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Scientific Data Documentation
Vision, Ages 6 - 74 years (1982-1984)DSN: CC37.HSPHANES.VISION ABSTRACT Introduction Hispanic Health and Nutrition Examination Survey Mexican Americans Cuban Americans Puerto Ricans The Hispanic Health and Nutrition Examination Survey (HHANES) was conducted from July 1982 through December 1984. The data on the tape documented here are from all three portions of the survey: Mexican Americans Residing in selected counties of Texas, Colorado, New Mexico, Arizona, and California Surveyed from July 1982 through November 1983 9,894 persons sampled; 8,554 interviewed; 7,462 examined Cuban Americans Residing in Dade County (Miami), Florida Surveyed from January 1984 through April 1984 2,244 persons sampled; 1,766 interviewed; 1,357 examined Puerto Ricans Residing in New York City area, including parts of New Jersey and Connecticut Surveyed from May 1984 through December 1984 3,786 persons sampled; 3,369 interviewed; 2,834 examinedCaution Notice C A U T I O N BEFORE USING THIS DATA TAPE, PLEASE READ THIS PAGE. * Read the accompanying description of the survey, "The Plan and Operation of the Hispanic Health and Nutrition Examination Survey", DHHS Publication No. (PHS) 85-1321 before conducting analyses of the data on this tape. * Two aspects of HHANES, especially, should be taken into account when conducting any analyses: the sample weights and the complex survey design. * Analyses should not be conducted on data combined from the three portions of the survey (Mexican-American, Cuban-American, Puerto Rican). * HHANES is a survey of Hispanic households and some of the sample persons included on this tape are not of Hispanic origin. A detailed description of the data codes dealing with national origin or ancestry appears in the NOTES section of this document. * Examine the range and frequency of values of a variable before conducting an analyses of data. The range may include unusual or unexpected values. The frequency counts may be useful to determine which analyses may be worthwhile. * Language of interview, which may appear several places on this tape, can vary depending on the questionnaire (several used in the survey) and on whether the response was provided by the sample person or by a proxy. * For some data items, reference is made to a note. The notes (in a separate section of this document) may be very important in data analyses. Attention to them is strongly urged. This Public Use Data Tape has been edited very carefully. Numerous consistency and other checks were also performed. Nevertheless, due especially to the large number of data items, some errors may have gone undetected. Please bring to the attention of NCHS any errors in the data tape or the documentation. Errata sheets will be sent to people who have purchased the data tapes and corrections will be made to subsequently released data tapes. In publications, please acknowledge NCHS as the original data source. The acknowledgment should include a disclaimer crediting the authors for analyses, interpretations, and conclusions; NCHS should be cited as being responsible for only the collection and processing of the data. In addition, NCHS requests that the acronym HHANES be placed in the abstracts of journal articles and other publications based on data from this survey in order to facilitate the retrieval of such materials through automated bibliographic searches. Please send reprints of journal articles and other publications that include data from this tape to NCHS. Division of Health Examination Statistics National Center for Health Statistics Center Building, Room 2-58 3700 East-West Highway Hyattsville, MD 20782 Public Use Data Tapes for the Hispanic Health and Nutrition Examination Survey will be released through the National Technical Information Service (NTIS) as soon as the data have been edited, validated, and documented. A list of NCHS Public Use Data Tapes that can be purchased from NTIS may be obtained by writing the Scientific and Technical Information Branch, NCHS. Scientific and Technical Information Branch National Center for Health Statistics Center Building, Room 1-57 3700 East-West Highway Hyattsville, MD 20782 301-436-8500BACKGROUND Introduction The National Center for Health Statistics (NCHS) collects, analyzes, and disseminates data on the health status of Americans. The results of surveys, analyses, and studies are made known primarily through publications and the release of computer data tapes. This document contains details required to guide programmers, statistical analysts, and research scientists in the use of a Public Use Data Tape. From 1960 through 1980 NCHS conducted five population-based, national health examination surveys. Each survey involved collecting data by direct physical examination, the taking of a medical history, and laboratory and clinical tests and measurements. Questionnaires and examination components have been designed to obtain and support analyses of data on certain targeted conditions such as diabetes, hypertension, and anemia. Beginning with the first National Health and Nutrition Examination Survey (NHANES I) a nutrition component was added to obtain information on nutritional status and dietary practices. The numbers of Hispanics in these samples were, however, insufficient to enable adequate estimation of their health conditions. From 1982 through 1984 a Hispanic Health and Nutrition Examination Survey (HHANES) was conducted to obtain data on the health and nutritional status of three Hispanic groups: Mexican Americans from Texas, Colorado, New Mexico, Arizona, and California; Cuban Americans from Dade County, Florida; and Puerto Ricans from the New York City area, including parts of New Jersey and Connecticut. The general structure of the HHANES sample design was similar to that of the previous National Health and Nutrition Examination Surveys. All of these studies have used complex, multistage, stratified, clustered samples of defined populations. The major difference between HHANES and the previous surveys is that HHANES was a survey of three special subgroups of the population in selected areas of the United States rather than a national probability sample. A detailed presentation of the design specifications is found in Chapter 5 of "Plan and Operation of the Hispanic Health and Nutrition Examination Survey, 1982-84" (Ref. No. 1). Data collection began with a household interview. Several questionnaires were administered: * A Household Screener Questionnaire (HSQ), administered at each selected address, for determining household eligibility and for selecting sample persons. * A Family Questionnaire (FQ), administered once for each family containing sample persons, which included sections on family relationships, basic demographic information for sample persons and head of family, Medicare and health insurance coverage, participation in income assistance programs, and housing characteristics. * An Adult Sample Person Questionnaire (ASPQ), for persons 12 through 74 years which, depending on age, included sections on health status measures, health services utilization, smoking (20 through 74 years), meal program participation, and acculturation. Information on the use of medicines and vitamins in the past two weeks was also obtained. * A Child Sample Person Questionnaire (CSPQ), for sample persons 6 months through 11 years which included sections on a number of health status issues, health care utilization, infant feeding practices, participation in meal programs, school attendance, and language use. Information on the use of medicines and vitamins in the past two weeks was also obtained. At the Mobile Examination Center two questionnaires were administered and an examination performed: * An Adult Sample Person Supplement (ASPS), for sample persons 12 through 74 years, which included sections on alcohol consumption, drug abuse, depression, smoking (12 through 19 years), pesticide exposure, and reproductive history. * A Dietary Questionnaire (DQ), for persons 6 months through 74 years, by which trained dietary interviewers collected information about "usual" consumption habits and dietary practices, and recorded foods consumed 24-hours prior to midnight of the interview. * An examination which included a variety of tests and procedures. Age at interview and other factors determined which procedures were administered to which examinees. A dentist performed a dental examination and a vision test. Technicians took blood and urine specimens and administered a glucose tolerance test, X-rays, electrocardiograms, and ultrasonographs of the gallbladder. Technicians also performed hearing tests and took a variety of body measurements. A physician performed a medical examination focusing especially on the cardiovascular, gastrointestinal, neurological, and musculoskeletal systems. The physician's impression of overall health, nutritional and weight status, and health care needs were also recorded. Some blood and urine specimen analyses were performed by technicians in the examination center; others were conducted under contract at various laboratories. Because the HHANES sample is not a simple random one, it is necessary to incorporate sample weights for proper analysis of the data. These sample weights are a composite of individual selection probabilities, adjustments for noncoverage and nonresponse, and poststratification adjustments. The HHANES sample weights, which are necessary for the calculation of point estimates, are located on all data tapes in positions 184-213. Because of the complex sample design and the ratio adjustments used to produce the sample weights, commonly used methods of point and variance estimation and hypothesis testing which assume simple random sampling may give misleading results. In order to provide users with the capability of estimating the complex sample variances in the HHANES data, Strata and Pseudo Primary Sampling Unit (PSU) codes have been provided on all data tapes in positions 214-217. These codes and the sample weights are necessary for the calculation of variances. There are computer programs available designed for variance estimation for complex sample designs. The balanced repeated replication approach (Ref. No. 2) is used in &REPERR and a linearization approach is used in &PSALMS to calculate variance-covariance matrixes. Both routines are available within the OSIRIS IV library (Ref. No. 3). SURREGR (Ref. No. 4) and SUPERCARP (Ref. No. 5) are programs that calculate variance-covariance matrixes using a linearization approach (Ref. No. 6) (Taylor series expansion). Another program, SESUDAAN (Ref. No. 7) calculates standard errors, variances, and design effects. (Note: This version of SESUDAAN should not be used to obtain variances for totals.) SURREGR and SESUDAAN are special procedures which run data under the SAS system (Ref. No. 8). Even though the total number of examined persons in this survey is quite large, subclass analyses can lead to estimates that are unstable, particularly estimates of variances. Consequently, analysis of subclasses require that the user pay particular attention to the number of sample persons in the subclass and the number of PSU's that contain at least one sample person in the subclass. Small sample sizes, or a small number of PSU's used in the variance calculations, may produce unstable estimates of the variances. A more complete discussion of these issues and possible analytic strategies for examining various hypotheses is presented in Chapter 11 of "Plan and Operation of the Hispanic Health and Nutrition Examination Survey, 1982-84" (Ref. No. 1) and in an earlier NCHS methodology (Series 2) publication (Ref. No. 9). Some users, however, may not have access to the computer programs for estimating complex sample variances or may want to do their preliminary analyses without using them. In addition, variance estimates calculated from HHANES data through use of the programs described previously are likely to be unstable because there were so few sample areas for each portion of HHANES. This instability is not due to there being too few people in the sample but may be due to the fact that the sample was selected from relatively few areas. Therefore, the following discussion is designed to provide an alternative approach to deal with the unavailability of software and the small number of PSU's. The approach is based on using average design effects (Ref. No. 10). The design effect, defined as the ratio of the variance of a statistic from a complex sample to the variance of the same statistic from a simple random sample of the same size, that is, DESIGN EFFECT (DEFF) = COMPLEX SAMPLE VARIANCE ------------------------------- SIMPLE RANDOM SAMPLE VARIANCE is often used to show the impact of the complex sample design on variances. If the design effect is near 1, the complex sample design has little effect on the variances and the user could consider assuming simple random sampling for the analysis. Some illustrative design effects for HHANES data on this tape are given in the following tables. The design effects in the tables are the average for the age groups usually presented in NCHS Series 11 publications. If the average design effect for a subgroup was less than 1.0 (implying an improvement over simple random sampling), it was coded as 1.0. The following guidelines were used in the calculation of the average design effects: 1. Exclude all persons of non-Hispanic origin, 2. Exclude all estimates for large age ranges, such as all ages combined or 'all adults', and 3. Exclude all estimates where the proportion of the subpopulation with the specific characteristic or condition was zero percent or one hundred percent. Design effects tend to be larger when age groups are combined, just as they are when the sexes are combined, as shown in the tables. The data in the tables give the user an idea of the range in design effects for selected response variables from this data tape. If a response variable is not one shown in the tables take the range into account; it is possible that a user could have one of the higher, rather than one of the lower, design effects. Suppose, for example, that of the 1,438 Mexican-Americans ages 6-11 years, 1,106 or 77 percent have binocular distance vision acuity without correction of 20/20 or better. Assuming simple random sampling, the variance for the percent is calculated by converting the percent to a proportion and using the standard formula for the variance of a proportion. V = pq -- n This variance (V) multiplied by the design effect (DEFF) provides an estimate of the variance from a complex sample of the same sample size (n). In the example above, (.77) (.23) V = 1,438 = 0.00012 = variance for a simple random sample. Then, multiplying by the design effect, = (0.00012) (2.4) = (0.00029) = estimated variance for the complex sample In a similar way, the complex sample variance of a mean is determined by multiplying the simple random sample variance of the mean by the appropriate design effect. The user can then proceed with estimating confidence intervals and testing hypotheses in the usual manner. The user should recognize that this approach does not incorporate the variance-covariance matrix. In most cases, this leads to a slight overestimate of the variance because the covariance terms, which are subtracted in the variance of a ratio, in general, are positive. Thus, in a borderline case, the null hypothesis would be less likely to be rejected (Ref. No. 11). Alternative or better approaches may exist or be developed. Users who want to suggest such approaches, or who want the latest information should contact the Scientific and Technical Information Branch (address given in the beginning of this documentation).Table 1 VISION Average Design Effects, by Sex, for Selected Variables -- Mexican-American Portion Mean or Tape Both Variable Proportion Positions Sexes Male Female Distance Vision Acuity of 20/20 or Better Both eyes without correction p 511-513 2.4 1.7 1.8 Right eye with correction if worn p 517-519 1.5 1.3 1.3 Both eyes with correction p 520-522 1.2 1.2 1.0 Distance Vision Acuity of worse than 20/50 Both eyes without correction p 511-513 1.8 1.1 1.6 Right eye with correction if worn p 517-519 1.0 1.1 1.1 Both eyes with correction p 520-522 1.0 1.0 1.2 Binocular Vision Pass at 50 cm p 523 1.3 1.2 1.2 Near Vision Acuity of 20/20 or better at 40 cm Both eyes without correction p 529-531 2.5 1.7 2.0 Both eyes with correction p 541-543 1.4 1.3 1.5 Source: NCHS, HHANES, 1982-84, Tape Number 6507, Version 1.Table 2 Average Design Effects, by Sex, for Selected Variables -- Cuban-American Portion Mean or Tape Both Variable Proportion Positions Sexes Male Female Distance Vision Acuity of 20/20 or Better Both eyes without correction p 511-513 1.0 1.0 1.0 Right eye with correction if worn p 517-519 1.0 1.0 1.0 Both eyes with correction p 520-522 1.1 1.1 1.2 Distance Vision Acuity of worse than 20/50 Both eyes without correction p 511-513 1.2 1.0 1.1 Right eye with correction if worn p 517-519 1.1 1.3 1.0 Both eyes with correction p 520-522 1.0 1.0 1.0 Binocular Vision Pass at 50 cm p 523 1.6 1.6 1.0 Near Vision Acuity of 20/20 or better at 40 cm Both eyes without correction p 529-531 1.0 1.0 1.0 Both eyes with correction p 541-543 1.2 1.0 1.2 Source: NCHS, HHANES, 1982-84, Tape Number 6507, Version 1.Table 3 Average Design Effects, by Sex, for Selected Variables -- Puerto Rican Portion Mean or Tape Both Variable Proportion Positions Sexes Male Female Distance Vision Acuity of 20/20 or Better Both eyes without correction p 511-513 1.1 1.0 1.0 Right eye with correction if worn p 517-519 1.9 1.3 1.6 Both eyes with correction p 520-522 1.4 1.0 1.5 Distance Vision Acuity of worse than 20/50 Both eyes without correction p 511-513 1.0 1.0 1.0 Right eye with correction if worn p 517-519 1.0 1.0 1.0 Both eyes with correction p 520-522 1.0 1.0 1.0 Binocular Vision Pass at 50 cm p 523 1.6 1.2 1.5 Near Vision Acuity of 20/20 or better at 40 cm Both eyes without correction p 529-531 2.7 2.1 1.5 Both eyes with correction p 541-543 1.0 1.0 1.0 Source: NCHS, HHANES, 1982-84, Tape Number 6507, Version 1.METHODS DATA COLLECTION AND PROCESSING PROCEDURES Data presented in Sections E through H and the family relationships data in Section J were collected on the Household Screener and Family Questionnaires. Data presented in Section K were collected on the Adult Sample Person Questionnaire or on the Child Sample Person Questionnaire. Section L data were collected during the physical examination which was administered in the mobile examination center. Data presented in Section M on the vision examination findings were collected by the dentist. Examination forms and complete descriptions of the vision examination procedures and equipment are given in Appendices 1 through 3. Completed interview and examination forms were reviewed in the Survey's field offices and again at the data processing center of NCHS by clerical editors. The editors checked the forms for completeness, clarity, and compliance with skip patterns, and they coded items such as industry and occupation. At the data processing center the questionnaires were keyed and verified on key-to-disk data entry equipment under the control of programs that checked for valid codes and ranges, compliance with skip patterns, and consistency. After being keyed, data were reedited by analysts for reasonableness and consistency and for compliance with instructions for sampling and questionnaire administration. The vision data, like the questionnaire data, have undergone numerous quality control and editing procedures in both the data collection and data processing phases of the survey. Where possible, the results have been compared with those of previous studies. The examination protocol included training and periodic retraining of examiners by a supervisor and consultant, as well as an ongoing system of quality control procedures to reduce variability introduced by errors of measurement. The vision screening included tests of near vision, binocularity of vision, and distance vision. The tests were administered in the order listed above to minimize the changes in lighting to which the eyes had to adjust. The tests were given by the dentist, who was trained in vision testing methods, to all sample persons 6-19 years of age and to a random half-sample of those 20-74 years of age. The tests were administered in the dental examining room immediately following completion of the dental examination. The conditions of the vision screening tests adhered largely to the procedures outlined in the report of the National Academy of Sciences-National Research Council Committee on Vision (Ref. No. 12). The near vision test determined visual acuity at up to four fixed distances from 30 to 60 centimeters (cm). A test card consisting of Sloan letters or, for illiterate examinees, Landolt Rings, was positioned at 40 cm from the eyes, using a bar with a chin rest on one end and a metal frame that held the card and could be moved to pre-marked distance settings. (This procedure provided a means for conducting the near vision test at standard distances.) Persons who were unable to read the 20/20 line at 40 cm were also tested at 60 cm, 50 cm and 30 cm. However, only the standard visual acuities recorded at 40 cm are provided on the accompanying data tape. Examinees who wore glasses for near vision and remembered to bring them to the examination center were tested first without correction and then with correction. Contact lens wearers were tested only with correction to avoid the problem of having to remove and re-insert the lenses. For persons who forgot their glasses or contact lenses, this information was recorded, but obviously only uncorrected vision could be tested. Bionocularity was assessed using the Random Dot E (RDE) test, which is valuable for determining the presence of amblyopia and for producing conservative estimates of stereoacuity thresholds. The test, developed primarily for use with young children, is simple, accurate, and quick, and makes minimal demands on the subject (Ref. No. 13). In HHANES, examinees were given polarized glasses to be worn during the test (the glasses were used over any corrective lenses); they were then shown an RDE test card and a stereo blank card and asked to identify the RDE card. The two cards looked identical to persons with impaired binocularity, whereas those with normal vision could easily distinguish the outline of an apparently recessed "E" on the test card. the test was conducted first at 50 cm and again at 100 cm. To minimize the problem of guessing, the test was repeated four times at each distance. A passing score depended on choosing the correct card all four times. Distance vision was tested using a chart with Sloan Letters or Landolt Rings. During the first 13 locations the basic test distance was 4 meters for determining visual acuity in the range 20/15 through 20/80 and 1 meter for the range 20/100 through 20/400. However, because of space limitations in the examination center, the 4 meter distance was simulated by placing the chart with reversed Sloan letters on an illuminated box on one wall of the examination room and situating a mirror of high optical quality on the opposite wall. The examinees then read the reflection in the mirror. Subsequent to location 13, for logistic reasons, the 1 meter chart for acuities 20/100 or worse was replaced with two 4 meter charts. This procedure allowed the determination of distance visual acuity as poor as 20/200+. All distance visual acuities poorer than 20/200 were recoded to 20/200 for comparability. To investigate the comparability of visual acuity determined with and without a mirror, up to four randomly selected sample persons each day were retested using an actual 4-meter test distance in another part of the examination center. The results of this experiment indicate that acuities obtained with a mirror are slightly worse than acuities obtained without a mirror. However, use of a mirror did not significantly compromise the validity of the data. Distance vision was measured for each eye separately and for both eyes together. Persons who wore glasses for distance vision were tested with uncorrected vision for both eyes first, followed by tests with correction for the left and right eyes separately, and then both eyes. Contact lens wearers were tested, with corrected vision only, first for each eye separately and then for both eyes. Examinees who had no corrective lenses, and those who forgot to bring them to the examination center, had their uncorrected vision tested, each eye separately, and then both eyes together. To control bias resulting from memorization of the chart, the examiner alternated the eye to be tested first -- sample persons with even numbers had the right eye tested first, and odd-numbered sample persons began with the left eye. The examination protocol included training of examiners by a consultant, as well as an ongoing system of quality control procedures to reduce variability introduced by errors of measurement. Despite these efforts to reduce measurement errors, residual errors of a magnitude large enough to warrant concern occur in any survey. In the HHANES, systematic examiner differences were observed for the distance vision examination, the binocular vision (RDE) examination, and the near vision examination. The use of multiple examiners increases the variability of the distribution because of the inclusion of interexaminer errors of measurement while minimizing the effect of an individual examiner bias. Users should be aware that these technician differences do exist and are encouraged to consider this issue before analyzing the vision examination data. The general tape description format is Tape Position X Item X Counts. The item (field) may be a tape descriptor (e.g., Version Number), a sample person descriptor (e.g., Age at Interview), or a question (e.g., Is sample person covered by Medicare?). Where appropriate, data entries are presented by codes. Frequency counts are given for each code. The counts are included to help the user in planning analyses and in verifying that programs account for all data. The data source is given also (e.g., from Family Questionnaire). In some cases, a note is referenced. The notes contain explanations of the item (e.g., how Poverty Index is calculated). The questionnaire data have undergone many quality control and editing procedures. The responses of sample persons to some questions may appear extreme or illogical. Self-reported data, especially, are subject to a number of sources of variability, including recall and other reporting errors. In the data clean-up process, responses that varied considerably from expected were verified through direct review of the collection form or a copy of it. Such responses may not represent fact, but they are included as recorded in the field. The user must determine if these responses should be included in analyses. Responses to "other" and "specify" were recoded to existing categories if possible. For responses that could not be recoded, new code categories were created if the information was deemed analytically useful. Caution should be used in interpreting the data from these new categories because there is no way of knowing which other respondents would have selected one of the new categories if given the option. Missing data or unintelligible entries were assigned a code, usually "8", which is labeled as "blank but applicable". These codes indicate that a sample person should have a data value for a particular item but for varying reasons that value is unavailable. Copies of the questionnaires, both in English and Spanish, can be found in the plan and operation report for HHANES (Ref. No. 1). Detailed information on interviewing and examination procedures is contained in the household interviewer's manual (Ref. No. 14) and the mobile examination center interviewer's manual (Ref. No. 15) and the dental examiner's manual (Ref. No. 16). These manuals are available upon request from: Division of Health Examination Statistics National Center for Health Statistics Center Building, Room 2-58 3700 East-West Highway Hyattsville, MD 20782 301-436-7080TAPE DESCRIPTION SUMMARY TAPE POSITIONS 1-400 contain data categories common to all data tapes: sociodemographic data, family composition, family income, residence and household. Sample weights are also in this set of data. TAPE POSITIONS 401+ contain data categories unique to this data tape. SOCIODEMOGRAPHIC DATA - SAMPLE PERSON (E) 1-5 Sample Person Sequence Number 6-15 Survey and Tape Identifiers 16 Examination Status 17 Language of Interview 18-21 Date of Interview 22-25 Date of Examination 26-29 Date of Birth 30-32 Age at Interview 33-38 Age at Examination 39-43 Family Number 44-45 Relationship to Head of Family 46 Sex 47 Race 48-49 National Origin or Ancestry 50-52 Birth Place 53 National Origin Recode 54-56 Education 57 Marital Status 58 Service in Armed Forces 59-69 Work/Occupation/Employment 70-95 Health Insurance/Health Care Support 96-99 Income Assistance/Public Compensation or Support SOCIODEMOGRAPHIC DATA - HEAD OF FAMILY (F) 100 Interview and Examination Status 102-105 Date of Birth 106-108 Age at Interview 109 Sex 110 Race 111-112 National Origin or Ancestry 113-115 Birth Place 116-118 Education 119 Marital Status 120 Service in Armed Forces 121-131 Work/Occupation/Employment FAMILY COMPOSITION AND INCOME DATA (G) 132-133 Number of People in Family 134-135 Number of Sample People in Family 136-138 Combined Family Income 139-143 Per Capita Income 144-146 Poverty Index 147-162 Income, Food Stamps RESIDENCE AND HOUSEHOLD DATA (H) 163 Size of Place 164 Standard Metropolitan Statistical Area 165-166 Number of People in Household 167-168 Number of Sample People in Household 169-170 Number of Rooms 171 Kitchen Facilities Access 172-183 Heating/Cooling Equipment SAMPLE WEIGHTS (I) 184-189 Examination Final Weight 190-195 Interview Final Weight 196-201 GTT/Ultrasound Weight 202-207 Audiometry/Vision Weight 208-213 Pesticide Weight 214-215 Strata Code 216-217 Pseudo PSU Code FAMILY RELATIONSHIPS (J) 218-400 Data not yet available MEDICAL HISTORY DATA-VISION (K) 403 Subsample Indicator 404-405 Birth Defects - Children 406-423 History and Care of Vision Problems - Children 424 Adult Sample Person Questionnaire Data Missing 425 Subsample Indicator 426-444 History and Care of Vision Problems - Adults PHYSICAL FINDINGS - EYES (L) 445 Physician's Examination Form Blank 446 Strabismus 447-448 Conjunctiva 449-450 Xerophthalmia, Keratomalacia 451 Pterygium 452-453 Corneal Lesion 454-455 Pupils 456-457 Globe Absent 458-459 Ocular Fundus - Red Reflex 460-461 Lens Opacities 462-463 Fundus Visualization 464-479 Ocular Fundus - Pathologies VISION TEST DATA (M) 501-504 Tape Number 505 Vision Exam Blank 506-508 Examiner Number 509 Optotype Used 510-522 Distance Vision 523-524 Binocular Vision 525-531 Near VisionRECORD LAYOUT Sociodemographic Data - Sample Person Postitions 1-21 Tape Counts Source Location Item Description and Code M C P and Notes SECTION E. SOCIODEMOGRAPHIC DATA - SAMPLE PERSON (POS 1-99) Source: Family Questionnaire (FQ) Household Screener Questionnaire (HSQ) 1-5 Sample person sequence number7462 00001-09894 Mexican Americans 7462 - - 10002-12238 Cuban Americans - 1357 - 13001-16785 Puerto Ricans - - 2834 6-12 Blank 13 Portion of survey 1 Mexican-American (M) 7462 - - 2 Cuban-American (C) - 1357 - 3 Puerto Rican (P) - - 2834 14 Family Questionnaire missing 1 Yes 21 6 10 See Note 1 2 No 7441 1351 2824 15 Version number 7462 1357 2834 2 16 Examination status 1 Examined 7462 1357 2834 See Note 2 2 Not examined 0 0 0 17 Language of interview (Pos. 1-400) FQ 1 English 4513 244 1229 2 Spanish 2929 1107 1595 Blank 20 6 10 Date of interview HSQ 4 18-19 01-12 Month 7462 1357 2834 20-21 82-84 Year 7462 1357 2834 3Positions 22-43 Date of examination From survey control record 22-23 01-12 Month 7462 1357 2834 24-25 82-84 Year 7462 1357 2834 Date of birth HSQ 2e 26-27 01-12 Month 7462 1357 2834 88 Blank but applicable 0 0 0 28-29 08-84 Year 7462 1357 2834 88 Blank but applicable 0 0 0 30-31 Age at interview (computed) 01-74 (See next column for units) 7462 1357 2834 32 Age at interview units HSQ 2f 1 Years 7342 1349 2796 2 Months 120 8 38 Age at examination (computed) Positions 33-38 are all 0 for non- examined persons. 33-34 00-75 Years 7462 1357 2834 35-36 00-11 Months 7462 1357 2834 37-38 00-30 Days 7462 1357 2834 39-43 Family number See Note 3 00002-03529 7462 - - 04005-04922 - 1357 - 07001-08584 - - 2834 3Positions 44-59 Tape Counts Source Location Item Description and Code M C P and Notes 44-45 What is sample person's relationship HSQ 2b to head of family? Sample person is: See Note 4 01 Head of family living alone (1 145 56 113 family with only 1 member) 02 Head of family, with no related 76 23 24 persons in household (2+ persons in household) 03 Head of family, with related 1582 369 678 persons in household 04 Wife of head (husband living at 1299 300 296 home and not in Armed Forces) 05 Wife of head (husband living at 5 0 0 home and is in Armed Forces) 06 Husband of head (wife living at 35 12 37 home and not in Armed Forces) 07 Husband of head (wife living at 0 0 0 home and is in Armed Forces) 08 Child of head or head's spouse 3769 484 1437 09 Grandchild of head or head's 217 32 115 spouse 10 Parent of head or head's spouse 57 35 33 11 Other relative (includes ex- 273 46 101 spouse, daughter-in-law, etc.) 12 Foster child 4 0 0 46 Sex FQ B-4 1 Male 3516 636 1237 2 Female 3946 721 1597 47 Observed race FQ B-5 1 White 7213 1300 2462 See Note 5 2 Black 76 15 152 3 Other 8 3 73 8 Blank but applicable 72 15 59 9 Not observed 72 18 78 Blank 21 6 10 48-49 Sample person's national origin or HSQ 2c ancestry. See Note 6 01 Mexican/Mexicano 1641 1 1 02 Mexican-American 5202 0 0 03 Chicano 102 0 0 04 Puerto Rican 7 3 2596 05 Boricuan 0 0 36 06 Cuban 4 1069 20 07 Cuban-American 0 222 0 08 Hispano - specify 150 14 26 09 Other Latin-American or other 37 18 41 Spanish - specify 00 Other - specify 276 30 114 10 Spanish-American 22 0 0 11 Spanish (Spain) 21 0 0 50-52 In what state or foreign country FQ B-6 was sample person born? See Note 7 001-118 State/country code 7403 1345 2771 888 Blank but applicable 38 6 53 Blank 21 6 10 53 National origin recode See Note 8 "Hispanic" = Mexican-American in Southwest, Cuban-American in Florida and Puerto Rican in New York City area. 1 "Hispanic" 7197 1291 2645 2 Not "Hispanic" 265 66 189 54-55 What is the highest grade or year of FQ B-7 regular school sample person has ever attended? 00 Never attended or kinder- 1476 116 446 garten only 01-08 Elementary grade 3118 556 1090 09-12 High school grade 2119 400 1011 13-16 College 581 243 225 17 Graduate school 70 30 14 88 Blank but applicable 77 6 38 Blank 21 6 10 56 Did sample person finish that FQ B-8 grade/year? 1 Yes 3938 853 1436 2 No 1934 368 861 8 Blank but applicable 93 14 81 Blank 1497 122 456 57 Is sample person now married, FQ B-9 widowed, divorced, separated, or has he or she never been married? 0 Under 14 years of age 2953 297 1000 1 Married - spouse in household 2600 632 660 2 Married - spouse not in household 70 17 54 3 Widowed 161 50 66 4 Divorced 214 92 155 5 Separated 159 21 149 6 Never married 1265 241 730 8 Blank but applicable 19 1 10 Blank 21 6 10 58 Did sample person ever serve in the FQ B-11 Armed Forces of the United States? 1 Yes 416 27 145 2 No 3557 952 1409 8 Blank but applicable 7 3 14 Blank 3482 375 1266 59 During the past 2 weeks, did sample FQ B-12 person work at any time at a job or business, not counting work around the house? 1 Yes 2210 622 613 2 No 1751 349 930 8 Blank but applicable 19 11 25 Blank 3482 375 1266 3Positions 60-80 Tape Counts Source Location Item Description and Code M C P and Notes 60 Even though sample person did not FQ B-13 work during those 2 weeks, did he or she have a job or business? 1 Yes 46 13 23 2 No 1704 334 902 8 Blank but applicable 20 13 30 Blank 5692 997 1879 61 Was sample person looking for work FQ B-14 or on layoff from a job? 1 Yes 217 43 60 2 No 1533 304 865 8 Blank but applicable 20 13 30 Blank 5692 997 1879 62 Which, looking for work or on layoff FQ B-15 from a job or both? 1 Looking 146 34 44 2 Layoff 46 6 8 3 Both 23 2 7 8 Blank but applicable 22 14 31 Blank 7225 1301 2744 63-65 What kind of business or industry FQ B-19 does sample person work for? See Note 9 010-932 Industry code 2429 665 681 990 Blank but applicable 49 18 37 Blank 4984 674 2116 66-68 What kind of work was sample FQ B-20 person doing? See Note 9 003-889 Occupation code 2432 666 681 999 Blank but applicable 46 17 37 Blank 4984 674 2116 69 Class of worker FQ B-22 1 An employee of a private company, 1912 543 551 business or individual for wages, salary, or commission 2 A Federal government employee 74 6 21 3 A State government employee 124 19 17 4 A Local government employee 169 17 56 5 Self-employed in own incorporated 17 12 7 business or professional practice 6 Self-employed in own unincorpora- 131 67 27 ted business, professional practice, or farm 7 Working without pay in family 3 0 0 business or farm 8 Blank but applicable 46 18 38 0 Never worked or never worked at a 2 1 1 full-time civilian job lasting 2 weeks or more Blank 4984 674 2116 70 Is sample person now covered by FQ C-2 Medicare? 1 Covered 303 107 139 2 Not covered 7129 1237 2674 8 Blank but applicable 6 6 11 9 Don't know 3 1 0 Blank 21 6 10 71 Is sample person now covered by the FQ C-3 part of Social Security Medicare which pays for hospital bills? 1 Yes 270 100 124 2 No 18 4 5 8 Blank but applicable 15 6 20 9 Don't know 6 3 1 Blank 7153 1244 2684 72 Is sample person now covered by that FQ C-4 part of Medicare which pays for doctor's bills? This is the Medi- care plan for which he or she or some agency must pay a certain amount each month. 1 Yes 269 100 111 2 No 17 5 17 8 Blank but applicable 15 6 20 9 Don't know 8 2 2 Blank 7153 1244 2684 73 Type of Medicare coverage FQ C-5 As shown on Medicare card 1 Hospital 0 0 0 2 Medical 2 0 0 3 Card not available 3 0 2 4 Hospital and medical 5 3 0 8 Blank but applicable 15 6 20 Blank 7437 1348 2812 HEALTH INSURANCE See Note 10 74 Is sample person covered by any FQ C-11 health insurance plan which pays any part of a hospital, doctor's, or surgeon's bill? 1 Yes 4094 818 1011 2 No 3326 526 1796 8 Blank but applicable 13 7 16 9 Don't know 8 0 1 Blank 21 6 10 75 Is sample person covered by a plan FQ C-9 that pays any part of hospital expenses? 1 Yes 4039 806 955 2 No 6 7 9 8 Blank but applicable 54 12 55 9 Don't know 8 0 8 Blank 3355 532 1807 76 Is sample person covered by a plan FQ C-10 that pays any part of a doctor's or surgeon's bills for operations? 1 Yes 4034 804 945 2 No 22 11 28 8 Blank but applicable 36 10 35 9 Don't know 15 0 19 Blank 3355 532 1807 Many people do not carry health FQ C-13/15 insurance for various reasons. Which of these statements describes why sample person is not covered by any health insurance (or Medicare)? (Positions 77-80) 77-78 Main Reason 01 Care received through Medicaid 267 31 854 or Welfare 02 Unemployed, or reasons related 350 40 114 to unemployment 03 Can't obtain insurance because 24 2 15 of poor health, illness or age 04 Too expensive, can't afford 1767 280 506 health insurance 05 Dissatisfied with previous 50 3 3 isurance 06 Don't believe in insurance 31 4 8 07 Have been healthy, not much sick- 206 23 31 ness in the family, haven't needed health insurance 08 Military dependent, (CHAMPUS), 45 1 15 Veteran's benefits 09 Some other reason - not specified 2 0 7 10 Some other reason - specified 255 35 58 88 Blank but applicable 118 34 77 Blank 4347 904 1146 79-80 Second Reason 00 No second reason reported 2573 339 1374 01 Care received through Medicaid 70 17 58 or Welfare 02 Unemployed or reasons related to 109 30 30 unemployment 03 Can't obtain insurance because of 4 2 3 poor health, illness or age 04 Too expensive, can't afford 168 20 132 health insurance 05 Dissatisfied with previous 15 1 2 insurance 06 Don't believe in insurance 18 3 3 07 Have been health, not much sick- 47 4 8 ness in the family, haven't needed health insurance 08 Military dependent, (CHAMPUS), 0 0 2 Veteran's benefits 09 Some other reason - not specified 0 0 0 10 Some other reason - specified 25 8 7 88 Blank but applicable 86 29 69 Blank 4347 904 1146 3Positions 81-99 Tape Counts Source Location Item Description and Code M C P and Notes 81-87 Blank 88 During the last 12 months, has sample FQ D-6 person received health care which has been or will be paid for by Medicaid? 1 Yes 537 101 1076 2 No 6859 1242 1708 8 Blank but applicable 45 7 40 9 Don't know 0 1 0 Blank 21 6 10 89 Does sample person have a Medicaid FQ D-8 card? 1 Yes 530 104 1144 2 No 6872 1232 1647 8 Blank but applicable 39 15 33 9 Don't know 0 0 0 Blank 21 6 10 90 Status of sample person's Medicaid FQ D-9 card? 1 Medicaid card seen - current 382 84 832 2 Medicaid card seen - expired 7 0 12 3 No card seen 128 17 274 4 Other card seen 0 0 0 5 Other card seen (specify) 5 0 2 8 Blank but applicable 47 18 57 Blank 6893 1238 1657 91 Is sample person now covered by any FQ D-11 other public assistance program that pays for health care? 1 Yes 54 2 28 2 No 7376 1348 2780 8 Blank but applicable 11 1 15 9 Don't know 0 0 0 Blank 21 6 10 92 Does sample person now receive FQ D-13 military retirement payments from any branch of the Armed Forced or a pension from the Veteran's Admini- stration? Do not include VA disa- bility compensation. 1 Yes 56 4 9 2 No 7373 1346 2806 8 Blank but applicable 12 1 9 9 Don't know 0 0 0 Blank 21 6 10 93 Which does sample person receive: FQ D-14 the Armed Forces retirement; the VA pension; or both? 1 Armed Forces 16 0 2 2 Veteran's Administration 30 0 5 3 Both 4 4 1 8 Blank but applicable 18 1 10 Blank 7394 1352 2816 94 Is sample person now covered by FQ D-16 CHAMP-VA, which is medical insurance for dependents or survivors of dis- abled veterans? 1 Yes 45 4 10 2 No 7388 1346 2806 8 Blank but applicable 8 1 6 9 Don't know 0 0 0 Blank 21 6 10 95 Is sample person now covered by any FQ D-18 other program that provides health care for military dependents or sur- vivors of military persons? 1 Yes 41 4 8 2 No 7387 1346 2804 8 Blank but applicable 13 1 12 9 Don't know 0 0 0 Blank 21 6 10 96 Is sample person included in the FQ D-2 AFDC, "Aid to Families With Dependent Children", assistance payment? 1 Yes 394 39 650 2 No 7020 1304 2134 8 Blank but applicable 27 6 39 9 Don't know 0 2 1 Blank 21 6 10 97 Does sample person now receive the FQ D-4 "Supplemental Security Income" or "SSI" gold-colored check? 1 Yes 131 44 135 2 No 7285 1295 2659 8 Blank but applicable 25 12 30 9 Don't know 0 0 0 Blank 21 6 10 98 Does sample person have a disability FQ D-20 related to his or her service in the Armed Forces of the United States? 1 Yes 48 2 14 2 No 346 20 108 8 Blank but applicable 29 8 37 Blank 7039 1327 2675 99 Does sample person now receive com- FQ D-21 pensation for this disability from the Veteran's Administration? 1 Yes 31 1 9 2 No 17 1 4 8 Blank but applicable 29 8 38 Blank 7385 1347 2783 2Sociodemographic Data - Head of Family Tape Counts Source Location Item Description and Code M C P and Notes SECTION F. SOCIODEMOGRAPHIC DATA - HEAD OF FAMILY (POS 100-131) Source: Family Questionnaire (FQ) Household Screener Questionnaire (HSQ) 100 Interview and examination status of See Note 4 head of family 1 Selected as sample person, 5523 1076 2098 interviewed on Adult Sample Person Questionnaire, and examined 2 Selected as sample person, 338 62 79 interviewed on Adult Sample Person Questionnaire, but not examined 3 Selected as sample person, not 218 34 23 interviewed, and not examined 4 Not selected as sample person 1362 179 624 Blank 21 6 10 101 Blank Date of birth HSQ 2e 102-103 01-12 Month 7413 1348 2830 88 Blank but applicable 49 9 4 104-105 08-86, 89-88 Year 7440 1353 2832 88 Blank but applicable 22 4 2 106-107 Age at interview 17-95 Years 7462 1357 2834 108 Blank 109 Sex FQ B-4 1 Male 5982 1069 1331 2 Female 1460 282 1493 Blank 20 6 10 110 Observed race FQ B-5 1 White 7138 1282 2511 See Note 5 2 Black 75 27 165 3 Other 6 3 58 8 Blank but applicable 106 31 59 9 Not observed 117 8 31 Blank 20 6 10 111-112 Head of family's national origin HSQ 2c or ancestry. See Note 6 01 Mexican/Mexicano 2068 0 3 02 Mexican-American 4523 0 0 03 Chicano 97 0 0 04 Puerto Rican 19 7 2503 05 Boricuan 0 0 29 06 Cuban 6 1197 46 07 Cuban-American 0 85 2 08 Hispano - specify 147 20 37 09 Other Latin-American or other 54 17 39 Spanish - specify 00 Other - specify 513 31 175 10 Spanish-American 17 0 0 11 Spanish (Spain) 18 0 0 113-115 In what state or foreign country FQ B-6 was head of family born? See Note 7 001-118 State/country code 7362 1331 2762 888 Blank but applicable 80 20 62 Blank 20 6 10 116-117 What is the highest grade or year FQ B-7 of regular school head of family has ever attended? 00 Never attended or kinder- 250 7 35 garten only 01-08 Elementary grade 2959 511 889 09-12 High school grade 2896 411 1445 13-16 College 1002 336 363 17 Graduate school 170 57 41 88 Blank but applicable 165 29 51 Blank 20 6 10 118 Did head of family finish that FQ B-8 grade/year? 1 Yes 5710 1171 2210 2 No 1316 137 492 8 Blank but applicable 166 36 87 Blank 270 13 45 119 Is head of family now married, FQ B-9 widowed, divorced, separated, or has he or she never been married? 0 Under 14 0 0 0 1 Married - spouse in household 5706 1059 1295 2 Married - spouse not in household 129 9 129 3 Widowed 333 48 133 4 Divorced 492 136 376 5 Separated 388 28 452 6 Never married 320 56 418 8 Blank but applicable 74 15 21 Blank 20 6 10 120 Did head of family ever serve in FQ B-11 the Armed Forces of the United States? 1 Yes 1478 64 383 2 No 5883 1265 2400 8 Blank but applicable 81 22 41 Blank 20 6 10 121 During the past 2 weeks, did head FQ B-12 of family work at any time at a job or business, not counting work around the house? 1 Yes 5443 1019 1283 2 No 1923 305 1504 8 Blank but applicable 76 27 37 Blank 20 6 10 122 Even though head of family did not FQ B-13 work during those 2 weeks, did he or she have a job or business? 1 Yes 101 19 28 2 No 1822 286 1476 8 Blank but applicable 76 27 37 Blank 5463 1025 1293 123 Was head of family looking for work FQ B-14 or on layoff from a job? 1 Yes 510 61 118 2 No 1413 244 1384 8 Blank but applicable 76 27 39 Blank 5463 1025 1293 124 Which, looking for work or on FQ B-15 layoff from a job or both? 1 Looking 270 43 69 2 Layoff 151 12 26 3 Both 85 3 17 8 Blank but applicable 80 30 45 Blank 6876 1269 2677 125-127 What kind of business or industry FQ B-19 does head of family work for? See Note 9 010-932 Industry code 5980 1080 1395 990 Blank but applicable 118 28 62 Blank 1364 249 1377 128-130 What kind of work was head of FQ B-20 family doing? See Note 9 003-889 Occupation code 5988 1080 1391 999 Blank but applicable 110 28 66 Blank 1364 249 1377 131 Class of worker FQ B-22 1 Employee of a private company, 4702 842 1058 business or individual for wages, salary, or commission 2 A Federal government employee 219 4 45 3 A State government employee 246 12 54 4 A Local government employee 359 22 169 5 Self-employed in own incorpora- 49 25 14 ted business or professional practice 6 Self-employed in own unincor- 420 171 56 porated business, profes- sional practice, or farm 7 Working without pay in family 0 0 0 business or farm 8 Blank but applicable 99 32 60 0 Never worked or never worked at 4 0 1 a full-ime civilian job lasting 2 weeks or more Blank 1364 249 1377 2Family Composition and Income Data Tape Counts Source Location Item Description and Code M C P and Notes G. FAMILY COMPOSITION AND INCOME DATA (POS 132-162) Source: Family Questionnaire (FQ) 132-133 Number of persons in family (computed) 01-18 Persons 7462 1357 2834 134-135 Number of sample persons in family (computed) 01-13 Persons 7462 1357 2834 136 Was the total combined family FQ E-10 income during the past 12 months more or less than $20,000? Include money from jobs, Social Security, retirement income, unemployment pay- ments, public assistance, and so forth. Also include income net from interest, dividends, income from business, farm or rent, and any other money income received. 1 $20,000 or more 2353 536 578 2 Less than $20,000 4856 795 2193 7 Refused information 31 1 7 8 Blank but applicable 202 19 46 Blank 20 6 10 137-138 Of those income groups, which best FQ E-11 represents the total combined family income during the past 12 months? Include wages, salaries, and other items we just talked about. (in dollars) 01 Less than 1,000 40 8 7 02 1,000 - 1,999 107 10 33 03 2,000 - 2,999 143 25 68 04 3,000 - 3,999 182 28 132 05 4,000 - 4,999 184 34 250 06 5,000 - 5,999 234 45 202 07 6,000 - 6,999 312 35 213 08 7,000 - 7,999 314 46 169 09 8,000 - 8,999 284 42 106 10 9,000 - 9,999 263 52 125 11 10,000 - 10,999 282 72 139 12 11,000 - 11,999 250 47 75 13 12,000 - 12,999 296 54 100 14 13,000 - 13,999 186 32 64 15 14,000 - 14,999 254 25 66 16 15,000 - 15,999 208 36 77 17 16,000 - 16,999 209 34 51 18 17,000 - 17,999 231 37 66 19 18,000 - 18,999 333 28 82 20 19,000 - 19,999 240 55 79 21 20,000 - 24,999 694 148 152 22 25,000 - 29,999 585 83 124 23 30,000 - 34,999 358 78 92 24 35,000 - 39,999 257 64 43 25 40,000 - 44,999 192 48 36 26 45,000 - 49,999 84 43 30 27 50,000 and over 107 55 54 77 Refused information 76 10 43 88 Blank but applicable 537 77 146 Blank 20 6 10 139-143 Per capita income (computed) See Note 11 00083-50000 Dollars 6829 1264 2636 88888 Blank but applicable 613 87 189 Blank 20 6 9 144-146 Poverty index (computed) See Note 12 Decimal not shown on tape 0.04-9.78 6829 1264 2636 999 Blank but applicable 613 87 189 Blank 20 6 9 147 Did any member of this family FQ E-12 receive any Government food stamps in any of the past 12 months? 1 Yes 1651 234 1344 2 No 5783 1115 1474 8 Blank but applicable 8 2 6 Blank 20 6 10 148-149 In how many months of the past 12 FQ E-13 months did any member of this family receive food stamps? 01-12 Months 1631 234 1335 88 Blank but applicable 28 2 15 Blank 5803 1121 1484 150 Did this family receive any FQ E-14 government food stamps last month? 1 Yes 1345 187 1290 2 No 303 47 50 8 Blank but applicable 11 2 10 Blank 5803 1121 1484 151-152 In which month did any member of FQ E-15 this family last receive food stamps? 01-12 Months 298 47 50 88 Blank but applicable 16 2 10 Blank 7148 1308 2774 153-154 For how many persons were those FQ E-16 food stamps authorized? 01-13 Persons 1641 234 1337 88 Blank but applicable 18 2 13 Blank 5803 1121 1484 155-157 What was the total face value of FQ E-17 those food stamps received by this family in that month? 010-520 Dollars 1567 230 1325 888 Blank but applicable 92 6 25 Blank 5803 1121 1484 158 Did this family spend more for food FQ E-18 in that month than the value of your food stamps? 1 Yes 1405 194 1279 2 No 231 40 64 8 Blank but applicable 23 2 7 Blank 5803 1121 1484 159-161 How much more? FQ E-19 003-880 Dollars 1314 182 1258 888 Blank but applicable 114 14 28 Blank 6034 1161 1548 162 Is your family receiving food FQ E-20 stamps at the present time? 1 Yes 1273 175 1269 2 No 6153 1171 1542 8 Blank but applicable 16 5 13 Blank 20 6 10 2Residence and Household Data Tape Counts Source Location Item Description and Code M C P and Notes H. RESIDENCE AND HOUSEHOLD DATA (POS 163-183) Source: Family Questionnaire (FQ) Household Screener Questionnaire (HSQ) 163 Size of place See Note 13 1 1 million or more 1049 0 2070 2 500,000 - 999,999 844 0 0 3 250,000 - 499,999 884 467 0 4 100,000 - 249,999 203 364 368 5 50,000 - 99,999 1277 70 76 6 25,000 - 49,999 785 205 216 7 10,000 - 24,999 746 120 79 8 200 - 9,999 1003 88 24 9 Not in a place 671 43 1 164 Standard Metropolitan Statistical See Note 13 Area 1 In SMSA, in central city 3707 467 2465 2 In SMSA, not in central city 2854 890 369 4 Not in SMSA 901 0 0 165-166 Number of persons in household HSQ 1a 01-18 Persons 7462 1357 2834 167-168 Number of sample persons in household (computed) 01-13 Persons 7462 1357 2834 169-170 How many rooms are in this home? FQ E-1 Count the kitchen, but not the bathroom. 01-14 Rooms 7433 1350 2816 88 Blank but applicable 9 1 8 Blank 20 6 10 171 Do you have access to complete FQ E-2 kitchen facilities in this home; that is, a kitchen sink with piped water, a refrigerator and a range or cookstove? 1 Yes 7136 1315 2548 2 No 83 10 18 8 Blank but applicable 223 26 258 Blank 20 6 10 172-173 What is the main fuel used for FQ E-3 heating this home? See Note 14 00 No fuel used 538 231 16 01 Oil 4 0 1988 02 Natural gas 5955 78 718 03 Electricity 604 1027 37 04 Bottled gas (propane) 174 2 0 05 Kerosene 13 3 0 06 Wood 98 3 0 07 Coal 0 0 14 08 Other, not specified 0 0 2 09 Other, specified 11 0 8 88 Blank but applicable 45 7 41 Blank 20 6 10 174-175 What is the main heating equipment FQ E-4 for this home? See Note 14 00 No heating equipment used 538 231 20 01 Steam or hot water with 44 5 1450 radiators or convectors 02 Central warm air furnace with 2677 542 180 ducts to individual rooms, or central heat pump 03 Built-in electric units (per- 474 323 63 manently installed in wall, ceiling or baseboard) 04 Floor, wall or pipeless furnace 1598 46 21 05 Room heaters with flue or vent, 805 17 596 burning oil, gas, or kerosene 06 Room heaters without flue or 847 6 425 vent, burning oil, gas, or kerosene 07 Heating stove burning wood, 88 0 9 coal or coke 08 Fireplace(s) 91 4 0 09 Portable electric heater(s) 139 137 4 10 Other, not specified 0 0 0 11 Other, specified 114 35 16 88 Blank but applicable 1 5 23 99 Don't know 26 0 17 Blank 20 6 10 176-177 Are any other types of equipment FQ E-5 used for heating this home? See Note 14 00 No other heating equipment used 6057 1073 2350 01 Steam or hot water with 0 0 13 radiators or convectors 02 Central warm air furnace with 11 15 7 ducts to individual rooms, or central heat pump 03 Built-in electric units (per- 24 0 2 manently installed in wall, ceiling or baseboard) 04 Floor, wall or pipeless furnace 11 0 0 05 Room heaters with flue or vent, 22 0 3 burning oil, gas, or kerosene 06 Room heaters without flue or 22 1 29 vent, burning oil, gas, or kerosene 07 Heating stove burning wood, 70 0 8 coal or coke 08 Fireplace(s) 449 8 9 09 Portable electric heater(s) 186 18 351 10 Other, not specified 4 2 3 11 Other, specified 18 2 4 88 Blank but applicable 30 1 25 Blank 558 237 30 178-179 What is the main fuel used by this FQ E-6 additional equipment? See Note 14 00 No fuel used 2 0 2 01 Oil 0 0 20 02 Natural gas 96 2 27 03 Electricity 214 35 345 04 Bottled gas (propane) 9 0 1 05 Kerosene 2 0 25 06 Wood 471 8 11 07 Coal 2 0 0 08 Other, not specified 0 0 0 09 Other, specified 7 0 0 88 Blank but applicable 44 2 3 Blank 6615 1310 2380 180-181 What is the main fuel used for FQ E-7 cooking in this home? 00 No fuel used 21 4 4 01 Oil 14 0 31 02 Natural gas 5899 253 2603 03 Electricity 1295 1083 148 04 Bottled gas (propane) 182 8 12 05 Kerosene 0 0 3 06 Wood 0 0 0 07 Coal 0 0 0 08 Other, not specified 0 0 0 09 Other, specified 14 1 0 88 Blank but applicable 17 2 23 Blank 20 6 10 182 Do you have air-conditioning - FQ E-8 either individual room units, a central system or evaporative cooling? 1 Yes 3583 1254 653 2 No 3845 96 2153 8 Blank but applicable 14 1 18 Blank 20 6 10 183 Which do you have? FQ E-9 1 Individual room unit 1625 583 613 2 Central air-conditioning 1233 660 22 3 Evaporative cooling 719 6 10 8 Blank but applicable 20 6 26 Blank 3865 102 2163 2Sample Weights Tape Counts Source Location Item Description and Code M C P and Notes I. SAMPLE WEIGHTS (POS 184-217) 184-189 Examined final weight 000439-002711 7462 - - 000223-000891 - 1357 - 000177-002000 - - 2834 190-195 Interview final weight 000447-002096 7462 - - 000176-000604 - 1357 - 000175-001220 - - 2834 GTT/ULTRASOUND, AUDIOMETRY/VISION, PESTICIDE WEIGHTS By design, only some of the persons in the sample were included in the GTT/ultrasound, audiometry/vision, and pesticide components of the survey. Tape positions for those persons not part of these subsamples are BLANK. 196-201 GTT/ultrasound weight 000843-005302 1777 - - 000469-001685 - 449 - 000349-003110 5685 908 2167 Blank - - 667 202-207 Audiometry/vision weight 000507-006283 4431 - - 000223-001600 - 804 - 000264-003123 - - 1759 Blank 3031 553 1075 208-213 Pesticide weight 000872-005584 2465 - - 000441-001600 - 568 - 000343-003117 - - 1012 Blank 4997 789 1822 214-215 Strata code 01-08 7462 1357 2834 216-217 Pseudo PSU code 01-02 7462 1357 2834 2Family Relationships Tape Counts Source Location Item Description and Code M C P and Notes J. FAMILY RELATIONSHIPS (POS 218-400) Source: Adult Sample Person Questionnaire Family Questionnaire 218-400 Blank Data not yet available 2Medical History Data - Vision Position Item description Counts Source and code M C P and notes K. MEDICAL HISTORY DATA - VISION (POS 401-444) Source: Child Sample Person Questionnaire (CSPQ) Source: Adult Sample Person Questionnaire (ASPQ) POSITIONS 404-423 CONTAIN SELECTED INTERVIEW DATA ON CHILDREN 6 THROUGH 11 YEARS. THIS DATA IS ALSO FOUND ON HHANES DATA-TAPE NUMBER 6522 (CHILD HISTORY QUESTIONNAIRE) 401-402 Blank 7462 1357 2834 403 Subsample Indicator 0 Ages 6 months - 5 years 1254 104 408 1 Ages 6-11 years 1296 133 437 Blank Ages 12-74 years 4912 1120 1989 404 Was the sample person born with any physical CSPQ A-11 or mental problem or birth defect? 1 Yes 184 14 92 2 No 2364 223 751 8 Blank but applicable 2 0 2 Blank 4912 1120 1989 405 Did the sample person's problem or defect CSPQ A-12 involve his or her eyes? 1 Yes 13 0 3 2 No 169 13 86 8 Blank but applicable 3 0 4 9 Don't know 1 1 1 Blank 7276 1343 2740 406 Has the sample person ever had trouble CSPQ D-1 seeing with one or both eyes when not See Note 15 wearing glasses or contact lenses? 1 Yes 227 28 131 2 No 2320 209 712 8 Blank but applicable 3 0 2 Blank 4912 1120 1989 407 How old was the sample person when he or she CSPQ D-2 first began having trouble seeing? 1 Under 1 year old 15 3 12 2 1-4 years old 22 4 23 3 5-11 years old 190 21 96 8 Blank but applicable 3 0 2 Blank 7232 1329 2701 408 Did the sample person ever see a doctor CSPQ D-3 about it? 1 Yes 168 27 113 2 No 59 1 18 8 Blank but applicable 3 0 2 Blank 7232 1329 2701 409 Does the sample person wear glasses or CSPQ D-4 contact lenses? 1 Yes 106 18 85 2 No 121 10 46 8 Blank but applicable 3 0 2 Blank 7232 1329 2701 410 Does the sample person have trouble with CSPQ D-5 his or her vision even when wearing glasses or contact lenses? 1 Yes 23 2 13 2 No 82 16 70 8 Blank but applicable 4 0 4 Blank 7353 1339 2747 411 Has the sample person ever worn glasses or CSPQ D-6 contact lenses? (Does not include glasses See Note 16 that are worn for purposes other than improving or correcting vision.) 1 Yes 15 3 11 2 No 106 7 35 8 Blank but applicable 3 0 2 Blank 7338 1347 2786 Reason sample person stopped wearing glasses CSPQ D-7 or contact lenses (Positions 412-415. More See Note 17 than one reason may apply) 412 1 No longer needed them 5 3 5 8 Blank but applicable 3 0 2 Blank 7454 1354 2827 413 1 Didn't seem to help 3 0 1 8 Blank but applicable 3 0 2 Blank 7456 1357 2831 414 1 Inconvenient 2 0 0 8 Blank but applicable 3 0 2 Blank 7457 1357 2832 415 1 Other - not specified 0 0 0 2 Other - specified 1 0 4 3 Other specified: glasses lost or broken 4 0 1 8 Blank but applicable 3 0 2 Blank 7454 1357 2827 Purpose for which sample person's CSPQ D-8 glasses or contact lenses were prescribed See Note 17 (Positions 416-418. More than one purpose may apply) 416 1 Reading/close work 60 5 63 8 Blank but applicable 5 0 3 Blank 7397 1352 2768 417 1 Seeing distant objects 66 12 47 8 Blank but applicable 5 0 3 Blank 7391 1345 2784 418 1 Other - not specified 1 0 0 2 Other - specified 12 7 9 3 Other specified: astigmatism 2 0 0 8 Blank but applicable 5 0 3 Blank 7442 1350 2822 419 How often (does/did) the sample person CSPQ D-9 use his or her glasses or contact lenses: all of the time, most of the time, hardly ever, or never? 1 All of the time 48 12 29 2 Most of the time 33 4 37 3 Hardly ever 29 4 23 4 Never 9 0 6 8 Blank but applicable 5 1 3 Blank 7338 1336 2736 420 Age of the sample child and school CSPQ D-10 status. 1 Under 5 years old 1029 93 347 2 5+ years old, goes to school 1458 142 475 3 5+ years old, doesn't go to school 63 2 22 8 Blank but applicable 0 0 1 Blank 4912 1120 1989 421 Is the sample person able to read from the CSPQ D-11 blackboard from the back of the classroom See Note 15 (when wearing glasses or contact lenses)? (Asked only of children five years of age and over who go to school) 1 Yes 1253 130 373 2 No 105 9 57 8 Blank but applicable 2 1 15 9 Don't know 98 2 31 Blank 6004 1215 2358 422 Were you ever told by a doctor that the CSPQ D-12 sample person had learning or developmental problems related to his or her vision? (Asked only of children five years of age and over) 1 Yes 47 5 22 2 No 1467 138 467 8 Blank but applicable 0 1 5 9 Don't know 7 0 4 Blank 5941 1213 2336 423 When was the last time the sample person CSPQ D-13 had his or her vision tested? See Note 18 (Asked all children) 1 6 months ago or less 567 81 278 2 Over 6 months to 12 months 436 33 159 3 Over 12 months to 2 years 260 15 87 4 Over 2 years to 5 years 122 11 29 5 More than 5 years 14 2 3 6 Never 1075 91 268 8 Blank but applicable 0 1 0 9 Don't know 76 3 21 Blank 4912 1120 1989 POSITIONS 426-444 CONTAIN SELECTED INTERVIEW DATA FOR ADOLESCENTS AND ADULTS AGES 12 THROUGH 74 YEARS. THIS DATA IS ALSO FOUND ON HHANES DATA TAPE NUMBER 652 1 (ADOLESCENT AND ADULT HISTORY QUESTIONNAIRE) 424 Adult Sample Person Questionnaire See Note 19 Data Missing? 1 Yes 1 0 1 2 No 4911 1120 1988 Blank 2550 237 845 425 Subsample Indicator 1 Ages 12-74 years 4912 1120 1989 Blank Ages 6 months-11 years 2550 237 845 426 Have you ever had trouble seeing with one ASPQ D-1 or both eyes when not wearing glasses or contact lenses? 1 Yes 2590 702 1170 2 No 2321 418 818 8 Blank but applicable 0 0 0 Blank 2551 237 846 427-428 How old were you when you first began ASPQ D-2 having trouble seeing? 01 0-4 years old 56 22 41 02 5-9 years old 289 50 170 03 10-19 years old 847 133 350 04 20-29 years old 316 56 110 05 30-39 years old 259 115 127 06 40-49 years old 505 246 258 07 50-59 years old 241 61 90 08 60-64 years old 46 10 15 09 65 years old or older 19 8 4 88 Blank but applicable 12 1 5 Blank 4872 655 1664 429 Did you ever see a doctor about it? ASPQ D-3 1 Yes 2240 661 1084 2 No 350 41 85 8 Blank but applicable 0 0 1 Blank 4872 655 1664 430 Do you wear glasses or contact lenses? ASPQ D-4 1 Yes 1930 621 923 2 No 660 81 247 8 Blank but applicable 0 0 0 Blank 4872 655 1664 431 Do you have trouble with your vision even ASPQ D-5 when wearing glasses or contact lenses? 1 Yes 411 91 224 2 No 1518 529 696 8 Blank but applicable 1 1 3 Blank 5532 736 1911 432 Have you ever worn glasses or contact ASPQ D-6 lenses? 1 Yes 232 37 123 2 No 428 44 124 8 Blank but applicable 0 0 0 Blank 6802 1276 2587 Why did you stop wearing them? (Pos. 433-438) ASPQ D-7 (MARK ALL THAT APPLY) See Notes 17,20 433 1 No longer need them 67 8 37 8 Blank but applicable 1 2 0 Blank 7394 1347 2797 434 1 Didn't seem to help 28 4 12 8 Blank but applicable 1 2 0 Blank 7433 1351 2822 435 1 Inconvenient 67 14 28 8 Blank but applicable 1 2 0 Blank 7394 1341 2806 436 1 Broken, lost or stolen 40 5 29 8 Blank but applicable 1 2 0 Blank 7421 1350 2805 437 1 Too expensive 25 1 2 8 Blank but applicable 1 2 0 Blank 7436 1354 2832 438 1 Other, not specified 2 0 1 2 Other, specified 19 5 20 8 Blank but applicable 1 2 0 Blank 7440 1350 2813 What (are/were) your glasses or contact ASPQ D-8 lenses prescribed for? (Pos. 439-444) See Notes 17, (More than one purpose may apply) 20 439 1 Reading/close work 1309 504 761 8 Blank but applicable 12 5 4 Blank 6141 848 2069 440 1 Seeing distant objects 1142 331 536 8 Blank but applicable 12 5 4 Blank 6308 1021 2294 441 1 Astigmatism 47 17 12 8 Blank but applicable 12 5 4 Blank 7403 1335 2818 442 1 Other, not specified 20 1 1 2 Other, specified 115 24 53 8 Blank but applicable 12 5 4 Blank 7315 1327 2776 443 How often (do/did) you use your glasses ASPQ D-9 or contacts: All of the time, most of the time, hardly ever, or never? 1 All of the time 920 276 358 2 Most of the time 604 165 365 3 Hardly ever 548 192 270 4 Never 82 18 48 8 Blank but applicable 8 7 5 Blank 5300 699 1788 444 When was the last time you had your vision ASPQ D-10 tested? 1 6 mos. ago or less 986 281 558 2 Over 6 mos. through 12 mos. 898 245 442 3 Over 12 mos. through 2 years 892 209 386 4 Over 2 years through 5 years 1021 223 317 5 More than 5 years 569 91 165 6 Never 486 67 84 8 Blank but applicable 2 1 1 9 Don't know 57 3 35 Blank 2551 237 846 2Physical Findings - Eyes Position Item description Counts Source and code M C P and notes L. PHYSICAL FINDINGS - EYES (POS 445-479) Source: Physician's Examination 445 Physician's examination form blank? See Note 21 1 No physician's examination data were taken. Positions 446-479 135 12 70 are blank. 2 Physician's examination data are present. 7327 1345 2764 446 Eyes-strabismus 1 Yes 733 14 42 4 No 6587 1327 2718 8 Blank but applicable 7 4 4 Blank 135 12 70 447 Eyes-conjunctival injection 1 Yes 84 9 9 4 No 7240 1332 2753 8 Blank but applicable 3 4 2 Blank 135 12 70 448 Eyes-pale conjunctiva 1 Yes 14 0 4 4 No 7309 1341 2758 8 Blank but applicable 4 4 2 Blank 135 12 70 449 Eyes-xerophthalmia 1 Yes 0 0 0 4 No 7323 1341 2762 8 Blank but applicable 4 4 2 Blank 135 12 70 450 Eyes-keratomalacia 1 Yes 0 0 0 4 No 7323 1341 2762 8 Blank but applicable 4 4 2 Blank 135 12 70 451 Eyes-pterygium 1 Yes 267 32 48 4 No 7056 1309 2714 8 Blank but applicable 4 4 2 Blank 135 12 70 452 Right eye-corneal lesion(s) 1 Yes 23 5 1 4 No 7243 1337 2756 8 Blank but applicable 56 3 7 Blank 140 12 70 453 Left eye-corneal lesion(s) 1 Yes 23 3 4 4 No 7243 1338 2751 8 Blank but applicable 56 3 7 Blank 140 13 72 454 Eyes-pupils 1 Right larger 18 4 12 2 Left larger 13 6 3 4 Equal 7281 1331 2738 8 Blank but applicable 5 3 9 Blank 145 13 72 455 Eyes-pupillary light reflex 1 Abnormal 32 13 20 4 Normal 7293 1328 2734 8 Blank but applicable 2 4 10 Blank 135 12 70 456 Right eye-globe absent See Note 22 1 Absent 5 0 0 Blank- Present or exam not given 7457 1357 2834 457 Left eye-globe absent See Note 22 1 Absent 5 1 2 Blank- Present or exam not given7457 1356 2832 458 Right eye-ocular fundus-red reflex 1 Abnormal 15 3 8 4 Normal 7261 1314 2734 8 Blank but applicable 46 28 22 Blank 140 12 70 459 Left eye-ocular fundus-red reflex 1 Abnormal 12 0 8 4 Normal 7266 1317 2732 8 Blank but applicable 44 27 22 Blank 140 13 72 460 Right eye-lens opacities 1 Yes 58 16 18 4 No 7203 1301 2724 8 Blank but applicable 61 28 22 Blank 140 12 70 461 Left eye-lens opacities 1 Yes 58 19 23 4 No 7207 1299 2717 8 Blank but applicable 57 26 22 Blank 140 13 72 462 Right eye-fundus visualization See Note 23 1 Not visualized 254 66 219 Blank Visualized 7165 1277 2596 8 Blank but applicable 43 14 19 463 Left eye-fundus visualization See Note 23 1 Not visualized 276 69 231 Blank Visualized 7144 1276 2584 8 Blank but applicable 42 12 19 464 Right eye-ocular fundus- narrow arterioles 1 Yes 110 2 6 4 No 6892 1263 2512 8 Blank but applicable 66 14 27 Blank 394 78 289 465 Left eye-ocular fundus- narrow arterioles 1 Yes 149 11 32 4 No 6834 1252 2471 8 Blank but applicable 63 12 28 Blank 416 82 303 466 Right eye-ocular fundus- tortuous arterioles 1 Yes 42 2 5 4 No 6952 1263 2513 8 Blank but applicable 74 14 27 Blank 394 78 289 467 Left eye-ocular fundus- tortuous arterioles 1 Yes 41 1 5 4 No 6934 1262 2499 8 Blank but applicable 71 12 27 Blank 416 82 303 468 Right eye-ocular fundus-AV compression 1 Yes 25 0 11 4 No 6964 1265 2507 8 Blank but applicable 79 14 27 Blank 394 78 289 469 Left eye-ocular fundus-AV compression 1 Yes 27 0 15 4 No 6943 1263 2489 8 Blank but applicable 76 12 27 Blank 416 82 303 470 Right eye-ocular fundus-hemorrhage 1 Yes 4 0 0 4 No 6986 1265 2518 8 Blank but applicable 78 14 27 Blank 394 78 289 471 Left eye-ocular fundus-hemorrhage 1 Yes 4 0 0 4 No 6967 1263 2504 8 Blank but applicable 75 12 27 Blank 416 82 303 472 Right eye-ocular fundus-exudate 1 Yes 5 0 4 4 No 6983 1265 2515 8 Blank but applicable 80 14 26 Blank 394 78 289 473 Left eye-ocular fundus-exudate 1 Yes 3 0 6 4 No 6966 1263 2499 8 Blank but applicable 77 12 26 Blank 416 82 303 474 Right eye-ocular fundus- venous engorgement 1 Yes 1 0 0 4 No 6987 1264 2519 8 Blank but applicable 80 15 26 Blank 394 78 289 475 Left eye-ocular fundus- venous engorgement 1 Yes 2 0 0 4 No 6967 1262 2505 8 Blank but applicable 77 13 26 Blank 416 82 303 476 Right eye-ocular fundus-papilledema 1 Yes 0 0 1 4 No 6988 1265 2523 8 Blank but applicable 80 14 21 Blank 394 78 289 477 Left eye-ocular fundus-papilledema 1 Yes 0 0 1 4 No 6969 1263 2509 8 Blank but applicable 77 12 21 Blank 416 82 303 478 Right eye-ocular fundus-disc abnormal 1 Yes 3 1 10 4 No 6985 1264 2514 8 Blank but applicable 80 14 21 Blank 394 78 289 479 Left eye-ocular fundus-disc abnormal 1 Yes 3 2 7 4 No 6966 1261 2503 8 Blank but applicable 77 12 21 Blank 416 82 303 480-500 Blank 7462 1357 2834 2Vision Test Data Position Item description Counts Source and code M C P and notes SECTION M. VISION TEST DATA - (POS 501-531) Source: Vision Examination Numbers in this column other than notes reflect the preprinted circled number shown on source document (Appendix 1) 501-504 Tape number 6507 7462 1357 2834 505 Vision exam blank See Note 24 1 Yes 3114 571 1118 2 No 4348 786 1716 506-508 Examiner number 105 - 557 4327 786 1713 VTF 102 888 21 0 3 Blank 3114 571 1118 509 Optotype VTF 104 1 Sloan letters 4237 778 1164 2 Landolt rings 72 5 27 8 Blank but applicable 39 3 525 Blank 3114 571 1118 DISTANCE VISION (POS 510-522) 510 Correction Worn VTF 105 1 Wears glasses for test 737 204 324 2 Wears contact lenses for test 56 19 18 3 Forgot (glasses, contact lenses) 190 41 115 4 Does not wear either glasses or contact lenses for distance vision 3343 517 1200 8 Blank but applicable 22 5 59 Blank 3114 571 1118 Visual Acuity 511-513 Both eyes without correction VTF 107 000 Not applicable 56 19 18 See Notes 25,26 015-160 Visual acuity equivalent 4114 741 1622 at 20 feet 200 20/200 or worse 128 23 56 888 Blank but applicable 50 3 20 Blank 3114 571 1118 514-516 Left eye with correction if worn VTF 109 015-160 Visual acuity equivalent 4264 778 1666 See Note 26 at 20 feet 200 20/200 or worse 51 5 19 777 Missing eye or prosthesis 4 0 5 888 Blank but applicable 29 3 26 Blank 3114 571 1118 517-519 Right eye with correction if worn VTF 111 015-160 Visual acuity equivalent 4270 781 1665 See Note at 20 feet 26 200 20/200 or Worse 47 2 20 777 Missing eye or prosthesis 2 0 1 888 Blank but applicable 29 3 30 Blank 3114 571 1118 520-522 Both eyes with correction VTF 113 000 Not applicable 3533 558 1315 See Notes 015-160 Visual acuity 25,26 equivalent 745 218 306 at 20 feet 200 20/200 or Worse 4 1 0 888 Blank but applicable 66 9 95 Blank 3114 571 1118 BINOCULAR VISION (POS 523-524) 523 50 cm VTF 114 1 Pass 3876 680 1527 2 Fail 387 101 145 8 Blank but applicable 85 5 44 Blank 3114 571 1118 524 100 cm VTF 115 1 Pass 3675 639 1480 2 Fail 504 142 188 8 Blank but applicable 169 5 48 Blank 3114 571 1118 NEAR VISION (POS 525-549) 525 Correction Worn VTF 116 1 Wears glasses for test 803 250 325 2 Wears contact lenses for test 55 18 20 3 Forgot (glasses, contact lenses) 239 63 110 4 Does not wear either glasses or contact lenses for near vision 3205 454 1200 8 Blank but applicable 46 1 61 Blank 3114 571 1118 Visual Acuity: Both eyes without correction 526-528 40 cm VTF 118 000 Not applicable 55 18 20 See Note 25 016-250 Visual acuity equivalent 4065 739 1617 at 20 feet 333 20/333 or worse 30 25 23 888 Blank but applicable 198 4 56 Blank 3114 571 1118 Visual Acuity: Both eyes with correction 529-531 40 cm VTF 122 000 Not applicabale 3444 517 1310 See Note 25 016-167 Visual acuity equivalent 818 267 337 at 20 feet 333 20/333 or worse 0 1 0 888 Blank but applicable 86 1 69 Blank 3114 571 1118 532-600 Blank 1GENERAL NOTES, SOCIODEMOGRAPHIC AND VISION DATA 2Family Questionnaire Missing A Family Questionnaire was to be completed for each eligible family in a household with sample persons. However, a few Family Questionnaires are missing. Data records for sample persons in families with missing questionnaires are flagged with a code = 1, and all family data are blank. Data records for sample persons in families with a Family Questionnaire are flagged with a code = 2. During the Mexican-American portion of the HHANES survey, a Family Questionnaire continuation booklet containing sample person information was lost for one sample person. Therefore, the sociodemographic data for this sample person are missing. The reference person, family composition, income, residence, and household data for this person were obtained from another person in the household. 2Examination Status Not all sample persons consented to come to a Mobile Examination Center to participate in the examination phase of the survey. In certain rare instances (less than 0.1%), sample persons who came to the Mobile Examination Centers did not participate in sufficient components of the examination to be considered as "examined." This data field contains code = 1 for those persons who participated fully in the examination phase, and code = 2 for those who did not come to the examination center or who did not satisfactorily complete the examination. 2Family Number In HHANES, all household members who were related by blood, marriage, or adoption were considered to be one "family." All sample persons in the same family unit have the same computer-generated family unit code. 2Head of Family Relationship of Sample Person to Head of Family (Pos. 44-45) Each family containing sample persons has a designated "head of family," and the relationship of each sample person to the head of his or her family is coded in tape positions 44-45. The first three categories of this variable describe the "head" of three different kinds of families. o Code '01' identifies sample persons who lived alone (i.e., "head" of one-person families, no unrelated individuals living in the household). o Code '02' identifies sample persons who lived only with unrelated persons. o Code '03' identifies sample persons who were "heads" of families containing at least one other person (whether or not the household included additional families unrelated to the sample person). Sociodemographic Data (Pos. 100-131) This data tape includes some sociodemographic data about the head of each sample person's family (Section F). Because there can only be one "head" per family, the data in this section (positions 100-131) are the same for all sample persons in the same family (i.e., with the same family number codes in positions 39-43). If the sample person is the head of his or her family, the data in positions 100-131 are the same as in the corresponding positions in Section E. 2Observed Race "Race" was observed by the interviewer for all sample persons actually seen. Rules for classification of observed race were consistent with those used in the NHANES II and the National Health Interview Survey at that time. The categories were coded as follows: White Includes Spanish origin persons unless they are definitely Black, Indian or other nonwhite. Black Black or Negro. Other Race other than White or Black, including Japanese, Chinese, American Indian, Korean, Eskimo. 2National Origin or Ancestry The value for national origin or ancestry is based on Item 2c in the Household Screener Questionnaire and was reported by the household respondent for all household members. In the Mexican-American portion of the survey, if "other Latin-American or other Spanish" (code 9) or "Other" (code 0) was recorded and the specified origin was "Spanish-American" or "Spanish (Spain)", a code of 10 or 11, respectively, was assigned. In all three portions of the survey, if more than one category was reported, the first appropriate "Hispanic" code, if any, was assigned (codes 1, 2, 3, 8, 10, or 11 in the Mexican-American portion; codes 6 or 7 in the Cuban-American portion; codes 4 or 5 in the Puerto Rican portion). If none of these codes was recorded, the first category entered was coded. 2Codes for States and Foreign Countries Code State or Foreign Country 001 Alabama 002 Alaska 004 Arizona 005 Arkansas 006 California 008 Colorado 009 Connecticut 010 Delaware 011 District of Columbia 012 Florida 013 Georgia 015 Hawaii 016 Idaho 017 Illinois 018 Indiana 019 Iowa 020 Kansas 021 Kentucky 022 Louisiana 023 Maine 024 Maryland 025 Massachusetts 026 Michigan 027 Minnesota 028 Mississippi 029 Missouri 030 Montana 031 Nebraska 032 Nevada 033 New Hampshire 034 New Jersey 035 New Mexico 036 New York 037 North Carolina 038 North Dakota 039 Ohio 040 Oklahoma 041 Oregon 042 Pennsylvania 044 Rhode Island 045 South Carolina 046 South Dakota 047 Tennessee 048 Texas 049 Utah 050 Vermont 051 Virginia 053 Washington 054 West Virginia 055 Wisconsin 056 Wyoming 060 American Samoa 093 Canada 061 Canal Zone 062 Canton and Enderbury Islands 091 Central America 095 Costa Rica 063 Cuba 064 Dominican Republic 065 El Salvador 062 Enderbury Islands 087 Germany 066 Guam 068 Guatemala 069 Haiti 088 Honduras 070 Jamaica 090 Japan 067 Johnston Atoll 080 Mexico 071 Midway Islands 081 Nicaragua 096 Palestine 097 Austria 098 Lebanon 099 Chile 100 Philippines 101 Brazil 102 Holland 103 Colombia 082 Panama 072 Puerto Rico 092 Saudi Arabia 083 Spain 094 Taiwan 089 Turkey 084 Uruguay 085 Venezuela 073 Ryukyu Islands, Southern 074 Swan Islands 075 Trust Territories of the Pacific Islands (includes Caroline, Mariana and Marshall Island groups) 076 U.S. miscellaneous Caribbean Islands (includes Navassa Islands, Quito Sueno Bank, Roncador Cay, Serrana Bank and Serranilla Bank) 077 U.S. miscellaneous Pacific Islands (includes Kingman Reef, Howland, Baker & Jarvis Islands, and Palmyra Atoll) 086 United States 078 Virgin Islands 079 Wake Island 104 Azores 105 Peru 106 England 107 Vietnam 108 Italy 109 Ecuador 110 North America 111 Surinam 112 Argentina 113 Portugal 114 Trinidad 115 Egypt 116 Sudan 117 British Honduras 118 China 888 Blank but applicable 2National origin recode In the HHANES, if any household member was identified as "Hispanic" (as defined below), all household members, regardless of origin, were eligible to be selected as sample persons. The national origin recode specifies whether a sample person is considered to be "Hispanic" or "not Hispanic" for purposes of analysis. "Hispanic" is defined as: Mexican-American, residing in selected counties of Texas, Colorado, New Mexico, Arizona, and California; Cuban-American, residing in Dade County (Miami), Florida; or Puerto Rican, residing in the New York City area, including parts of New Jersey and Connecticut The recode was assigned as follows: A. Southwest portion 1) If the original national origin or ancestry code on the Household Screener Questionnaire was 1, 2, 3, 8, 10, or 11, then National origin recode = 1; 2) If national origin or ancestry was 4, 5, 6, 7, 9, or 0 but the person specified Mexican/Mexicano, Chicano, or Mexican-American self-identification on the Adult Sample Person Questionnaire (question M10), or the person was the biological child of a household member with Recode equal to 1 (as determined by questions A-1/A-11 on the Family Questionnaire), then National origin recode = 1; 3) In all other cases, National origin recode = 2. B. Dade County, Florida portion 1) If the original national origin or ancestry code was 6 or 7, then National origin recode = 1; 2) In all other cases, National origin recode = 2. C. New York City area portion 1) If the original national origin or ancestry code was 4 or 5, then National origin recode = 1. 2) If national origin or ancestry was 1, 2, 3, 6, 7, 8, 9, or 0 but the person specified Boricuan or Puerto Rican self-identification on the Adult Sample Person Questionnaire (question M10), or the person was the biological child of a household member with Recode equal to 1 (as determined by questions A-1/A-11 on the Family Questionnaire), then National origin recode = 1. 3) In all other cases, National origin recode = 2. The national origin recode may be used in analysis in one of two ways: a. Selecting on Recode = 1 will restrict analysis to "Hispanics" only. In this case, in the Southwest portion of the survey, the weighted estimates by age and sex will approximately equal U.S. Bureau of Census population estimates of the number of Mexican Americans and a small proportion of other Hispanics assumed to be Hispano in the five Southwest States (Arizona, California, Colorado, New Mexico, and Texas) at the midpoint of the Mexican-American portion of HHANES - March 1983. The weighted estimates of Cuban Americans represents an independent estimate of the number of Cuban Americans in Dade County at the midpoint, February 1984. The weighted estimates of Puerto Ricans represents an independent estimate of the number of Puerto Ricans in the sample counties in New York, New Jersey, and Connecticut at the midpoint of the Puerto Rican portion - September 1984. b. Using Recode greater than 0, that is, all sample persons, will include "Hispanic" and "not Hispanic" persons and the Southwest weighted estimates by age and sex will overestimate the U.S. Bureau of the Census population estimates of Mexican Americans and other Hispanics by about 4.5 percent. In Dade County, using recode greater than 0 will increase the weighted estimates by about 5.3 percent over that for Cuban Americans only, using recode greater than 0 for the New York area will increase the weighted estimates by about 9.2 percent over that for Puerto Ricans only. 2Industry and Occupation Code Family Questionnaire questions B-12 through B-15 (see page 117 or 139 of Ref. No 1 in Section C) identified sample persons 17 years old or older who were in the labor force working for pay at a job or business or who worked without pay in a family business or farm operated by a related member of the household without receiving wages or salary for work performed. Questions B-17 through B-22 provided a full description of sample persons' current or most recent job or business. The detail asked for in these questions was necessary to properly and accurately code each occupation and industry. Interviewers were trained to define a job as a definite arrangement for regular work for pay every week or every month. This included arrangements for either regular or part-time or regular full-time work. If a sample person was absent from his or her regular job, worked at more than one job, was on layoff from a job or was looking for work during the two week reference period, interviewers were trained to use the following criteria to determine the job described: a. If a sample person worked at more than one job during the two week reference period or operated a farm or business and also worked for someone else, the job at which he or she worked the most hours was described. If the sample person worked the same number of hours at all jobs, the job at which he or she had been employed the longest was entered. If the sample person was employed at all jobs the same length of time, the job the sample person considered the main job was entered. b. If a sample person was absent from his or her regular job all of the two week reference period, but worked temporarily at another job, the job at which the sample person actually worked was described, not the job from which he or she was absent. c. If a sample person had a job but did not work at all during the two week reference period, the job he or she held was described. d. If a sample person was on layoff during the two week reference period, the job from which he or she was laid off, regardless of whether a full-time or part-time job, was described. e. If a sample person was looking for work or waiting to begin a new job within 30 days of the interview, the last full-time civilian job which lasted two consecutive weeks or more was described. The 1980 census of population Alphabetical Index of Industries and Occupations was used in the coding of both industry and occupation. This book has Library of Congress Number 80-18360, and is for sale by the Superintendent of Documents, U.S. Government Printing Office, Washington, D.C. 20402 for $3.00. Its Stock Number is 003024049-2. 2Health Insurance a. In the Health Insurance section of the Family Questionnaire, up to three separate health insurance plans could be reported for a family. Each sample person could have been covered by any combination of the three, or by none at all. In order to simplify the health insurance coverage data, the information on all reported plans was combined to a single variable for each sample person, i.e., whether or not the person is covered by any plan (position 74). For all persons covered by at least one plan, information on the type of coverage is then indicated: position 75 specifies whether any of the sample person's plans pays hospital expenses and position 76 specifies whether any of the sample person's plans pays doctor's or surgeon's bills. b. For all sample persons who were not covered by Medicare or any health insurance plan, the reasons for not being covered were ascertained. Positions 77-78 contain the main or only reason reported. For persons with one or more additional reasons, the first (lowest) code entered on the questionnaire was coded in positions 79-80. 2Per Capita Income Per capita income was computed by dividing the total combined family income by the number of people in the family. 2Poverty Index The poverty index is a ratio of two components. The numerator is the midpoint of the income bracket reported for each family in the Family Questionnaire (E-11). Respondents were asked to report total combined family income during the 12 months preceding the interview. The denominator is a poverty threshold which varied with the number of persons in the family, the adult/child composition of the family, the age of the reference person, and the month and the year in which the family was interviewed. Poverty thresholds published in Bureau of the Census reports* are based on calendar years and were adjusted to reflect differences caused by inflation between calendar years and 12 month income reference periods to which question E-11 referred. Average Consumer Price Indexes for all Urban consumers (CPI-U) for the calendar year for which the poverty thresholds were published (see table below) and for the 12 months representing the income reference period for the respondent were calculated. The percentage difference between these two numbers represents the inflation between these two periods and was applied to the poverty threshold appropriate for the family (based on the characteristics listed above). For example, for a family interviewed in November, 1983, the 1982 poverty threshold was updated to reflect inflation by multiplying by the percent change in the average CPI-U for the 12 month reference period, which would have been November, 1982 through October, 1983, over the calendar year January through December, 1982, in this example. To compute poverty indexes, the midpoint of the total combined family income bracket was divided by the updated poverty threshold. *U.S. Bureau of the Census, Current Population Reports, Series P-60, No. 138, "Characteristics of the Population Below the Poverty Level: 1981", U.S. Government Printing Office, Washington, D.C., March 1983. U.S. Bureau of the Census, Current Population Reports, Series P-60, No. 144, "Characteristics of the Population Below the Poverty Level: 1982", U.S. Government Printing Office, Washington, D.C., March 1984. Average Consumer Price Index, all Urban consumers (CPI-U), U. S., city average, 1981-84 Month Year 1981 1982 1983 1984 January 260.5 282.5 293.1 305.2 February 263.2 283.4 293.2 306.6 March 265.1 283.1 293.4 307.3 April 266.8 284.3 295.5 308.8 May 269.0 287.1 297.1 309.7 June 271.3 290.6 298.1 310.7 July 274.4 292.2 299.3 311.7 August 276.5 292.8 300.3 313.0 September 279.3 293.3 301.8 October 279.9 294.1 302.6 November 280.7 293.6 303.1 December 281.5 292.4 303.5 Average 272.4 289.1 298.4 Source: U. S. Department of Labor, Bureau of Labor Statistics Members of families with incomes equal to or greater than poverty thresholds have poverty indexes equal to or greater than 1.0 and can be described as "at or above poverty"; those with incomes less than the poverty threshold have indexes less than 1.0 and can be described as "below poverty". Poverty thresholds used were computed on a national basis only. No attempt was made to adjust these thresholds for regional, State, or other variations in the cost of living. None of the noncash public welfare benefits such as food stamp bonuses were included in the income of the low income families receiving these benefits. 2Size of Place and SMSA Codes for size of place and SMSA were obtained from Bureau of Census summary tape files (STF1B). A place is a concentration of population. Most places are incorporated as cities, towns, villages or boroughs, but others are defined by the Bureau of the Census around definite residential nuclei with dense, city-type street patterns, with, ideally, at least 1,000 persons per square mile. The boundaries of Census defined places may not coincide with civil divisions. A Standard Metropolitan Statistical Area (SMSA) is a large population nucleus and nearby communities which have a high degree of economic and social integration with that nucleus. Generally, an SMSA includes one or more central cities, all urbanized areas around the city or cities, and the remainder of the county or counties in which the urbanized areas are located. SMSAs are designated by the Office of Management and Budget. The same place size and SMSA codes were assigned to all persons in the same segment (for the definition of segments see Ref. No. 1 in Section C). In a few cases segments were divided by place boundaries. In these cases codes were assigned after inspecting segment maps. If the segment was predominantly in one place, then the place code for that place was used. If the segment was approximately evenly divided, the code for the larger place was used. 2Home Heating Questions E-3 through E-6, pertaining to the main fuel and equipment used for heating the home, appear to have codes which are inconsistent. It has been verified that these are the codes that were recorded on the original document; that is, codes that appear inconsistent were not incorrectly keyed. 2Ability to Read Blackboard from Back of Room D1, D11: For some individuals there is an inconsistency between D1 and D11. These were persons who were reported to have never had trouble seeing with one or both eyes when not wearing glasses or contact lenses but were reported as being unable to read the blackboard from the back of the classroom. These records were looked up on microfilm and verified and not changed. 2Use of Glasses or Contact Lenses D6: Sunglasses, safety glasses or other kinds of lenses that were used for purposes other than improving or correcting vision were not included. 2Responses specified in open-ended response categories Some of the "other" or "specify" responses to this question were recoded to existing categories, if possible. For responses that could not be recoded, new code categories were created if the information was deemed analytically useful. Caution should be used in interpreting the data from these new categories because there is no way of knowing which other respondents would have selected one of the new categories if given the option. 2Vision Test D13: This includes any test in which the child was asked to read numbers or letters from a chart or through a machine. It may or may not have included a complete eye examination or have been part of a general check-up. No change was made to correct an inconsistency between the demographic age and the length of time since the vision was tested. 2Adult Sample Person Questionnaire Data Missing In a few instances, data are not available from the ASPQ form because of technical problems such as lost questionnaires, incorrect forms administered, or forms filled out so inadequately that data were later judged to be unreliable. For these two cases, tape positions 426-444 are all blanks. 2Multiple Responses D7, D8: The interviewer was instructed to mark all responses that apply. As a result, each respondent may have more than one answer to this question. 2Blank Records In this field a "1" indicates respondents who were included in the sample, but did not receive a physical exam. Although positions 446-479 are blank, demographic data are available for these respondents. 2Eye The blank code has one of two meanings: 1) the respondent did not undergo a physical exam and consequently all fields 446-479 are blank (see note 21); or 2) the eye was present. 2Fundus The fundus was not visualized either due to physical reasons or lack of patient cooperation. 2Vision Exam Missing Not all sample persons who came to the mobile examination center to participate in the examination phase of the survey were given a vision examination. Reasons for noninclusion in the examination included insufficient time for the examination, child crying or misbehaving, and sample person having to leave. This data field contains code = '1' for those persons who did not have a vision examination, and code = '2' for those who were given a vision examination. 2Vision Exam Not Applicable As explained in Section B, not all examinees were eligible for selected portions of the vision examination. Contact lens wearers were not tested without correction (VTF 107, 117, 118, 119, 120). Examinees who had no corrective lenses, and those who forgot to bring them to the examination center, could not be tested with correction (VTF 113, 121, 122, 123, 124). These data fields were coded "000" for "Not applicable." 2Distance Visual Acuity Range of Testing Distance visual acuity was tested to 20/400 in the first 13 stands and to 20/200 in subsequent stands. For comparability, distance visual acuity equal to or poorer than 20/200 was recoded to 20/200 for all stands. 1APPENDIX 1 - VISION TEST EXAMINATION FORM Form PHS 6214 7 OMB No. 0937-0078 9 8 82 Approval Expires 12/84 Vision Test Examination Form NOTICE - Information con- Department of Health and Human Services tained in this form which Public Health Service would permit identification Office of Health Research, of any individual or estab- Statistics, and Technology lishment has been collected National Center For Health Statistics with a guarantee that it VISION TEST (507) will be held in strict con- (AGES 6 - 74 YEARS) fidence, will be used only HISPANIC HEALTH AND NUTRITION EXAMINATION SURVEY for purposes stated for this study, and will not be disclosed or released to others without the consent of the individual or the establishment in accordance with section 308(d) of the Public Health Service Act (42 USC 242m). a. Age b. Sex c. Examiner No. M Yrs. F 102 CHECK ITEM A: 104 1 Sloan Letters Used 2 Landolt Rings Used I. DISTANCE VISION CHECK 105 1 Wears glasses for test ITEM B: 2 Wears contact lenses for test 3 Forgot (glasses, contact lenses) 4 Does not wear either glasses or contact lenses for distance vision VISUAL ACUITY Both eyes without correction ........................... 107 20/ START HERE IF SAMPLE NUMBER IS ODD: 2. Left eye with correction if worn ................... 109 20/ START HERE IF SAMPLE NUMBER IS EVEN: 3. Right eye with correction if worn .................. 111 20/ 4. Both eyes with correction .......................... 113 20/ II. BINOCULAR VISION Test using Random Dot E with both eyes and with glasses/contact lenses (if examinee wears glasses/contact lenses). Distance cm Pass/Fail 50 cm ..................... 114 1 P 2 F 100 cm ..................... 115 1 P 2 F III. NEAR VISION CHECK 116 1 Wears glasses for test ITEM C: 2 Wears contact lenses for test 3 Forgot (glasses, contact lenses) 4 Does not wear either glasses or contact lenses for distance vision VISUAL ACUITY 1. Both eyes without correction 30 cm 40 cm 50 cm 60 cm 117 20/ 118 20/ 119 20/ 120 20/ 2. Both eyes with correction 30 cm 40 cm 50 cm 60 cm 121 20/ 122 20/ 123 20/ 124 20/ 1APPENDIX 2 - VISION EXAMINATION EQUIPMENT AND PROCEDURES 2Introduction Chapters 1, 2, 3, 4B and 5 are excerpted from Instruction Manual Part 15d, Dental Examiner's Manual for the Hispanic Health and Nutrition Examination Survey, 1982-84. Hyattsville, Maryland, 1986. Note that the referenced figures were unavailable for reproduction. However, they can be obtained upon request at the address given at the front of this documentation. 2Chapter 1 INTRODUCTION Immediately after the dental examination is completed, the dentist will administer the vision test to those scheduled to get it and record the findings of the test on the vision test form. The dentist will then edit the form for consistency and completeness. She/he will also fill out the vision section of the Report of Findings I. The vision test form is a two-page form consisting of three sections. The top of the first page of the form contains space for identifying iformation about the SP such as age and sex. The SP number will be stamped at the bottom of each page of the form. In most cases the Coordinator will have filled in Items a and b at the top of page one; however, if this has not been done, the dentist will have to fill in these items. Items a and b can be obtained from the Control Record. The dentist must record his/her examiner's number in Item c. Check Item A indicated whether Sloan Letters Vision Charts or Landolt Ring Vision Charts have been used for the exam. Sloan Letters Charts contain alphabetic characters and should be used for literate SPs. Landolt Ring Charts contain symbols and are used with illiterate SPs. Check the Sample Person Questionnaire (Medical History) to determine whether the SP is literate. Remember, some people will say they can read when they cannot. This is especially true for young children. If you begin the exam using the Sloan Letters and find the SP can't read, you will have to switch to the Landolt Ring Charts. Review of medical histories should be done before the arrival of the SPs for the session. The physician will have the questionnaires. Be sure to check the appropriate box in Check Item A. The vision test parts should be done in the following order. First, test near vision, then test binocularity of vision, and finally test far vision. This order is important for two reasons. It minimizes the amount the SP has to move around the dental room, which is very small, and it minimizes the changes in lighting in the room to which the SP's eyes must adjust. Before beginning the vision exam, explain to the SP that you are going to be testing her/his vision for reading, seeing distances and focusing. Explain that the tests will take about ten minutes. 2Chapter 2, Near Vision Test 3General The near vision test involves determining visual acuity at up to four fixed distances from 30 to 60 centimeters by having the SP read lines of letters on the Sloan or Landolt charts for near vision. The near vision test will be administered to all examinees ages 6-19 years and half the examinees ages 20-74 (those not in the glucose tolerance test subsample). 3Equipment In order to perform the near vision test you will need the following equipment: Sloan letters acuity card for near vision Landolt rings acuity card for near vision Near vision test bar Before discussing the procedures for administering the test, it is important for the examiner to familiarize herself/himself with the equipment. The near vision test bar is about 65 centimeters long with distances marked along its side. It also has a sliding metal frame which holds the near vision test card. There is a chin rest at one end of the bar. The SP places his/her chin against this rest. When positioning the bar, make sure the SP's eyes are on a vertical line with the zero mark on the distance bar. Also, remember to have the SP place one hand on the bar to prevent the slide from moving and hitting him/her. The bar provides a means of conducting the test at standard distances. The near vision test card contains the letters to be read by the SP. Notice the distances listed along the left hand column of the card. Also note the distance equivalents in terms of visual acuity on the right side of the card. The first four lines of the card (lines 620 through 310) have between five and ten letters in sequence across the card. If the SP reads these lines she/he should try to read the entire line. The next three lines, 250-160, also have ten letters but have a break in the middle. The entire line should also be read if these lines are attempted by the SP. The remainder of the card, lines 125 through 30, consists of 3 columns of five letters. If an SP is being tested without correction, she/he should start on the left side of the card and read the first ten letters (columns 1 and 2) on the line. If the SP is being tested with correction, she/he should read the second 10 letters on the line (columns 2 and 3). This prevents the SP from memorizing the letters the first time through. Finally, look at the near vision test recording form. Check Item C at the top of the form contains information that will be used in analysis about whether or not the SP wears glasses. We are only interested in glasses or contact lenses worn to improve near vision in this part of the vision test. If the SP wears glasses for near vision for the test, check the appropriate box on the form. The near vision form is actually divided into two main sections. Line number one of the form contains space to record test results without correction. The next line contains space to record visual acuity at four different distance readings on the near vision test bar. 3Before the Test 1. Make sure the lights in the dental room are turned on for the near vision exam. 2. Have the examinee get in a comfortable position for administering the test. She/he should be seated on the dental chair. 3. Ask the examinee whether she/he wears glasses or contact lenses for near vision. Mark the response in the appropriate answer box on the near vision form. 4. Explain to the examinee that the purpose of the test is to see how good her/his eyesight is for reading letters. Tell her/him to do her/his best in reading each letter on a given line, and even if she/he cannot identify all of the lettrs, she/he should read the ones that she/he can. 5. If an SP wears glasses for near vision, test him/her with and without correction. Test without correction first. Ask the SP to remove her/his glasses for this first part of the test. (If an SP wears contact lenses, she/he should not remove them. If the contacts are for near vision, the SP will only be tested once rather than twice.) Once the SP has been tested without correction, ask her/him to put on her/his glasses. Repeat the test with corrective lenses. If the SP is being tested without correction, you would record the results on the line marked "Both eyes without correction." If the SP is being tested with correction, you would fill out the second line on the form. 3Administering the Test 1. Place the test card at a distance of 40 centimeters by moving the metal slide on the near vision test bar (NVTB) to the 40 mark. Ask the SP to rest her/his chin against the chin rest and hold the NVTB with one hand. 2. Start the test by asking the SP to read the 20/20 line on the card. a. Situation A, SP reads line correctly If the SP reads the line with 3 or fewer errors, she/he has read the line correctly. The SP is allowed to make a specified number of errors in reading a line and still is considered to have read the line correctly. Next ask the SP to try to read the 20/16 line (one line down). This will determine whether the SP's near vision acuity is better than 20/20. If the SP can read this line, record this on the near vision test recording form in the column headed 40 cm. If she/he fails to read the 20/16 line correctly, then her/his visual acuity is 20/20. Record this on the recording form. If the SP can read the 20/20 line (or better) at 40 centimeters, go on to test the SP with correction, if appropriate. If the SP does not wear corrective lenses, or had to be tested only with corrective lenses (wears contacts for near vision), the near vision test is completed with the SP. b. Situation B, SP cannot read line correctly If the SP cannot read the 20/20 line at 40 centimeters, point to the 20/30 lines (2 lines up) and ask the SP to read it. If the SP reads this correctly (getting all letters correct or within the acceptable number of errors), move down one line to see if the SP's near vision acuity is better than 20/30 but not as good as 20/20. If the SP fails to read the 20/30 line correctly, move up 2 more lines to the 20/50 line and repeat the process. Record the smallest line read correctly at 40 centimeters on the data form in the column headed 40 cm. For example, if an SP fails the 20/20 line and the 20/30 line, but reads the 20/50 line, you would ask him/her to read the 20/40 line. If the SP reads this line correctly, this would be recorded on the form. 3. Data are recorded on the recording form by locating, across the top of the form, the distance from the SP the card is being held. Thus far, we have been talking about 40 centimeters. This is the second column in this section. Simply write in the visual acuity on the first line for both eyes without correction. Use lead zeros if necessary. For example, if the SP's visual acuity is 20/40, it should be recorded as 20/040. If the SP's visual acuity is 20/100, no lead zero is necessary. 4. All SPs who cannot read the 20/20 line at 40 centimeters will also be tested at 60, 50, and 30 centimeters. Begin by moving the metal slide out to 60 centimeters. Ask the SP to read the 20/20 line. Follow the procedures for administering and recording the test at 40 centimeters. Repeat for 50, 30 centimeters. 5. Once the SP has been tested without correction, repeat the test with correction (wearing glasses). Begin at 40 centimeters and follow the procedures outlined above. 2Chapter 3, Random Dot E Test 3Purpose The Random Dot E (RDE) is used to test for binocularity of vision. It is particularly useful for determining the presence of amblyopia and for measuring stereoacuity thresholds, although it produces underestimates of actual thresholds. All SPs who are eligible for the vision exam will be given the RDE Test. 3Materials In order to perform the RDE Test, you will need to use the following materials: Polarized glasses Random Dot E test card with an E in stereo depth Stereo blank card with no E, just a dotted background A Model E card to be used during the explanation of the test A dark shade that can be pulled down behind the SP to prevent glare on the surface of the cards. 3Introduction to the Test To better understand what is involved in the use of the RDE, put on the polarized glasses and view the RDE card which is labeled on the back with "RAISED" toward one edge of the card and "RECESSED" upside-down toward the opposite edge of the card. The cards are called stereograms. It is important to hold the stereogram so that the long sides of the card are horizontal and the word "RAISED" is at the top of the card. If the long sides of the card are held vertically, the E may not be seen. If you have normal stereopsis, you will see the letter E in stereo depth on the card. The E should appear to be raised up off the test card. If you rotate the RDE card, so the word "RECESSED" is at the top, the E will appear to sink into the background, making an E shaped hole. During test administration, the RDE card should only be used with the word "RAISED" at the top of the card. Now look at the card labeled "STEREO BLANK" through the polarized glasses. No E is seen, only the dotted background. To understand how the test would work for someone who has a problem with binocular vision, hold the RDE and STEREO BLANK cards side by side. Look at them through the polarized glasses while you close one eye. The E should disappear and both cards will look the same. 3Instructions for Administering the RDE Test 1. Turn on the lights in the dental exam room for the test. Pull down the dark shade on the wall behind the SP. This will prevent any glare or light reflections on the card. The SP should be sitting on the dental chair. 2. Place the polarized glasses on the SP. If the SP wears prescription glasses, do not have her/him remove them for the test. If you are testing a child who is hesitant about putting on the glasses because she/he doesn't wear glasses, try creating a game. Tell her/him that they are "like sunglasses", or "special or magic glasses" and that she/he has to wear them to see magic pictures. Make sure the glasses are back on the SPs nose. If they slip forward, binocular vision may be impaired. Similarly, the SP should keep her/his head straight as tilting to one side will also interfere with the test. 3. Explain the test to the SP and let her/him practice until you are sure she/he understands. Hold the Model E card up to the SP and ask the SP what the figure is. If the SP cannot name it, tell her/him that it is an E and ask if she/he can see it. Hold the RDE card next to the STEREO BLANK card and ask the SP to tell you which card has the E. If the SP cannot tell you which card has the E, repeat the explanation process, put the cards behind your back and hold them out of sight (underneath the back of the dental chair is a good place) and shuffle them. Ask the SP to tell you on which card the E is this time. Once the SP understands the process continue with the test. Some SPs may not be completely literate. We have found that children sometimes have trouble naming the letter. If the SP appears to have a problem, simply tell her/him to indicate with her/his hand which card contains the E or to tell you on which card the three-legged table appears. 4. Perform the RDE test at two distances from the SP, 50 and 100 centimeters. In order to standardize the distance, we will be placing tape marks on the dental chair or on the wall to show you where to hold the cards from a fixed place on the dental chair. Ask the SP to sit back against the far arm of the chair with her/his back touching the counter in the dental room so that she/he is in the correct position. Check to see that the chair is in the correct position on the floor. There will be tape marks on the floor as guides. Hold the RDE and STEREO BLANK cards side by side at about 50 centimeters from the SP and ask on which card the E appears. Shuffle the cards as described above. Show the cards to the SP and ask again where the E is located. 5. Repeat this process two more times at 50 centimeters. The SP should be tested four times at each distance so you can identify guessing. Once the process has been understood, the answer should be correct every time if the SP has normal binocular vision. 6. Now hold the cards out at the 100 centimeter mark from the SP. Perform the test at that distance 4 times. Remember to shuffle the cards out of sight between each test administration. When you shuffle the cards, be careful not to use any consistent pattern since the SP may learn the pattern quickly and guess the correct answer. 3Recording the Results The space for recording the results of the binocular vision (RDE) test can be found on page 2 of the vision test form. You will record whether the SP passed or failed the test at 50 and 100 centimeters. In order to pass, the SP must answer correctly all 4 times at a particular distance. If she/he answers incorrectly even one time at a specified distance, she/he has failed the test at that distance. Simply place a check in the appropriate box. Only one box may be checked for each distance. 3Criteria for Referral If the SP cannot distinguish the E in the RDE card at all or if she/he can only see it when the card is 50 centimeters or closer, the SP should be referred to an eye doctor for further testing. Use the procedure described in Chapter 5 for this process. 2Chapter 4 A, The Distance Vision Test 3Note NOTE: This chapter documents the distance vision test procedures and equipment for the first 13 stand locations of the Mexican-American portion of the survey. 3Introduction The distance vision test determines visual acuity at a fixed distance of either one or four meters by having the SP read lines of either the Sloan Letters or Landolt Rings charts. The distance vision test is administered to all SPs ages 6-74 years. 3Materials and Equipment You will need the following materials to perform the distance vision exam. o Illuminated wall charts with Sloan Letters (SL) I and II, wall charts with Landolt Rings (LR) o Distance vision recording form o Eye cover (paddle) o A dark shade that can be pulled down over the window The illuminated wall charts which the SPs will read during the distance vision test are located in two places in the dental room. Chart I, the chart that will be used the most, is located on the wall (Wall A) to the left as one enters the room. Chart II is located on the wall (Wall D) which separates the room from the hallway, (the inside wall) next to the door. See Exhibit 4-1. Chart I is viewed at a distance of four meters. Chart II is viewed at a distance of one meter. Exhibit 4-2 depicts Chart II, the one meter chart. Chart I is similar, only viewed at a farther distance. The recording form for distance vision has space to record visual acuity for four categories, (1) both eyes without correction, (2) the left eye with correction (if applicable), (3) the right eye with correction and (4) both eyes with correction (See Exhibit 4-11). Within each of these four categories, the distance vision recording form is divided into two parts. The left side of the form is used for recording when the SP reads Chart II, the one meter chart. The right side of the form is used when the SP reads Chart I, the four meter chart. The right and left sides of the form are completed in the same way. If the SP reads Chart I, there is no need to have her/him read Chart II, and the left side of the form will be blank. The letters in column one on the recording form correspond to the letters on the charts. Column two on the form lists the visual acuity, for example, 20/400, 20/320, 20/240. Column three on the form lists the acceptable number of errors for the line. For example, if the SP were reading the one meter chart line three (SRDVC OZKNH) she/he could read the line with three errors and still read the line "correctly" since line three allows three errors. Column four on the form provides boxes for you to check the smallest line the SP reads correctly (within the acceptable number of errors). The boxes are preceded by codes that will be used when the data are computerized. You need not concern yourself with them. Eye covers (paddles) are to be used when testing the right and left eyes separately. The SP uses the paddle to cover the eye not being tested. It is important to remind each SP not to push against his/her eye with the paddle. This will temporarily blur her/his vision in the covered eye. 3Before Conducting the Distance Vision Exam * Have the SP sit on the dentist's stool. Notice that there are marks on the far wall (Wall B, Exhibit 4-1) of the dental exam room towards the left corner. The stool should be positioned between these marks. You will also notice that there is a mark on the wall indicating about where the top of the SPs head should be. You will need to raise or lower the examining stool so that the SP is at the correct height. * The SP will be facing the mirror located above the sink on wall C. Chart I will be behind the SP on wall A. The SP will read the reflection of the letters in Chart I in the mirror, not the chart itself. This arrangement provides the distance needed for this test. * Chart II will be to the right of the SP on wall D. If the SP needed to read this chart, she/he will actually read the chart, not a reflection. * Determine whether you should be using the Sloan Letters (SP literate) or Landolt Rings (SP illiterate). Generally, you should keep the Sloan Letters Charts in the light box since you will be using these the most. If the SP is illiterate, slide the Sloan Chart out of the light box and replace them with the Landolt Rings Charts. * Turn off the lights in the dental exam room and pull the shade down over the window. * Turn the light on in Charts box. * Ask the SP if she/he wears glasses for distance vision. If she/he does and has them available for the test, check #1 in Check Item B on the form. If the SP wears contact lenses for distance vision, check #2. You would not ask the SP to remove her/his contacts for the test. You would only test the SP with corrective lenses in this case. 3Procedures for Conducting the Distance Vision Exam * The distance vision exam should be conducted in the following order: - For SPs with glasses Both eyes uncorrected Each eye (separately) corrected Both eyes corrected - For SPs without glasses/contacts Each eye (separately-uncorrected) Both eyes uncorrected - For SPs with contact lenses (for distance vision) Each eye (separately) corrected Both eyes corrected * Point to the 20/30 line on the eye Chart I and ask the SP to read it. To the left of the letters on the eye chart are three numbers. the first number tells you the visual acuity for the line at four meters. In order to calculate the acuity for a line, multiply this number by 20. The bottom line on the chart is 20/15 (.75 x 20), the next line up is 20/20 (1 x 20), the third line up is 20/24 (1.2 x 20), and so on. Notice when you get to 20/40 (lines five and six from the bottom) the SP must read two lines. This is true for the remander of the chart, except for the top line. The number of acceptable errors is based on the number of letters in the line. For the 20/40 through 20/80 lines, this is two lines of five letters each. Consequently, it is important for the SP to attempt all the appropriate letters for the line. * If the SP reads the 20/30 line correctly (within the acceptable number of errors) have her/him read down successive lines on the chart until she/he fails to read a line correctly. The acuity for the smallest line read correctly should be recorded. For example, if the SP reads the 20/30 line correctly, the 20/24 line and the 20/20 line but fails to read the 20/15 line, you would record 20/20 as the SPs visual acuity. * If the SP initially fails to read the 20/30 line correctly, point to the 20/60 line and have her/him try to read it. If she/he reads that line correctly, move down successive lines until the SP fails to read a line correctly. Record the visual acuity for the smallest line read correctly. If she/he cannot read the 20/60 line, have her/him try the 20/100 line. If she/he can read the 20/100 line move down until the SP fails to read a line correctly and record the visual acuity for smallest line read correctly. After recording acuity, move on to test the right or left eye. If the SP cannot read the 20/100 line or reads the 20/100 but not the 20/80 line correctly, go to the one meter chart. * The one meter chart is the same as the four meter chart except the letters appear in a different order on each line. Also, the difference in distance viewed changes the acuity readings for each line. In order to calculate the acuity for a line, take the number that appears in the third column of numbers to the left of the letters and multiply by 20. For example, the visual acuity for the bottom line at one meter is 20/60 (20 x 3). If the SP must switch to the one meter chart, the right side of the distance vision form will be blank and you will record on the left side. * If the SP reads the 20/100 line on the one meter chart correctly, have him/her move down a line. Record the acuity for the smallest line reads correctly. * If the SP cannot read the 20/100 line, have her/him try to read the 20/100 line on the one meter chart. Repeat the process until you determine the smallest line which can be read correctly and record the acuity for that line. * Recording--You will record the same way whether you are using the one meter or four meter chart. Once you have determined the smallest line the SP can read correctly, find this on the recording form. You can use either the first column on the form, the column showing the letters as they appear on the chart, or column 2, the acuity level (20/20, 20/60, etc.) to identify the appropriate line on the recording form. Once you identify the line, place a check ( ) in the box in column 4 across from the appropriate letters or acuity level. You should have only one mark on the section of the form for recording acuity for both eyes (uncorrected), one mark for the left eye, one for the right eye and one for both eyes (corrected). As you administer the test, place a horizontal line through any letters or groups of letters that the SP misses or does not attempt. Also draw a horizontal line directly below the smallest line attempted. * After testing both eyes without correction, test the right and left eyes separately with correction, if applicable. The right and left eyes should be tested separately regardless of whether the SP wears corrective lenses. Ask the SP to put her/his glasses back on. If the SP's number is odd, begin with the left eye, if it is even, begin with the right eye. Alternating whether the SP begins with the right or left eye is important since the SP will be learning the order of the letters each time she/he reads them. Alternating insures that the reported acuity in one or the other eye will not systematically be better. Follow the testing and recording procedures described above. * Finally, test both the SP's eyes with corrective lenses, if applicable. Use the same testing and recording procedures described above. If the SP does not wear corrective lenses, the distance vision testing is completed. * Exhibit 4-3 is an example of how to record the following test results for SP number 34622: - Both eyes - without correction - 20/24 - Errors in 20/30 line - C,D - Errors in 20/24 line - C,O,D - Errors in 20/20 line - O,S,D,C 3Editing the Form 4Near vision section * Check to see that Check Item C is completed. * If 1 is checked in Check Item C, both the right and left side of the form should be completed. * If 2 is checked in Check Item C, only the right side of the form should be checked. * If 3 or 4 is checked in Check Item C, only the left side of the form should be completed. * Check each line with acuity recorded. The acceptable number of errors should equal the number of letters with horizontal lines through them. * If 40 centimeter distance = 20/20 or better, no other checkmarks should appear on the form. * If 40 centimeters = 20/25 or worse, results should also be recorded for 30,50 and 60 centimeters. 4Random Dot E Test (Binocular Vision) * Check to see that only one box is marked for each distance. 4Distance Vision Test * Check to see that a, b, and c at the top of the form is completed. * Make sure Check Items A and B are completed. * If 1 is checked in Check Item B, acuity should be recorded for both eyes, with and without correction and for the right and left eye with correction. * If 2 is checked, acuity should be recorded for both eyes with correction, right and left eye with correction. * If 3 or 4 is checked, acuity should be recorded for both eyes without correction, right and left eye without correction. * Within the recording tables, either the one meter or four meter chart should be used. Only one acuity should be recorded. * Check the line with acuity recorded, the acceptable number of errors should equal the number of letters with horizontal lines through them. 2Chapter 4 B, Distance Vision Test 3Note NOTE: This chapter documents the distance vision test procedures and equipment for the total survey with the exception of the first 13 stand locations of the Mexican-American portion of the survey. 3Introduction The distance vision test determines visual acuity at a fixed distance of 4 meters by having the SP read lines of either the Sloan Letters or Landolt Rings Charts. The distance vision test is administered to all examinees ages 6-19 years and half the examinees ages 20-74 years (those not in the glucose tolerance test subsample). 3Materials and Equipment You will need the following materials to perform the distance vision exam. Illuminated wall charts with Sloan Letters (SL) I, II, and III; wall charts with Landolt Rings (LR) I, II, and III; and wall charts with Sloan Letters reversed (SLR) I, II, and III Eye cover (paddle) Dark shade that can be pulled down over the window Usually when vision is tested, individuals move closer or farther away to read the far vision test charts. However, the exam room in the Medical Examination Center does not have enough space to allow SPs to move the appropriate distances from the chart. Consequently, charts with different size letters will be used at a fixed distance, 4 meters. This should approximate having the SP move closer or farther from the charts. The Sloan Letters Reversed (SLR) Charts are the primary measurement device. As in the case of near vision testing, the Landolt Rings Charts are used with illiterate respondents. Both the SLR and Landolt Rings Charts are used with the light box. The Sloan Letters Charts (SL) are used with a small subsample of the SPs in an experiment designed to examine the effect of using the mirror on the visual acuity data. The experiment, which will be conducted in the x-ray room, is discussed in more detail at the end of this section. Each set of charts consists of three separate pages (charts), for example, SLR I, II, and III. Begin the test with SLR I. This chart will test visual acuity up to 20/100. If the respondent has to read the 20/100 line on this chart, you will have to remove SLR I from the light box and replace it in the light box with SLR II. The letters on this chart are bigger than those on SLR I. This chart tests visual acuity up to 20/160. SLR III tests acuity at 20/200 and must be slipped into the light box if the SP cannot read SLR II. If the SP can read the SLR I, there is no need to have her/him read SLR II or III. The illuminated wall charts which the SPs will read during the distance vision test are located in two places in the dental room. SLR I, the chart that will be used the most, is located on the wall (Wall A) to the left as one enters the room. Chart II is located on the wall to the left as one enters the room. SLR II and III, as well as LR I, II and III are located in a packet in the dental room. SL I is also in the x-ray room vision chart box and SL II and III and located in a packet in the x-ray room. All charts are viewed at a distance of four meters either as a linear distance or via a mirror. The recording form for distance vision has space to record visual acuity for four categories, (1) both eyes without correction, (2) the left eye with correction (if applicable), (3) the right eye with correction (if applicable), and (4) both eyes with correction. The form provides space to enter the visual acuity, for example, 20/200, 20/100, 20/60, depending on the smallest line the SP can read given the allowable number of errors. The allowable number of errors an SP can make and still read the line correctly is determined by the number of letters in the line. Each line (which may consist of one or two rows on the chart) has either 6, 8, or 10 letters. If there are 10 letters, the SP is allowed 3 errors. If there are 8 letters, the SP is allowed 2 errors and with 6 letters the SP is allowed 1 error. For example, if the SP were reading SL I, line 3 (SRDVC OZKNH), she/he could make 3 errors and still read the line "correctly" since line 3 allows 3 errors. The lines on the data form are preceded by codes that will be used when the data are computerized. You need not concern yourself with them. Eye covers (paddles) are to be used when testing the right and left eyes separately. The SP uses the paddle to cover the eye not being tested. It is important to remind each SP not to push against his/her eye with the paddle. This will temporarily blur his/her vision in the covered eye. 3Before Conducting the Distance Vision Exam 1. Have the SP sit on the dentist's stool. Notice that there are marks on the far wall of the dental exam room towards the left corner. The stool should be positioned between these marks. You will also notice that there is a mark on the wall indicating about where the top of the SPs head should be. You will need to raise or lower the examining stool so that the SP is at the correct height. 2. The SP will be facing the mirror located above the sink on wall C. SLR I will be on the wall behind the SP. The SP will read the reflection of the letters in the mirror, not on the chart itself. This arrangement provides the distance needed for this test. 3. SLR II and III and LR I, II, and III are to be read in the same manner as SLR I. 4. Determine whether you should be using the Sloan Letters (SP literate) or Landolt Rings (SP illiterate). Generally, you should keep the SLR I in the light box since you will be using it the most. If the SP is illiterate, slide the Sloan Chart out of the light box and replace it with LR I. 5. Turn off the lights in the dental exam room and pull the shade down over the window. 6. Turn the light on in the chart box. 7. Ask the SP if she/he wears glasses for distance vision. If she/he does and has them available for the test, check Box 1 in Check Item B on the form. If the SP wears contact lenses for distance vision, check Box 2. You would not ask the SP to remove his/her contacts for the test. You would only test the SP with corrective lenses in this case. 3Procedures for Conducting the Distance Vision Test 1. The distance vision exam should be conducted in the following order: a. For SPs with glasses Both eyes uncorrected Each eye (separately) corrected Both eyes corrected b. For SPs without glasses or contact lenses Each eye (separately-uncorrected) Both eyes uncorrected c. For SPs with contact lenses (for distance vision) Each eye (separately) corrected Both eyes corrected 2. Point to the 20/30 line on SLR I and ask the SP to read it. To the left of the letters on the eye chart are three numbers. The first number tells you the visual acuity for the line at 4 meters. In order to calculate the acuity for a line, multiply this number by 20. The bottom line on the chart is 20/15 (.75 x 20), the next line up is 20/20 (1 x 20), the third line up is 20/24 (1.2 x 20), and so on. The other two numbers that precede the lines of letters are used to calculate visual acuity at other distances. Since we will only be using one distance, 4 meters, these other numbers should be disregarded. Notice when you get to 20/40 (lines 5 and 6 from the bottom) the SP must read 2 lines. This is true for the remainder of the chart, except for the top line. If the SP fails to read the 20/80 line correctly, move to SLR II since the top line on SLR I is not a complete line. The number of acceptable errors is based on the number of letters in the line. For the 20/40 through 20/80 lines, this is two lines of five letters each. Consequently, it is important for the SP to attempt all the appropriate letters for the line. 3. If the SP reads the 20/30 line correctly (within the acceptable number of errors) have her/him read down successive lines on the chart until she/he fails to read a line correctly. The acuity for the smallest line read correctly should be recorded. For example, if the SP reads the 20/30 line correctly, the 20/24 line and the 20/20 line but fails to read the 20/15 line, you would record 20/20 as the SPs visual acuity. 4. If the SP initially fails to read the 20/30 line correctly, point to the 20/60 line and have her/him try to read it. If she/he reads that line correctly, move down successive lines until the SP fails to read a line correctly. Record the visual acuity for the smallest line read correctly. If she/he cannot read the 20/60 line, have her/him try the 20/80 line. If she/he cannot read this line correctly, move down the chart until the SP fails to read a line correctly and record visual acuity. If she/he cannot read the 20/80 line correctly, remove SLR I from the light box and replace it with SLR II. Have the respondent try the 20/100 line on SLR II. Record the visual acuity for the smallest line read correctly. 5. At no time is the top line of SLR I (20/100) considered a complete line. It has only three letters. The bottom line of SLR II must be used to test 20/100 vision. 6. Notice that each line on SLR II consists of two rows of three letters each. The visual acuity for the line at 4 meters appears to the left of the letters on the chart, 20/160, 20/120, and 20/100. 7. SLR III test for 20/200 visual acuity. If the SP cannot read the 20/160 line (top of SLR II) have him/her try SLR III (20/200). 8. Record findings the same way no matter what charts you are using. Once you have determined the smallest line the SP can read correctly, record the correct visual acuity for the line. You should have only one entry on the line of the form for recording acuity for both eyes (uncorrected), one entry for the left eye, one for the right eye and one for both eyes (corrected). Record the values by right-justifying the entries: that is, use a zero in the first space when vision is better than 20/100, e.g., "20/020". If a line is not used, for example, when the SP is wearing contact lenses there is no value in the first line, fill in the spaces with zeroes. This also applies when the SP does not wear corrective lenses and the bottom line is not used. 9. The right and left eyes should be tested separately regardless of whether the SP wears corrective lenses. Ask the SP to put her/his glasses back on. If the SP's number is odd, begin with the left eye, if it is even, begin with the right eye. Alternating whether the SP begins with the right or left eye is important since the SP will be learning the order of the letters each time she/he reads them. Alternating insures that the reported acuity in one or the other eye will not systematically be better. Follow the testing and recording procedures described above. 10. Finally, test both the SP's eyes with corrective lenses, if applicable or uncorrected for persons who do not wear glasses. Use the same testing and recording procedures described above. 11. Use the same testing and recording procedures for the SL and Landolt Ring Charts as for the SLR charts. 3Conducting the Distance Vision Experiment The procedure involving the use of a mirror to approximate the 4-meter distance needed to conduct the vision exam was designed by NCHS staff in conjunction with representatives from the American Association of Optometrists. The accuracy of the procedure has not been tested. Consequently, NCHS is interested in conducting an experiment to determine whether or not the use of the mirror distorts vision and thus effects visual acuity in any way. The experiment will be conducted in the x-ray room. A light box will be placed in the room and the floor will be marked off at 4 meters. The Sloan Letters (SL) or Landolt Ring (LR) Charts will be used to conduct this test. One person who is eligible for the vision test will be randomly selected from each exam session to participate in the distance vision experiment. After SPs have arrived at the Medical Examination Center take the daily list of SPs and number all eligible SPs. Use the random number table to randomly select an SP. The random number table is made up of rows and columns of numbers ordered randomly on the page. Enter the table randomly as discussed in training and identify the entry point. Your start point will be a one-digit number if fewer than ten SPs are eligible, or a two-digit number if ten or more SPs are eligible. Move vertically down the table number by number until you hit a number that represents an eligible respondent. This SP will participate in the vision test experiment. Conduct the regular vision exam first. The SP should participate in at least one other exam component before the distance vision experiment is conducted. The experiment will need to be coordinated with the x-ray techs since the x-ray room will be in use. The SP should stand at the 4 meter line and attempt to read the SL I (or Landolt I) chart. The procedures for testing distance vision, using the chart and recording visual acuity are the same as those described for the SLR charts used in the regular vision exam. If the SP cannot read the SL I (or Landolt I) chart, replace it in the light box with the SL II (or Landolt II) chart. Use the SL III (or Landolt III) chart the same way. Always begin with Chart I even if the SP needed to read Chart II or III during the regular exam. Record the results for the distance experiment on a second vision exam form. Be sure to mark the top of the distance vision experiment form. 2Chapter 5, Other Responsibilities 3Editing the Form 1. Near vision section a. Check to see that Check Item C is completed. b. If 1 is checked in Check Item C, be sure both lines 1 and 2 are completed. c. If 2 is checked in Check Item C, be sure only line 2 is completed. d. If 3 or 4 is checked in Check Item C, be sure only line 1 is completed. e. If vision at the 40-centimeter distance is 20/20 or better, be sure no other entries appear in this section. f. If at 40 centimeters, vision is 20/25 or worse, see that results are also recorded for 30, 50, and 60 centimeters. 2. Random Dot E test (binocular vision) Check to see that only one box is marked for each distance. 3. Distance vision section a. Check to see that a, b, and c at the top of the form are completed. b. Make sure Check Items A and B are completed. c. If Box 1 is checked in Check Item B, be sure acuity is recorded for both eyes, with and without correction, and for the right and left eye with correction. d. If 2 is checked, be sure acuity is recorded for both eyes with correction, and right and left eye with correction. e. If 3 or 4 is checked, be sure acuity is recorded for both eyes without correction, right and left eye without correction. f. Check to see that for each of the four entry lines, an entry exists. If the SP did not wear glasses, zero-fill the space marked both eyes with correction. If the SP wore contact lenses, zero-fill the space marked both eyes without correction. g. Check to see that all entries are righthand justified using a zero to fill in the entry when the acuity is better than 20/100, for example, 20/080. 3Using the Landolt Ring Charts Landolt Ring Charts (symbols) are used to test illiterate SPs. Use these charts in exactly the same way you use the Sloan Letter Charts. Use the Landolt Rings to test near and distance vision; they are not applicable for testing binocular vision. The Landolt Ring Charts contain the symbol "C" instead of letters. There are four types of rings, those with the opening pointing left, and those with the opening pointing right, up and down. The rings are randomly ordered on each line on the charts for distance and near vision testing. To use the Landolt Rings you will need to have the SP look at the Landolt Charts instead of those with the Sloan Letters. Using the "mask" you will screen out all the symbols except the one you want the SP to "read". Simply ask the SP to point in the direction the opening of the ring is pointing. You will have to let the SP practice once or twice in order for her/him to become familiar with the procedure. Use the recording form and determine visual acuity exactly the same way you would if the Sloan Letters are used. 3Completing the Report of Findings After conducting the vision test, fill in the sections of the Report of Findings I that apply. Record acuity for the right eye and left eye separately. Check whether the test results were obtained with the SP wearing corrective lenses or not. Next complete the section of the form for near vision test results. Report results for acuity at 40 centimeters distance only, corrected if applicable. 3Referral The Report of Findings which contains information about the results of the near and far vision tests will be sent to the SPs health care provider 4 to 6 weeks after the exam. Furthermore, the physician will report any conditions of the eye on the Report of Findings that she/he observes. The physician will also be referring SPs who require eye care within 4 weeks of the exam using special referral procedures. Consequently, it is unnecessary for you to refer any SPs who have near or distance vision disorders for eye care. The only exception to this is if an SP does not pass the Random Dot E Test and has a problem with binocular vision. In that case, you should notify the physician of the problem and ask him/her to prepare a Type II Referral Letter which describes the problem and asks the SPs regular care giver to refer the SP to a local ophthalmologist. 3Unusual Situations If the SP is blind in both eyes, write this on the top of the vision exam form and return it to the Coordinator. If the SP is blind in one eye, but has vision in the other, place a large X through the sections of the form that are inappropriate but administer the tests for near and far vision for the eye with sight, following the instructions that pertain to the test. 3Completing the Dental/Vision Log and Control Record As you may recall, you are required to complete the required information in the Dental/Vision Log for both the dental and vision exams. Fill in your initials under vision test form for each completed exam and your initials under Report of Physical Findings when you complete the appropriate section of the report form. If you do not conduct the vision exam on a SP or a problem arises during the exam, document this in the comments column. You will also need to fill in the time in and out and your initials on the Control Record. 1APPENDIX 3 - SPECTACLE READINGS EQUIPMENT AND PROCEDURES 2Purpose There were two objectives in collecting the lensmeter data during the Cuban-American and Puerto Rican portions of the survey. First, the lensmeter data could be used to validate the acuity data at near and at distance. Second, the lensmeter data could also be used to determine the prevalence of myopia, hyperopia, and astigmatism for those people wearing glasses and achieving 20/20 acuity. 2Materials The following was used to perform the lensmeter test: TOPCON Digital Projection Lensmeter, Model LM-P5. 2Procedure Immediately after the other three portions of the vision exam were completed, the dentist administered the lensmeter test to all examinees with glasses. Glasses were placed into the lensmeter machine and a digital display indicated the power of the lenses. The dentists had to turn dials to focus images and then record the data from the lensmeter display screen onto the Spectacle Reading recording form (see Appendix 1). The data was recorded for the sphere, cylinder and axis of the lenses. 2Training and Monitoring A manual was provided to the dentists to practice and understand the use of the lensmeter test. The HHANES vision examination consultant, Dr. John Whitener of the American Optometric Association, made a field site visit to make sure the dentist-examiners were administering the test properly. *U.S. GOVERNMENT PRINTING OFFICE: 1988 -240-95200016 1REFERENCES 1. National Center for Health Statistics: Maurer, K. R. and others: Plan and Operation of the Hispanic Health and Nutrition Examination Survey, 1982-84. Vital and Health Statistics. Series 1, No. 19. DHHS Pub. No. (PHS) 85-1321. Public Health Service. Washington. 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