LB. Leave-behind Questionnaires (respondent)
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LB. Leave-behind Questionnaires (respondent) module of HRS 2004
Start of LB. Leave-behind Questionnaires (respondent)
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JLB001
Introduction to disability qnaire
BLUE= OTHER THAN THE CONDITIONS EXPLICITLY MENTIONED, YOU SHOULD IMAGINE THE INDIVIDUAL IS IN REASONABLY GOOD HEALTH.
RED= OTHER THAN THE CONDITIONS EXPLICITLY MENTIONED, YOU SHOULD IMAGINE THE INDIVIDUAL IS LIKE YOURSELF.
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1. Blue introduction
2. Red introduction
Blank. Inapplicable
BLUE= OTHER THAN THE CONDITIONS EXPLICITLY MENTIONED, YOU SHOULD IMAGINE THE INDIVIDUAL IS IN REASONABLY GOOD HEALTH.
RED= OTHER THAN THE CONDITIONS EXPLICITLY MENTIONED, YOU SHOULD IMAGINE THE INDIVIDUAL IS LIKE YOURSELF.
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1. Blue introduction
2. Red introduction
Blank. Inapplicable
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JLB002
Disability qnaire topic order
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1. Affect, pain, cvd
2. Affect, cvd, pain
3. Cvd, affect, pain
4. Cvd, pain, affect
5. Pain, affect, cvd
6. Pain, cvd, affect
Blank. Inapplicable
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1. Affect, pain, cvd
2. Affect, cvd, pain
3. Cvd, affect, pain
4. Cvd, pain, affect
5. Pain, affect, cvd
6. Pain, cvd, affect
Blank. Inapplicable
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JLB003
AFFECT- GENERALLY ENJOYS WORK
WE WOULD NOW LIKE TO GIVE YOU A NUMBER OF EXAMPLES OF (MEN/WOMEN) WITH SOME HEALTH PROBLEMS. WE WOULD LIKE YOU TO INDICATE THE EXTENT TO WHICH YOU THINK THESE (MEN/WOMEN) WOULD BE LIMITED IN THE KIND OR AMOUNT OF WORK THEY CAN DO. IN TERMS OF THEIR AGE, THEIR EDUCATION, OTHER THAN THE CONDITIONS EXPLICITLY MENTIONED, YOU SHOULD IMAGINE THE INDIVIDUAL IS IN REASONABLY GOOD HEALTH. PLEASE GIVE US YOUR JUDGMENT ON HOW LIMITED THESE PEOPLE ARE IN THE KIND OR AMOUNT OF WORK THEY CAN DO.
(TIM/MARY) GENERALLY ENJOYS (HIS/HER) WORK. (HE/SHE) GETS DEPRESSED EVERY THREE WEEKS FOR A DAY OR TWO AND LOSES INTEREST IN WHAT (HE/SHE) USUALLY ENJOYS, BUT IS ABLE TO CARRY ON WITH (HIS/HER) DAY-TO-DAY ACTIVITIES ON THE JOB.
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1. Not at all limited
2. Mildly limited
3. Moderately limited
4. Severely limited
5. Cannot do any work
Blank. Inapplicable
WE WOULD NOW LIKE TO GIVE YOU A NUMBER OF EXAMPLES OF (MEN/WOMEN) WITH SOME HEALTH PROBLEMS. WE WOULD LIKE YOU TO INDICATE THE EXTENT TO WHICH YOU THINK THESE (MEN/WOMEN) WOULD BE LIMITED IN THE KIND OR AMOUNT OF WORK THEY CAN DO. IN TERMS OF THEIR AGE, THEIR EDUCATION, OTHER THAN THE CONDITIONS EXPLICITLY MENTIONED, YOU SHOULD IMAGINE THE INDIVIDUAL IS IN REASONABLY GOOD HEALTH. PLEASE GIVE US YOUR JUDGMENT ON HOW LIMITED THESE PEOPLE ARE IN THE KIND OR AMOUNT OF WORK THEY CAN DO.
(TIM/MARY) GENERALLY ENJOYS (HIS/HER) WORK. (HE/SHE) GETS DEPRESSED EVERY THREE WEEKS FOR A DAY OR TWO AND LOSES INTEREST IN WHAT (HE/SHE) USUALLY ENJOYS, BUT IS ABLE TO CARRY ON WITH (HIS/HER) DAY-TO-DAY ACTIVITIES ON THE JOB.
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1. Not at all limited
2. Mildly limited
3. Moderately limited
4. Severely limited
5. Cannot do any work
Blank. Inapplicable
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JLB004
Affect- enjoys work very much
(JIM/ANN) ENJOYS WORK VERY MUCH. (HE/SHE) FEELS THAT (HE/SHE) IS DOING A VERY GOOD JOB AND IS OPTIMISTIC ABOUT THE FUTURE.
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1. Not at all limited
2. Mildly limited
3. Moderately limited
4. Severely limited
5. Cannot do any work
Blank. Inapplicable
(JIM/ANN) ENJOYS WORK VERY MUCH. (HE/SHE) FEELS THAT (HE/SHE) IS DOING A VERY GOOD JOB AND IS OPTIMISTIC ABOUT THE FUTURE.
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1. Not at all limited
2. Mildly limited
3. Moderately limited
4. Severely limited
5. Cannot do any work
Blank. Inapplicable
If Affect- enjoys work very much (JLB004) = 1. Not at all limited »
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JLB005
Affect- mood swings on job
(BOB/NANCY) HAS MOOD SWINGS ON THE JOB. WHEN (HE/SHE) GETS DEPRESSED, EVERYTHING (HE/SHE) DOES AT WORK IS AN EFFORT FOR (HIM/HER) AND (HE/SHE) NO LONGER ENJOYS (HIS/HER) USUAL ACTIVITIES AT WORK. THESE MOOD SWINGS ARE NOT PREDICTABLE AND OCCUR TWO OR THREE TIMES DURING A MONTH.
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1. Not at all limited
2. Mildly limited
3. Moderately limited
4. Severely limited
5. Cannot do any work
Blank. Inapplicable
(BOB/NANCY) HAS MOOD SWINGS ON THE JOB. WHEN (HE/SHE) GETS DEPRESSED, EVERYTHING (HE/SHE) DOES AT WORK IS AN EFFORT FOR (HIM/HER) AND (HE/SHE) NO LONGER ENJOYS (HIS/HER) USUAL ACTIVITIES AT WORK. THESE MOOD SWINGS ARE NOT PREDICTABLE AND OCCUR TWO OR THREE TIMES DURING A MONTH.
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1. Not at all limited
2. Mildly limited
3. Moderately limited
4. Severely limited
5. Cannot do any work
Blank. Inapplicable
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JLB006
Affect- worried all the time
(FRANK/BARB) FEELS WORRIED ALL THE TIME. (HE/SHE) GETS DEPRESSED ONCE A WEEK AT WORK FOR A COUPLE OF DAYS IN A ROW, THINKING ABOUT WHAT COULD GO WRONG AND THAT (HIS/HER) BOSS WILL DISAPPROVE OF (HIS/HER) CONDITION. BUT (HE/SHE) IS ABLE TO COME OUT OF THIS MOOD IF (HE/SHE) CONCENTRATES ON SOMETHING ELSE.
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1. Not at all limited
2. Mildly limited
3. Moderately limited
4. Severely limited
5. Cannot do any work
Blank. Inapplicable
(FRANK/BARB) FEELS WORRIED ALL THE TIME. (HE/SHE) GETS DEPRESSED ONCE A WEEK AT WORK FOR A COUPLE OF DAYS IN A ROW, THINKING ABOUT WHAT COULD GO WRONG AND THAT (HIS/HER) BOSS WILL DISAPPROVE OF (HIS/HER) CONDITION. BUT (HE/SHE) IS ABLE TO COME OUT OF THIS MOOD IF (HE/SHE) CONCENTRATES ON SOMETHING ELSE.
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1. Not at all limited
2. Mildly limited
3. Moderately limited
4. Severely limited
5. Cannot do any work
Blank. Inapplicable
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JLB007
Affect- depressed most of the time
(GARY/KATHLEEN) FEELS DEPRESSED MOST OF THE TIME. (HE/SHE) WEEPS FREQUENTLY AT WORK AND FEELS HOPELESS ABOUT THE FUTURE. (HE/SHE) FEELS THAT (HE/SHE) HAS BECOME A BURDEN ON (HIS/HER) CO-WORKERS AND THAT (HE/SHE) WOULD BE BETTER DEAD.
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1. Not at all limited
2. Mildly limited
3. Moderately limited
4. Severely limited
5. Cannot do any work
Blank. Inapplicable
(GARY/KATHLEEN) FEELS DEPRESSED MOST OF THE TIME. (HE/SHE) WEEPS FREQUENTLY AT WORK AND FEELS HOPELESS ABOUT THE FUTURE. (HE/SHE) FEELS THAT (HE/SHE) HAS BECOME A BURDEN ON (HIS/HER) CO-WORKERS AND THAT (HE/SHE) WOULD BE BETTER DEAD.
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1. Not at all limited
2. Mildly limited
3. Moderately limited
4. Severely limited
5. Cannot do any work
Blank. Inapplicable
If Affect- depressed most of the time (JLB007) = 1. Not at all limited »
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JLB008
Pain- occasional back pain at work
(MICHAEL/SUE) OCCASIONALLY FEELS BACK PAIN AT WORK, BUT THIS HAS NOT HAPPENED FOR THE LAST SEVERAL MONTHS NOW. IF (HE/SHE) FEELS BACK PAIN, IT TYPICALLY LASTS ONLY FOR A FEW DAYS.
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1. Not at all limited
2. Mildly limited
3. Moderately limited
4. Severely limited
5. Cannot do any work
Blank. Inapplicable
(MICHAEL/SUE) OCCASIONALLY FEELS BACK PAIN AT WORK, BUT THIS HAS NOT HAPPENED FOR THE LAST SEVERAL MONTHS NOW. IF (HE/SHE) FEELS BACK PAIN, IT TYPICALLY LASTS ONLY FOR A FEW DAYS.
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1. Not at all limited
2. Mildly limited
3. Moderately limited
4. Severely limited
5. Cannot do any work
Blank. Inapplicable
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JLB009
Pain- stiffness in back at work
(CARL/CAROL) SUFFERS FROM BACK PAIN THAT CAUSES STIFFNESS IN (HIS/HER) BACK, ESPECIALLY AT WORK, BUT IS RELIEVED WITH LOW DOSES OF MEDICATION. (HE/SHE) DOES NOT HAVE ANY PAINS OTHER THAN THIS GENERALIZED DISCOMFORT.
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1. Not at all limited
2. Mildly limited
3. Moderately limited
4. Severely limited
5. Cannot do any work
Blank. Inapplicable
(CARL/CAROL) SUFFERS FROM BACK PAIN THAT CAUSES STIFFNESS IN (HIS/HER) BACK, ESPECIALLY AT WORK, BUT IS RELIEVED WITH LOW DOSES OF MEDICATION. (HE/SHE) DOES NOT HAVE ANY PAINS OTHER THAN THIS GENERALIZED DISCOMFORT.
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1. Not at all limited
2. Mildly limited
3. Moderately limited
4. Severely limited
5. Cannot do any work
Blank. Inapplicable
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JLB010
Pain- constant back pain
(MATTHEW/RUTH) HAS ALMOST CONSTANT PAIN IN (HIS/HER) BACK AND THIS SOMETIMES PREVENTS (HIM/HER) FROM DOING (HIS/HER) WORK.
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1. Not at all limited
2. Mildly limited
3. Moderately limited
4. Severely limited
5. Cannot do any work
Blank. Inapplicable
(MATTHEW/RUTH) HAS ALMOST CONSTANT PAIN IN (HIS/HER) BACK AND THIS SOMETIMES PREVENTS (HIM/HER) FROM DOING (HIS/HER) WORK.
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1. Not at all limited
2. Mildly limited
3. Moderately limited
4. Severely limited
5. Cannot do any work
Blank. Inapplicable
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JLB011
Pain-changes in position affect work
(GEORGE/LINDA) HAS BACK PAIN THAT MAKES CHANGES IN BODY POSITION WHILE (HE/SHE) IS WORKING VERY UNCOMFORTABLE. (HE/SHE) IS UNABLE TO STAND OR SIT FOR MORE THAN HALF AN HOUR. MEDICINES DECREASE THE PAIN A LITTLE, BUT IT IS THERE ALL THE TIME AND INTERFERES WITH (HIS/HER) ABILITY TO CARRY OUT EVEN DAY-TO- DAY TASKS AT WORK.
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1. Not at all limited
2. Mildly limited
3. Moderately limited
4. Severely limited
5. Cannot do any work
Blank. Inapplicable
(GEORGE/LINDA) HAS BACK PAIN THAT MAKES CHANGES IN BODY POSITION WHILE (HE/SHE) IS WORKING VERY UNCOMFORTABLE. (HE/SHE) IS UNABLE TO STAND OR SIT FOR MORE THAN HALF AN HOUR. MEDICINES DECREASE THE PAIN A LITTLE, BUT IT IS THERE ALL THE TIME AND INTERFERES WITH (HIS/HER) ABILITY TO CARRY OUT EVEN DAY-TO- DAY TASKS AT WORK.
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1. Not at all limited
2. Mildly limited
3. Moderately limited
4. Severely limited
5. Cannot do any work
Blank. Inapplicable
If Pain-changes in position affect work (JLB011) = 1. Not at all limited »
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JLB012
Pain-back and leg pain almost always
(MARK/JANE) HAS PAIN IN (HIS/HER) BACK AND LEGS, AND THE PAIN IS PRESENT ALMOST ALL THE TIME. IT GETS WORSE WHILE (HE/SHE) IS WORKING. ALTHOUGH MEDICATION HELPS, (HE/SHE) FEELS UNCOMFORTABLE WHEN MOVING AROUND, HOLDING AND LIFTING THINGS AT WORK.
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1. Not at all limited
2. Mildly limited
3. Moderately limited
4. Severely limited
5. Cannot do any work
Blank. Inapplicable
(MARK/JANE) HAS PAIN IN (HIS/HER) BACK AND LEGS, AND THE PAIN IS PRESENT ALMOST ALL THE TIME. IT GETS WORSE WHILE (HE/SHE) IS WORKING. ALTHOUGH MEDICATION HELPS, (HE/SHE) FEELS UNCOMFORTABLE WHEN MOVING AROUND, HOLDING AND LIFTING THINGS AT WORK.
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1. Not at all limited
2. Mildly limited
3. Moderately limited
4. Severely limited
5. Cannot do any work
Blank. Inapplicable
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JLB013
Cvd- active and fit
(PETER/KAREN) IS VERY ACTIVE AND FIT. (HE/SHE) TAKES AEROBIC CLASSES 3 TIMES A WEEK.
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1. Not at all limited
2. Mildly limited
3. Moderately limited
4. Severely limited
5. Cannot do any work
Blank. Inapplicable
(PETER/KAREN) IS VERY ACTIVE AND FIT. (HE/SHE) TAKES AEROBIC CLASSES 3 TIMES A WEEK.
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1. Not at all limited
2. Mildly limited
3. Moderately limited
4. Severely limited
5. Cannot do any work
Blank. Inapplicable
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JLB014
Cvd- heart problems in the past
(JACOB/LORI) HAS HAD HEART PROBLEMS IN THE PAST AND (HE/SHE) HAS BEEN TOLD TO WATCH (HIS/HER) CHOLESTEROL LEVEL. SOMETIMES IF (HE/SHE) FEELS STRESSED AT WORK (HE/SHE) FEELS PAIN IN (HIS/HER) CHEST AND OCCASIONALLY IN (HIS/HER) ARMS.
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1. Not at all limited
2. Mildly limited
3. Moderately limited
4. Severely limited
5. Cannot do any work
Blank. Inapplicable
(JACOB/LORI) HAS HAD HEART PROBLEMS IN THE PAST AND (HE/SHE) HAS BEEN TOLD TO WATCH (HIS/HER) CHOLESTEROL LEVEL. SOMETIMES IF (HE/SHE) FEELS STRESSED AT WORK (HE/SHE) FEELS PAIN IN (HIS/HER) CHEST AND OCCASIONALLY IN (HIS/HER) ARMS.
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1. Not at all limited
2. Mildly limited
3. Moderately limited
4. Severely limited
5. Cannot do any work
Blank. Inapplicable
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JLB015
Cvd- history of heart problems
(PAUL/BETH)'S FAMILY HAS A HISTORY OF HEART PROBLEMS. (HIS/HER) FATHER DIED OF A HEART ATTACK WHEN (PAUL/BETH) WAS STILL VERY YOUNG. THE DOCTORS HAVE TOLD (PAUL/BETH) THAT (HE/SHE) IS AT SEVERE RISK OF HAVING A SERIOUS HEART ATTACK (HIMSELF/HERSELF) AND THAT (HE/SHE) SHOULD AVOID STRENUOUS PHYSICAL ACTIVITY OR STRESS. (HE/SHE) SOMETIMES FEELS SEVERE PAIN IN (HIS/HER) CHEST AND ARMS, AND SUFFERS FROM DIZZINESS, FAINTING, SWEATING, NAUSEA OR SHORTNESS OF BREATH.
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1. Not at all limited
2. Mildly limited
3. Moderately limited
4. Severely limited
5. Cannot do any work
Blank. Inapplicable
(PAUL/BETH)'S FAMILY HAS A HISTORY OF HEART PROBLEMS. (HIS/HER) FATHER DIED OF A HEART ATTACK WHEN (PAUL/BETH) WAS STILL VERY YOUNG. THE DOCTORS HAVE TOLD (PAUL/BETH) THAT (HE/SHE) IS AT SEVERE RISK OF HAVING A SERIOUS HEART ATTACK (HIMSELF/HERSELF) AND THAT (HE/SHE) SHOULD AVOID STRENUOUS PHYSICAL ACTIVITY OR STRESS. (HE/SHE) SOMETIMES FEELS SEVERE PAIN IN (HIS/HER) CHEST AND ARMS, AND SUFFERS FROM DIZZINESS, FAINTING, SWEATING, NAUSEA OR SHORTNESS OF BREATH.
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1. Not at all limited
2. Mildly limited
3. Moderately limited
4. Severely limited
5. Cannot do any work
Blank. Inapplicable
If Cvd- history of heart problems (JLB015) = 1. Not at all limited »
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JLB016
Cvd- diagnosed high blood pressure
(TOM/DIANE) HAS BEEN DIAGNOSED WITH HIGH BLOOD PRESSURE. (HIS/HER) BLOOD PRESSURE GOES UP QUICKLY IF (HE/SHE) FEELS UNDER STRESS. (TOM/DIANE) DOES NOT EXERCISE MUCH AND IS OVERWEIGHT. LIFE CAN SOMETIMES CAN BE HECTIC FOR (HIM/HER). (HE/SHE) DOES NOT GET ALONG WITH (HIS/HER) BOSS VERY WELL.
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1. Not at all limited
2. Mildly limited
3. Moderately limited
4. Severely limited
5. Cannot do any work
Blank. Inapplicable
(TOM/DIANE) HAS BEEN DIAGNOSED WITH HIGH BLOOD PRESSURE. (HIS/HER) BLOOD PRESSURE GOES UP QUICKLY IF (HE/SHE) FEELS UNDER STRESS. (TOM/DIANE) DOES NOT EXERCISE MUCH AND IS OVERWEIGHT. LIFE CAN SOMETIMES CAN BE HECTIC FOR (HIM/HER). (HE/SHE) DOES NOT GET ALONG WITH (HIS/HER) BOSS VERY WELL.
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1. Not at all limited
2. Mildly limited
3. Moderately limited
4. Severely limited
5. Cannot do any work
Blank. Inapplicable
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JLB017
Cvd- triple bypass heart surgery
(DAN/JUDY) HAS UNDERGONE TRIPLE BYPASS HEART SURGERY. (HE/SHE) IS A HEAVY SMOKER AND STILL EXPERIENCES SEVERE CHEST PAIN SOMETIMES.
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1. Not at all limited
2. Mildly limited
3. Moderately limited
4. Severely limited
5. Cannot do any work
Blank. Inapplicable
(DAN/JUDY) HAS UNDERGONE TRIPLE BYPASS HEART SURGERY. (HE/SHE) IS A HEAVY SMOKER AND STILL EXPERIENCES SEVERE CHEST PAIN SOMETIMES.
- - - - - - - - - - - - - - - - - - - - - - - - -
1. Not at all limited
2. Mildly limited
3. Moderately limited
4. Severely limited
5. Cannot do any work
Blank. Inapplicable
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JLB018
Who answered disability qnaire
WERE THE QUESTIONS IN THIS BOOKLET ANSWERED BY THE PERSON WHOSE INITIALS ARE WRITTEN ON THE FRONT COVER, OR DID SOMEONE ELSE PROVIDE THEIR OWN ANSWERS? (CHECK ONE.)
- - - - - - - - - - - - - - - - - - - - - - - - -
1. The questions were answered by the person whose initials are written on the front cover.
2. Someone else provided their own answers.
Blank. Inapplicable
WERE THE QUESTIONS IN THIS BOOKLET ANSWERED BY THE PERSON WHOSE INITIALS ARE WRITTEN ON THE FRONT COVER, OR DID SOMEONE ELSE PROVIDE THEIR OWN ANSWERS? (CHECK ONE.)
- - - - - - - - - - - - - - - - - - - - - - - - -
1. The questions were answered by the person whose initials are written on the front cover.
2. Someone else provided their own answers.
Blank. Inapplicable
End of LB. Leave-behind Questionnaires (respondent)