Questionnaire Module Main Survey

scasf12_w14

Self-Completion SF12 Module

Questions 12

scasf12_w14.scsf6b

Last 4 weeks: Had a lot of energy

Type: choice

Source: Quality Metric Inc., 2007

Text: Did you have a lot of energy?

Option	Label
1	All of the time
2	Most of the time
3	Some of the time
4	A little of the time
5	None of the time

Universe:
if (GRIDVARIABLES.ModeType = 1 & CASISTART.scac = 1 thru 3) | (GRIDVARIABLES.ModeType = 2 | 3) (Mode is face-to-face and has agreed to self-completion OR mode is telephone or web)

scasf12_w14.scsf6c

Last 4 weeks: Felt downhearted and depressed

Type: choice

Source: Quality Metric Inc., 2007

Text: Have you felt downhearted and depressed?

Option	Label
1	All of the time
2	Most of the time
3	Some of the time
4	A little of the time
5	None of the time

Universe:
if (GRIDVARIABLES.ModeType = 1 & CASISTART.scac = 1 thru 3) | (GRIDVARIABLES.ModeType = 2 | 3) (Mode is face-to-face and has agreed to self-completion OR mode is telephone or web)

scasf12_w14.scsf1

General health

Type: choice

Source: Quality Metric Inc., 2007

Text: In general, would you say your health is...

Option	Label	Associated variables
1	Excellent	n_scsf1 (n_indresp) General health
2	Very good
3	Good
4	Fair
5	Poor

Universe:
if (GRIDVARIABLES.ModeType = 1 & CASISTART.scac = 1 thru 3) | (GRIDVARIABLES.ModeType = 2 | 3) (Mode is face-to-face and has agreed to self-completion OR mode is telephone or web)

scasf12_w14.scsf2a

Health limits moderate activities

Type: choice

Source: Quality Metric Inc., 2007

Text: The following questions are about activities you might do during a typical day. Does your health now limit you in these activities? If so, how much? Moderate activities, such as moving a table, pushing a vacuum cleaner, bowling or playing golf

Option	Label	Associated variables
1	Yes, limited a lot
2	Yes, limited a little	n_scsf2a (n_indresp) Health limits moderate activities
3	No, not limited at all

Universe:
if (GRIDVARIABLES.ModeType = 1 & CASISTART.scac = 1 thru 3) | (GRIDVARIABLES.ModeType = 2 | 3) (Mode is face-to-face and has agreed to self-completion OR mode is telephone or web)

scasf12_w14.scsf2b

Health limits several flights of stairs

Type: choice

Source: Quality Metric Inc., 2007

Text: Climbing several flights of stairs

Option	Label	Associated variables
1	Yes, limited a lot
2	Yes, limited a little	n_scsf2b (n_indresp) Health limits several flights of stairs
3	No, not limited at all

Universe:
if (GRIDVARIABLES.ModeType = 1 & CASISTART.scac = 1 thru 3) | (GRIDVARIABLES.ModeType = 2 | 3) (Mode is face-to-face and has agreed to self-completion OR mode is telephone or web)

scasf12_w14.scsf3a

Last 4 weeks: Physical health limits amount of work

Type: choice

Source: Quality Metric Inc., 2007

Text: During the past 4 weeks, how much of the time have you had any of the following problems with your work or other regular daily activities as a result of your physical health? Accomplished less than you would like

Option	Label	Associated variables
1	All of the time
2	Most of the time
3	Some of the time	n_scsf3a (n_indresp) Last 4 weeks: Physical health limits amount of work
4	A little of the time
5	None of the time

Universe:
if (GRIDVARIABLES.ModeType = 1 & CASISTART.scac = 1 thru 3) | (GRIDVARIABLES.ModeType = 2 | 3) (Mode is face-to-face and has agreed to self-completion OR mode is telephone or web)

scasf12_w14.scsf3b

Last 4 weeks: Physical health limits kind of work

Type: choice

Source: Quality Metric Inc., 2007

Text: Were limited in the kind of work or other activities

Option	Label	Associated variables
1	All of the time
2	Most of the time
3	Some of the time	n_scsf3b (n_indresp) Last 4 weeks: Physical health limits kind of work
4	A little of the time
5	None of the time

Universe:
if (GRIDVARIABLES.ModeType = 1 & CASISTART.scac = 1 thru 3) | (GRIDVARIABLES.ModeType = 2 | 3) (Mode is face-to-face and has agreed to self-completion OR mode is telephone or web)

scasf12_w14.scsf4a

Last 4 weeks: Mental health meant accomplished less

Type: choice

Source: Quality Metric Inc., 2007

Text: During the past 4 weeks, how much of the time have you had any of the following problems with your work or other regular daily activities as a result of any emotional problems (such as feeling depressed or anxious)? Accomplished less than you would like

Option	Label	Associated variables
1	All of the time
2	Most of the time
3	Some of the time
4	A little of the time	n_scsf4a (n_indresp) Last 4 weeks: Mental health meant accomplished less
5	None of the time

Universe:
if (GRIDVARIABLES.ModeType = 1 & CASISTART.scac = 1 thru 3) | (GRIDVARIABLES.ModeType = 2 | 3) (Mode is face-to-face and has agreed to self-completion OR mode is telephone or web)

scasf12_w14.scsf4b

Last 4 weeks: Mental health meant worked less carefully

Type: choice

Source: Quality Metric Inc., 2007

Text: Did work or other activities less carefully than usual

Option	Label	Associated variables
1	All of the time
2	Most of the time
3	Some of the time
4	A little of the time	n_scsf4b (n_indresp) Last 4 weeks: Mental health meant worked less carefully
5	None of the time

Universe:
if (GRIDVARIABLES.ModeType = 1 & CASISTART.scac = 1 thru 3) | (GRIDVARIABLES.ModeType = 2 | 3) (Mode is face-to-face and has agreed to self-completion OR mode is telephone or web)

scasf12_w14.scsf5

Last 4 weeks: Pain interfered with work

Type: choice

Source: Quality Metric Inc., 2007

Text: During the past 4 weeks, how much did pain interfere with your normal work (including both work outside the home and housework)?

Option	Label	Associated variables
1	Not at all
2	A little bit
3	Moderately
4	Quite a bit
5	Extremely	n_scsf5 (n_indresp) Last 4 weeks: Pain interfered with work

Universe:
if (GRIDVARIABLES.ModeType = 1 & CASISTART.scac = 1 thru 3) | (GRIDVARIABLES.ModeType = 2 | 3) (Mode is face-to-face and has agreed to self-completion OR mode is telephone or web)

scasf12_w14.scsf6a

Last 4 weeks: Felt calm and peaceful

Type: choice

Source: Quality Metric Inc., 2007

Text: These questions are about how you feel and how things have been with you during the past 4 weeks. For each question, please give the one answer that comes closest to the way you have been feeling. How much of the time during the past 4 weeks... Have you felt calm and peaceful?

Option	Label
1	All of the time
2	Most of the time
3	Some of the time
4	A little of the time
5	None of the time

Universe:
if (GRIDVARIABLES.ModeType = 1 & CASISTART.scac = 1 thru 3) | (GRIDVARIABLES.ModeType = 2 | 3) (Mode is face-to-face and has agreed to self-completion OR mode is telephone or web)

scasf12_w14.scsf7

Last 4 weeks: Physical or mental health interfered with social life

Type: choice

Source: Quality Metric Inc., 2007

Text: During the past 4 weeks, how much of the time has your physical health or emotional problems interfered with your social activities (like visiting friends, relatives)?

Option	Label
1	All of the time
2	Most of the time
3	Some of the time
4	A little of the time
5	None of the time

Universe:
if (GRIDVARIABLES.ModeType = 1 & CASISTART.scac = 1 thru 3) | (GRIDVARIABLES.ModeType = 2 | 3) (Mode is face-to-face and has agreed to self-completion OR mode is telephone or web)

scasf12_w14

Self-Completion SF12 Module

scasf12_w14.scsf6b

scasf12_w14.scsf6c

scasf12_w14.scsf1

scasf12_w14.scsf2a

scasf12_w14.scsf2b

scasf12_w14.scsf3a

scasf12_w14.scsf3b

scasf12_w14.scsf4a

scasf12_w14.scsf4b

scasf12_w14.scsf5

scasf12_w14.scsf6a

scasf12_w14.scsf7

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