Canadian Health Measures Survey – Cycle 3

2012 to 2013
Clinic Questionnaire

Explanatory notes for this document

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.
Question text in bold font enclosed by brackets () is read to the respondent at the discretion of the person asking the questions.
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.
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.
In this document, the flow direction from a given response is not provided when it is to the next immediate question.
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

Variables output from Clinic Shell:

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
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 Respondent Verification Sheet.
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 Respondent Verification Sheet.

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 output from Clinic Shell:

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

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.

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

NSC_N12

Instruction: Record whether corrections are to be made to:

...the first name only?
...the last name only? (Go to NSC_N14)
...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 output from Clinic Shell:

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.

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

SXC_N12

Instruction: Record ^RespondentName's sex.

Male
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 output from Clinic Interface:

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:

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
RateFlag : flag for subsampling

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.

Yes (Go to DDN_E4)
No, return and correct date of birth (Go to DDN_B2)
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 <12 THEN

IF (BPAFLG = 1 or TRICFLG =1 or ARSCFLG = 1 or BENZFLG = 1 or CARBFLG = 1 or ORGPFLG = 1 or PARAFLG = 1 or GLYPFLG = 1 or
PAHFLG = 1 or NICOFLG = 1) or (UFLUFLG = 1) or (NNALFLG = 1)
THEN

DDN_D6 = 50.0 ml

Else

DDN_D6 = 25.0 ml

ENDIF

ELSE

IF (BPAFLG = 1 or TRICFLG =1 or ARSCFLG = 1 or BENZFLG = 1 or CARBFLG = 1 or ORGPFLG = 1 or PARAFLG = 1 or GLYPFLG = 1 or
PAHFLG = 1 or NICOFLG = 1) or (UFLUFLG = 1) or (NNALFLG = 1)
THEN

DDN__D6 = 80.0 ml

Else

DDN_D6 = 50.0 ml

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 output from Clinic Interface:

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

Variables output from Clinic Interface:

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
HouseholdContact: name of household contact
STOREBLD: flag for whether storage is available for blood and urine samples (1= blood/urine storage ; 2= No blood/urine storage)
STOREDNA: flag for whether storage is available for DNA samples (1= DNA storage; 2= NO DNA storage)

Variables output from Clinic Shell:

SCS_N12: visit type (3= clinic visit; 4= home visit)

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

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 = "^FNAME'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 (Go to CON_R13)
(DK, RF not allowed)

CON_D11

Programmer:

IF SCS_N12 = 4 THEN

CON_D11 = EMPTY

ELSE

IF CON_Q11 = 1 and CON_D11 = EMPTY,

Set CON_D11 = Current Time (in HH:MM:SS format)

ENDIF

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 a copy of [^FNAME's/his/her] test results.

1 Yes
2 No
(DK, RF not allowed)

CON_C23A

If DryRun in (1, 2), go to CON_END.
Otherwise, go to CON_D23.

CON_D23

Not Applicable

CON_N23

Instruction: Record whether [the parent or guardian/the respondent] has consented to allowing Statistics Canada to test [^FNAME's/his/her] blood and urine for contaminants that are reportable in this province, 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_C24A.
Otherwise, go to CON_R23.

CON_R23
You have indicated on your Consent Form that you do not want to receive a copy of your laboratory test results. However, you have agreed that Statistics Canada can test your blood and urine for reportable diseases and contaminants. I just want you to be aware that, by agreeing to have the reportable disease and contaminant tests done, you will receive the results if you test positive.

Instruction: Answer any questions as thoroughly as possible.

Press <1> to continue.

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.

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.

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.

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

Variables output from Clinic Interface:

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
HouseholdContact: name of household contact

Variables output from Clinic Shell:

MailAddress: mailing address of respondent

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
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 has requested a copy of his/her 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_C21.
Otherwise, go to REP_D11.

REP_D11

If CON_AGE < 14, DT_REP11TEXTE = "^RespondentFirstName's".
Otherwise, DT_REP11TEXTE = "your".

REP_R11
You will receive a copy of some of DT_REP11TEXTE physical measurement test results at the end of the clinic visit today. The remaining results will be delivered to you by mail as soon as they are available, which should be in about 3 months.

Instruction: Press <1> to continue.

REP_Q12
Which delivery method would you prefer?

Instruction: Read categories to respondent.

Regular mail
Courier
(DK, RF not allowed)

REP_C13

If CON_AGE > 13, go to REP_C21.
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_C21

If no mailing address exists (i.e., the street and city fields in the mailing address 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 "What is your mailing address?" as a parameter.

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 home telephone number of the respondent
TelephoneNumber2: Second home telephone number of the respondent

Variables output from Clinic Interface:

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
HouseholdContact: name of household contact

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
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)

URG_B07

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

Programmer:

Pass "What is the correct phone number?" as parameter.

URG_C08

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

URG_Q09
Is ^TelephoneNumber2 correct?

1 Yes (Go to URG_N12)
2 No (DK, RF not allowed)

URG_B09

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

Programmer:

Pass "What is the correct phone number?" as parameter.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_N12)
DK, RF (Go to URG_N12)

URG_B11

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

Programmer:

Pass "What is it?" as parameter.

URG_N12

Instruction: Do you have an email address we can use if we experience difficulty reaching you by phone?

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

URG_B12

Call the E-mail collection block (ECB).

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_Q16.

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_Q16

Instruction: Press <1> to print the Contact Information Form.

Ask the respondent to fill out the form by the end of the clinic visit to facilitate the exit process.
1 Print the form
(DK, RF not allowed)

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

Email Collection (ECB)

ECB_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 output from Clinic Interface:

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

ECB_Q2

What is your email address?

Instruction: Ask about upper and lower case, special characters, etc. If the respondent or parent/guardian has more than one email address, enter the best email address.

(80 spaces)
(DK, RF not allowed)

ECB_N3

Instruction: Re-enter the email address.

(80 spaces)
(DK, RF not allowed)

ECB_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 output from Clinic Interface:

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 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 brown 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 brown 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_N42A

Instruction: Was the urine collection hat used for the urine collection?

1 Yes
2 No
(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 you urinated prior to providing this sample.

Instruction: Read categories to respondent.

Less than 1 hour ago
1 to 2 hours ago
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 output from Clinic Interface:

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 output from Clinic Interface:

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:

AppointmentTime: time of the clinic visit (in 99:99 format)

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)
(MAX: 13)
(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)
(MAX: 13)
(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_C14B.

ATG_C14B

If (SCS_N12 = 3 AND ((ATG_N11 = 1 and the difference between CurrentDate-1/ATG_Q11 and CurrentDate/CurrentTime is 3 hours or more) OR (ATG_N11 = 2 and difference between CurrentDate/ATG_Q11 and CurrentDate/CurrentTime is 3 hours or more))) OR (SCS_N12 = 4 AND ((ATG_N11 = 1 and the difference between CurrentDate-1/ATG_Q11 and CurrentDate/ATG_N12 is 3 hours or more) OR (ATG_N11 = 2 and difference between CurrentDate/ATG_Q11 and CurrentDate/ATG_N12 is 3 hours or more))), go to ATG_C21.
Otherwise, go to ATG_Q14.

Content type: Note to data users:

3 hr fasting status is calculated above. If respondents are fasted for 3 hrs or more then they are flowed to ATG_C21, otherwise they flow to ATG_Q14.

ATG_Q14
Within the past three hours have you eaten beets, broccoli, cabbage, celery, lettuce, spinach, or radishes?

1 Yes
2 No
(DK, RF not allowed)

ATG_Q15
Within the past three hours have you eaten smoked fish, ham, bacon, or hot dogs, not including vegetarian?

1 Yes
2 No
(DK, RF not allowed)

ATG_C21

If CON_AGE < 12, go to ATG_Q21B.
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 (Go to ATG_Q22)
2 No
(DK, RF not allowed)

ATG_Q21B
Have you been exposed to second-hand smoke during the past 2 hours (e.g., from a cigarette, cigar, or pipe)?

Instruction: Exposure to second-hand smoke can occur indoors, outdoors or in a vehicle.

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 output from Clinic Interface:

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:

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_C20.
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_C13AIf PHCFLAG = 2, go to PHC_C20.
Otherwise, go to PHC_C13B.

Content type: Note to data users:

For cycle 3 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_C20.

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_C20

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_C20

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: 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_C20

If CON_AGE < 6, go to PHC_D41.
Otherwise, go to PHC_Q20.

PHC_Q20
Are you currently suffering from the effects of an allergy, cold or respiratory infection?

1 Yes
2 No (Go to PHC_Q41)
(DK, RF not allowed)

PHC_Q21
Do you have a runny or stuffy nose, post nasal drip, sore throat or phlegm as a result of your allergy, cold, or respiratory infection?

1 Yes
2 No
(DK, RF not allowed)

PHC_D41

If AGE > 5, DT_PHCTEXTE = " other".
If AGE < 6, DT_PHCTEXTE = "EMPTY".

PHC_Q41
Do you have any[ other/EMPTY] acute conditions, for example 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
13 FENO (Fractional Exhaled Nitric Oxide)
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.

Bone, joint or muscle problem
Cardiovascular condition
Respiratory condition
Physically impaired
Other health problem
(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
13 FENO (Fractional Exhaled Nitric Oxide)
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 not allowed)

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_D55

Programmer:

IF PHC_B55.Year / PHC_B55.DATE_Month / PHC_B55.DATE_Day = YesterdayYear / YesterdayMonth / YesterdayDay THEN

PHC_D55 = 1

ENDIF

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

1 Yes
2 No
(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 output from Clinic Interface:

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.

Less than a year ago
1 to less than 5 years ago
5 to less than 10 years ago
10 or more years ago
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)?

Right
Left
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)

PQ_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 output from Clinic Interface:

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 to 3 attacks
4 to 12 attacks
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.

Never woken with wheezing
Less than one night per week
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 output from Clinic Interface:

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 output from Clinic Interface:

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

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

Today
Yesterday
Within the last week
Within the last month
More than one month ago
Never ^DT_TAKE1E the product
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
SEX_Q01 : sex of respondent
CON_AGE : age of respondent
FNAME: first name of respondent

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 SEX_Q01 = 1 and CON_AGE > 13, DT_MEUTEXT2E = "antibiotics and nicotine patches".
Otherwise, if SEX_Q01 = 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 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: 1)
(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 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 and other health products, including natural health products, that you have taken or used in the past month, that is, from ^DT_DATELASTMONTHE to today.

Instruction: Has the respondent taken or used any over-the-counter medications or 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 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
DT_DateLastMonthE: English text of date one month ago
FollowUpFlag: 0 or 1

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.

(MIN: 1)
(MAX: 99,999,995)
(DK, RF not allowed)

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 DV_PIN = EMPTY (product identification number not found in PIN_Database), go to NPI_D18A.
Otherwise, go to NPI_Q10.

NPI_Q10

Product identification number: ^DV_PIN
Product name: ^DV_PRODUCT_NAME
Form: ^DV_FORME
Strength: ^DT_STRENGTH

Instruction: Confirm whether the information displayed is correct.

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

NPI_N11

Instruction: Is ^DV_PIN 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_D17

Not Applicable

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_N16, 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_D18B

Not Applicable

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.)

Today
Yesterday
Within the last week
Within the last month
More than one month ago (Go to NPI_END)
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 a prescription 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: 1)
(MAX: 500)
DK (Go to NPI_Q65)
RF (Go to NPI_END)

NPI_N64

Instruction: Select the reporting period.

Days
Weeks
Months
Years
(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 output from Clinic Interface:

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:

DT_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_N6)
(DK, RF not allowed)

ORS_S2

Instruction: Specify the reason.

(80 spaces)
(DK, RF not allowed)

ORS_N6

Instruction: Is there any other reason why the respondent should not perform the Fractional Exhaled Nitric Oxide (FENO) test?

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

ORS_S6

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
FNAME: first name of respondent
LNAME: last name of respondent
CON_AGE:age of respondent

Variables output from Clinic Interface:

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: VOC flag (1= VOC will be measured in blood; 2= VOC will not be measured in blood)
UFLUFLG: Fluoride flag (1= Fluoride will be measured in urine; 2= Fluoride will not be measured in urine)
SCS_N12: Visit type (3= clinic visit; 4= home visit)

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.

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.

Less than 6 hours ago
6 to less than 12 hours ago
12 to less than 24 hours ago
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.

Less than 6 hours ago
6 to less than 12 hours ago
12 to less than 24 hours ago
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.

Per day
Per week
Per month
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.

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

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

Instruction: Read categories to respondent.

Less than 6 hours ago
6 to less than 12 hours ago
12 to less than 24 hours ago
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.

Less than 3 months ago
3 to less than 6 months ago
6 to less than 9 months ago
9 to less than 12 months ago
12 or more months ago
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.

Less than 6 hours ago
6 to less than 12 hours ago
12 to less than 24 hours ago
24 or more hours ago
DK, RF

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 output from Clinic Interface:

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:

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)

Screen display:

The following header should be displayed for each question:

Stand : ^STAND Date : ^CurrentDate Session : essionE Comp : ^CompE
Clinic ID : ^ClinicID Name : RespondentName Age : ^CON_AGE Sex : ^GenderE

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.

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
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_B24Call 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.

...light (flaked or chunk) tuna?
...white (solid) tuna? (Go to FSF_C25B)
...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_C42.

FSF_B41

Call the Detail Fish and Shellfish (DFS) block.

Programmer:

Pass DT_QuestionE = "tilapia" 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_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 output from Clinic Interface:

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.

Per month
Per week
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
FNAME: first name of respondent
LNAME: last name of respondent
CON_AGE:age of respondent

Variables output from Clinic Interface:

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:

HER_Q41: Whether respondent has ear infection
HER_Q51: Whether respondent has cochlear implant
SCS_N12: Visit type (3= clinic visit; 4= home visit)

HCI_D01

If (HER_Q41=3 or HER_Q51=3) or (HER_Q41=1 and HER_Q51=2) or (HER_Q41=2 and HER_Q51=1) , 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. ^HCIText1E

Instruction: Press <1> to continue.

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 output from Clinic Interface:

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

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 output from Clinic Interface:

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

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.

Less than 12 months
1 to less than 5 years
5 to less than 10 years
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.

Machinery such as bulldozers, backhoes or sawmill equipment
Modes of transportation such as trains, airplanes, cars or trucks
Munitions such as guns or canons
Music, for example, at a concert or other amplified music
People
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 to 19 times
20 to 99 times
100 to 9999 times
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.

Always
Often
Sometimes
Rarely
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_NEXTEXT29E?

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.

Days
Weeks
Months
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.

Within the last 7 days
8 days to less than 1 month ago (Go to NEX_Q43)
1 month to less than 6 months ago (Go to NEX_D45)
6 months to less than 1 year ago (Go to NEX_D45)
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.

Always
Often
Sometimes (Go to NEX_D45)
Rarely (Go to NEX_D45)
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.

Days
Weeks
Months
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

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.

Per day
Per week
Per month
Per year
(DK, RF not allowed)

ACD_Q12
How much time did you typically spend on each occasion?

Instruction: Read categories to respondent.

Less than 10 minutes
10 to less than 30 minutes
30 minutes to less than 1½ hours
1½ hours to less than 5 hours
5 hours or more
DK, RF

ACD_Q13
How often did you wear hearing protection?

Instruction: Read categories to respondent.

Always
Often
Sometimes
Rarely
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 output from Clinic Interface:

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:

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.

Introduction: Press <1> to continue.

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].

Introduction: 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]?

Introduction: Read categories to respondent.

Less than 5 minutes (Go to SEB_Q13A)
5 to less than 30 minutes
30 minutes to less than 1 hour
1 hour to less than 2 hours
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?

Introduction: Read categories to respondent.

Always
Often
Sometimes
Rarely
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

Introduction: 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.

Covered
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

Covered
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

Covered
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

Covered
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

Covered
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)

Covered
Uncovered
DK, RF

SEB_Q11
How often did you usually use sunscreen...

...on your face, ears or neck?

Read categories to respondent.

Always
Often
Sometimes
Rarely
Never
DK, RF

SEB_Q12A
How often did you usually use sunscreen...

...on other areas (for example, hands, arms or legs)?

Always
Often
Sometimes
Rarely
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]?

Introduction: If the respondent was never in the sun during these hours, select <1> 'Less than 5 minutes'.

Read categories to respondent.

Less than 5 minutes (Go to SEB_Q23)
5 to less than 30 minutes
30 minutes to less than 1 hour
1 hour to less than 2 hours
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?

Introduction: Read categories to respondent.

Always
Often
Sometimes
Rarely
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

Covered
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

Covered
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

Covered
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

Covered
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

Covered
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)

Covered
Uncovered
DK, RF

SEB_Q21
How often did you usually use sunscreen...

...on your face, ears or neck?

Read categories to respondent.

Always
Often
Sometimes
Rarely
Never
DK, RF

SEB_Q22
How often did you usually use sunscreen...

...on other areas (for example, hands, arms or legs)?

Always
Often
Sometimes
Rarely
Never
DK, RF

SEB_Q23
In the past 2 months, that is, from ^Date2MonthsAgoE to yesterday, have you traveled to a warm, sunny climate?

Yes
No (Go to SEB_C35)
DK, RF (Go to SEB_C35)

SEB_Q24
How long were you there?

Introduction: Enter amount only.

Amount
(MIN: 1)
(MAX: 61)
DK, RF (Go to SEB_Q25)

SEB_N24

Introduction: Select the reporting period.

Days
Weeks
Months
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.?

Less than 5 minutes (Go to SEB_C35)
5 to less than 30 minutes
30 minutes to less than 1 hour
1 hour to less than 2 hours
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?

Always
Often
Sometimes
Rarely
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

Introduction: The reference period for these questions is between the hours of 10 a.m. and 4 p.m.

Covered
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

Covered
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

Covered
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

Covered
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

Covered
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)

Covered
Uncovered
DK, RF

SEB_Q33
How often did you usually use sunscreen...

...on your face, ears or neck?

Introduction: Read categories to respondent. The reference period for these questions is between the hours of 10 a.m. and 4 p.m.

Always
Often
Sometimes
Rarely
Never
DK, RF

SEB_Q34
How often did you usually use sunscreen...

...on other areas (for example, hands, arms or legs)?

Always
Often
Sometimes
Rarely
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.

Introduction: Press <1> to continue.

SEB_Q35
In the past 12 months, have you used a tanning bed or booth with tanning lamps?

Yes
No (Go to SEB_END)
DK, RF (Go to SEB_END)

SEB_Q36
How often?

Introduction: Enter amount only.

Times
(MIN: 1)
(MAX: 365)
DK, RF (Go to SEB_Q37)

SEB_N36

Introduction: Select the reporting period.

Per day
Per week
Per month
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?

Yes
No
DK, RF (Go to SEB_END)

SEB_Q38
During which months do you typically use a tanning bed or booth?

Introduction: 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

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 output from Clinic Interface:

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 output from Clinic Interface:

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.

1 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, RFSKR_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 output from Clinic Shell:

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_R02
Next will be a series of body measurements.

Instruction: Press <1> to continue.

ACI_D02

Programmer:

IF SCS_N12 = 4 THEN

ACI_D02 = EMPTY

ELSE

IF (ACI_R01 = 1 or ACI_R02 = 1) and ACI_D02 = EMPTY

Set ACI_D02 = Current Time (in HH:MM:SS format)

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 output from Clinic Interface:

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

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: 834)
(MAX: 2,130)
(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)
(MAX: 208)
DK, RF (Go to HWM_D11)

HWM_N11C

Instruction: Re-enter the standing height in centimetres.

(MIN: 19)
(MAX: 208)
DK, RF

HWM_N11

DInstruction: Re-enter the standing height in millimeters.

Millimeters
(MIN: 834)
(MAX: 2,130)
DK, RF

HWM_D11

Programmer:

Set standing height in centimeters and derive standing height in inches (HWM_D11).

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: 834)
(MAX : 2 130)
DK, RF (Go to HWM_D12)

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)
(MAX: 208)
DK, RF (Go to HWM_D12)

HWM_N12C

Instruction: Re-enter the sitting height in centimetres.

(MIN: 73)
(MAX: 208)
DK, RF

HWM_N12D

Instruction: Re-enter the sitting height in millimeters.

(MIN: 834)
(MAX: 2,130)
DK, RF

HWM_D12

Programmer

Set sitting height in centimeters and derive sitting height in inches (HWM_D12).

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.

Electronically
Manually with a portable device (Go to HWM_N13B)
Self-report (Go to HWM_N13B)
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.

HWM_N13B

Instruction: When the measurement is stable, record the weight in kilograms.

(MIN: 1)
(MAX: 500)
DK, RF (Go to HWM_D13)

HWM_N13C

Instruction: Re-enter the weight in kilograms.

(MIN: 1)
(MAX: 500)
DK, RF

HWM_D13

Programmer:

Set weight in kilograms and derive weight in pounds (HWM_D13).

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_D20.
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)
(MAX: 305)
DK, RF (Go to HWM_D14)

HWM_N14B

Instruction: Re-enter the waist circumference in centimetres.

(MIN: 0)
(MAX: 305)
DK, RF

HWM_D14

Programmer:

Set waist circumference in centimeters and derive waist circumference in inches (HWM_D14).

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)
(MAX: 305)
DK, RF (Go to HWM_D15)

HWM_N15B

Instruction: Re-enter the hip circumference in centimetres.

(MIN: 0)
(MAX: 305)
DK, RF

HWM_D15

Programmer:

Set hip circumference in centimeters and derive hip circumference in inches (HWM_D15).

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_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_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 output from Clinic Interface:

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)

BPM_N101

Instruction: Record how the first set of data will be captured.

Electronically (BpTRU)
Manually (auscultation) (Go to BPM_D110)
BpTRU data entered manually (Go to BPM_B110)
(DK, RF not allowed)

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_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 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, RF not allowed)

BPM_C102

If BPM_Q101 = RF, go to BPM_D110.
Otherwise, go to BPM_D102A.

BPM_D102A

Not Applicable

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 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_D110

If CON_AGE < 14, DT_BPM110TEXTE = "I will fill the cuff with air and it will squeeze your arm a little. During the test you need to sit really still, you cannot talk and you must keep your feet flat on the floor. You should stay relaxed to make sure that 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 take the measurements. It is very important that we don't talk until the test is done. Do you have any questions before we begin?".
Otherwise, DT_BPM110TEXTE = "I will inflate the cuff once every minute, applying pressure to your arm. 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 to sit and relax for 5 minutes. I will then return to take the measurements. I ask that you do not talk when I leave the room. Do you have any questions before we begin?".

BPM_Q110
Now I will take your blood pressure and heart rate. I will measure your blood pressure using this arm cuff and stethoscope, and your heart rate using this heart rate monitor. 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 right arm on the table, palm facing up.

I will take your blood pressure and heart rate 6 times.

^DT_BPM110TEXTE

Instruction:

- Show the heart rate monitor to the respondent and help him/her put it on.

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 right arm
Ensure respondent is in the correct position (palm up, feet flat, arm and back rested, relaxed).
Start the stopwatch to return to the room after 5 minutes.
After the 5- minute rest, return to the room to take the measurements at 1- minute intervals.
Use the stopwatch during the measurements to ensure they are taken every minute.
Press <1> to continue.
1 Continue
(DK not allowed)
RF

BPM_C110

If BPM_Q110 = RF, go to BPM_END.
Otherwise, go to BPM_R110.

BPM_R110

Instruction: Determine the maximum inflation level before taking the measurements.

Press <1> to continue.

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_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 = 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_C161B

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_C163

If BPM_D160A = 1, go to BPM_C201.
Otherwise, go to BPM_C163A.

BPM_C163A

If BPM_N160 = 1 and BPM_D160A > < 1, go to BPM_D402.
Otherwise, go to BPM_E163.

BPM_C201

If BPM_Q101 = RF, go to BPM_D210.
Otherwise, go to BPM_N201.

BPM_N201

Instruction: Record how the second set of data will be captured.

Electronically (BpTRU)
Manually (auscultation) (Go to BPM_D210)
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 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.
1 Press <1> to continue.
(DK not allowed)
RF

BPM_C202

If BPM_Q201 = RF, go to BPM_D210.
Otherwise, go to BPM_E202.

BPM_N205

Instruction: Press <1> to save the measurements in Blaise.

1 Save the measurements (Go to BPM_D260A)
(DK, RF not allowed)

BPM_D210

If BPM_N160 = 2 OR BPM_D160A = 1, DT_BPM210TEXT1E = "There were too many problems with that set of measurements, so we have to do the test again. ".
Otherwise, DT_BPM210TEXT1E = "Now I will retake your blood pressure and heart rate.".
If BPM_N101 = 1 or 3 and Q101 > < RF, DT_BPM210TEXT2E = "I will measure your blood pressure using this arm cuff and stethoscope, and your heart rate using this heart rate monitor. I will take your blood pressure and your heart rate 6 times.".
Otherwise, DT_BPM210TEXT2E = "EMPTY".
If CON_AGE < 14, DT_BPM210TEXT3E = "Remember, during the test you need to sit really still, you cannot talk and you must keep your feet flat on the floor or step. You should stay relaxed to make sure that we get good results.".
Otherwise, DT_BPM210TEXT3E = "Remember, 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.".
If BPM_N101 = 1 or 3, DT_BPM210TEXT4E = "Show the heart monitor to the respondent and help him/her put it on.".
Otherwise, DT_BPM210TEXT4E = "EMPTY".

BPM_Q210
^DT_BPM210TEXT1E ^DT_BPM210TEXT2E ^DT_BPM210TEXT3E

Instruction:

^DT_BPM210TEXT4E
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 right arm.
Ensure respondent is in the correct position (palm up, feet flat, arm and back rested, relaxed).
Take the measurements at 1- minute intervals.
Use stopwatch during the measures to ensure they are taken every minute.
1 Press <1> to continue.
(DK not allowed)
RF

Go to BPM_C210

BPM_C210

If BPM_Q210 = RF, go to BPM_D402.
Otherwise, go to BPM_B210.

BPM_R210

Instruction: Determine the maximum inflation level before taking the measurements.

Press <1> to continue.

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 = 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_C261A

If (BPM_N201=1 and BPM_Q201=1) or BPM_N201=3, go to BPM_N261.
Otherwise, go to BPM_C261B.

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".

BPM_R411
Your average blood pressure today was ^BPM_D317 / ^BPM_D318 mmHg. Based on a report by the Canadian Coalition for High Blood Pressure Prevention and Control, this means your blood pressure is [above the acceptable range/moderately high/high/very high].

Instruction: Answer any questions as thoroughly as possible.

Press <1> to continue.

BPM_D412A

Programmer:

Calculate the blood pressure norms for respondents less than 18.

BPM_C412

If BPM_D412A = RESPONSE and BPM_D412A > 2, go to BPM_D412B.
Otherwise, go to BPM_END.

BPM_D412B

If BPM_D412A = 3, DT_BPM412TEXTE = "high".
Otherwise BPM_D412A = 4, DT_BPM412TEXTE = "very high".

BPM_R412
Your average blood pressure today was ^BPM_D317 / ^BPM_D318 mmHg. Based on The Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents, this means your blood pressure is [high/very high].

Instruction: Answer any questions as thoroughly as possible.

Press <1> to continue.

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.

05 Deflation too slow
06 Deflation too fast
20 Indeterminate systolic blood pressure
21 Indeterminate diastolic blood pressure
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 E

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 output from Clinic Interface:

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
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, RF 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 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.

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 output from Clinic Interface:

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

IAS_N11

Instruction: Record whether an indoor air sampler is available.

1 Yes
2 No
(DK, RF 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 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.

1 Press <1> to continue. (Go to IAS_R21)
(DK 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.

Burden
Invasive
Away during the collection period
Worried about losing or damaging the device
Other - Specify (Go to IAS_S12)
(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.

Burden
Invasive
Away during the collection period
Worried about losing or damaging device
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

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 output from Clinic Interface:

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.

Less than 10 years old
10 years old to less than 20
20 years old to less than 30
30 years old to less than 40
40 years old to less than 50
50 or more years old
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.

600 sq. ft (55 square metres) or less
601 to 1,000 sq. ft (56 to 95 square metres)
1,001 to 2,000 sq. ft (96 to 185 square metres)
2,001 to 3,000 sq. ft (186 to 280 square metres)
3,001 to 4,000 sq. ft (281 to 371 square metres)
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.

Oil furnace
Gas furnace
Electric heat
Wood-burning stove
Wood-burning fireplace
Gas fireplace
Other - Specify (Go to IAQ_S07)
DK, RF

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_C14.
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 not allowed)
RF (Go to IAQ_Q15)

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.

Detached garage
Attached garage without a connecting door to your home
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.

More than 5 times a week
1 to 5 times a week
Less than once a week
Never
DK, RF

IAQ_C14

If IAQ_D04 > 0 (excluding DK, RF) and < 5 (dwelling is single detached, double, row or terrace, duplex), 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.

Indoor or underground parking lot
Outdoor or partially enclosed parking lot
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.

More than 5 times a week
1 to 5 times a week
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.

More than once a week
About once a week
Less than once a week
Never
DK, RF

IAQ_END

Fractional Exhaled Nitric Oxide Component

Fractional Exhaled Nitric Oxide Component Introduction (NOI)

NOI_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 output from Clinic Interface:

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)

NOI_N01

Instruction: Press < 1 > to capture the sensor information.

1 Capture the sensor information
(DK, RF not allowed)

Programmer:

TestsRemaining_beg = Value at TestsRemaining key

NOI_C01

If TestsRemaining_beg = Empty, go to NOI_N05A.
Otherwise, go to NOI_E05B.

NOI_N05A

Instruction: Enter the number of tests remaining on the sensor.

(MIN: 0)
(MAX: 300)
DK
(RF is not allowed)

Programmer:

TestsRemaining_beg = NOI_N05A

NOI_N05B

Instruction: Re-enter the number of tests remaining on the sensor.

(MIN: 0)
(MAX: 300)
DK (Go to NOI_END)
(RF is not allowed)

NOI_C05C

If NOI_N01 = 1 and SensorID = EMPTY, go to NOI_D05.
Otherwise, go to NOI_C06.

NOI_D05

Not Applicable

Programmer:

SensorID = Value at SensorID keyNOI_C06If SensorID = Empty, go to NOI_N06A.
Otherwise, go to NOI_R07.

NOI_N06A

Instruction: To log in the serial number of the sensor, scan the sensor bar code located on the bottom of the monitor.

(13 spaces)
(DK, RF not allowed)

NOI_N06B

Instruction: Re-scan the sensor bar code located on the bottom of the monitor.

(13 spaces)
(DK, RF not allowed)

NOI_R07
Now we are going to conduct a breathing test to measure the level of inflammation in your airways.

Instruction: Press <1> to continue.

NOI_D07

Programmer:

IF SCS_N12 = 4 THEN

NOI_D07 = EMPTY

ELSE

If NOI_R07 = RESPONSE and NOI_D07 = EMPTY,
Set NOI_D07 = Current Time (in HH:MM:SS format)

ENDIF

NOI_Q08
This test has a few easy steps:

First, you will need to breathe out slowly and completely facing away from the mouthpiece.
Next, you will put this mouthpiece in your mouth making sure your lips are nice and tight so that no air escapes.
Then you will breathe in slowly and deeply through the mouthpiece.
When your lungs are full, breathe out at a steady speed into the machine until I tell you to stop, which will take about 10 seconds. Again, make sure your lips stay nice and tight around the mouthpiece.
When you begin to exhale into the machine, you will feel some resistance; your breath will not be registered until you hear a clicking sound.

Instruction:

Show the device to the respondent.
Demonstrate the test from start to finish, as realistically as possible.
Press <1> to continue.
1 Continue
DK, RF (Go to NOI_END)

NOI_R09
The results of this test greatly depend on the speed that you blow into the machine. To help you blow at the right speed I may tell you to blow faster or slower. The machine is very sensitive, so it is important to only slightly adjust your breathing speed during the measurement.

Instruction: Press <1> to continue.

NOI_R10
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.

NOI_END

Fractional Exhaled Nitric Oxide Measurement (NOM)

NOM_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 identifierVariables output from Clinic Interface:
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: English text for sex of respondent
GenderE: English text for sex of respondent
CON_AGE: age of respondent
NOI_N05A: the number of tests remaining on the sensor
NOI_Q08: the explanation of the FENO test
SCS_N12 : visit type (3= clinic visit; 4= home visit)

NOM_C01

If NOI_N05A or NOI_Q08 = DK, go to NOM_N60
Else If NOI_Q08 = RF, go to NOM_END.
Otherwise, go to NOM_R02.

NOM_R02
Please sit up straight in your chair and keep both feet flat on the floor.

Instruction: Ensure the respondent does not drink anything (including water) until after the test has been completed.

Administer the test and provide feedback following each attempt.

Press <1> to continue.

Content type: Note to data users:

Up to ten FENO attempts are conducted to achieve two reproducible FENO results. Once two reproducible FENO results are achieved then the measurement is over. If after 4 completed tests, no reproducible FENO results are achieved, then the measurement is over.

NOM_B03

Call the NOA block (Fractional Exhaled Nitrite Oxide Attempts)

Programmer:

The NOA block can be called up at NOM_B03, NOM_B13, NOM_B23 and NOM_B33 to a combined maximum of 10 instances during the NOM block.
When instance number 10 is reached, set FLGTEN = 1If instance 1: Pass DT_NoaE = "first" as a parameter
If instance 2: Pass DT_NoaE = "second" as a parameter
If instance 3: Pass DT_NoaE = "third" as a parameter
If instance 4: Pass DT_NoaE = "fourth" as a parameter
If instance 5: Pass DT_NoaE = "fifth" as a parameter
If instance 6: Pass DT_NoaE = "sixth" as a parameter
If instance 7: Pass DT_NoaE = "seventh" as a parameter
If instance 8: Pass DT_NoaE = "eighth" as a parameter
If instance 9: Pass DT_NoaE = "ninth" as a parameter
If instance 10: Pass DT_NoaE = "tenth" as a parameter

NOM_C04

If NOM_B03.NOA_N01 = DK, go to NOM_N60.
Else if NOM_B03.NOA_N01 = RF or (NOM_B03.NOA_N01 = 2 and FLGTEN = 1), go to NOM_C61.
Else if NOM_B03.
NOA_N01 = 2, go to NOM_B03.
Otherwise, go to NOM_N04.

NOM_N04

Instruction: Record how the data will be captured.

1 Electronically
2 Electronic data captured manually (Go to NOM_B06)
(DK, RF not allowed)

NOM_N05

Instruction: Press <1> to save the result in Blaise.

1 Save the measurement
(DK, RF not allowed)

Go to NOM_N07

NOM_B06

Call the NOR block

NOM_N07

Instruction: Does the value in Blaise match the result displayed on the monitor?

1 Yes
2 No (Go to NOM_N04)
(DK, RF not allowed)

NOM_C07

If FLGTEN = 1, go to NOM_C61.
Otherwise, go to NOM_B13.

Content type: Note to data users:

If 10 FENO attempts (instances) have been completed FLGTEN = 1, otherwise FLGTEN = EMPTY.

NOM_B13

Call the NOA block (Fractional Exhaled Nitrite Oxide Attempts )

Programmer:

The NOA block can be called up at NOM_B03, NOM_B13, NOM_B23 and NOM_B33 to a combined maximum of 10 instances during the NOM block.
When instance number 10 is reached, set FLGTEN = 1If instance 1: Pass DT_NoaE = "first" as a parameter
If instance 2: Pass DT_NoaE = "second" as a parameter
If instance 3: Pass DT_NoaE = "third" as a parameter
If instance 4: Pass DT_NoaE = "fourth" as a parameter
If instance 5: Pass DT_NoaE = "fifth" as a parameter
If instance 6: Pass DT_NoaE = "sixth" as a parameter
If instance 7: Pass DT_NoaE = "seventh" as a parameter
If instance 8: Pass DT_NoaE = "eighth" as a parameter
If instance 9: Pass DT_NoaE = "ninth" as a parameter
If instance 10: Pass DT_NoaE = "tenth" as a parameter

NOM_C14

If NOM_B13.NOA_N01 = DK, go to NOM_N60.
Else if NOM_B13.NOA_N01 = RF or (NOM_B13.NOA_N01 = 2 and FLGTEN = 1), go to NOM_C61.
Else if NOM_B13.NOA_N01 = 2, go to NOM_B13.
Otherwise, go to NOM_N14.

NOM_N14

Instruction: Record how the data will be captured.

1 Electronically
2 Electronic data captured manually (Go to NOM_B16)
(DK, RF not allowed)

NOM_N15

Instruction: Press <1> to save the result in Blaise.

1 Save the measurement
(DK, RF not allowed)

Go to NOM_N17

NOM_B16

Call the NOR block

NOM_N17

Instruction: Does the last value in Blaise match the result displayed on the monitor?

1 Yes
2 No (Go to NOM_N14)
(DK, RF not allowed)

Content type: Note to data users:

If two reproducible results are achieved (the results are within 10% of one another) then the FENO test is complete, otherwise go to NOM_B23.

NOM_C17

If FLGTEN=1, go to NOM_C61.
Otherwise, go to NOM_C18.

NOM_C18

If (NOM_B06.DV_N05A = NOM_B16.DV_N05A) and (NOM_B06.DV_N05A <> "> 300"), go to NOM_C61.
Otherwise, go to NOM_C19.

NOM_C19

If NOM_B06.DV_N05A or NOM_B16.DV_N05A = ("> 300" or "< 5"), go to NOM_B23.
Otherwise, go to NOM_C20.

NOM_C20

If (NOM_B06.DV_N05A >= 30) and (NOM_B16.DV_N05A >= 30), go to NOM_D21.
Otherwise, go to NOM_D22.

NOM_D21

Programmer:

Set DV_RATIO1 = the calculated ratio of NOM_B06.DV_N05A and NOM_B16.DV_N05A (greater/smaller).
Divide the greater of (NOM_B06.DV_N05A and NOM_B16.DV_N05A) by the smaller of (NOM_B06.DV_N05A and NOM_B16.DV_N05A).

NOM_C21

If DV_RATIO1 <= 1.10, go to NOM_C61.
Otherwise, go to NOM_B23.

NOM_D22

Programmer:

Set DV_Difference1 = (NOM_B06.DV_N05A - NOM_B16.DV_N05A)

NOM_C22

If -3 <= DV_Difference1 <= 3, go to NOM_C61.
Otherwise, go to NOM_B23.

NOM_B23

Call the NOA block (Nitrite oxide attempts)

Programmer:

The NOA block can be called up at NOM_B03, NOM_B13, NOM_B23 and NOM_B33 to a combined maximum of 10 instances during the NOM block.
When instance number 10 is reached, set FLGTEN = 1If instance 1: Pass DT_NoaE = "first" as a parameter
If instance 2: Pass DT_NoaE = "second" as a parameter
If instance 3: Pass DT_NoaE = "third" as a parameter
If instance 4: Pass DT_NoaE = "fourth" as a parameter
If instance 5: Pass DT_NoaE = "fifth" as a parameter
If instance 6: Pass DT_NoaE = "sixth" as a parameter
If instance 7: Pass DT_NoaE = "seventh" as a parameter
If instance 8: Pass DT_NoaE = "eighth" as a parameter
If instance 9: Pass DT_NoaE = "ninth" as a parameter
If instance 10: Pass DT_NoaE = "tenth" as a parameter

NOM_C24

If NOM_B23.NOA_N01 = DK, go to NOM_N60.
Else if NOM_B23.NOA_N01 = RF or (NOM_B23.NOA_N01 = 2 and FLGTEN = 1), go to NOM_C61.
Else if NOM_B23.NOA_N01 = 2, go to NOM_B23.
Otherwise, go to NOM_N24.

NOM_N24

Instruction: Record how the data will be captured.

1 Electronically
2 Electronic data captured manually (Go to NOM_B26)
(DK, RF not allowed)

NOM_N25

Instruction: Press <1> to save the result in Blaise.

1 Save the measurement
(DK, RF not allowed)

Go to NOM_N27

NOM_B26

Call the NOR block

NOM_N27

Instruction: Does the last value in Blaise match the result displayed on the monitor?

1 Yes
2 No (Go to NOM_N24)
(DK, RF not allowed)

NOM_C27

If FLGTEN = 1, go to NOM_C61.
Otherwise, go to NOM_C28.

Content type: Note to data users:

If two of the three results are reproducible (two results are within 10% of one another) then the FENO test is complete, otherwise go to NOM_B33.

NOM_C28

If NOM_B26.DV_N05A = "< 5'' or NOM_B26.DV_N05A = "> 300", go to NOM_B33
Else if [(NOM_B06.DV_N05A = "> 300" or NOM_B06.DV_N05A = "< 5") and (NOM_B16.DV_N05A = "> 300" or NOM_B16.DV_N05A = "< 5")], go to NOM_B33.
Otherwise, go to NOM_D29.NOM_D29 If NOM_B06.DV_N05A <> "> 300" and NOM_B06.DV_N05A <> "< 5" and NOM_B06.DV_N05A >= 30 and NOM_B26.DV_N05A >= 30 , DV_RATIO2 = the calculated ratio of NOM_B26.DV_N05A and NOM_B06.DV_N05A (greater result / smaller result).
Otherwise, DV_RATIO2 = 99
If NOM_B16.DV_N05A <> "> 300" and NOM_B16.DV_N05A <> "< 5" and NOM_B16.DV_N05A >= 30 and NOM_B26.DV_N05A >= 30, DV_RATIO3 = the calculated ratio of NOM_B26.DV_N05A and NOM_B16.DV_N05A (greater result / smaller result).
Otherwise, DV_RATIO3 = 99

NOM_C30

If DV_RATIO2 <=1.10 or DV_RATIO3 <= 1.10, go to NOM_C61.
Otherwise, go to NOM_D31.

NOM_D31

If (NOM_B06.DV_N05A <> "> 300" and NOM_B06.DV_N05A <> "< 5") and (NOM_B06.DV_N05A < 30 or NOM_B26.DV_N05A < 30), DV_DIFFERENCE2 = NOM_B26.DV_N05A - NOM_B06.DV_N05A
Otherwise, DV_DIFFERENCE2 = 99
If (NOM_B16.DV_N05A <> "> 300" and NOM_B16.DV_N05A <> "< 5") and (NOM_B16.DV_N05A < 30 or NOM_B26.DV_N05A < 30), DV_DIFFERENCE3 = NOM_B26.DV_N05A - NOM_B16.DV_N05A
Otherwise, DV_DIFFERENCE3 = 99NOM_C32If -3<= DV_Difference2 <=3 or -3<= DV_Difference3 <= 3, go to NOM_C61.
Otherwise, go to NOM_B33.

NOM_B33

Call the NOA block (Fractional Exhaled Nitrite Oxide Attempts )

Programmer:

The NOA block can be called up at NOM_B03, NOM_B13, NOM_B23 and NOM_B33 to a combined maximum of 10 instances during the NOM block.
When instance number 10 is reached, set FLGTEN = 1If instance 1: Pass DT_NoaE = "first" as a parameter
If instance 2: Pass DT_NoaE = "second" as a parameter
If instance 3: Pass DT_NoaE = "third" as a parameter
If instance 4: Pass DT_NoaE = "fourth" as a parameter
If instance 5: Pass DT_NoaE = "fifth" as a parameter
If instance 6: Pass DT_NoaE = "sixth" as a parameter
If instance 7: Pass DT_NoaE = "seventh" as a parameter
If instance 8: Pass DT_NoaE = "eighth" as a parameter
If instance 9: Pass DT_NoaE = "ninth" as a parameter
If instance 10: Pass DT_NoaE = "tenth" as a parameter

NOM_C34

If NOM_B33.NOA_N01 = DK, go to NOM_N60.
Else if NOM_B33.NOA_N01 = RF or (NOM_B33.NOA_N01 = 2 and FLGTEN = 1), go to NOM_C61.
Else if NOM_B33.NOA_N01 = 2, go to NOM_B33.
Otherwise, go to NOM_N34.

NOM_N34

Instruction: Record how the data will be captured.

1 Electronically
2 Electronic data captured manually (Go to NOM_B36)
(DK, RF not allowed)

NOM_N35

Instruction: Press <1> to save the result in Blaise.

1 Save the measurement
(DK, RF not allowed)

Go to NOM_N37

NOM_B36

Call the NOR block

NOM_N37

Instruction: Does the last value in Blaise match the result displayed on the monitor?

1 Yes
2 No (Go to NOM_N34)
(DK, RF not allowed)

Go to NOM_C61

NOM_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
04 Equipment problem / technical difficulty
05 Respondent's mental condition
16 No time
20 Other - Specify (Go to NOM_S60)
(DK, RF not allowed)

Go to NOM_C61

NOM_S60
(Why was the component not fully completed?)

Instruction: Specify.

(80 spaces)
(DK, RF not allowed)

NOM_C61

If NOM_N17 = RESPONSE, go to NOM_N61.
Otherwise, go to NOM_N61.

NOM_N61

Instruction: Press < 1 > to capture the sensor information.

1 Capture the sensor information
(DK, RF not allowed)

Programmer:

TestsRemaining_end = Value at TestsRemaining key

NOM_C62

If TestsRemaining_end = Empty, go to NOM_N62A.
Otherwise, go to NOM_E62B.

NOM_N62A

Instruction: Enter the number of tests remaining on the sensor.

(MIN: 0)
(MAX: 300)
(DK, RF not allowed)

NOM_N62B

Instruction: Re-enter the number of tests remaining on the sensor.

(MIN: 0)
(MAX: 300)
(DK, RF not allowed)

NOM_END

Fractional Exhaled Nitric Oxide Attempts (NOA)

NOA_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 output from Clinic Interface:

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

NOA_N01

Instruction: Was the ^DT_NOAE attempt successful?

1 Yes (Go to NOA_END)
2 No
DK, RF (Go to NOA_END)

Programmer:

ErrorCode = value in ErrorCode keySet DT_ErrorCode = ErrorCode

NOA_C02

If ErrorCode = EMPTY, go to NOA_N04.
Otherwise, go to NOA_N03.

NOA_N03

Instruction: This error code was generated during the last attempt:^DT_ERRORCODE

Does this error code match the error code displayed on the monitor?

1 Yes (Go to NOA_END)
2 No (Go to NOA_N04)
(DK, RF not allowed)

NOA_N04

Instruction: Which error code indicates that the attempt was not successful?

10 A10 - Exhalation too strong
11 A11 - Exhalation too weak
12 A12 - No exhalation detected
13 A13 - Premature breathing
20 A20 - Ambient temperature check
21 A21 or A23 - Source of interference (cell phone, etc.)
31 A31 - USB cable connection
50 Other - Specify (Go to NOA_S04)
(DK, RF not allowed)

Programmer:

ErrorCode = NOA_N04NOA_S04

(Which error code indicates that the attempt was not successful?)

Instruction: Specify.

(80 spaces)
(DK, RF not allowed)

Programmer:

ErrorCode = NOA_NO4 (NOA_S04)

NOA_END

Fraction Exhaled Nitric (NOR)

NOR_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 output from Clinic Interface:

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

NOR_N01

Instruction: Record the result in parts per billion.Mark one response only.

1 < 5 ppb (Go to NOR_D10)
2 5 to 300 ppb
3 > 300 ppb (Go to NOR_D10)
(DK, RF not allowed)

NOR_N05A

Instruction: Enter the result in parts per billion, as displayed on the monitor.

ppb
(MIN: 5)
(MAX: 300)
(DK, RF not allowed)

NOR_N05B

Instruction: Re-enter the result in parts per billion, as displayed on the monitor.

ppb
(MIN: 5)
(MAX: 300)
(DK, RF not allowed)

NOR_D10

If NOR_N01=1, DV_N05A = "< 5"
If NOR_N01=3, DV_N05A = "> 300"
Otherwise, DV_N05A = "NOR_N05A"

NOR_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
AMB_Q01: respondent's racial background is Aboriginal
PGMQ01A: respondent's racial background is White
PGMQ01B: respondent's racial background is South Asian
PGMQ01C: respondent's racial background is Chinese
PGMQ01D: respondent's racial background is Black
PGMQ01E: respondent's racial background is Filipino
PGMQ01F: respondent's racial background is Latin American
PGMQ01G: respondent's racial background is Arab
PGMQ01H: respondent's racial background is Southeast Asian
PGMQ01I: respondent's racial background is West Asian
PGMQ01J: respondent's racial background is Korean
PGMQ01K: respondent's racial background is Japanese
PGMQ01L: respondent's racial background is Other
PG_S01

Variables output from Clinic Interface:

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 not allowed)
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 AMB_Q01 = 1, DT_RBE1 = "Aboriginal".
If PG_Q01A = 1, DT_RBE2 = "White".
If PG_Q01B = 1, DT_RBE3 = "South Asian ".
If PG_Q01C = 1, DT_RBE4 = "Chinese".
If PG_Q01D = 1, DT_RBE5 = "Black".
If PG_Q01E = 1, DT_RBE6 = "Filipino".
If PG_Q01F = 1, DT_RBE7 = "Latin American".
If PG_Q01G = 1, DT_RBE8 = "Arab".
If PG_Q01H = 1, DT_RBE9 = "Southeast Asian".
If PG_Q01I = 1, DT_RBE10 = "West Asian".
If PG_Q01J = 1, DT_RBE11 = "Korean".
If PG_Q01K = 1, DT_RBE12 = "Japanese".
If PG_Q01L = 1, DT_RBE13 = "^PG_S01".

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 AMB_Q01=1 or PG_Q01A=1 or PG_Q01G=1, DT_RACEWE = "White".
If PG_Q01D=1, DT_RACEBE = "Black".
If PG_Q01F=1, DT_RACEHE = "Hispanic".
If PG_Q01B=1 or PG_Q01C=1 or PG_Q01E=1 or PG_Q01H=1 or PG_Q01I=1 or PG_Q01J=1 or PG_Q01K=1, DT_RACEAE = "Asian".
If PG_Q01L=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.

White
Black
Hispanic
Asian
Other
(DK, RF not allowed)

Go to SPM_D023

Content type: NOTE TO DATA USER:

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?

Morphology does not match race adjustment category
No reported racial background during household interview
Incomplete/incorrect racial background from household interview
Other - Specify (Go to SPM_S022B)
DK, RF

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_N023Instruction: Check the data to be sent to the spirometry software.
Press <1> to transmit the data.
1 Transmit 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.

First, you are going to breathe normally.
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.
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.
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.
When you've finished blowing out, I'm going to tell you to take a big breath in again, just like the first one.
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 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 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 not allowed)
RF (Go to SPM_END)

SPM_R033

Instruction: Common verbal cues

"Take a few normal breaths."
"Big breath in!"
"Blow!"
"Keep blowing, keep blowing, keep blowing..."
"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?

Respondent unable to continue for health reasons
Respondent unable to understand technique / Health Measures Specialist unable to adapt coaching
Respondent refuses to continue
Equipment problem / technical difficulty
Respondent's mental condition
Other - Specify (Go to SPM_S901)
(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 output from Clinic Interface:

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 the 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

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 (Go to OTM_N90)
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 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.

Blood
Pus / Wax
Foreign object
Pressure equalization tube
Narrow, collapsible ear canal
Other - Specify (Go to OTM_S40)
None
(DK not allowed)
RF (Go to OTM_C60A)

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.

Normal
Excessive
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.

Blood
Pus / Wax
Foreign object
Pressure equalization tube
Narrow, collapsible ear canal
Other - Specify (Go to OTM_S70)
None
(DK not allowed)
RF (Go to OTM_END)

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.

Normal
Excessive
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)

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 output from Clinic Interface:

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_Q50: whether the respondent has a cochlear implant
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

TYM_C10

If (OTM_Q20 = DK or 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), 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 = 2TYM_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.

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 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 not allowed)
RF (Go to TYM_C40)

TYM_N32A

Instruction: Record the canal volume (ECV cm3) for the right ear.

(MIN: 0)
(MAX: 5)
DK
(RF is not allowed)

TYM_N32B

Instruction: Re-enter the canal volume (ECV cm3) for the right ear.

(MIN: 0)
(MAX: 5)
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)
(MAX: 5)
(DK, RF not allowed)

TYM_N33C

Instruction: Re-enter the compliance peak value (PEAK cm3) for the right ear.

(MIN: 0)
(MAX: 5)
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.

Accept the measurements
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 not allowed)
RF (Go to TYM_C56)

TYM_N52A

Instruction: Record the canal volume (ECV cm3) for the left ear.

(MIN: 0)
(MAX: 5)
DK
(RF is not allowed)

TYM_N52B

Instruction: Re-enter the canal volume (ECV cm3) for the left ear.

(MIN: 0)
(MAX: 5)
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)
(MAX: 5)
(DK, RF not allowed)

TYM_N53C

Instruction: Re-enter the compliance peak value (PEAK cm3) for the left ear.

(MIN: 0)
(MAX: 5)
(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.

Accept the measurements
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

Variables output from Clinic Interface:

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:

FName: first name of respondent
LName: 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
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 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)

OAE_C10

If (OTM_Q20 = DK or 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), 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)) or OTM_N40 =RF, set REFLAG = 1
Otherwise, set REFLAG = 2OAE_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)), or OTM_N70 = RF set LEFLAG = 1
Otherwise, set LEFLAG = 2OAE_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 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
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)

OAE_S47

Instruction: Specify.

(80 spaces)
(DK, RF not allowed)

OAE_END

Audiometry Measurement (AUD)

AUD_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 output from Clinic Interface:

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: in which ear(s)
HER_Q52: whether the respondent has a hearing aid
HER_Q53: in which ear(s)
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 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".

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 [insert earphones/supra-aural 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 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 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.

3 error codes or more
1-2 error codes
No error codes
(DK, RF not allowed)

AUD_N34

Instruction: Record how the test was administered.

Automatic Mode
Manual Mode
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
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)

AUD_S36

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 output from Clinic Interface:

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.

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 output from Clinic Interface:

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

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_C11A

If GSM_N11A = DK, go to GSM_S11.
Otherwise, go to GSM_C11B.

GSM_C11B

If GSM_N11A = RF, go to GSM_END.
Otherwise, go to GSM_N12A.

GSM_S11

Instruction: Specify the reason why the measurement could not be taken.

(80 spaces)
(DK, RF not allowed)

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_C12

If GSM_N12A = DK, go to GSM_S12.
Otherwise, go to GSM_N21A.

GSM_S12

Instruction: Specify the reason why the measurement could not be taken.

(80 spaces)
(DK, RF not allowed)

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_C21

If GSM_N21A = DK, go to GSM_S21.
Otherwise, go to GSM_N22A.

GSM_S21

Instruction: Specify the reason why the measurement could not be taken.

(80 spaces)
(DK, RF not allowed)

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_C22

If GSM_N22A = DK, go to GSM_S22.
Otherwise, go to GSM_D51.

GSM_S22

Instruction: Specify the reason why the measurement could not be taken.

(80 spaces)
(DK, RF not allowed)

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_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 output from Clinic Interface:

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 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.

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
T133FLAG: whether Test 133 is to be done

Variables output from Clinic Interface:

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: Omega 3 & 6 subsampling flag
PHC_Q56: whether the respondent felt dizzy or fainted previously during a blood draw
PHI_D12: whether respondent has fasted for 10 hours (1 = fasted; 2 = non-fasted)

BDC_C10

If PHC_Q56 = 1, go to BDC_N10.

Otherwise, go to BDC_Q21.

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.

Press < 1 > to continue.
1 Continue
(DK not allowed)
RF (Go to BDC_END)

BDC_D21

Content type: Note to data user:

Tubes for blood collection are determined by the age of the respondent and whether he/she consented to blood and/or DNA storage.

BDC_C22

If DryRun in (1,2) or BDC_D21 = 1 or BDC_D21 = 2, go to BDC_N24.
Otherwise, go to BDC_N23.

BDC_N23

Instruction: If you think that the tubes you are drawing will not yield sufficient volume of serum, draw optional tube #14.

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

BDC_N24

Instruction: Record which of the required tubes of blood were collected.

Mark all that apply.

50 All of the main required tubes (Sub Tubes and Tube#14 not selected)
51 None of the required tubes (Go to BDC_N44)
52 Tube # 14 and all of the main required tubes
(DK 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: Stick each label on the appropriate blood collection tube and if applicable on the CBC report.

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.

Respondent refused
Respondent fainted
Unable to find vein
Blood flow stopped
Physical limitation
Other - Specify (Go to BDC_S44)
(DK, RF not allowed)
Go to BDC_N51

BDC_S44

(Record the reason why all required tubes were not collected.)

Instruction: Specify.

(80 spaces)
(DK, RF not allowed)

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: 1,000)
(MAX: 9,995)
(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 output from Clinic Interface:

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.

Refusal
Unable to provide
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 output from Clinic Shell:

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 18 or older
BPM_412A: blood pressure norms for respondents 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)

RM_N90

Instruction: Press <1> to print the Report of 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 output from Clinic Shell:

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
OHE_N71: whether a serious medical condition requiring immediate attention was discovered during the dental examination
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

Variables output from Clinic Interface:

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
DryRun: whether the case is a dry run case (1or 2= dryrun; 3= survey 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_R12
Statistics Canada may combine your responses from this survey to responses to other surveys or administrative data sources.

Instruction: Press <1> to continue.

Help text:

Provincial Ministry of Health;
health registries or other recognized health organizations.

This would include information on past and continuing use of:

services provided at hospitals, clinics and doctor's offices;
other health services provided by the province.

ECQ_Q13
The linkage will be done by Statistics Canada, and the results will be used for statistical purposes only.

Do we have your permission to combine this information?

1 Yes
2 No (Go to ECQ_R21)
DK, RF (Go to ECQ_R21)

ECQ_Q14
Having a [provincial/territorial] health number will assist Statistics Canada in linking the survey data to the [provincial/territorial] health information. Do you have a(n) ^DT_PROVINCEE health number?

1 Yes (Go to ECQ_Q16)
2 No
DK, RF (Go to ECQ_R21)

ECQ_Q15
For which [province/territory] is your 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 health number?

Instruction: Enter a health number. Do not insert blanks, hyphens or commas between the numbers.

(12 spaces)
DK, RF (Go to ECQ_R21)

ECQ_N16

Instruction: Re-enter the health number.

(12 spaces)
DK, RF

ECQ_D21

If ECQ_Q16 = RESPONSE,
DT_ECQ21TEXTE = "Your name, address, telephone number and health number".
Otherwise, DT_ECQ21TEXTE = "Your name, address and telephone number".

ECQ_R21
To avoid duplication of surveys, Statistics Canada has a signed agreement with Health Canada and the Public Health Agency of Canada to share the information collected during this survey. [Your name, address, telephone number and health number/Your name, address and telephone number] will not be shared.

Instruction: Press <1> to continue.

ECQ_Q22
Health Canada and the Public Health Agency of Canada will keep the information confidential, and use it for statistical purposes only.Do you agree to share the information?

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 output from Clinic Interface:

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: name of respondent
GenderE: English text for sex of respondent
CON_AGE: age of respondent
CON_SEX: sex of respondent
CON_N24: yes/no indicator of whether the respondent's parent or guardian provided consent for blood and urine storage
CON_N25: yes/no indicator of whether the respondent provided consent for blood and urine storage
UC1_N40: yes/no indicator of whether a urine sample was provided
BDC_Q21: indicator if blood was drawn
BDC_N24: indicator of which tubes were collected
BDC_N43: how blood collection was performed

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 not allowed)
RF

CONT_C03A

If (CON_AGE > 13 or CON_N24 = 2 or [(BDC_Q21 = RF or BDC_N24 = 51 or BDC_N24 = RF) and UC1_N40 = 2]), go to CONT_C03B.
Otherwise, go to CONT_C03C.CONT_C03B If FLAGReconsent = 2 and (CONT_Q01 = 2 or RF), go to CONT_END.
Otherwise, go to CONT_Q03.CONT_C03C If ((CONT_Q01 = 2 or RF) and CONT_Q02 = 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 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 "I want to emphasize that we will contact this person only if we experience difficulty reaching you." as parameter.

CONT_C05

If CONT_B05.GCN_CONFNAME = 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 "What is the address for ^CONT1_NAMEE? " as parameter.

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 "What is the telephone number for ^CONT1_NAMEE, including the area code? " as parameter.

CONT_B08

Call the Overseas Telephone block (OSTP). See Appendix I.

Programmer:

Pass "What is the telephone number for ^CONT1_NAMEE, including the area code? " as parameter.

CONT_B09

Call the Get Contact Name block (GCN). See Appendix I.

Programmer:

Pass "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." as parameter.

CONT_C09

If CONT_B09.GCN_CONFNAME = 1, go to CONT_END.
Otherwise, go to CONT_D09.

CONT_D09

Programmer:

IF CONT_B09.GCN_FNAME = 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 "What is the address for ^CONT2_NAMEE? " as parameter.

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 "What is the telephone number for ^CONT2_NAMEE, including the area code? " as parameter.

CONT_B12

Call the Overseas Telephone block (OSTP). See Appendix I.

Programmer:

Pass "What is the telephone number for ^CONT2_NAMEE, including the area code?" as parameter.

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 Clinic Interface:

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
REP_Q12: selected method of delivery of final report
FNAME: first name of respondent
LNG_N11: respondent's preferred official language
SCS_N12: visit type (3= clinic visit; 4= home visit)

CSO_R11A
Here is a Report of Measurements containing the results of the tests you performed today. Your results are organized under various sections: your results are on the right and the interpretation is in italics under each section.

Instruction: Provide the respondent with his/her Report of 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 your report? If you would like, a Health Measures Specialist can spend a few minutes reviewing your 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 = "Thank you for your participation to the dry-run day. Your results will be sent to you when ready. If you move before you receive this package you can inform us by phoning our toll-free number or e-mailing us.".
Otherwise, DT_CSO12TEXTE = "Your final report package will be sent to you in about 3 months. If you move before you receive this package you can inform us by phoning our toll-free number, e-mailing us or by sending in a change of address card.".

CSO_R12
^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 = "I,".
Otherwise, DT_CSO30TEXTE = "I have received the stated reimbursement for expenses related to".
If CON_AGE > 13, DT_CSO30TEXTE2 = ", have received the stated reimbursement for expenses related to my participation in the Canadian Health Measures Survey.".
Otherwise, DT_CSO30TEXTE2 = "'s participation in the Canadian Health Measures Survey.".

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_CSO31TEXT1E = "your".
Otherwise, DT_CSO31TEXT1E = "^Fname's".
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 DT_CSO31TEXT1E 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 CHMS 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)

AD_Q02
(^DV_QTEXT_E)

Interviewer: Enter the street name.

If necessary, ask: (What is the street name?)
(50 spaces)
DK, RF

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 = "Blank".
Otherwise, DT_CLANOTEXT_E = "If the address is outside Canada, press <Enter>".

AD_Q05
(^DV_QTEXT_E)

Interviewer:

Enter the postal code.
[Blank /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

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 = "Bristish 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_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 ne 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 Hawaï
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

GCN_N01

Instruction:

Enter the first name.
DK, RF

GCN_C01

If GCN_N01 = DK or RF, go to GCN_N02.
Otherwise, go to GCN_N03.

GCN_N02

Instruction: Do you wish to skip the remaining contact fields?

1 Yes
2 No
(DK, RF not allowed)

GCN_C03

If GCN_N02 = 1 (Yes) fill contact fields with DK or RF, go to GCN_END.
Otherwise, go to GCN_N03.

GCN_N03

Instruction:

Enter the last name.
(DK, RF not allowed)

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:
ASKEXT tYesNo

NATP_Q01

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

Interviewer: Enter the telephone number.

If necessary, ask: (What is the telephone number?)

(MIN: 0)
(MAX: 9,999,995)
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

Interviewer: Enter the extension, if applicable.

(6 spaces)
DK, RF

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

Canadian Health Measures Survey – Cycle 3

2012 to 2013 Clinic Questionnaire

Respondent Verification (RVB)

Language Confirmation (LNG)

Report (REP)

Urgent Condition (URG)

Email Collection (ECB)

Urine Collection 1 Component (UC1)

Screening Component Introduction (SCI)

Adherence to Guidelines (ATG)

Physical and Health Conditions (PHC)

Hearing Restriction (HER)

Spirometry Questions (SPQ)

Spirometry Restriction (SPR)

Water Analysis Questions Component (WAQ) (ORS)

Fish and Shellfish Consumption (FSF)

Detail Fish and Shellfish (DFS)

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)

Fractional Exhaled Nitric Oxide Component

Fractional Exhaled Nitric Oxide Component Introduction (NOI)

Fractional Exhaled Nitric Oxide Measurement (NOM)

Fractional Exhaled Nitric Oxide Attempts (NOA)

Fraction Exhaled Nitric (NOR)

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)

2012 to 2013
Clinic Questionnaire