Otherwise, go to AD_Q06.

AD_Q06
(^DV_QTEXT_E)

Interviewer: Confirm that the ^DT_PROV_TERR_E is ^DT_PROV_E.

• If necessary, ask: (So the ^DT_PROV_TERR_E is ^DT_PROV_E?)
• 1 Yes (Go to AD_END)
• 2 No
  (DK, RF not allowed)

AD_D07

• If NONCANADFLAG = Yes, DT_USA_E = "U.S.A.".
  Otherwise, DT_USA_E = "" "".
• If NONCANADFLAG = Yes, DT_OUTSIDE_E = "Outside of Canada and U.S.A.".
  Otherwise, DT_OUTSIDE_E = "" "".

AD_Q07
(^DV_QTEXT_E)

Interviewer: Select the province or territory.

• If necessary, ask: (What is the province or territory?)
• 10 Newfoundland and Labrador
• 11 Prince Edward Island
• 12 Nova Scotia
• 13 New Brunswick
• 24 Quebec
• 35 Ontario
• 46 Manitoba
• 47 Saskatchewan
• 48 Alberta
• 59 British Columbia
• 60 Yukon
• 61 Northwest Territories
• 62 Nunavut
• 76 [U.S.A./" "]
• 77 [Outside of Canada and U.S.A./" "]
  (DK, RF not allowed)

AD_D07A

• If AD_Q07 = 60 or 61 or 62, DT_PROV_TERR2_E = "territory".
• Otherwise, DT_PROV_TERR2_E = "province".

AD_C08

• If 76 "U.S.A." is selected and NONCANADFLAG = Yes, go to AD_Q08.
• Otherwise, go to AD_END.

AD_Q08
(^DV_QTEXT_E)

Interviewer: Select the state.

• If necessary, ask: (What is the state?)
• 01 Alabama
• 02 Alaska
• 03 Arizona
• 04 Arkansas
• 05 California
• 06 Colorado
• 07 Connecticut
• 08 Delaware
• 09 District of Columbia
• 10 Florida
• 11 Georgia
• 12 Hawaii
• 13 Idaho
• 14 Illinois
• 15 Indiana
• 16 Iowa
• 17 Kansas
• 18 Kentucky
• 19 Louisiana
• 20 Maine
• 21 Maryland
• 22 Massachusetts
• 23 Michigan
• 24 Minnesota
• 25 Mississippi
• 26 Missouri
• 27 Montana
• 28 Nebraska
• 29 Nevada
• 30 New Hampshire
• 31 New Jersey
• 32 New Mexico
• 33 New York
• 34 North Carolina
• 35 North Dakota
• 36 Ohio
• 37 Oklahoma
• 38 Oregon
• 39 Pennsylvania
• 40 Rhode Island
• 41 South Carolina
• 42 South Dakota
• 43 Tennessee
• 44 Texas
• 45 Utah
• 46 Vermont
• 47 Virginia
• 48 Washington
• 49 West Virginia
• 50 Wisconsin
• 51 Wyoming
  (DK, RF not allowed)

AD_Q09
(^DV_QTEXT_E)

Interviewer: Enter only a US zip code.

• If necessary, ask: (What is the zip code?)
• (12 spaces)
• DK, RF (Go to AD_END)

AD_END

Get Contact Name (GCN)

GCN_BEG

Import the following variables:

• DV_QTEXT_E (Question text)

GCN_N01
^DV_QTEXT_E

Instruction: Enter the first name.

• (50 spaces)
• DK, RF (Go to GCN_Q02)
• Go to GCN_Q03

GCN_Q02
(^DV_QTEXT_E)

Instruction: Do you wish to skip the remaining contact fields?

• 1 Yes (Go to GCN_END)
• 2 No
• (DK, RF not allowed)

Programmer:

• If "Yes" is selected, fill contact fields with DK or RF (based on the response to GCN_Q01).

GCN_Q03
(^DV_QTEXT_E)

Instruction: Enter the last name.

• (50 spaces)
• DK, RF

GCN_END

North American Telephone (NATP)

Overview: The North American Telephone block is called from within other blocks. Only a telephone number is collected.

NATP_BEG

• Import the following variables:
• DV_QTEXT_E (Question Text)
• ASKEXT tYesNo

NATP_Q01
^DV_QTEXT_E

Interviewer: Enter the area code.

• If necessary, ask: (What is the area code?)
• Enter "000" if no telephone.
• (MIN: 0)
• (MAX: 9,999,995)
• DK, RF (Go to NATP_Q02)

NATP_C01

• If NATP_Q01 = "000", fill NATP_Q02 with "0000000", go to NATP_END.
• Otherwise, go to NATP_E01A.

NATP_Q02
(^DV_QTEXT_E)

Interviewer: Enter the telephone number.

• If necessary, ask: (What is the telephone number?)
• (MIN: 0)
• (MAX: 9999995)
• DK, RF (Go to NATP_END)

NATP_C03

• If NATP_Q02 = DK, RF or "0000000" or ASKEXT = No, go to NATP_END.
• Otherwise, go to NATP_Q03.

NATP_Q03
(^DV_QTEXT_E)

Interviewer: Enter the extension, if applicable.

• (6 spaces)
• DK, RF

Programmer:

• The extension field can be left empty.

NATP_END

Overseas Telephone (OSTP)

Overview: The Overseas Telephone block is called from within other blocks. Only a telephone number is collected.OSTP_BEG

Import the following variables:

• DV_QTEXT_E (Question Text)

OSTP_Q01
^DV_QTEXT_E

Interviewer: Enter the country code.

• If necessary, ask: (What is the country code?)
• Enter "000" if no telephone.
• (3 spaces)
• DK, RF (Go to OSTP_Q02)

OSTP_C01

• If OSTP_Q01 = "000", fill OSTP_Q02 with "0000" and OSTP_Q03 with "0000000", go to OSTP_END.
• Otherwise, go to OSTP_Q02.

OSTP_Q02
(^DV_QTEXT_E)

Interviewer: Enter the city code (if required).

• If necessary, ask: (What is the city code?)
• (4 spaces)
• DK, RF

OSTP_C02

• If OSTP_Q02 = "blank", go to OSTP_Q03.
• Otherwise, go to OSTP_Q03.

OSTP_Q03
(^DV_QTEXT_E)

Interviewer: Enter the telephone number.

• If necessary, ask: (What is the telephone number?)
• (8 spaces)
• DK, RF

OSTP_END