SIPP Home > Survey Content > Topical Modules > Topical Module Chart Listing > 1996 Schedule > 1996 Topical Module Questionnaires > Wave 8 Questionnaires > Adult Well-Being
1996 Panel SIPP Wave 8 Adult Well-Being User Note
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>AW2_APT<
DO NOT READ TO RESPONDENT (ASK ONLY IF NECESSARY)
Is there more than one housing unit in this building?
(1)Yes
(2)No
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>AW5_CNDUR<
SHOW FLASHCARD AA (READ ANSWER CATEGORIES IF NECESSARY)
Do you currently have the following items in your home, in working condition?
(1) Yes (2) No
___(01)Washing machine
___(02)Clothes dryer
___(03)Dishwasher
___(04)Refrigerator
___(05)Stand-alone food freezer (separate from refrigerator)
___(06)Color television
___(07)Gas or electric stove (with or without oven)
___(08)Microwave oven
___(09)Videocassette recorder (VCR)
___(10)Air conditioner (central or room)
___(11)Personal computer
___(12)Cellular phone or car phone
___(13)Regular telephone
__________________________________________________________________
>AW6_CBLD1<
You didn't list a washing machine in your home. Is there a washing machine
in your
BUILDING provided for your use?
(1)Yes
(2)No
@___
_________________________________________________________________
>AW7_CBLD2<
You didn't list a dryer in your home. Is there a dryer in your BUILDING provided for your use?
(1) Yes
(2) No
__________________________________________________________________
>AW8_CBLD13<
You didn't list a telephone in your home. Is there a way for people to reach you by telephone?
(1) Yes, neighbor's phone, common phone, pay phone
(2) Yes, cell phone
(3) Yes, other device
(4) No, cannot be reached by telephone
___________________________________________________________________
>AW9_ROOMS<
The next set of questions are about the quality of your neighborhood,
crime in your
neighborhood, and the type of services available to you. First, I will
ask about your home.
How many rooms are there in your home? Count the kitchen but do not count the bathrooms.
FR NOTE: Acceptable range is 1-20. Enter 20 to indicate 20 or more rooms.
@ ___(Number of rooms)
____________________________________________________________________
>AW10_HOUSE1<
SHOW FLASHCARD BB (READ ANSWER CATEGORIES IF NECESSARY)
Are any of the following conditions present in your home?
ENTER ALL THAT APPLY AND ENTER "N" AFTER LAST ENTRY
(1) Problem with pests such as rats, mice, roaches, or other insects
(2) A leaking roof or ceiling
(3) Broken window glass or windows that can't shut
(4) Exposed electrical wires in the finished areas of your home
(5) A toilet, hot water heater, or other plumbing that doesn't work
(6) Holes in the walls or ceiling, or cracks wider than the edge of
a dime
(7) Holes in the floor big enough for someone to catch their foot on
____________________________________________________________________
>AW11_HOUSE2<
SHOW FLASHCARD CC
Now I'm going to ask you a few questions about your satisfaction with
certain aspects of your
housing. Are you very satisfied, somewhat satisfied, somewhat dissatisfied,
or very dissatisfied,
with the following:
FR NOTE: Very satisfied=1
Somewhat satisfied=2
Somewhat dissatisfied=3
Very dissatisfied=4
Haven't lived here long enough to know=5
[BLIND] Don't know=D
[BLIND] Refused=R
@___ (1)The general state of repair of your home
@___ (2)The amount of room or space in your home
@___ (3)The furnishings in your home
@___ (4)The warmth of your home in winter
@___ (5)The coolness of your home in summer
@___ (6)The amount of privacy your home offers
___________________________________________________________________
>AW12_SATLV1<
SHOW FLASHCARD DD (READ ANSWER CATEGORIES IF NECESSARY)
Overall, how satisfied are you with your home?
(1) Very satisfied
(2) Somewhat satisfied
(3) Somewhat dissatisfied
(4) Very dissatisfied
___________________________________________________________________
>AW13_SATLV2<
Are conditions in your home undesirable enough that you would like to move?
(1) Yes
(2) No
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LIVING CONDITIONS -- CRIME
The next few questions are about crime and things you have done to protect yourself from crime.
Is there any area right around your home that is, within a mile where
you would be afraid
to walk alone at night?
(1) Yes
(2) No
__________________________________________________________________
>AW15_CRIME2<
In the past month, have you done any of the following because you thought
you might be
unsafe?
(1) Yes (2) No
___(1) Have you stayed in your home at certain times?
___(2) Have you taken someone with you or traveled with other people
when going out into your neighborhood?
___(3) Have you carried anything to protect yourself?
_____________________________________________________________________
>AW16_CRIME3<
Do you consider your neighborhood very safe from crime, somewhat safe,
somewhat unsafe, or
very unsafe?
(1) Very safe
(2) Somewhat safe
(3) Somewhat unsafe
(4) Very unsafe
____________________________________________________________________
>AW17_CRIME4<
How about your home? Do you consider it very safe from crime, somewhat
safe, somewhat
unsafe, or very unsafe?
(1) Very safe
(2) Somewhat safe
(3) Somewhat unsafe
(4) Very unsafe
____________________________________________________________________
>AW18_CRIME5<
We are interested in finding out if people do anything in particular
to keep thieves or intruders
out of their homes.
(DO/DOES)(YOU/YOUR HOUSEHOLD) have a dog?
(1) Yes
(2) No
___________________________________________________________________
>AW19_CRIME6<
When you got (this dog/these dogs), was it in part to keep your home
safe from thieves or
intruders?
(1) Yes
(2) No
____________________________________________________________________
>AW20_CRIME7<
(DO/DOES)(YOU/YOUR HOUSEHOLD) have any special safety DEVICES such as
electric
timers for lights, or an alarm system?
(1) Yes
(2) No
___________________________________________________________________
>AW21_SATLV3<
Overall, is the threat of crime where you live undesirable enough that you would like to move?
(1) Yes
(2) No
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LIVING CONDITIONS -- NEIGHBORHOOD CONDITIONS
Now I will ask some questions about general conditions in your neighborhood.
SHOW FLASHCARD EE (READ ANSWER CATEGORIES IF NECESSARY)
Do you think any of the following conditions are problems in your neighborhood?
ENTER ALL THAT APPLY AND ENTER "N" AFTER LAST ENTRY
(1) Street noise or heavy street traffic
(2) Streets in need of repair
(3) Trash, litter, or garbage in the streets and lots
(4) Rundown or abandoned houses or buildings
(5) Industries, businesses, or other non-residential activities
(6) Odors, smoke, or gas fumes
______________________________________________________________________
>AW23_NBRHD2<
SHOW FLASHCARD DD
How satisfied are you with your relationship with your neighbors?
Are you very satisfied, somewhat satisfied, somewhat dissatisfied, or very dissatisfied?
(1) Very satisfied
(2) Somewhat satisfied
(3) Somewhat dissatisfied
(4) Very dissatisfied
_______________________________________________________________________
>AW24_SATLV4<
SHOW FLASHCARD DD
Overall, how satisfied are you with conditions in your neighborhood?
READ IF NECESSARY
(1) Very satisfied
(2) Somewhat satisfied
(3) Somewhat dissatisfied
(4) Very dissatisfied
_______________________________________________________________________
>AW25_SATLV5<
Is your neighborhood undesirable enough that you would like to move?
(1) Yes
(2) No
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LIVING CONDITIONS -- COMMUNITY SERVICES
Now I'm going to ask you a few questions about your satisfaction with
services and facilities in
your neighborhood.
PRESS ENTER
____________________________________________________________________
>AW27_CS1<
SHOW FLASHCARD DD
How satisfied are you with the local public schools in your neighborhood?
READ IF NECESSARY
(1) Very satisfied
(2) Somewhat satisfied
(3) Somewhat dissatisfied
(4) Very dissatisfied
_____________________________________________________________________
>AW28_CS2<
SHOW FLASHCARD FF (READ ANSWER CATEGORIES IF NECESSARY)
We are interested in schools from kindergarten through 12th grade. Do
any of the
children in your household attend:
(1) Yes (2) No
___(1) Private school
___(2) Magnet, charter, or other public school apart from the assigned
school
___(3) Assigned public school
___(4) Home school
___(5) Not in school or other arrangement
___________________________________________________________________
>AW29_CS3<
Would (YOU/ANYONE IN YOUR HOUSEHOLD/YOU OR THE OTHER ADULTS IN THE
HOUSEHOLD/YOU OR THE OTHER ADULT IN THE HOUSEHOLD) prefer a different
school for any child in this home?
(1) Yes
(2) No
____________________________________________________________________
>AW30_CS4<
Are you very satisfied, somewhat satisfied, somewhat dissatisfied, or
very dissatisfied with each
of the following services in your neighborhood:
FR NOTE: Very satisfied=1
Somewhat satisfied=2
Somewhat dissatisfied=3
Very dissatisfied=4
Haven't lived here long enough to know=5
[BLIND] Don't know=D
[BLIND] Refused=R
@___ (1)Hospitals, health clinics, and doctors
@___ (2)Police services
@___ (3)Fire department services
__________________________________________________________________
>AW31_CS5 <
Are the public transportation services available in your neighborhood adequate for you?
(1) Yes
(2) No
(3) Not sure because you do not use public transportation
___________________________________________________________________
>AW32_SATLV6<
SHOW FLASHCARD DD
Overall, how satisfied are you with the public services in your neighborhood?
READ IF NECESSARY
(1) Very satisfied
(2) Somewhat satisfied
(3) Somewhat dissatisfied
(4) Very dissatisfied
___________________________________________________________________
>AW33_SATLV7<
Are the public services undesirable enough that you would like to move?
(1) Yes
(2) No
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BASIC NEEDS -- ABILITY TO MEET EXPENSES
Next are questions about difficulties people sometimes have in meeting
their essential household
expenses for such things as mortgage or rent payments, utility bills,
or important medical care.
During the past 12 months, has there been a time when (YOU/YOUR HOUSEHOLD)
did not
meet all of your essential expenses?
(1) Yes
(2) No
____________________________________________________________________
>AW35_NEED1<
The following are some of the specific difficulties people experience with household expenses.
Was there any time in the past 12 months when (YOU/YOUR HOUSEHOLD) did
not pay the
full amount of the rent or mortgage?
(1) Yes
(2) No
____________________________________________________________________
>AW36_GETH1<
When (YOU/YOUR HOUSEHOLD) had this problem, did any person or organization help?
(1) Yes
(2) No
____________________________________________________________________
>AW37_WHOH1<
ENTER ALL THAT APPLY AND ENTER "N" AFTER LAST ENTRY
Who was that?
(1) A family member or relative
(2) A friend, neighbor or other non-relative
(3) A department of social services
(4) A church or nonprofit group
(5) Other
@___
_____________________________________________________________________
>AW38_NEED2<
In the past 12 months (WERE/WAS) (YOU/ANYONE IN YOUR HOUSEHOLD) evicted
from
your home or apartment for not paying the rent or mortgage?
(1) Yes
(2) No
____________________________________________________________________
>AW39_GETH2<
When (YOU/YOUR HOUSEHOLD) had this problem, did any person or organization help?
(1) Yes
(2) No
___________________________________________________________________
>AW40_WHOH2<
ENTER ALL THAT APPLY AND ENTER "N" AFTER LAST ENTRY
Who was that?
(1) A family member or relative
(2) A friend, neighbor or other non-relative
(3) A department of social services
(4) A church or nonprofit group
(5) Other
_______________________________________________________________
>AW41_NEED3<
How about not paying the full amount of the gas, oil, or electricity bills?
Was there a time in the past 12 months when that happened to (YOU/YOUR HOUSEHOLD)?
(1) Yes
(2) No
________________________________________________________________
>AW42_GETH3<
When (YOU/YOUR HOUSEHOLD) had this problem, did any person or organization help?
(1) Yes
(2) No
________________________________________________________________
>AW43_WHOH3<
ENTER ALL THAT APPLY AND ENTER "N" AFTER LAST ENTRY
Who was that?
(1) A family member or relative
(2) A friend, neighbor or other non-relative
(3) A department of social services
(4) A church or nonprofit group
(5) Other
_________________________________________________________________
>AW44_NEED4<
In the past 12 months did the gas or electric company turn off service,
or the oil company not
deliver oil?
(1) Yes
(2) No
_________________________________________________________________
>AW45_GETH4<
When (YOU/YOUR HOUSEHOLD) had this problem, did any person or organization help?
(1) Yes
(2) No
_________________________________________________________________
>AW46_WHOH4<
ENTER ALL THAT APPLY AND ENTER "N" AFTER LAST ENTRY
Who was that?
(1) A family member or relative
(2) A friend, neighbor or other non-relative
(3) A department of social services
(4) A church or nonprofit group
(5) Other
__________________________________________________________________
>AW47_NEED5<
How about the telephone company disconnecting service because payments were not made?
Was there a time in the past 12 months when that happened to (YOU/YOUR HOUSEHOLD)?
(1) Yes
(2) No
____________________________________________________________________
>AW48_GETH5<
When (YOU/YOUR HOUSEHOLD) had this problem, did any person or organization help?
(1) Yes
(2) No
_______________________________________________________________
>AW49_WHOH5<
ENTER ALL THAT APPLY AND ENTER "N" AFTER LAST ENTRY
Who was that?
(1) A family member or relative
(2) A friend, neighbor or other non-relative
(3) A department of social services
(4) A church or nonprofit group
(5) Other
_______________________________________________________________
>AW50_NEED6<
In the past 12 months was there a time (YOU/ANYONE IN YOUR HOUSEHOLD)
needed to
see a doctor or go to the hospital but did not go?
(1) Yes
(2) No
_______________________________________________________________
>AW51_GETH6<
When (YOU/YOUR HOUSEHOLD) had this problem, did any person or organization help?
(1) Yes
(2) No
______________________________________________________________
>AW52_WHOH6<
ENTER ALL THAT APPLY AND ENTER "N" AFTER LAST ENTRY
Who was that?
(1) A family member or relative
(2) A friend, neighbor or other non-relative
(3) A department of social services
(4) A church or nonprofit group
(5) Other
_______________________________________________________________
>AW53_NEED7<
In the past 12 months was there a time (YOU/ANYONE IN YOUR HOUSEHOLD)
needed to
see a dentist but did not go?
(1) Yes
(2) No
______________________________________________________________
>AW54_GETH7<
When (YOU/YOUR HOUSEHOLD) had this problem, did any person or organization help?
(1) Yes
(2) No
________________________________________________________________
>AW55_WHOH7<
ENTER ALL THAT APPLY AND ENTER "N' AFTER LAST ENTRY
Who was that?
(1) A family member or relative
(2) A friend, neighbor or other non-relative
(3) A department of social services
(4) A church or nonprofit group
(5) Other
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BASIC NEEDS -- HELP WHEN IN NEED
SHOW FLASHCARD GG (READ ANSWER CATEGORIES IF NECESSARY)
If (YOU/YOUR HOUSEHOLD) had a problem with which you needed help (for
example,
sickness or moving), how much help would you expect to get from family
living nearby?
(1) All of the help needed
(2) Most of the help needed
(3) Very little of the help needed
(4) No help
_______________________________________________________________
>AW57_HELP2<
SHOW FLASHCARD GG (READ ANSWER CATEGORIES IF NECESSARY)
If (YOU/YOUR HOUSEHOLD) had a problem with which you needed help
How much help would you expect to get from friends?
(1) All of the help needed
(2) Most of the help needed
(3) Very little of the help needed
(4) No help
______________________________________________________________
>AW58_HELP3<
SHOW FLASHCARD GG (READ ANSWER CATEGORIES IF NECESSARY)
If (YOU/YOUR HOUSEHOLD) had a problem with which you needed help
How much help would you expect to get from other people in the community
besides family and
friends, such as a social agency or a church?
(1) All of the help needed
(2) Most of the help needed
(3) Very little of the help needed
(4) No help
----------------------------------------------------------------
BASIC NEEDS -- FOOD ADEQUACY
SHOW FLASHCARD HH (READ ANSWER CATEGORIES IF NECESSARY)
Getting enough food can also be a problem for some people. Which of
these statements best
describes the food eaten in your household in the last four months:
(1) Enough of the kinds of food we want
(2) Enough but not always the kinds of food
we want to eat
(3) Sometimes not enough to eat
(4) Often not enough to eat
______________________________________________________________
>AW60_FOOD2<
In which of the last four months did (YOU/ANYONE IN YOUR HOUSEHOLD)
NOT have
enough to eat?
ENTER ALL THAT APPLY AND ENTER "N" AFTER LAST ENTRY
(1) 4 mos. ago [Fill month 1]
(2) 3 mos. ago [Fill month 2]
(3) 2 mos. ago [Fill month 3]
(4) last month [Fill month 4]
(5) current month [Fill month 5]
__________________________________________________________________
>AW61_FOOD3<
I'm going to read you some statements that people have made about their
food situation. For
these statements, please tell me whether it was OFTEN TRUE, SOMETIMES
TRUE, or NEVER
TRUE for (YOU/ANYONE IN YOUR HOUSEHOLD) in the last four months.
"The food that (I/WE) bought just didn't last and (I/WE) didn't have money to get more."
Was that often, sometimes or never true for (YOU/YOUR HOUSEHOLD) in
the last four
months?
(1) Often true
(2) Sometimes true
(3) Never true
______________________________________________________________
>AW62_FOOD4<
The next statement is: "(I/WE2) couldn't afford to eat balanced meals."
Was that often, sometimes or never true for (YOU/YOUR HOUSEHOLD) in
the last four
months?
(1) Often true
(2) Sometimes true
(3) Never true
________________________________________________________________
>AW63_FOOD5<
The next statement is: "(MY CHILD WAS/OUR CHILD WAS/ THE CHILDREN WERE)
not
eating enough because (I/WE) couldn't afford enough food."
Was that often, sometimes or never true for (YOU/YOUR HOUSEHOLD) in
the last four
months?
(1) Often true
(2) Sometimes true
(3) Never true
________________________________________________________________
>AW64_FOOD6<
The next questions refer to adults in the household.
In the past four months did (YOU/ANYONE IN YOUR HOUSEHOLD/ YOU OR THE
OTHER
ADULTS IN THE HOUSEHOLD/YOU OR THE OTHER ADULT IN THE HOUSEHOLD)
ever cut the size of your meals or skip meals because there wasn't
enough money for food?
(1) Yes
(2) No
________________________________________________________________
>AW65_FOOD7<
In the past four months, did (YOU/ANYONE IN YOUR HOUSEHOLD/ YOU OR THE
OTHER ADULTS IN THE HOUSEHOLD/YOU OR THE OTHER ADULT IN THE
HOUSEHOLD) ever eat less than you felt you should because there wasn't
enough money to buy
food?
(1) Yes
(2) No
_________________________________________________________________
>AW66_FOOD8<
In the past four months, did (YOU/ANYONE IN YOUR HOUSEHOLD/ YOU OR THE
OTHER ADULTS IN THE HOUSEHOLD/YOU OR THE OTHER ADULT IN THE
HOUSEHOLD) ever not eat for a whole day because there wasn't enough
money for food?
(1) Yes
(2) No
-----------------------------------------------------------------
Did respondent use any records when reporting the amount of annual
income received, or income received from retirement accounts?
(1) Yes
(2) No
@
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Page Last Modified: May 12, 2006
