I_C. Health (HT)

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I_C. Health (HT) of LASI 2017-2019

Label	Type	Description
HT001a		Now I want to ask you about your health. In general, would you say your health is excellent, very good, good, fair, or poor?
HT001b		[If HT001_a was not asked] Now I want to ask you about your general health. Overall, how is your health in general? Would you say it is very good, good, fair, poor, or very poor?
HT002		Has any health professional ever told you that you have Hypertension or high blood pressure ?
HT003		Has any health professional ever told you that you have Diabetes or high blood sugar ?
HT004		Has any health professional ever told you that you have Cancer or a malignant tumor ?
HT005		Has any health professional ever told you that you have Chronic lung disease such as asthma ,chronic obstructive pulmonary disease/Chronic bronchitis or other chronic lung problems ?
HT006		Has any health professional ever told you that you have Chronic heart diseases such as Coronary heart disease (heart attack or Myocardial Infarction), congestive heart failure, or other chronic heart problems ?
HT007		Has any health professional ever told you that you have Stroke ?
HT008		Has any health professional ever told you that you have Arthritis or rheumatism, Osteoporosis or other bone/joint diseases ?
HT009		Has any health professional ever told you that you have Any neurological, or psychiatric problems such as depression , Alzheimers/Dementia, unipolar/bipolar disorders, convulsions, Parkinsons etc. ?
HT010		Has any health professional ever told you that you have High cholesterol?
HT002a		[Ask only if HT002=1] Who first diagnosed you with high blood pressure or hypertension?
HT002b		[Ask only if HT002=1] When were you first diagnosed with high blood pressure or hypertension? Year _____ [Hard check: HT002b_year > current year] OR Age ______ [Hard check: HT002b_age > Rs current age]
HT002c		[Ask only if HT002=1] In order to control your blood pressure or hypertension, are you currently taking any medication?
HT002d		[Ask only if HT002=1] In order to control your blood pressure, are you under salt or other diet restrictions?
HT003a		[Ask only if HT003=1] Who first diagnosed you with diabetes or high blood sugar?
HT003b		[Ask only if HT003=1] When were you first diagnosed with diabetes or high blood sugar? Year _____ [Hard check: HT003b_year is > current year] OR Age ______ [Hard check: HT003b_age is > Rs current age]
HT003c		[Ask only if HT003=1] In order to treat or control your diabetes or high blood sugar, are you currently taking medications that you swallow?
HT003d		[Ask only if HT003=1] Are you currently using insulin shots/injections?
HT003e		[Ask only if HT003=1] In order to control your diabetes, are you following a special diet?
HT004a		[Ask only if HT004=1] Who first diagnosed you with cancer?
HT004b		[Ask only if HT004=1] When were you first diagnosed with cancer? Year _____[Hard check: HT004b_year is > current year] OR Age ______ [Hard check: HT004b_age is > Rs current age]
HT004c		[Ask only if HT004=1] Have you been diagnosed with more than one type of cancer?
HT004d		[Ask only if HT004=1] first diagnosed organ/body part: ____[CAPI will provide drop down list for single answer]
HT004e		[Ask only if HT004c=1] all other organs/body parts: ____ [CAPI will provide drop down list] [Multiple answers are allowed]
HT004f		[Ask only if HT004=1] During the last two years, what type of treatments have you received for cancer? [Multiple answers are allowed] [Hard check: if response is None, freeze all other option categories]
HT004g		[Ask if HT004f != fand HT004c=1] for which cancer(s) have you received the treatment? [Multiple answers allowed]
HT005a		[Ask only if HT005=1] Who first diagnosed you with chronic lung disease?
HT005b		[Ask only if HT005=1] When were you first diagnosed with a chronic lung disease such as asthma, chronic obstructive pulmonary disease/chronic bronchitis or other chronic lung problems? Year_____ [Hard check: HT005b_year is > current year] OR Age ______ [Hard check:HT005b_age>Rs current age ]
HT005c		[Ask only if HT005=1] Are you receiving physical or respiratory therapy, or any other treatment for your lung disease?
HT005d		[Ask only if HT005=1] Which type of chronic lung disease do you have? [Multiple answers are allowed]
HT006a		[Ask only if HT006=1] Have you ever had a heart attack?
HT006b		[Ask only if HT006a=1] When did you first have a heart attack? Year _____ [Hard check: HT006b_year >current year] OR Age ______ [Hard check:HT006b_age > Rs current age]
HT006c		[Ask only if HT006a=1] Was this the time when you were first diagnosed with a heart disease?
HT006d		[Ask only if HT006c=2] When were you first diagnosed with a heart disease? Year _____ [Hard check: HT006d_year is > current year] OR Age ______ [Hard check: HT006d_age is> Rs current age]
HT006e		[Ask only if HT006=1] Who first diagnosed you with heart disease?
HT006f		[Ask if HT006 =1] What kind of heart related conditions have you been diagnosed with? a. Rheumatic heart disease b. Congenital / Structural Disorders c. Conduction Disorders / Cardiac arrhythmias d. Congestive heart failure e. Other heart conditions please specify
HT006g		[Ask only if current age of respondent- (minus) respondents age in HT006b > 2] In the last two years, have you had a heart attack?
HT006h		[Ask only if HT006=1] Are you currently taking any medication for your heart disease?
HT007a		[Ask only if HT007=1] Who first diagnosed you with a stroke?
HT007b		[Ask only if HT007=1] When were you first diagnosed with a stroke? Year _____ [Hard check: HT007b_year > current year] OR Age ______ [Hard check: HT007b_age > Rs current age]
HT007c		[Ask only if HT007=1] Are you currently taking any medications because of your stroke or its complications?
HT007d		[Ask only if HT007=1] Are you receiving physical or occupational therapy because of your stroke or its complications?
HT007e		[Ask only if HT007=1] Have you had any subsequent stroke after the first diagnosed stroke you just told me about?
HT007f		[Ask only if HT007e=1] In the last two years, have you consulted a doctor in connection with this most recent stroke?
HT007g		[Ask only if HT007=1] Do you still have any remaining problems because of your stroke(s), such as difficulty in moving or speaking?
HT007h.		Weakness in your arms and legs, or decreased ability to move or use them?
HT007i.		Difficulty in speaking or swallowing?
HT007j.		Difficulty with your vision?
HT007k.		Difficulty in thinking or finding the right words to say?
HT008a		[Ask only if HT008=1] Have you ever been diagnosed with the following bone/joint diseases/problems? [Multiple answers are allowed]? a. Arthritis b. Rheumatism c. Osteoporosis d. Other, please specify______
HT008b		[Ask if HT008a= a or b] Who first diagnosed you with arthritis or rheumatism?
HT008c		[Ask if HT008a=a or b] When were you first diagnosed with arthritis or rheumatism? Year _____ [Hard check: HT008c_year> current year] OR Age ______ [Hard check: HT008c_age > Rs current age]
HT008d		[Ask only if HT008a=c]Who first diagnosed you with osteoporosis?
HT008e		[Ask only if HT008a=c]When you were first diagnosed with osteoporosis? Year _____ [Hard check: HT008e year> current year] OR ______ Age [Hard check: HT008e_age > Rs current age]
HT008f		[Ask only if HT008=1] Are you currently taking any medication or receiving other treatments for your arthritis, rheumatism or osteoporosis?
HT009a		[Ask only if HT009=1] Which type of neurological or psychiatric problem(s) have you been diagnosed with [Multiple answers are allowed]?
HT009b		[Ask only ifHT009=1] Who first diagnosed you with your neurological, or psychiatric problems or conditions?
HT009c		[Ask only if HT009=1] When were you first diagnosed with this problem? _____Year [Hard check: HT009c_year > current year] OR ______ Age [Hard check: HT009b_age > Rs current age]
HT009d		[Ask only if HT009=1] Are you currently taking any psychiatric or psychological treatment or therapy for your condition?
HT009e		[Ask only if HT009=1] Are you currently taking tranquilizers, antidepressants, or other types of medication for neurological or psychiatric problem (s)?
HT010a		[Ask only if HT010=1] Who first diagnosed you with high cholesterol?
HT010b		[Ask only if HT010=1] When were you first diagnosed with high cholesterol? Year _____ [Hard check: HT0010b_year > current year] OR Age ______ [Hard check:HT0010b_age > Rs current age]
HT010c		[Ask only if HT010=1] Do you regularly take medications to help lower your cholesterol?
HT010d		[Ask ALL respondents] In the past 2 years, have you had a blood test for cholesterol?
HT011		Now I would like to ask about other chronic conditions. Have you ever been diagnosed with any of the following chronic conditions or diseases? [Multiple answers are allowed]
HT012		Have you ever been diagnosed with any of the following urogenital conditions or diseases? [Multiple answers are allowed] [Instruction for CAPI : Freeze all other option if HT012 = e]
HT013		[Ask only if HT012=a] In last two years, have you been on dialysis?
HT014		Do you ever pass urine while sneezing, coughing, laughing or lifting heavy objects?
HT015		Now I have some questions about your eyesight. Have you ever been diagnosed with any eye or vision problem or condition, including ordinary nearsightedness or farsightedness?
HT016		[Ask only if HT015 =1] Were you diagnosed with an eye or vision problem or condition in one or both eyes?
HT017		[Ask only if HT015=1] With which problem or condition were you diagnosed? [Multiple answers are allowed]
HT018		[Ask only if HT015=1] Have you ever undergone any treatment or corrective surgery for an eye problem or condition?
HT019		How good is your eyesight for seeing things at a distance, like recognizing a person across the street (or 20 meters away) whether or not you wear glasses, contacts, or corrective lenses?
HT020		How good is your eyesight for seeing things up close, like reading ordinary newspaper print whether or not you wear glasses, contacts, or corrective lenses
HT021		Have you ever been diagnosed with any hearing or ear-related problem or condition?
HT022		[Ask only if HT021=1] Were you diagnosed with an ear or hearing problem or condition in one or both ears?
HT023		[Ask only if HT021 =1]Have you ever undergone any treatment or corrective surgery for ear-related problem or condition?
HT024		Now, I have some questions about your oral (dental) health. In the last 12 months, have you ever been diagnosed with or suffered from any of the following oral problem(s)? [Multiple answers are allowed]
HT025		Have you lost some or all of your natural teeth?
HT026		How well can you chew solid foods such as chapati, apple, guava, or nuts?
HT101		Now we will ask about some other health concerns, such as injuries and falls. In the past two years, have you sustained any major injury?
HT102		[Ask only ifHT101=1] Did you receive medical treatment for that injury?
HT102a		[Ask only ifHT101=1] What was the cause of that injury? [Multiple answers are allowed] a. Traffic accident b. Struck by person or object c. Fire, flames, burn, electric Shock d. Drowning e. Poisoning f. Animal attack or bite g. Fall h. Other, please specify_______
HT103		[Ask only if HT102a!= g]In the past two years, have you fallen down?
HT103a		[Ask if HT102a=g or HT103=1] How many times have you fallen in the last 2 years? Number of times: ____
HT103b		[Ask only if HT102a=g or HT103=1] In that fall/in any of these falls, did you injure yourself seriously enough to need medical treatment?
HT104		In the past 2 years, have you fractured any of your bones/joints?
HT105		In the past 2 years, have you undergone any surgery related to bones or joints?
HT105a		[Ask only if HT105=1] Which bone or joint have you undergone surgery for? [Multiple answers are allowed]
HT106		Now we are going to ask some questions about natural disasters, which may have affected your health as well. In the last five years, has your health been severely affected by disasters such as floods, landslides, extreme cold and hot weather, cyclone/typhoons, droughts, earthquakes, tsunamis, or any other natural calamities?
HT106a		[Ask only if HT106=1] Which of these natural disasters affected your health? Please identify all natural disasters that affected you. [Multiple answers are allowed]
HT107		In the last five years, has your health been severely affected by man-made incidents such as riots, terrorism, building collapses, fires, traffic accidents or any other man-made incidents?
HT107a		[Ask only if HT107=1] Which of these man-made disasters affected your health? Please identify all man-made incidents that affected you. [Multiple answers are allowed]
HT108		[Ask if HT106=1 or HT107=1]What were the health consequences that you suffered as a result of these disasters or incidents? [Multiple answers are allowed]
HT201		In the past 2 years, have you had Jaundice/ Hepatitis
HT201a		[Ask only if HT201-HT210=1]Was this disease treated by a health professional? Jaundice/ Hepatitis
HT202		In the past 2 years, have you had Tuberculosis (TB)
HT202a		[Ask only if HT201-HT210=1]Was this disease treated by a health professional? Tuberculosis (TB)
HT203		In the past 2 years, have you had Malaria
HT203a		[Ask only if HT201-HT210=1]Was this disease treated by a health professional? Malaria
HT204		In the past 2 years, have you had Diarrhea/gastroenteritis
HT204a		[Ask only if HT201-HT210=1]Was this disease treated by a health professional? Diarrhea/gastroenteritis
HT205		In the past 2 years, have you had Typhoid
HT205a		[Ask only if HT201-HT210=1]Was this disease treated by a health professional? Typhoid
HT206		In the past 2 years, have you had Urinary Tract Infection
HT206a		[Ask only if HT201-HT210=1]Was this disease treated by a health professional? Urinary Tract Infection
HT207		In the past 2 years, have you had Anemia
HT207a		[Ask only if HT201-HT210=1]Was this disease treated by a health professional? Anemia
HT208		In the past 2 years, have you had Chikungunya
HT208a		[Ask only if HT201-HT210=1]Was this disease treated by a health professional? Chikungunya
HT209		In the past 2 years, have you had Dengue
HT209a		[Ask only if HT201-HT210=1]Was this disease treated by a health professional? Dengue
HT210		In the past 2 years, have you had Other, please specify _____
HT210a		[Ask only if HT201-HT210=1]Was this disease treated by a health professional? Other, please specify _____
HT211		Have you ever received any immunizations for adults, such as the influenza vaccine, pneumococcal vaccine, hepatitis B vaccine, or typhoid vaccine? [Multiple answers are allowed]
HT212		Do you ever have any pain or discomfort in your chest?
HT213		[Ask only if HT212=1] Do you get this pain or discomfort when you walk uphill or hurry?
HT214		Do you get it when you walk at an ordinary pace on the level?
HT215		When you get any pain or discomfort in your chest while walking or moving, what do you do?
HT216		Does it go away when you stop moving?
HT217		How quickly the pain subsides when it occurs?
HT218		Where do you get this pain or discomfort? [Multiple answers are allowed] -------
HT219		How often do you have trouble falling asleep?
HT220		How often did you wake up during the night and had trouble getting back to sleep?
HT221		How often did you wake up too early in the morning and were not being able to fall asleep again?
HT222		How often did you feel unrested during the day, no matter how many hours of sleep you had?
HT222a		How often did you take a nap during the day?
HT223		In the past 1 month, have you taken any medications or used other treatments to help you sleep?
HT224		[Ask only if HT223=1] Were these medications or other treatments recommended to you by a doctor?
HT225		Are you often troubled with pain?
HT226		[Ask only if HT225 =1] How frequently do you experience pain?
HT227		[Ask only if HT225=1] Do you take any medication or therapy to get relief from the pain [Multiple answers are allowed]?
HT228		[Ask only if HT225=1] Does the pain make it difficult for you to do your usual activities such as household chores or work?
HT229		Have you had any of the following persistent or troublesome problems in past two years? [Multiple answers are allowed]
HT230		Aside from any hospital or nursing home stays, about how many days did you stay in bed more than half day because of illness or injury during the last 30 days ? Use 0 for none. Number of days: ___ [Hard check: HT247 >31]
HT231		[Ask only if interview is NOT a proxy interview] Now I want to ask you about your overall childhood health up to age 16. In general, would you say your childhood health was very good, good, fair, poor or very poor on the basis of what you remember, or what you heard or perceived from your parents?
HT232		[Ask only if interview is a proxy interview] Consider [his/her] health while [he/she] was growing up, from birth to age
HT233		When you were growing up, before you were 16 years old, were you ever bedridden for a month or more because of a health problem?
HT234		[Ask only if DM006=1] When you were growing up, before you were 16 years old, did you ever miss a month or more of school because of a health problem?
HT235		Now think about your family when you were growing up, from birth to age 16. Compared to other families in your community, would you say your family during that time was pretty well off financially, about average, or poor?
HT236		When did you have your last menstrual bleeding /period? ._______ Year and _______ month
HT237		[Ask only if DM005 < 60years] In the last 12 months, have you had any of the following health problem(s)? [Multiple answers are allowed]
HT238		[Ask only if HT237!=i]Did you seek doctor's consultation or treatment for any of these health problems?
HT239		Have you undergone an operation to remove your uterus (hysterectomy)?
HT240		HT240 [Ask only if HT239= 1] What were the reason(s) for undergoing hysterectomy? [Multiple responses are allowed] [Instructionfor CAPI: If option h is selected, other given options should be freeze]
HT241		In the last 2 years, have you had a PAP smear test?
HT242		In the last 2 years, have you had a mammogram?
HT300		[Ask only WE004=1 or WE005=1] Now I want to ask how your health affects paid work activities. Do you have any impairment or health problem that limits the kind or amount of paid work you can do?
HT301		Do you have any form of physical or mental impairment?
HT302		[Ask only if HT301= 1] Which form of impairment do you have? [Multiple answers are allowed]
HT303		Do you have difficulty with Walking 100 yards
HT304		Do you have difficulty with Sitting for 2 hours or more
HT305		Do you have difficulty with Getting up from a chair after sitting for long period
HT306		Do you have difficulty with Climbing one flight of stairs without resting
HT307		Do you have difficulty with Stooping, kneeling or crouching
HT308		Do you have difficulty with Reaching or extending arms above shoulder level (either arm)
HT309		Do you have difficulty with Pulling or pushing large objects
HT310		Do you have difficulty with Lifting or carrying weights over 5 kilos, like a heavy bag of groceries
HT311		Do you have difficulty with Picking up a coin from a table
HT401		Because of a health or memory problem, do you have any difficulty with Dressing, including putting on chappals, shoes, etc.
HT402		Because of a health or memory problem, do you have any difficulty with Walking across a room
HT403		Because of a health or memory problem, do you have any difficulty with Bathing
HT404		Because of a health or memory problem, do you have any difficulty with Eating, chewing, breaking chapatti, mixing rice, etc.
HT405		Because of a health or memory problem, do you have any difficulty with Getting in or out of bed
HT406		Because of a health or memory problem, do you have any difficulty with Using the toilet, including getting up and down
HT407		Because of a health or memory problem, do you have any difficulty with Preparing a hot meal (cooking and serving)
HT408		Because of a health or memory problem, do you have any difficulty with Shopping for groceries
HT409		Because of a health or memory problem, do you have any difficulty with Making telephone calls
HT410		Because of a health or memory problem, do you have any difficulty with Taking medications
HT411		Because of a health or memory problem, do you have any difficulty with Doing work around the house or garden
HT412		Because of a health or memory problem, do you have any difficulty with Managing money, such as paying bills and keeping track of expenses
HT413		Because of a health or memory problem, do you have any difficulty with Getting around or finding address in unfamiliar place
HT414		Are you using any aid or supportive device(s) to assist you in the activities of daily living? Examples of supportive devices include spectacles and dentures, and devices to help you in moving or sitting.
HT415		Please tell me which of the following device(s), you have been using to assist you in the activities of daily living Hearing Aid
HT416		Please tell me which of the following device(s), you have been using to assist you in the activities of daily living Spectacles/contact lenses
HT417		Please tell me which of the following device(s), you have been using to assist you in the activities of daily living Denture
HT418		Please tell me which of the following device(s), you have been using to assist you in the activities of daily living Walker/ walking Sticks
HT419		Please tell me which of the following device(s), you have been using to assist you in the activities of daily living Wheel chairs
HT420		Please tell me which of the following device(s), you have been using to assist you in the activities of daily living Adjustable shower stools /Commodes
HT421		Please tell me which of the following device(s), you have been using to assist you in the activities of daily living Back/ neck collar
HT422		Please tell me which of the following device(s), you have been using to assist you in the activities of daily living Orthesis and prosthesis
HT423		Please tell me which of the following device(s), you have been using to assist you in the activities of daily living Other, please specify.
HT424		Does anyone help you with these difficulties you mentioned above?
HT425		How many people usually help you with these activities? _______
HT426		Who helps you with that most often? Select person if helper is a household member [CAPI will show HH person IDs] ____ Name if helper is not a household member
HT427		[Ask only if helper is not a household member].What is that persons relationship to you?
HT428		During the last month, on about how many days did [NAME OF CARE PROVIDER] assist you? ______days in last month (Hard check:>31)
HT429		On the days [NAME OF CARE PROVIDER] assisted you, about how many hours per day was that? [Instruction for Interviewer: Enter 0 if LESS THAN ONE HOUR] _______hours [Hard check : >24]
HT430		Is [NAME OF CARE PROVIDER] paid to help you?
HT431		How often did the respondent receive assistance in answering this section?
HT432		[Ask only if HT431>1] Who helped the respondent in answering this section?
FM301		[Ask only if DM021 < 6]Is your current or former spouse related to you by blood (like a cousin)?
FM302a		[Ask only if DM021< 6] How many times have you / your spouse been pregnant? Number of pregnancies: _____
FM302b		[Ask only if DM021< 6] How many times have you / your spouse been pregnant? Number of live births: _____
FM302c		[Ask only if DM021< 6] How many times have you / your spouse been pregnant? Number of still births: _____
FM302d		[Ask only if DM021< 6] How many times have you / your spouse been pregnant? Number of Spontaneous abortions /miscarriages: _____
FM302e		[Ask only if DM021< 6] How many times have you / your spouse been pregnant? Number of Medical Termination of Pregnancy (MTP)/induced abortion: _____
FM303		Could you tell me if your father, mother, brother, sister, children, grandchildren, has ever been diagnosed with the following diseases? Please only refer to blood-related family members. Hypertension
FM304		Could you tell me if your father, mother, brother, sister, children, grandchildren, has ever been diagnosed with the following diseases? Please only refer to blood-related family members. Diabetes
FM305		Could you tell me if your father, mother, brother, sister, children, grandchildren, has ever been diagnosed with the following diseases? Please only refer to blood-related family members. Heart disease
FM306		Could you tell me if your father, mother, brother, sister, children, grandchildren, has ever been diagnosed with the following diseases? Please only refer to blood-related family members. Stroke
FM307		Could you tell me if your father, mother, brother, sister, children, grandchildren, has ever been diagnosed with the following diseases? Please only refer to blood-related family members. Cancer
FM308		Could you tell me if your father, mother, brother, sister, children, grandchildren, has ever been diagnosed with the following diseases? Please only refer to blood-related family members. Alzheimers disease
FM309		Could you tell me if your father, mother, brother, sister, children, grandchildren, has ever been diagnosed with the following diseases? Please only refer to blood-related family members. Parkinsons disease
FM310		Could you tell me if your father, mother, brother, sister, children, grandchildren, has ever been diagnosed with the following diseases? Please only refer to blood-related family members. Psychotic Disorder
FM311		Does your family have a history of birth defects or congenital disorders in children?
FM312		[Ask only if FM311=1]Does your family have a history of any of the following? [Multiple answers are allowed]
FM313		Who was present while interviewing this module?[Multiple answers are allowed].
FM314		How often did the respondent receive assistance in answering this section?
FM315		[Ask only if FM314>1] Who helped the respondent in answering this section?
MH001		Now Im going to ask several simple questions to test your memory. Some may be easy and some may be hard to answer. Please try to answer as honestly as you can.
MH002		Please tell me todays date. Date [display day number]
MH003		Please tell me todays date. Month [display month]
MH004		Please tell me todays date. Year [display year]
MH005		Please tell me which day of week is today. Is it Monday, Tuesday, Wednesday, Thursday, Friday, Saturday, or Sunday? [Instruction for CAPI: Display day of the week]
MH006		What is this place used for? [Instruction for Interviewer: plausible answers are specific answers such as living room, house, apartment, hospital, market, etc.]
MH007		Name of village/town/city
MH008		Street number/ colony name/landmark/neighbourhood
MH009		What is name of your district?
MH010		I will read a set of 10 words and ask you to recall as many as you can. We have purposely made the list long so that it will be difficult for anyone to recall all the words. Most people recall just a few. Please listen carefully as I read the set of words because I cannot repeat them. When I finish, I will ask you to recall aloud as many of the words as you can, in any order. Is this clear?
MH011		[Instructions for Interviewer: One of the following three lists of words will appear on the screen for Interviewer to read] List 1: River, Tree, Temple, School, Hospital, Dog, Cat, Radio, Chair, Gold; List 2: Monkey, Car, Stone, Doctor, Phone, Fire, Road, Silver, Flower, Cow; List 3: Elephant, Bike, Kite, Teacher, House, Water, Butter, Book, Market, Baby; [Instruction for Interviewer: Enter which list appeared on the screen]
MH012		Now please tell me the words you can recall from. Number of words R correctly recalls: _____ [Hard check: MH012>10]
MH013		Now please tell me the words you can recall from. Number of words R incorrectly recalls: ______ [Soft check:MH013<=15]
MH014		Please indicate whether any of the following problems occurred in relation to word recall. [Multiple answers are allowed][Instructions for CAPI: if BM014=d then freeze other options]
MH015		Now we are going to ask you to think of animals and name as many as you can. If you wish you may also include birds along with animals. I am going to give you one minute and I want to see how many animals you can name. [Instructions for Interviewer: Count Categories of animals (e.g., dogs), as well as specific types (e.g., Doberman, Shepherd) as correct. Any members of the animal kingdom, real or mythical, are scored as correct, except repetitions and proper nouns (e.g., Mickey Mouse)]
MH016		Total number of animals and/or birds named [this number is generated from CAPI]: ______
MH017		[Instructions for Interviewer: If R did incorrect naming, anything that is not an animal or bird]: Was there incorrect naming?
MH018		[Instructions for Interviewer: If R did repetition, giving the same animal name more than once] Was there repetition?
MH019		[Instructions for Interviewer: pointing to item #1] What is this? [Instructions for Interviewer: Items can be anything from cell phones, gloves, hats, rings, and umbrella that can be within close reach.]
MH020		[Instructions for Interviewer: pointing to item #2] What is this?
MH021a		Can we now proceed to do similar tests? a. Yes b. No. Go to MH036 c. Refused. Go to MH036
MH021		Fill the blank [7, 8, , 10]
MH022		Fill the blank [8, , 10, 12]
MH023		Fill the blank [18, 10, 6, , 3]
MH024		Fill the blank [1, 2, 3, ]
MH025		Fill the blank [6, 5, 4, ]
MH026		Fill the blank [12, , 16, 18]
MH027		Fill the blank [5, , 3, 2]
MH028		Fill the blank [4, 7, 10, ]
MH029		Fill the blank [, 4, 6, 8]
MH030		Fill the blank [1, 3, 3, 5, 7, 7, ]
MH031		Fill the blank [3, , 8, 12, 17]
MH032		Fill the blank [17, , 12, 8]
MH033		Fill the blank [10, , 3, 1]
MH034		Fill the blank [18, 17, 15, , 8]
MH035		Fill the blank [3, 3, 4, 6, 6, 7, , ]
MH036		[Instructions for Interviewer: Please select one of the following]
MH037		[Ask if MH036=1 or 2]The time taken for backward counting ___secs You may stop now. Thank you.
MH038		[Instruction for Interviewer: Please select the appropriate answer]
MH039		[Ask if MH038= 1or 2]The time taken for backward counting ___secs [Hard check : >120 secs]
MH040		Now let's try some subtraction of numbers. One hundred minus 7 equals what? Enter the answer R gave:
MH041		And 7 from that equals what? [Interviewer: enter the answer R gave] ____
MH042		And 7 from that equals what? [Interviewer: enter the answer R gave] ____
MH043		And 7 from that equals what? [Interviewer: enter the answer R gave] ____
MH044		And 7 from that equals what? [Interviewer: enter the answer R gave] ____
MH045		[CAPI generated score] ____
MH046		A shop is having a sale and selling all items at half price. Before the sale, a sari costs 300 Rs. How much will it cost in the sale?
MH047		If 5 people all have the winning numbers in the lottery and the prize is 1,000 Rs, how much will each of them get?
MH048		[Instruction for Interviewer: Make sure R doesnt see the test paper with the words Close your eyes written before asking the question. Make sure that someone doesnt read the sentence to R] I will show you a sentence. Please read the sentence aloud and act it out.
MH049		[Ask if MH048 != 4] [Instruction for Interviewer: Give R a pen and point to the blank part of the paper] Please write one sentence about how you are feeling today or todays weather. [Instruction for Interviewer: spelling error is OK, as long as you can understand the meaning of the sentence written]
MH050		Now, listen carefully and follow my direction. Are you ready? When I give you a piece of paper, please turn it over, fold it in half, and give it back to me. [Instruction for Interviewer: (1) Tidy up the surroundings (especially the front) so it doesnt interfere with the respondent. (2) Do not repeat the question in the middle of the process. (3) Do not give out the paper in advance. (4) Directions can be repeated if the respondent seems unable to understand the directions or if the respondent asks you to repeat the directions. In this case, the paper first given out should be collected and the process should start over]
MH051		[Instruction for Interviewer: Show the picture of two pentagons overlapped] Do you see this picture? Please draw that picture on this paper.
MH052		Could you draw picture of clock, showing ten past eleven and Contour looks OK?
MH053		Could you draw picture of clock, showing ten past eleven and Number looks OK?
MH054		Could you draw picture of clock, showing ten past eleven and Hands look right?
MH055		A little while ago, I read you a list of words and you repeated the ones you could remember. Please tell me any of the words that you remember now. [Instruction for Interviewer: Permit as much time as R wishes, up to 2 minutes] The list of words is: [The same list of words will appear on the screen for Interviewer] List 1: River, Tree, Temple, School, Hospital, Dog, Cat, Radio, Chair, Gold; List 2: Monkey, Car, Stone, Doctor, Phone, Fire, Road, Silver, Flower, Cow; List 3: Elephant, Bike, Kite, Teacher, House, Water, Butter, Book, Market, Baby;
MH056		Number of words R correctly recalls ______ [Hard check: MH056>10]
MH057		[For the interviewer] Was there any interruptions or noise that could distract the respondent during administering this module?
MH058		[For the interviewer] How often did the respondent receive assistance in answering this section?
MH059		[Ask only if MH058>1] Who helped the respondent in answering this section?
MH101		Part of this study is concerned with people's memory, and ability to think about things. First, how would you rate [NAME]'s memory at the present time? Would you say it is excellent, very good, good, fair, or poor?
MH102		Now we want you to remember what your friend or relative was like 10 years ago and to compare it with what he/she is like now. Ten years ago was [Year]. Compared to ten years ago, would you say [Rs NAME]'s memory is better now, about the same, or worse now than it was then?
MH103		I will present situations where this person has to use his/her memory or intelligence and I want you to indicate whether this has improved, stayed the same or got worse than in that situation over the past 10 years. Note the importance of comparing his/h
MH104		Remembering things about family and friends, e.g. occupations, birthdays, addresses
MH105		Remembering things that have happened recently
MH106		Recalling conversations a few days later
MH107		Remembering her/his address and telephone number
MH108		Remembering what day and month it is
MH109		Remembering where things are usually kept
MH110		Remembering where to find things which have been put in a different place from usual
MH111		Knowing how to work familiar machines around the house
MH112		Learning to use a new gadget or machine around the house
MH113		Learning new things in general
MH114		Following a story in a book or on TV
MH115		Making decisions on everyday matters
MH116		Handling money for shopping
MH117		Handling financial matters, e.g. the pension, dealing with the bank
MH118		Handling other everyday arithmetic problems, e.g. knowing how much food to buy, knowing how long between visits from family or friends
MH119		Using his/her intelligence to understand whats going on and to reason things through
MH120		Now, please think about [Rs NAME] some current behaviors,
MH121		Does [she/he] ever get lost in a familiar environment?
MH122		Does [she/he] ever wander off and not return by [her-self/him-self]?
MH123		Can [she/he] be left alone for an hour or so?
MH124		Does [she/he] ever see or hear things that are not really there?
MH125		During the past week, how often has [Rs NAME] become angry or hostile without reason? Was it most of the time, some of the time, or never?
MH126		[Interviewer: if proxy is a household member, please enter Household Person ID from pre-loaded household roster] Proxys Household Person ID: ___________
MH127		How often did the proxy receive assistance in answering this section?
MH128		Who helped the respondent in answering this section?
MH201		[Screening Question] During the last 12 months, was there ever a time when you felt sad, blue, or depressed for two weeks or more in a row?
MH202		[Ask only If MH201=1]Please think of the two-week period during the last 12 months when these feelings were worst. During that time did the feelings of being sad, blue, or depressed usually last all day long, most of the day, about half the day, or less than half the day?
MH203		[Ask If MH202=1 or 2]During those two weeks, did you feel this way every day, almost every day, or less often than that?
MH204		Thinking about those same two weeks, Did you lose interest in most things?
MH205		Thinking about those same two weeks, Did you ever feel more tired out or low in energy than is usual for you?
MH206		Thinking about those same two weeks, Did you lose your appetite?
MH207		Thinking about those same two weeks, [Ask only if MH206=2]Did your appetite increase during those same two weeks?
MH208		Thinking about those same two weeks, During the same two-week period did you have a lot more trouble concentrating than usual?
MH209		Thinking about those same two weeks, People sometimes feel down on themselves, and no good or worthless. During that two-week period, did you feel this way?
MH210		Thinking about those same two weeks, Did you think a lot about death - either your own, someone elses, or death in general - during those two weeks?
MH211		Thinking about those same two weeks, Did you have more trouble falling asleep than you usually do during those two weeks?
MH212		[Ask only If MH211=1] Did the problem with falling asleep happen every night, nearly every night, or less often during those two weeks?
MH213		[Ask only if CIDI_1 > 0] About how many weeks altogether - out of 52 - did you feel sad, blue, or depressed during the last 12 months? ____ Number of weeks [Hard check: MH213<2 &>52]
MH214		[Screening Question] During the past 12 months, was there ever a time lasting two weeks or more when you lost interest in most things like hobbies, work, or activities that usually give you pleasure?
MH215		[Ask only if MH214=1] Please think of the two-week period during the last 12 months when you had the most complete loss of interest in things. During that two-week period, did the loss of interest usually last all day long, most of the day, about half the day, or less than half the day?
MH216		[Ask if MH215 = 1 or 2] Did you feel this way every day, almost every day, or less often during the two weeks?
MH217		Did you feel tired out or low on energy all the time during those two weeks?
MH218		During those same two weeks, did you lose your appetite during those two weeks?
MH219		During those two weeks, did you have more trouble concentrating than usual during those two weeks?
MH220		People sometimes feel down on themselves, no good or worthless. Did you feel this way during that two-week period during those two weeks?
MH221		Did you think a lot about death during those two weeks - either your own, someone elses, or death in general during those two weeks?
MH222		During those same two weeks, did you have more trouble falling asleep than you usually do during those two weeks?
MH223		[Ask only if CIDI_2>0] About how many weeks altogether - out of 52 - did you lose interest in most things like hobbies, work, or activities that usually give you pleasure during the last 12 months? ____ Number of weeks [Hard check : MH223 <2 &>52]
HB001		Have you ever smoked tobacco (cigarette, bidi, cigar, hookah, cheroot) or used smokeless tobacco (such as chewing tobacco, gutka, pan masala, etc.)?
HB002		[Ask only if HB001=1] How old were you when you first started smoking or using smokeless tobacco? Age _____ OR Year started smoking or consume smokeless tobacco _____ OR ______ Years ago [Soft check: 5 years<=HB002_age<=Rs current age][HB002_Years ago <=Current age -5years] [HB002<=Rs current age]
HB003		[Ask only if HB001 = 1] What type of tobacco product have you used or consumed?
HB003a		[Ask if HB001=1 and HB003=1 or 3] Do you currently smoke any tobacco products (cigarettes, bidis, cigars, hookah, cheroot)?
HB004		[Ask if HB003=1 or 3] How many cigarettes, bidis, cigars, cheroot do you usually smoke in a day? ____ Number of cigarettes/bidis/cigars/ cheroot [Soft check: HB004_Number of cigarettes bidis/cigars/cheroots<=30]
HB005		[Ask only if HB003_a=2]At what age did you completely stop smoking? Age _____ OR Year quit smoking_____ OR _____ years ago [Soft check: HB005_Age<=Rs current age] [HB005_years ago<=Rs current age-5 years]
HB006		[Ask if HB001=1 AND HB003=2 or 3]Do you currently consume any smokeless tobacco products such as chewing tobacco, gutka, or pan masala?
HB007		[Ask only if HB006=1]Please tell me approximately how many grams of tobacco you normally consume per day, including chewing tobacco, sniffing tobacco, and other tobacco products. If it is easier you can tell me how many grams per week. Grams: ____
HB008		[Ask only if HB006=1]Please tell me approximately how many grams of tobacco you normally consume per day, including chewing tobacco, sniffing tobacco, and other tobacco products. If it is easier you can tell me how many grams per week. Per: day/week
HB009		[Ask only if HB007 is DK]How many times per day/week do you chew tobacco, pan masala, etc.? Times: ____
HB010		[Ask only if HB007 is DK]How many times per day/week do you chew tobacco, pan masala, etc.? Per: day/week
HB011		[Ask only if HB006=2]At what age did you totally stop consuming smokeless tobacco? Age _____ OR Year quit consuming smokeless tobacco_____ OR _____ years ago [Soft check: HB011_Age<=Rs current age] [HB011_years ago<=Rs current age-5years]
HB101		Have you ever consumed any alcoholic beverages such as beer, wine, liquor, country liquor etc.?
HB102		[Ask only if HB101=1] At what age did you first consume alcoholic beverages? Age------- OR ---------Year [Soft Check: 5 years<=HB102_age<=Rs current age]
HB103		[Ask only if HB101=1] In the past three months, on an average, how frequently [on how many days], have you had at least one alcoholic drink? (For example, beer, wine, or any drink, such as country liquor, containing alcohol.)
HB104		[Ask only if HB103>0] What type of drinks do you usually drink? [ Multiple answers allowed]
HB105		[Ask only if HB103>0] In the past 3 months, on the days you drank alcoholic beverages; about how many drinks did you have on average? (SHOW CARD: number of standard drinks (cc cl/ unit in ml)) ____ Number of drinks
HB106		[Ask only If HB103>0]In the last 3 months, how frequently on average, have you had atleast 5 or more drinks on one occasion?
HB107		Have you ever felt that you should cut down on drinking?
HB108		Have people ever annoyed you by criticizing your drinking?
HB109		Have you ever felt bad or guilty about drinking?
HB110		Have you ever taken a drink first thing in the morning to steady your nerves or get rid of a hangover?
HB211		We would like to know the type and amount of physical activity involved in your daily life. How often do you take part in sports or vigorous activities, such as running or jogging, swimming, going to a health center or gym, cycling, or digging with a spade or shovel, heavy lifting, chopping, farm work, fast bicycling, cycling with loads: everyday, more than once a week, once a week, one to three times a month, or hardly ever or never?
HB212		[Ask only if HT211<5] On the days you did vigorous activity, how much time did you usually spend doing any vigorous activity? MINUTES____ [Soft check: 0
HB213		How often do you take part in sports or activities that are moderately energetic such as, cleaning house, washing clothes by hand, fetching water or wood, drawing water from a well, gardening, bicycling at a regular pace, walking at a moderate pace, dancing, floor or stretching exercises (everyday, more than once a week, once a week, one to three times a month, hardly ever, or never)?
HB214		[Ask only if HB213<5] How much time did you usually spend doing any moderate activity on an average in a day? MINUTES____ [Soft check: 0
HB215		How often do you engage in any of the following activities like yoga, meditation, asana, pranayama or similar?
HB216		[Ask only if HB215<5] How much time do you usually spend doing these activities on an average in a day? MINUTES____ [Soft Check: 0
HB217		How often did the respondent receive assistance in answering this section?
HB219		[Ask only if HB217>1] What is his/her relationship to [NAME OF RESPONDENT]?
FO230		[Now we would like to ask you questions about household food availability. In India many people have uncertain access to adequate quantity and quality of food due to constrained resources, either temporary or on a chronic basis. Also food availability, variety, and quality are often not enough to meet household needs. As a result some policy discussions are going on to ensure food and nutrition security for the people of our country. We would very much appreciate your honest participation in this section. (For the interviewer: Please ensure that the respondent is alone while answering this section]. In the last 12 months, did you ever reduce the size of your meals or skip meals because there was not enough food at your household?
FO231		In the last 12 months, did you eat enough food of your choice? Please exclude fasting/food related restrictions due to religious or health related reason.
FO232		In the last 12 months, were you hungry but didnt eat because there was not enough food at your household? Please exclude fasting/food related restrictions due to religious or health related reasons.
FO233		In the past 12 months did you ever not eat for a whole day because there was not enough food at your household? Please exclude fasting/food related restrictions due to religious or health related reasons.
FO234		Do you think that you have lost weight in the last 12 months because there was not enough food at your household?
FO236		How often did the respondent receive assistance in answering this section?
FO238		[Ask only if FO236>1What is his/her relationship to [NAME OF RESPONDENT]?

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I_C. Health (HT)