Survey Text

2011
2010
2009
2008
top
2011
Survey form view entire document:  text  image

PE21
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
(Have/Has) (PERSON) ever been told by a doctor or other health professional that (PERSON) had cancer or a malignancy of any kind?
YES .................................... 1 [PE22]
NO ..................................... 2 [BOX_12]
REF ................................... -7 [BOX_12]
DK .................................... -8 [BOX_12]
PE22
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
What kind of cancer was it?
IF RESPONDENT DOESN'T KNOW OR REFUSES THE KIND OF CANCER, SELECT 'OTHER' AND THEN SELECT 'DON'T KNOW' OR 'REFUSAL.'
CHECK ALL THAT APPLY.
BLADDER ................................ 1
BLOOD .................................. 2
BONE ................................... 3
BRAIN .................................. 4
BREAST ................................. 5
CERVIX ................................. 6
COLON .................................. 7
ESOPHAGUS .............................. 8
GALLBLADDER ............................ 9
KIDNEY ................................ 10
LARYNX-WINDPIPE ....................... 11
LEUKEMIA .............................. 12
LIVER ................................. 13
LUNG .................................. 14
LYMPHOMA .............................. 15
MELANOMA .............................. 16
MOUTH/TONGUE/LIP ...................... 17
OVARY ................................. 18
PANCREAS .............................. 19
PROSTATE .............................. 20
RECTUM ................................ 21
SKIN NON-MELANOMA ..................... 22
SKIN DK WHAT KIND ..................... 23
SOFT TISSUE MUSCLE OR FAT ............. 24
STOMACH ............................... 25
TESTIS ................................ 26
THROAT-PHARYNX ........................ 27
THYROID ............................... 28
UTERUS ................................ 29
OTHER ................................. 91 [PE22OV]
[Code All That Apply]
----------------------------------------------------
HARD CHECK:
EDITS: IF PE22 IS CODED '6' (CERVIX), '18' (OVARY), OR '29' (UTERUS), CHECK THAT PERSON IS FEMALE. IF NOT, DISPLAY THE FOLLOWING MESSAGE:
"CODE UNAVAILABLE FOR MALES. VERIFY AND RE-ENTER."

IF PE22 IS CODED '20' (PROSTATE) OR '26' (TESTIS), CHECK THAT PERSON IS MALE. IF NOT, DISPLAY THE FOLLOWING MESSAGE: "CODE UNAVAILABLE FOR FEMALES.
VERIFY AND RE-ENTER."
----------------------------------------------------
----------------------------------------------------
FOR EACH TYPE OF CANCER SELECTED AT PE22, ADD THE PRIORITY CONDITION 'CANCER-[SPECIFY TYPE........]' TO PERSON'S-MEDICAL-CONDITIONS-ROSTER, WHERE 'SPECIFY TYPE' IS THE NAME OF THE CANCER TYPE SELECTED. SINCE THE LENGTH OF THE CONDNAM IS LIMITED TO 30 CHARACTERS, ABBREVIATE 'SOFT TISSUE' OPTION TO 'CANCER - SOFT TISSUE MUSCL/FAT'. FOR EACH TYPE OF CANCER SELECTED, CREATE A CONDITION AND CONDITION-BY-ROUND RECORD.

REFUSED AND DON'T KNOW DISALLOWED. INTERVIEWER MUST SELECT '91' (OTHER) AND ENTER THE APPROPRIATE TEXT STRING.
----------------------------------------------------
----------------------------------------------------
IF 'OTHER' SELECTED ALONE OR IN COMBINATION WITH ANY OTHER RESPONSE, CONTINUE WITH PE22OV
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO LOOP_02
----------------------------------------------------
PE22OV
======

[PERSON'S FIRST MIDDLE AND LAST NAME]
SPECIFY OTHER TYPE OF CANCER:
[Enter Other Specify-23] .............. [LOOP_02]
REF ................................... -7 [LOOP_02]
DK .................................... -8 [LOOP_02]
----------------------------------------------------
ALLOW UP TO 23 CHARACTERS FOR THIS FIELD.
----------------------------------------------------
----------------------------------------------------
ADD THE PRIORITY CONDITION 'CANCER - [OTHER SPECIFY]' TO PERSON'S-MEDICAL-CONDITIONS-ROSTER.
----------------------------------------------------

top
2010
Survey form view entire document:  text  image

PE21
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
(Have/Has) (PERSON) ever been told by a doctor or other health professional that (PERSON) had cancer or a malignancy of any kind?
YES .................................... 1 [PE22]
NO ..................................... 2 [BOX_12]
REF ................................... -7 [BOX_12]
DK .................................... -8 [BOX_12]
PE22
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
What kind of cancer was it?
IF RESPONDENT DOESN'T KNOW OR REFUSES THE KIND OF CANCER, SELECT 'OTHER' AND THEN SELECT 'DON'T KNOW' OR 'REFUSAL.'
CHECK ALL THAT APPLY.
BLADDER ................................ 1
BLOOD .................................. 2
BONE ................................... 3
BRAIN .................................. 4
BREAST ................................. 5
CERVIX ................................. 6
COLON .................................. 7
ESOPHAGUS .............................. 8
GALLBLADDER ............................ 9
KIDNEY ................................ 10
LARYNX-WINDPIPE ....................... 11
LEUKEMIA .............................. 12
LIVER ................................. 13
LUNG .................................. 14
LYMPHOMA .............................. 15
MELANOMA .............................. 16
MOUTH/TONGUE/LIP ...................... 17
OVARY ................................. 18
PANCREAS .............................. 19
PROSTATE .............................. 20
RECTUM ................................ 21
SKIN NON-MELANOMA ..................... 22
SKIN DK WHAT KIND ..................... 23
SOFT TISSUE MUSCLE OR FAT ............. 24
STOMACH ............................... 25
TESTIS ................................ 26
THROAT-PHARYNX ........................ 27
THYROID ............................... 28
UTERUS ................................ 29
OTHER ................................. 91 [PE22OV]
[Code All That Apply]
----------------------------------------------------
HARD CHECK:
EDITS: IF PE22 IS CODED '6' (CERVIX), '18' (OVARY), OR '29' (UTERUS), CHECK THAT PERSON IS FEMALE. IF NOT, DISPLAY THE FOLLOWING MESSAGE:
"CODE UNAVAILABLE FOR MALES. VERIFY AND RE-ENTER."

IF PE22 IS CODED '20' (PROSTATE) OR '26' (TESTIS), CHECK THAT PERSON IS MALE. IF NOT, DISPLAY THE FOLLOWING MESSAGE: "CODE UNAVAILABLE FOR FEMALES.
VERIFY AND RE-ENTER."
----------------------------------------------------
----------------------------------------------------
FOR EACH TYPE OF CANCER SELECTED AT PE22, ADD THE PRIORITY CONDITION 'CANCER-[SPECIFY TYPE........]' TO PERSON'S-MEDICAL-CONDITIONS-ROSTER, WHERE 'SPECIFY TYPE' IS THE NAME OF THE CANCER TYPE SELECTED. SINCE THE LENGTH OF THE CONDNAM IS LIMITED TO 30 CHARACTERS, ABBREVIATE 'SOFT TISSUE' OPTION TO 'CANCER - SOFT TISSUE MUSCL/FAT'. FOR EACH TYPE OF CANCER SELECTED, CREATE A CONDITION AND CONDITION-BY-ROUND RECORD.

REFUSED AND DON'T KNOW DISALLOWED. INTERVIEWER MUST SELECT '91' (OTHER) AND ENTER THE APPROPRIATE TEXT STRING.
----------------------------------------------------
----------------------------------------------------
IF 'OTHER' SELECTED ALONE OR IN COMBINATION WITH ANY OTHER RESPONSE, CONTINUE WITH PE22OV
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO LOOP_02
----------------------------------------------------
PE22OV
======

[PERSON'S FIRST MIDDLE AND LAST NAME]
SPECIFY OTHER TYPE OF CANCER:
[Enter Other Specify-23] .............. [LOOP_02]
REF ................................... -7 [LOOP_02]
DK .................................... -8 [LOOP_02]
----------------------------------------------------
ALLOW UP TO 23 CHARACTERS FOR THIS FIELD.
----------------------------------------------------
----------------------------------------------------
ADD THE PRIORITY CONDITION 'CANCER - [OTHER SPECIFY]' TO PERSON'S-MEDICAL-CONDITIONS-ROSTER.
----------------------------------------------------

top
2009
Survey form view entire document:  text  image

PE22OV
======

[PERSON'S FIRST MIDDLE AND LAST NAME]
SPECIFY OTHER TYPE OF CANCER:
[Enter Other Specify-23] .............. [LOOP_02]
REF ................................... -7 [LOOP_02]
DK .................................... -8 [LOOP_02]
----------------------------------------------------
ALLOW UP TO 23 CHARACTERS FOR THIS FIELD.
----------------------------------------------------
----------------------------------------------------
ADD THE PRIORITY CONDITION 'CANCER - [OTHER SPECIFY]' TO PERSON'S-MEDICAL-CONDITIONS-ROSTER.
----------------------------------------------------

top
2008
Survey form view entire document:  text  image

PE21
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
(Have/Has) (PERSON) ever been told by a doctor or other health professional that (PERSON) had cancer or a malignancy of any kind?
YES .................................... 1 [PE22]
NO ..................................... 2 [BOX_12]
REF ................................... -7 [BOX_12]
DK .................................... -8 [BOX_12]
PE22
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
What kind of cancer was it?
IF RESPONDENT DOESN'T KNOW OR REFUSES THE KIND OF CANCER, SELECT 'OTHER' AND THEN SELECT 'DON'T KNOW' OR 'REFUSAL.'
CHECK ALL THAT APPLY.
BLADDER ................................ 1
BLOOD .................................. 2
BONE ................................... 3
BRAIN .................................. 4
BREAST ................................. 5
CERVIX ................................. 6
COLON .................................. 7
ESOPHAGUS .............................. 8
GALLBLADDER ............................ 9
KIDNEY ................................ 10
LARYNX-WINDPIPE ....................... 11
LEUKEMIA .............................. 12
LIVER ................................. 13
LUNG .................................. 14
LYMPHOMA .............................. 15
MELANOMA .............................. 16
MOUTH/TONGUE/LIP ...................... 17
OVARY ................................. 18
PANCREAS .............................. 19
PROSTATE .............................. 20
RECTUM ................................ 21
SKIN NON-MELANOMA ..................... 22
SKIN DK WHAT KIND ..................... 23
SOFT TISSUE MUSCLE OR FAT ............. 24
STOMACH ............................... 25
TESTIS ................................ 26
THROAT-PHARYNX ........................ 27
THYROID ............................... 28
UTERUS ................................ 29
OTHER ................................. 91 [PE22OV]
[Code All That Apply]
----------------------------------------------------
HARD CHECK:
EDITS: IF PE22 IS CODED '6' (CERVIX), '18' (OVARY), OR '29' (UTERUS), CHECK THAT PERSON IS FEMALE. IF NOT, DISPLAY THE FOLLOWING MESSAGE:
"CODE UNAVAILABLE FOR MALES. VERIFY AND RE-ENTER."

IF PE22 IS CODED '20' (PROSTATE) OR '26' (TESTIS), CHECK THAT PERSON IS MALE. IF NOT, DISPLAY THE FOLLOWING MESSAGE: "CODE UNAVAILABLE FOR FEMALES.
VERIFY AND RE-ENTER."
----------------------------------------------------
----------------------------------------------------
FOR EACH TYPE OF CANCER SELECTED AT PE22, ADD THE PRIORITY CONDITION 'CANCER-[SPECIFY TYPE........]' TO PERSON'S-MEDICAL-CONDITIONS-ROSTER, WHERE 'SPECIFY TYPE' IS THE NAME OF THE CANCER TYPE SELECTED. SINCE THE LENGTH OF THE CONDNAM IS LIMITED TO 30 CHARACTERS, ABBREVIATE 'SOFT TISSUE' OPTION TO 'CANCER - SOFT TISSUE MUSCL/FAT'. FOR EACH TYPE OF CANCER SELECTED, CREATE A CONDITION AND CONDITION-BY-ROUND RECORD.

REFUSED AND DON'T KNOW DISALLOWED. INTERVIEWER MUST SELECT '91' (OTHER) AND ENTER THE APPROPRIATE TEXT STRING.
----------------------------------------------------
----------------------------------------------------
IF 'OTHER' SELECTED ALONE OR IN COMBINATION WITH ANY OTHER RESPONSE, CONTINUE WITH PE22OV
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO LOOP_02
----------------------------------------------------
PE22OV
======

[PERSON'S FIRST MIDDLE AND LAST NAME]
SPECIFY OTHER TYPE OF CANCER:
[Enter Other Specify-23] .............. [LOOP_02]
REF ................................... -7 [LOOP_02]
DK .................................... -8 [LOOP_02]
----------------------------------------------------
ALLOW UP TO 23 CHARACTERS FOR THIS FIELD.
----------------------------------------------------
----------------------------------------------------
ADD THE PRIORITY CONDITION 'CANCER - [OTHER SPECIFY]' TO PERSON'S-MEDICAL-CONDITIONS-ROSTER.
----------------------------------------------------