Health

Q11-1

Now we have a few questions about health care and hospitalization plans.

Are you covered by any kind of private or governmental health or hospitalization plans or health maintenance organization (HMO) plans?

 READ IF NECESSARY: Examples of health and hospitalization insurance plans include Blue Cross-Blue Shield, Medicaid, Medplan.

         1     YES...(Go to Q11-2)

         0     NO

  Go To: Q11-7

Q11-2

[Hand Card L/ ""]

What is the source of your health or hospitalization plan?  Is it your current or previous employer, [a health care policy from the current or previous employer of your spouse/partner (if R has a s/p)], a plan bought directly from a medical insurance company,  Medicaid/Medplan, or is it from some other source?

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INTERVIEWER (DO NOT READ): The following are names of Medicaid Alternative plans in Ohio and should be coded as Medicaid or Medicaid Alternative Plan:

Go To: Q11-3

Q11-3

Do you consider this coverage adequate?

         1     YES

         0     NO

Go To: Q11-4

Q11-4

Since [01/1997], were there any months when you were not covered by health insurance?

         1     YES...(Go to Q11-5)

         0     NO

Go To: Q11-7b

Q11-5

Which months?

Go To: Q11-8

Q11-7

When was the most recent time you were covered by health insurance?

         1     SELECT TO ENTER DATE

         0     NEVER COVERED BY HEALTH INSURANCE...(Go to Q11-7c)

Go To: Q11-7a

Q11-7a

(When was the most recent time you were covered by insurance?)

INTERVIEWER: ENTER MONTH AND YEAR.

       Enter Date: |__|__||__|__|__|__|

                            Mon       Year

Go To: Q11-7c

Q11-7b

([health plan]=6);/*If R reports having medicaid, skip medicaid eligibility questions */

If Answer =1    Then Go To: Q11-7c

Go To: Q11-8

Q11-7c

Are you eligible for coverage by Medicaid?

         1     YES

         0     NO...(Go to Q11-8)

Go To: Q11-7d

Q11-7d

Why are you not using Medicaid?

Go To: Q11-8

Q11-8

([Final count of household members] > 0);/*Are there other people in this household */

If Answer =1    Then Go To: Q11-8a

Go To: Q11-SF12-1

Q11-8a

([Is R covered by any kind of private or governmental health or hospitalization plans or health maintenance organization (HMO) plans]);

/*Skip to next question based on whether or not R said s/he was covered by insurance */

If Answer =1    Then Go To: Q11-9

Go To: Q11-9a

Q11-9

Are all of other members of your household also covered by this plan?

         1     YES...(Go to Q11-SF12-1)

         0     NO

Go To: Q11-10

Q11-9a

Are the other members of your household covered by any type of health insurance?

         1     YES

         0     NO...(Go to Q11-SF12-1)

Go To: Q11-10

Q11-10

(([spouse in hh?]=1) or ([partner in hh?]=1));/*Is there a spouse or partner in the HH*/

If Answer =1    Then Go To: Q11-11

Go To: Q11-12

Q11-11

What is the source of [Spouse/partner's name]'s health or hospitalization plan, if any?

INTERVIEWER: The following are names of Medicaid Alternative plans  and should be coded as Medicaid or Medicaid Alternative Plan:

Go To: Q11-12

Q11-12

([total number kids in household] > 0);/*Is there at least one child in the hh*/

If Answer =1    Then Go To: Q11-LOOP-BEGIN

Go To: Q11-SF12-1

Q11-LOOP-BEGIN

REPEAT([loop about each child's health insurance plan]);/*start loop about each child's health insurance plan*/

Go To: Q11-14

Q11-14

What is the source of [HH child's name()]'s health or hospitalization plan, if any?

INTERVIEWER: The following are names of Medicaid Alternative plans in Ohio and should be coded as Medicaid or Medicaid Alternative Plan:

Go To: Q11-15

Q11-15

([total number kids in household]=[loop about each child's health insurance plan]);

If Answer =1    Then Go To: Q11-LOOP-END

Go To: Q11-15a

Q11-15a

([loop about each child's health insurance plan]);

If Answer =1    Then Go To: Q11-15b

Go To: Q11-LOOP-END

Q11-15b

([Source of child()'s health or hospitalization plan

   ()]=7);/*did R say that child had no insurance coverage */

If Answer =1    Then Go To: Q11-17

Go To: Q11-16

Q11-16

Are all of your other children also covered under this plan?

         1     YES

         0     NO

Go To: Q11-LOOP-END

Q11-17

Are any of your other children covered by health insurance?

         1     YES

         0     NO

Go To: Q11-LOOP-END

Q11-LOOP-END

UNTIL([loop about each child's health insurance plan], ([loop about each child's health insurance plan]=[total number kids in household]) or ([whether or not all of R's children are covered under a health plan()]=1) or ([Whether or not any of R's other children are covered by health insurance()]=0));

Go To: Q11-SF12-1

Q11-SF12-1

Next I will be asking you more specific questions about your health.  If you are unsure how to answer, please give the best answer you can.

In general, would you say your health is .... (READ LIST):

         1     Excellent

         2     Very Good

         3     Good

         4     Fair

         5     Poor

Go To: Q11-SF12-2

Q11-SF12-2

During the past 4 weeks, how much of the time has your physical health or emotional condition interfered with your social activities (such as visiting with friends or relatives)?  Would you say it is...(READ LIST):

Go To: Q11-SF12-4

Q11-SF12-4

([R's age] > 14) AND ([R's age] < 46);/* Is  Respondent between 15 and 45?  If so ask birth control questions */

If Answer =0    Then Go To: Q11-CESD-1A

Go To: Q11-SF12-5

Q11-SF12-5

During the last month, have you (or your spouse/partner) used any form of birth control?

         1     YES

         0     NO...(Go to Q11-CESD-1A)

         2     YOUR PARTNER/SPOUSE IS CURRENTLY PREGNANT

If Answer >=-2 and Answer <=-1     Then Go To: Q11-CESD-1A

Go To: Q11-SF12-6

Q11-SF12-6

In the past month, did you use birth control Always, Sometimes, or Almost Never?

         1     Always

         2     Sometimes

         3     Almost never

Go To: Q11-CESD-1A

Q11-CESD-1A

Next I am going to read a list of the ways that you might have felt or behaved recently.  After I read each statement, please tell me how often you've felt that way in the last week.

The first statement is...

        You did not feel like eating; your appetite was poor.

In the past week, did you feel this way Rarely or None of the time, a Little or Some of the time, a Moderate amount of time, or Most or All of the time.

         0     Rarely or None of the time   (0-1 day)

         1     A little or some of the time  (2-3 days)

         2     Moderate amount of time  (4-5 days)

         3     Most or All of the time  (6-7 days)

Go To: Q11-CESD-1B

Q11-CESD-1B

During the past week....

     You had trouble keeping your mind on what you were doing.

IF NEEDED:  Was that  Rarely or None of the time, a Little or Some of the time, a Moderate amount of time, or Most or All of the time.

         0     Rarely or None of the time   (0-1 day)

         1     A little or some of the time  (2-3 days)

         2     Moderate amount of time  (4-5 days)

         3     Most or All of the time  (6-7 days)

Go To: Q11-CESD-1C

Q11-CESD-1C

(During the past week....)

      You felt depressed.

IF NEEDED:  Was that  Rarely or None of the time, a Little or Some of the time, a Moderate amount of time, or Most or All of the time.

         0     Rarely or None of the time   (0-1 day)

         1     A little or some of the time  (2-3 days)

         2     Moderate amount of time  (4-5 days)

         3     Most or All of the time  (6-7 days)

Go To: Q11-CESD-1D

Q11-CESD-1D

(During the past week....)

    You felt that everything you did was an effort.

IF NEEDED:  Was that  Rarely or None of the time, a Little or Some of the time, a Moderate amount of time, or Most or All of the time.

         0     Rarely or None of the time   (0-1 day)

         1     A little or some of the time  (2-3 days)

         2     Moderate amount of time  (4-5 days)

         3     Most or All of the time  (6-7 days)

Go To: Q11-CESD-1E

Q11-CESD-1E

(During the past week....)

      Your sleep was restless.

IF NEEDED:  Was that  Rarely or None of the time, a Little or Some of the time, a Moderate amount of time, or Most or All of the time.

         0     Rarely or None of the time   (0-1 day)

         1     A little or some of the time  (2-3 days)

         2     Moderate amount of time  (4-5 days)

         3     Most or All of the time  (6-7 days)

Go To: Q11-CESD-1F

Q11-CESD-1F

(During the past week....)

    You felt sad.

IF NEEDED:  Was that  Rarely or None of the time, a Little or Some of the time, a Moderate amount of time, or Most or All of the time.

         0     Rarely or None of the time   (0-1 day)

         1     A little or some of the time  (2-3 days)

         2     Moderate amount of time  (4-5 days)

         3     Most or All of the time  (6-7 days)

Go To: Q11-CESD-1G

Q11-CESD-1G

(During the past week....)

      You could not "get going".

IF NEEDED:  Was that  Rarely or None of the time, a Little or Some of the time, a Moderate amount of time, or Most or All of the time.

         0     Rarely or None of the time   (0-1 day)

         1     A little or some of the time  (2-3 days)

         2     Moderate amount of time  (4-5 days)

         3     Most or All of the time  (6-7 days)

Go To: Q11-DOMVIO

Q11-DOMVIO

Many people have been in relationships in which they have been physically abused by a spouse, a partner, or someone they are dating.  Since January 1994, have you ever been in a relationship with someone who physically abused or injured you 3 or more times?

         1     YES

         0     NO

Go To: Q13-1A

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