Document 1
1982
Act
New Zealand Health Survey
Information
Adult Questionnaire (Year 12)
1 July 2022 – 30 June 2023
Official
the
under
In field July 2022
Released
Document 1
Table of Contents
Overview and programming information ............................................................... 4 Informed consent ..................................................................................................... 7 Initial demographics and overall wellbeing self-complete section ...................... 8
Age group ............................................................................................................... 8
Sex and gender ...................................................................................................... 8
Overall life satisfaction and family wellbeing ........................................................... 9
Long-term health conditions ................................................................................. 10
Heart disease ....................................................................................................... 10
Stroke ................................................................................................................... 11
Diabetes ............................................................................................................... 12
Asthma ................................................................................................................. 12
1982
Arthritis ................................................................................................................. 13
Chronic pain ......................................................................................................... 14
Hysterectomy self-complete section ..................................................................... 15
Act
Oral health ............................................................................................................ 15
Interviewer observations – language / cognitive assistance ................................. 16
Health service utilisation ....................................................................................... 17
Usual primary health care provider ....................................................................... 17
General practitioners ............................................................................................ 18
Nurses at general practices and medical centres ................................................. 20
Emergency department ........................................................................................ 20
Information
Specialist doctors.................................................................................................. 22
Dental health care workers ................................................................................... 23
Health behaviours and risk factors ....................................................................... 24
High blood pressure .............................................................................................. 24
Official
High cholesterol .................................................................................................... 24
Body size self-complete section............................................................................ 25
the
Physical activity .................................................................................................... 26
Sleep .................................................................................................................... 29
Tooth brushing ...................................................................................................... 29
Tobacco ................................................................................................................ 30
under
Electronic cigarettes ............................................................................................. 33
Dietary habits ........................................................................................................ 33
Alcohol .................................................................................................................. 34
Drugs .................................................................................................................... 38
Health status ........................................................................................................... 39
SF-12v2® Health Survey (Four-week Recall) ........................................................ 39
Released
Functional difficulties – Washington Group Enhanced Short Set .......................... 43
Mental health – K10 .............................................................................................. 46
Mental health and substance use self-complete section ....................................... 49
Patient Health Questionnaire (GAD-7 and PHQ-9) ............................................... 50
The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) ..... 52
Use of services and informal help for mental health and substance use .............. 60
Unmet need and barriers accessing mental health and addictions services ......... 64
Socio-demographics .............................................................................................. 65
Date of birth .......................................................................................................... 65
Ethnic group(s) ..................................................................................................... 65
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Education .............................................................................................................. 67
Income sources .................................................................................................... 69
Income .................................................................................................................. 70
Employment .......................................................................................................... 71
Medical insurance ................................................................................................. 71
Housing ................................................................................................................ 72
Sexual identity self-complete section .................................................................... 74
Household composition ........................................................................................ 75
Gender and age .................................................................................................... 75
Relationships ........................................................................................................ 75
Exit ........................................................................................................................... 77
Recontact information for quality control ............................................................... 77
Recontact information for follow-up research ....................................................... 77
Consent for data linkage ....................................................................................... 78
1982
Interviewer observations – setting and assistance ............................................... 79
Respondent burden assessment self-complete section ........................................ 80
Act
Health measurements ............................................................................................ 82
Height ................................................................................................................... 82
Weight .................................................................................................................. 82
Waist ..................................................................................................................... 82
Thank you ............................................................................................................... 84
Child health component ........................................................................................ 84
Information
Official
the
under
Released
NZHS Year 12 Adult Questionnaire
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Document 1
Overview and programming information
Design
Approximately 14,000 adults are interviewed face-to-face each year for the New Zealand Health
Survey. Interviews are administered using a combination of computer-assisted personal interviewing
(CAPI) and computer-assisted self-interviewing (CASI). Key topics include long-term health conditions,
heath status and behaviours, health service utilisation and patient experience. Anthropometric
measurements (height, weight and waist circumference) are also taken. NZHS collects information that
cannot be obtained more effectively or efficiently through other means, such as by analyses of hospital
administrative records, disease registries or epidemiological research.
Text Format
Examples
1982
Black
Text read by interviewer or respondent:
The next set of questions is about nurses who
introductions, questions / question options
work at general practices and medical centres
Act
Blue
Showcard note positioned above a question [Showcard]
Multiple response allowed for a question
[Select all that apply]
Instructional text specifically for interviewers Record to nearest hour
Other [Specify]
Information
Text read verbatim to respondents
Say “We can skip this section then”
Interviewer observations: section completed
Complete following observations without
unobtrusively (solely) by interviewer
asking the respondent
Official
Tool tips or Showcards with a ⚐ symbol,
Here is a list of examples of specialist
contain information that only appears if the
doctors ⚐
mouse pointer hovers over the underlined
the
words, or if underlined words are touched
with a finger
Green
Copyright / attribution, displayed on screen
SF-12® is a registered trademark of Medical
under
as a requirement of usage
Outcomes Trust
Purple
Text specifically for questionnaire readers,
Toothpaste picture showcard needs updating if
not displayed on screen
there are any major changes in the market
Red
Programmer information, instructions, alerts
Calculated age must be ≥15 years
Released
and headings, not displayed on screen
Abbreviations used in programming text
Respondent interviewed in person by
F2F
Face-to-face
interviewer
Survey tool enabling remote interviewing via
VIP
Virtual Interface Platform
computer software
NZHS Year 12 Adult Questionnaire
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Key Edit Checks
Description
Type
Single and multiple-
For each question, only one answer can be selected, except
Hard edit
choice responses
for multiple-choice questions, represented by the instruction
[Select all that apply].
Exclusive answer
Don't know, Refused / Prefer not to say, Doesn’t apply, None
Hard edit
options
of the above, None, and No treatment are all exclusive
responses, ie they cannot be selected in conjunction with other
responses.
Range checks
For numeric response questions, the data entered must fall
Hard edit
within a certain range. Range checks prompt interviewers to
change an answer falling outside the pre-set range
parameters. For example, a person cannot enter an amount 1982
more than $199.00 for the cost of GP visits.
Confirmation checks
For some questions, the survey prompts the interviewer to
Act Soft edit
check a response which may be unlikely, or which may be
incompatible with previous answers. For example, a person is
unlikely to usually sleep for less than 4 hours in a 24 hour
period.
Consistency checks
Some checks enforce consistency of responses between
Hard edit
questions. When edit checks are triggered, the interviewer or
Information
respondent must go back and change their answer to ensure
response consistency. For example, if a person reports that
they have used an emergency department (ED) in the past 12
months, when they are later asked to report the number of
times they have used an ED, this response must be greater
than zero.
Official
Completeness checks
For some of the grid-style questions, where multiple items /
the
Hard edit
statements are combined into a table, each row must contain a
response. For example, relationship information is captured for
every pair of occupants in a household. This is recorded in a
grid format and each row must be completed.
under
Hard edit checks require the interviewer / respondent to change the data they have entered before
continuing. Soft edit checks provide an opportunity to check a response, and if applicable, change the
data entered before continuing; however, the original response entered can also be retained.
Released
Showcards
Showcard tablet
Answer options are visible for some questions on a separate tablet device
which the respondent views during the survey.
Response option
Selected options are allocated numbers allowing respondents to discretely
numbering
provide a response; ie to call out a number opposed to the descriptive text.
NZHS Year 12 Adult Questionnaire
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Year 12 Modules
Perceived body size
The three perceived body size questions provide alternatives to the physical
measurement of height and weight.
Washington Group
The six extra items in the Washington Group Enhanced Short Set
Enhanced Short Set
supplement the existing six items of the Washington Group Short Set in the
core questionnaire.
Mental health and
• Anxiety symptoms (GAD-7), depression symptoms (PHQ-9), and
substance use self-
patient-rated psychosocial functional impairment. Note there is a gap in
complete section
question numbering between the GAD-7 and PHQ-9 because three
anxiety attack questions (in 2016/17 Health Survey) were removed.
• The Alcohol, Smoking and Substance Involvement Screening Test
(ASSIST). Core cannabis questions included within module.
1982
• Mental health services: use, unmet need, and barriers to access.
Act
Information
Official
the
under
Released
NZHS Year 12 Adult Questionnaire
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Informed consent
Before we begin, I need to check that:
• You have read and understand the information pamphlet on the New Zealand Health
Survey. You know you can ask questions at any time and you can contact CBG
Health Research or the Ministry of Health if you want further information.
• You know that you can stop the interview at any time and you don’t have to answer
every question. There is no disadvantage to you if you don’t want to take part, or if
you choose to stop at any time.
• You know that your participation in the New Zealand Health Survey is confidential
and no information that could identify you will ever be used in any reports. All your
answers are protected by the Privacy Act 2020.
AC.01 You agree to take part in the New Zealand Health Survey on behalf of: 1982
1
Yourself [Only display for respondents aged 15 years and over]
2
An adult who is unable to provide consent, and for whom you have Enduring
Act
Power of Attorney for their personal care and welfare, or for whom you are the
welfare guardian [Only display for respondents aged 16 years and over]
3
A person aged 15 years whom you are the parent / legal guardian of [Only
display for respondents aged 15 years]
If AC.01=1 and respondent is 15 years of age, ask AC.02:
Information
AC.02 Has the parent / legal guardian of the survey respondent consented to them taking
part?
1
Yes
2
No
Official
If AC.02=2, display message: Consent must be provided by a parent / legal guardian
for 15 year old respondents to complete the survey themselves. Please obtain consent
the
before continuing.
AC.03 You agree for parts of this survey to be audio recorded for quality monitoring and you
understand that any recording will be anonymous.
under
1
Yes
2
No
Released
NZHS Year 12 Adult Questionnaire
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Initial demographics and overall wellbeing self-
complete section
[For VIP survey insert: Before we begin, can I please check that you are in a private space,
where our conversation will not be overheard?
If the answer is ‘No’, request that the respondent find a private space before you
continue. Alternatively, rearrange the interview to a time when the respondent will have
privacy.
I’l just explain some key features of this video interview:
• Three types of questions will be asked: questions that include an option list for you to
select from; yes or no questions that do not include an option list; and questions that
are more personal, that you can complete yourself.
1982
• To pause the survey at any time, just click the pause button at the top right of the
screen. To turn off your camera or microphone, select the camera or microphone
Act
icons below the video feed. If you need help with your audio or video, using
headphones, or help with anything else, just let me know.]
New screen.
The first section asks about age group, sex, gender, and wellbeing. Age group and sex are
asked here so that only questions which apply to you are asked in the survey.
These questions are for you to answer on your own. [For F2F survey insert: I will turn the
Information
computer towards you, so you can answer the questions privately.] If you need help, I can
show you what to do.
I can also read the questions out, and you can answer by calling out the option number
[For F2F survey insert: from the showcard] that best applies to you.
Official
START OF SELF-COMPLETE.
the
Age group
[Showcard]
AD.02 Which of these age groups do you belong to?
under
1
15–19 years
2
20–24 years
3
25–34 years
4
35–44 years
5
45–54 years
Released
6
55–64 years
7
65–74 years
8
75+ years
Sex and gender
[Showcard]
AD.01a At birth, what was your sex recorded as?
1
Male
2
Female
3
Another term
NZHS Year 12 Adult Questionnaire
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[Showcard]
AD.01b What is your gender?
A person's gender may be different from their sex at birth. Gender refers to a
person's social and personal identity as male, female, or another gender such as
non-binary.
1
Male
2
Female
3
Another gender please specify, if you are comfortable doing so [Other screen
text: (leave blank if you do not wish to specify)] [Allow blank if respondent does
not volunteer any detail] [To be programmed from the codefile from StatsNZ
after interview – ie NOT by respondent / interviewer]
Overall life satisfaction and family wellbeing
1982
[Showcard]
AMH2.01 This is a general question about your life as a whole these days. This includes all
Act
areas of your life.
Where zero is completely dissatisfied, and ten is completely satisfied, how do you
feel about your life as a whole?
_____ (range 0–10)
.K Don’t know
.R Prefer not to say
Information
[Showcard]
AMH2.02 Now, a question about your family. Please think in general about how your family
is doing.
Official
Where zero means extremely badly and ten means extremely well, how would you
rate how your family is doing these days?
the
If necessary: Include all areas of life for your family.
If necessary: Your 'family' is the group of people you think of as your family.
_____ (range 0–10)
under
11 Don’t have any family
12 Can’t define my family
.K Don’t know
.R Prefer not to say
New screen.
Released
Thank you for answering these questions; please click ‘Next’. [For F2F survey insert:
Please return the computer to the interviewer and they will continue the questionnaire.]
END OF SELF-COMPLETE SECTION.
NZHS Year 12 Adult Questionnaire
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Document 1
Long-term health conditions
The next section of the Health Survey is about
long-term health conditions you may have.
A long-term health condition is a
physical or mental illness that has lasted, or is expected
to last, for
more than six months. The symptoms may come and go, or be present all the
time.
Heart disease
The first few questions are about heart disease. Please
do not include high blood pressure
or high blood cholesterol here, as I will ask you about those later.
A1.01 Have you ever been told by a doctor that you have had a heart attack?
1
Yes
1982
2
No [go to angina A1.04]
.K Don’t know [go to A1.04]
.R Refused [go to A1.04]
Act
A1.02 Have you ever been admitted to hospital with a heart attack?
1
Yes
2
No [go to angina A1.04]
.K Don’t know [go to A1.04]
.R Refused [go to A1.04]
Information
A1.03 Was this in the last 12 months?
1
Yes
2
No
Official
.K Don’t know
.R Refused
the
A1.04 Have you ever been told by a doctor that you have angina?
If clarification is required, angina is typically chest pain when you walk or do
exercise.
under
1
Yes
2
No
.K Don’t know
.R Refused
A1.05 Have you ever been told by a doctor that you have heart failure? That is,
Released
inadequate heart pumping, or a build-up of fluid in the lungs or legs.
1
Yes
2
No
.K Don’t know
.R Refused
NZHS Year 12 Adult Questionnaire
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A1.06 Have you ever been told by a doctor that you have any other heart disease? Please
include problems with heart rhythm and heart valves, but not high blood pressure or
high cholesterol.
1
Yes
2
No
.K Don’t know
.R Refused
Ask A1.07 if respondent answered ‘Yes’ to one or more of A1.01, A1.04, A1.05 or A1.06.
Everyone else go to Stroke A1.10.
[Showcard]
A1.07 What treatments do you
now have for your heart condition(s)?
[Select all that apply]
1982
Probe “Any others?” until no other treatment mentioned.
Don’t include surgery the respondent has had or is scheduled to have in the
future.
Act
1
No treatment
2
Aspirin
3
Other medicines, tablets or pills (including spray under the tongue, patches on
the skin and blood thinners)
4
Diet
5
Exercise
Information
77 Other [Specify]
_________________
.K Don’t know
.R Refused
A1.09 Have you ever had bypass surgery or angioplasty for your heart condition(s)?
Official
If asked: Angioplasty is a procedure that helps improve your blood supply to the
heart muscle. A tube is inserted into one of your arteries through an incision in your
groin, wrist or arm. The doctor then directs the tube into a blocked or narrow heart
the
artery, which expands the artery and allows the blood to flow more easily to the
muscle. Often, a stent will be inserted at this time.
1
Yes
under
2
No
.K Don’t know
.R Refused
Stroke
Released
A1.10 Have you ever been told by a doctor that you have had a
stroke? Please do not
include “mini-stroke” or transient ischaemic attack (or TIA).
1
Yes
2
No [go to Diabetes A1.12]
.K Don’t know [go to A1.12]
.R Refused [go to A1.12]
NZHS Year 12 Adult Questionnaire
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[Showcard]
A1.11 What treatments do you
now have for your stroke?
[Select all that apply]
1
No treatment
2
Aspirin
3
Other medicines, tablets or pills
4
Diet
5
Exercise or rehabilitation (include speech therapy, occupational therapy,
physiotherapy)
77 Other [Specify]
_________________
.K Don’t know
.R Refused
1982
Diabetes
A1.12 Have you ever been told by a doctor that you have diabetes?
Act
If respondent’s sex is female (AD.01a=2) insert: Please do
not include diabetes
during pregnancy.
1
Yes
2
No [go to Asthma A1.15]
.K Don’t know [go to A1.15]
.R Refused [go to A1.15]
Information
A1.13 How old were you when you were first told by a doctor that you had diabetes?
If from birth record 0.
_____ years (range 0–120)
.K Don’t know
Official
.R Refused
the
[Showcard]
A1.14 What treatments do you
now have for your diabetes?
[Select all that apply]
under
1
No treatment
2
Insulin injections
3
Medicines, tablets or pills
4
Diet
5
Exercise
77 Other [Specify]
_________________
.K Don’t know
Released
.R Refused
Asthma
A1.15 Have you ever been told by a doctor that you have asthma?
1
Yes
2
No [go to Arthritis A1.18]
.K Don’t know [go to A1.18]
.R Refused [go to A1.18]
NZHS Year 12 Adult Questionnaire
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A1.16 In the last 12 months, have you had an attack of asthma?
1
Yes
2
No
.K Don’t know
.R Refused
[Showcard]
A1.17 What treatments do you
now have for asthma?
[Select all that apply]
1
No treatment
2
Inhalers
3
Medicines, tablets or pills
77 Other [Specify]
_________________
1982
.K Don’t know
.R Refused
Act
Arthritis
A1.18 Have you ever been told by a doctor that you have arthritis? Please include gout,
lupus and psoriatic arthritis.
1
Yes
2
No [go to Chronic pain A1.29]
Information
.K Don’t know [go to A1.29]
.R Refused [go to A1.29]
[Showcard]
A1.19 What kind of arthritis was that? Official
[Select all that apply]
the
1
Rheumatoid
2
Osteoarthritis
3
Gout
4
Psoriatic
under
5
Systemic lupus erythematosus (SLE)
77 Other [Specify]
_________________
.K Don’t know [go to treatments A1.21]
.R Refused [go to A1.21]
Ask A1.20 if respondent has more than one kind of arthritis in A1.19.
Released
[Showcard]
A1.20 Which kind of arthritis affects you most?
1
Rheumatoid
2
Osteoarthritis
3
Gout
4
Psoriatic
5
Systemic lupus erythematosus (SLE)
77 Other ([pipe through response from A1.19=77])
.K Don’t know
.R Refused
NZHS Year 12 Adult Questionnaire
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[Showcard]
A1.21 What treatments do you
now have for arthritis?
[Select all that apply]
Don’t include surgery the respondent has had or is scheduled to have in the
future.
1
No treatment
2
Medicines, tablets or pills (including painkillers)
3
Exercise or physiotherapy
4
Injections
5
Diet
77 Other [Specify]
_________________
.K Don’t know
.R Refused
1982
A1.22 Have you ever had an operation or surgery because of your arthritis?
1
Yes
Act
2
No
.K Don’t know
.R Refused
[Showcard]
A1.22a Are you now limited in any way, in your usual activities, because of arthritis
symptoms?
Information
1
Yes, limited a lot
2
Yes, limited a little
3
No, not limited at all
.K Don’t know
Official
.R Refused
the
Chronic pain
A1.29 Do you experience chronic pain? This is pain that is present almost every day, but
the intensity of the pain may vary. Please only include pain that has lasted, or is
under
expected to last, for
more than six months.
This includes chronic pain that is reduced by treatment.
1
Yes
2
No
.K Don’t know
.R Refused
Released
NZHS Year 12 Adult Questionnaire
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Hysterectomy self-complete section
Ask L1.29t if sex is female, AD.01a=2 and aged 20 years and over (AD.02≠1). Otherwise
go to Oral health introduction.
The next question is for you to answer on your own. If you need help, I can show you what
to do.
I can also read the question out, and you can answer by calling out the option number.
START OF SELF-COMPLETE.
L1.29t Have you ever had a hysterectomy, that is, when your uterus or womb is removed?
1
Yes
2
No
.K Don’t know
1982
.R Prefer not to say
Act
New screen.
Thank you for answering this question; please click ‘Next’. [For F2F survey insert: Please
return the computer to the interviewer and they will continue the questionnaire.]
END OF SELF-COMPLETE SECTION.
Information
Oral health
The next questions are about your teeth, gums and mouth. When I say dental health care
worker, I mean dentists, dental therapists (formerly known as dental nurses), as well as any
Official
dental health specialists such as orthodontists.
A1.30 How many of your teeth have been removed by a dental health care worker because of
the
tooth decay, an abscess, infection or gum disease? Do not include teeth lost for other
reasons such as injury, crowded mouth or orthodontics.
Includes teeth that were removed while overseas (as well as in New Zealand).
Includes baby teeth and wisdom teeth
ONLY if removed because of tooth decay,
under
an abscess, infection or gum disease.
Most adults grow 32 teeth in total.
_____ teeth (range 0–32) [if 0 teeth removed, go to health of mouth A1.31a]
99 All of my teeth have been removed because of tooth decay or gum disease
.K Don’t know [go to A1.31a]
Released
.R Refused [go to A1.31a]
A1.31 Were any of these teeth removed in the last 12 months?
1 Yes
2
No
.K Don’t know
.R Refused
NZHS Year 12 Adult Questionnaire
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Ask all respondents following question, A1.31a.
[Showcard]
A1.31a How would you describe the health of your teeth or mouth?
1
Excellent
2
Very good
3
Good
4
Fair
5
Poor
.K Don’t know
.R Refused
Interviewer observations – language / cognitive assistance
1982
Complete following observations without asking the respondent:
Act
If the survey is completed on behalf of the respondent by someone with EPOA (Enduring
Power of Attorney), or by the respondent’s welfare guardian (AC.01=2), auto code A6.13=2
and A6.12=2 and go to A6.14.
A6.13 Interview is being conducted with
language assistance from a
family member /
friend of respondent.
Only code ‘Yes’ if the respondent has required more than a couple of questions to
be interpreted.
Information
1
Yes
2
No
A6.12 Interview is being conducted with
cognitive assistance from a
family member /
Official
caregiver.
Only code ‘Yes’ if the respondent has required more than a couple of questions to
the
be answered completely on their behalf.
1
Yes
2
No
under
A6.14 Interview is being conducted with
language assistance from a
professional
translator.
1
Yes
2
No
Released
NZHS Year 12 Adult Questionnaire
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Document 1
Health service utilisation
The next set of questions is about your use of health care services, for your
own health, in
New Zealand.
Usual primary health care provider
A2.01 Do you have a
general practice or medical centre that you
usually go to when you
are feeling unwell or are injured?
Do not include emergency department (ED).
1
Yes
2
No [go to General practitioners introduction before A2.13a]
.K Don’t know [go to introduction before A2.13a]
.R Refused [go to introduction before A2.13a]
1982
From now on, we’l call this place your
usual medical centre.
Act
A2.03a Have you been to your usual medical centre, for your
own health, in the
past 12
months?
1
Yes
2
No [go to General practitioner introduction before A2.13a]
.K Don’t know [go to introduction before A2.13a]
.R Refused [go to introduction before A2.13a]
Information
[Showcard]
A2.040
At your
usual medical centre have you had an appointment with any of the
following health care workers about your own health, in the
past 12 months?
[Select all that apply]
Official
1 GP (general practitioner or family doctor)
2 Nurse
the
3 Physiotherapist
4 Mental health professional (eg psychologist or counsellor)
5 Dietitian
77 Another health care worker [Specify]
________________
under
0 None of the above
.K Don’t know
.R Refused
If A2.03a=1 and A2.040=0, display message: Consistency check In question A2.03a
you recorded that the respondent had visited their usual medical centre, but in A2.040 you
Released
recorded that they have not had an appointment at their medical centre. Verify answers with
respondent. Go back to A2.03a. Go back to A2.040.
NZHS Year 12 Adult Questionnaire
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Document 1
General practitioners
These next questions are about seeing general practitioners (GPs) or family doctors.
This
can be at your
usual medical centre or
somewhere else.
GP – utilisation
A2.13a How many times did you see a GP in the past 12 months? This may have been
about your physical health, or your mental or emotional health.
_____ times (range 1–99)
0
Haven’t seen a GP in last 12 months [go to GP – barriers to access A2.33a]
If A2.040=1 and A2.13a=0, display message: Consistency check In question A2.040
you recorded that the respondent had visited a GP at their usual medical centre, but in
A2.13a you recorded that they haven’t seen a GP. Verify answers with respondent. Go back
1982
to A2.040. Go back to A2.13a.
Act
.K Don’t know [go to A2.33a]
.R Refused [go to A2.33a]
A2.16 Thinking about your last visit to a GP, what were you charged for that visit?
Record amount in dollars and cents, eg $60=60.00.
If respondent says between two amounts, record the average in dollars and cents
(eg between $40 and $50: record 45.00).
Information
If free enter 0.00.
If respondent says an amount greater than $199, record as $199.00.
Can give an estimate if exact amount unknown.
$___.___ (range 0.00–199.00) Official
.K Don’t know
.R Refused
the
GP – barriers to access
A2.33a In the past 12 months, was there a time when you had a medical problem but did
not visit a GP because of cost?
under
1
Yes
2
No
.K Don’t know
.R Refused
Released
NZHS Year 12 Adult Questionnaire
18
Document 1
[Showcard]
A2.360 In the
past 12 months, was there a time when you had a
medical problem but did
not visit a GP for any of the following reasons?
[For VIP survey insert: You may need to scroll down to see all the answer options.]
[Select all that apply]
Read each response option aloud and allow respondents to respond to each
option.
Please exclude not visiting a GP because of cost.
1
Time taken to get an appointment too long
2
Owed money to the medical centre
3
Dislike or fear of the GP
4
Difficult to take time off work
5
No transport or too far to travel
1982
6
Could not arrange childcare or care for a dependent adult An adult who is ill
or disabled
7
Didn’t have a carer, support person or interpreter to go with you
Act
77 Another reason [Specify]
_________________
0
None of the above
.K Don’t know
.R Refused
A2.35a In the past 12 months, was there a time when you got a prescription for yourself,
but did not collect one or more prescription items from the pharmacy or chemist
Information
because of cost?
1
Yes
2
No
.K Don’t know
Official
.R Refused
the
under
Released
NZHS Year 12 Adult Questionnaire
19
Document 1
Nurses at general practices and medical centres
The next set of questions is about nurses who work at general practices and medical
centres.
Please do
not include nurses who may have visited you at home or seen you in a hospital.
Also, don’t include midwives or dental nurses.
A2.41a In the past 12 months, have you seen a nurse at a general practice or medical
centre, about your own health? This may have been about your physical health, or
your mental or emotional health.
1
Yes
2
No [go to emergency department introduction before A2.69]
If A2.040=2 and A2.41a=2, display message: Consistency check In question A2.040
1982
you recorded that the respondent had visited a nurse at their usual medical centre, but in
A2.41a you recorded that they haven’t seen a nurse. Verify answers with respondent. Go
Act
back to A2.040. Go back to A2.41a.
.K Don’t know [go to introduction before A2.69]
.R Refused [go to introduction before A2.69]
A2.42a How many times in the past 12 months did you see a nurse
as part of a GP
consultation? This includes seeing the nurse before or after seeing the GP.
If none enter 0.
Information
_____ times (range 0–99)
.K Don’t know
.R Refused
Official
A2.43a How many times in the past 12 months did you see a nurse
without seeing a GP at
the same visit?
the
If none enter 0.
_____ times (range 0–99)
.K Don’t know
.R Refused under
If A2.41a=1 and A2.42a=0 and A2.43a=0, display message: Consistency check If
A2.41a=1 (saw a nurse), then number of times at A2.42a OR A2.43a should be >=1. Go
back to A2.41a OR go back to A2.42a OR go back to A2.43a.
Released
Emergency department
The next questions are about your use and experience of emergency departments at public
hospitals for your
own health.
A2.69 In the past 12 months, how many times did you go to an emergency department at a
public hospital about your own health?
_____ times (range 0–99) [if 0 go to Specialist doctors introduction before A2.820]
.K Don’t know [go to introduction before A2.820]
.R Refused [go to introduction before A2.820]
NZHS Year 12 Adult Questionnaire
20
Document 1
[Showcard]
A2.720
Thinking about your last visit to an emergency department for your own health, what
were
all the reasons you went?
[Select all that apply]
Read each response option aloud and allow respondents to respond to each
option.
If respondent says they were taken by ambulance or sent by someone such as a
GP, Option 1 should be selected.
1
Condition appeared serious / life threatening; or sent by GP
2
GP or after-hours too expensive
3
Time of day / day of week (outside of usual medical centre hours)
4
Time taken to get an appointment was too long at usual medical centre
77 Another reason [Specify]
_________________
.K Don’t know [go to Specialist doctors introduction before A2.820]
1982
.R Refused [go to introduction before A2.820]
Ask next question if more than one of the Options 1–4/77 selected in A2.720. Only show
Act
responses that were selected in A2.720 (as well as .K and .R).
[Showcard]
A2.730 What was the
main reason you went to a hospital emergency department?
1
Condition appeared serious / life threatening; or sent by GP
2
GP or after-hours too expensive
3
Time of day / day of week (outside of usual medical centre hours)
Information
4
Time taken to get an appointment was too long at usual medical centre
77 Another reason ([pipe through response from A2.720)
.K Don’t know
.R Refused
Official
the
under
Released
NZHS Year 12 Adult Questionnaire
21
Document 1
Specialist doctors
The next few questions are about specialist doctors. By specialist I mean the kind of doctor
that people go to for a particular health condition, problem or service, not a GP. You may
have seen the specialist in a hospital or at their private rooms or clinic.
Specialist – utilisation
A2.820
In the
past five years, has a doctor
referred you to a
specialist?
Select 'Yes' even if they did not visit the specialist.
Here is a list of examples of specialist doctors ⚐:
Anaesthetist
Kidney or renal specialist
Cardiologist
Neurologist
Dermatologist
Oncologist
Diabetologist
Ophthalmologist
1982
Ear, nose and throat specialist
Orthopaedic surgeon
Endocrinologist
Plastic surgeon Act
Gastroenterologist
Psychiatrist
General or Internal Medical specialist
Respiratory medicine specialist
General surgeon
Rheumatologist
Gynaecologist or obstetrician
Urologist
Haematologist
Vascular surgeon
1
Yes
2
No [go to Dental health care workers introduction before A2.91]
Information
.K Don’t know [go to introduction before A2.91]
.R Refused [go to introduction before A2.91]
Specialist – barriers to access
Official
[Showcard]
A2.830 In the
past five years, was there a time when a doctor
referred you to a
specialist
the
but you did not go for any of the following reasons?
[For VIP survey insert: You may need to scroll down to see all the answer options.]
[Select all that apply]
under
Read each response option aloud and allow respondents to respond to each
option.
1
Cost
2
Dislike or fear of the treatment
3
Difficult to take time off work
Released
4
No transport or too far to travel
5
Could not arrange childcare or care for a dependent adult An adult who is ill
or disabled
6
Didn’t have a carer, support person or interpreter to go with you
7
Hospital or specialist doctor didn't accept the referral
8
No longer needed or issue was resolved
77 Another reason [Specify]
_________________
0 None of the above
.K Don’t know
.R Refused
NZHS Year 12 Adult Questionnaire
22
Document 1
Dental health care workers
These next questions are about dental health care services you have used in
New Zealand.
When I say “dental health care worker”, I mean dentists, dental therapists (formerly known
as dental nurses), dental hygienists, as well as any dental health specialists such as
orthodontists.
Dental health care workers – utilisation
[Showcard]
A2.91 How long has it been since you last visited a dental health care worker about your
own dental health, for any reason?
1
Within the past year (less than 12 months ago)
2
Within the past two years (more than 1 year but less than 2 years ago)
3
Within the past five years (more than 2 years but less than 5 years ago)
1982
4
Five or more years ago
5
Have never seen a dental health care worker
Act
.K Don’t know
.R Refused
[Showcard]
A2.95 Which of the following statements best describes the regularity of your consultations
with a dental health care worker?
1
I visit a dental health care worker at least every two years for a check up
Information
2
I visit a dental health care worker for check-ups regularly, but with intervals of
more than two years
3
I only visit a dental health care worker when I have a toothache or other similar
trouble
4
I never visit a dental health care worker
Official
.K Don’t know
.R Refused
the
Dental health care workers – barriers to access
A2.95a In the last 12 months, have you avoided going to a dental health care worker
under
because of the cost?
1
Yes
2
No
.K Don’t know
.R Refused
Released
NZHS Year 12 Adult Questionnaire
23
Document 1
Health behaviours and risk factors
The next section is about things that can influence your health.
High blood pressure
A3.01 Have you ever been told by a doctor that you have high blood pressure?
If respondent is female, insert: Please do not include high blood pressure you may
have had during pregnancy.
1
Yes
2
No [go to High cholesterol A3.03]
.K Don’t know [go to A3.03]
.R Refused [go to A3.03]
1982
A3.02 Are you currently taking pills regularly for high blood pressure?
1
Yes
Act
2
No
.K Don’t know
.R Refused
High cholesterol
A3.03 Have you ever been told by a doctor that you have high cholesterol levels in your
Information
blood?
1
Yes
2
No [go to Body size introduction before DH1.19]
.K Don’t know [go to introduction before DH1.19]
Official
.R Refused [go to introduction before DH1.19]
the
A3.04 Are you currently taking pills regularly for high cholesterol?
1
Yes
2
No
under
.K Don’t know
.R Refused
Released
NZHS Year 12 Adult Questionnaire
24
Document 1
Body size self-complete section
The next few questions about weight and height are for you to answer on your own. If you
need help, I can show you what to do.
I can also read the questions out, and you can answer by calling out the option number.
START OF SELF-COMPLETE.
[Showcard]
DH1.19 On a scale of one to five, where one is very underweight and five is very
overweight, how do
you view your weight?
1
Very underweight
2
Underweight
3
Neither underweight nor overweight
4
Overweight
1982
5
Very overweight
6 Currently pregnant [Only show this option for cis-female respondents (sex is
Act
female, AD.01a=2 AND gender is female, AD.01b=2) aged 15–54 years].
[Pregnant respondents skip to Physical Activity introduction before A3.06]
.K Don’t know
.R Prefer not to say
[Showcard]
BS3.01 How tall are you without shoes?
Please enter answer using just one type of unit.
Information
Data to be converted to m (0.000 m).
1 ____ centimetres (range 60–250)
2 ____ metres (range 0.6–2.5) Official
3 ____ feet (range 2–8) and ____ inches (range 0–35)
.K Don’t know
the
.R Prefer not to say
[Showcard]
BS3.02 How much do you weigh?
under
Please enter answer using just one type of unit.
Data to be converted to kg (000.0kg).
1 ____ kilograms (range 6–250)
2 ____ stones (range 1–40) and ____ pounds (range 0–14)
3 ____ pounds (range 14–550)
Released
.K Don’t know
.R Prefer not to say
New screen.
Thank you for completing this section; please click ‘Next’. [For F2F survey insert: Please
return the computer to the interviewer and they will continue the questionnaire.]
END OF SELF-COMPLETE SECTION.
NZHS Year 12 Adult Questionnaire
25
Document 1
Physical activity
I’m now going to ask you about the time you spent being
physically active in the last 7
days, from last [enter day] to yesterday. Do not include activity undertaken today.
By ‘active’ I mean doing anything using your muscles. Think about activities at work, school
or home, getting from place to place, and any activities you did for exercise, sport, recreation
or leisure.
I will ask you separately about brisk walking, moderate activities, and vigorous activities.
A3.06 During the last 7 days, on how many days did you
walk at a brisk pace – a brisk
pace is a pace at which you are breathing harder than normal? This includes walking
at work, walking to travel from place to place, and any other walking that you did
solely for recreation, sport, exercise or leisure.
1982
Think
only about walking done for at least 10 minutes at a time.
Act
_____ days per week (range 0–7) [if A3.06=0 go to moderate activity A3.08]
.K Don’t know [go to A3.08]
.R Refused [go to A3.08]
A3.07 How much time did you typically spend walking at a brisk pace on
each of those
days?
If respondent cannot provide a typical duration, record the average time per day.
All fields (hours and minutes) must be completed.
Information
_____
hours (range 0–24) _____ minutes (range 0–59) If under 10 minutes,
display message: Total time must be >=10 mins.
.K Don’t know
Official
.R Refused
If A3.07>=8 hours, display message: A person is unlikely to walk at a brisk pace (breathe
the
harder than normal) for 8 or more hours per day. Go back to question A3.07 and verify
answer with respondent.
under
Released
NZHS Year 12 Adult Questionnaire
26
Document 1
Picture Showcard]
A3.08 During the last 7 days, on how many days did you do
moderate physical activities?
‘Moderate’ activities make you breathe harder than normal, but only a little – like
carrying light loads, bicycling at a regular pace, or other activities like those shown on
the [For F2F insert: Showcard.] [For VIP insert: screen image (you may need to scroll
down).] Do not include walking of any kind.
Think
only about those physical activities done for at least 10 minutes at a time.
Activities shown on the Showcard / screen image are examples of moderate
activity. Many other activities may fall into this category.
Activities on the Moderate Activity Showcard / screen image and Vigorous Activity
Showcard / screen image can be interchangeable. If a respondent defines an activity
as being moderate, even though it is on the Vigorous Activity Showcard / screen
image, it should be included here.
1982
_____ days per week (range 0–7) [if A3.08=0 go to vigorous activity A3.10]
.K Don’t know [go to A3.10]
Act
.R Refused [go to A3.10]
A3.09 How much time did you typically spend on
each of those days doing moderate
physical activities?
If respondent cannot provide a typical duration, record the average time per day.
All fields (hours and minutes) must be completed.
Information
_____ hours (range 0–24) _____ minutes (range 0–59) If under 10 minutes,
display message: Total time must be >=10 mins.
.K Don’t know
.R Refused
Official
If A3.09>=8 hours, display message: A person is unlikely to do moderate physical activity
(breathe harder than normal) for 8 or more hours per day. Go back to question A3.09 and
the
verify answer with respondent.
If A3.09=A3.07, display message: A person is unlikely to spend exactly the same amount
of time brisk walking as they do moderate activity each day. Go back to question A3.07 or
under
A3.09 and verify answer with respondent.
Released
NZHS Year 12 Adult Questionnaire
27
Document 1
[Picture Showcard]
A3.10 During the last 7 days, on how many days did you do
vigorous physical activities?
‘Vigorous’ activities make you breathe a lot harder than normal (‘huff and puff’) – like
heavy lifting, digging, aerobics, fast bicycling, or other activities like those shown on
the [For F2F insert: Showcard.] [For VIP insert: screen image. You may need to
scroll down.]
Think
only about those physical activities done for at least 10 minutes at a time.
Activities shown on the Showcard / screen image are examples of vigorous
activity. Many other activities may fall into this category.
Activities on the Vigorous Activity Showcard / screen image and Moderate Activity
Showcard / screen image can be interchangeable. If a respondent defines an activity
as being vigorous, even though it is on the Moderate Activity Showcard / screen
image, it should be included here.
1982
_____ days per week (range 0–7) [if A3.10=0 go to all activities A3.12]
.K Don’t know [go to A3.12]
Act
.R Refused [go to A3.12]
A3.11 How much time did you typically spend on
each of those days doing vigorous
physical activities?
If respondent cannot provide a typical duration, record the average time per day.
All fields (hours and minutes) must be completed.
Information
_____ hours (range 0–24) _____ minutes (range 0–59) If under 10 minutes,
display message: Total time must be >=10 mins.
.K Don’t know
.R Refused
Official
If A3.11>=4 hours, display message: A person is unlikely to do vigorous activity (huff and
puff) for 4 or more hours per day. Go back to question A3.11 and verify answer with
the
respondent.
A3.12 Thinking about all your activities over the last 7 days (including brisk walking), on
how many days did you engage in:
•
at least 30 minutes of moderate activity (including brisk walking) that made
under
you breathe a little harder than normal, OR
•
at least 15 minutes of vigorous activity that made you breathe a lot harder
than normal (‘huff and puff’)?
_____ days per week (range 0–7)
.K Don’t know
Released
.R Refused
NZHS Year 12 Adult Questionnaire
28
Document 1
Sleep
Now, a question about sleep.
A3.12a How many hours of sleep do you usually get in a 24 hour period, including
all naps
and sleeps?
Enter whole numbers. Round 30 minutes or more up to the next whole hour and
round 29 or fewer minutes down.
_____ hours (range 1–24)
.K Don’t know
.R Refused
If A3.12a<4 hours, display message: A person is unlikely to usually sleep less than 4
hours in a 24 hour period. Verify answer with respondent.
1982
If A3.12a>12 hours, display message: A person is unlikely to usually sleep more than 12
hours in a 24 hour period. Verify answer with respondent.
Act
Ask next two tooth brushing questions, A3.12b and A3.12c, only if respondent has natural
teeth, that is, A1.30 not equal to 99.
Tooth brushing
Now, a couple of questions about tooth brushing.
Information
[Showcard]
A3.12b How often do you brush your teeth?
0
Never [go to Tobacco introduction before A3.13]
Official
1
Less than once a day
2
Once a day
3
Twice a day
the
4
More than twice a day
5 No natural teeth [go to introduction before A3.13]
.K Don’t know
.R Refused under
Released
NZHS Year 12 Adult Questionnaire
29
Document 1
[Picture Showcard]
A3.12c Looking at the [For F2F insert: Showcard] [For VIP insert: options on the screen],
what type of toothpaste do you usually use?
[For VIP survey insert: You may need to scroll down to see the answer options.]
If respondent is unsure about what type of toothpaste is used, and give their
permission, you could ask to see the toothpaste that is currently used.
• Standard fluoride packaging might include: “0.221% sodium fluoride”, “0.76%
sodium monofluorophosphate”, “1000–1450 ppm” and/or “fluoride toothpaste”.
Homemade toothpaste or baking soda should be coded as ‘Don’t use toothpaste
/ no toothpaste available in the house’.
1
Standard fluoride toothpaste
3
Non-fluoridated toothpaste
1982
4
Don’t use toothpaste / no toothpaste available in house
.K Don’t know
Act
.R Refused
The toothpaste picture showcard needs updating if there are any major changes in the
market. This should be reviewed annually, in consultation with the Ministry’s oral health
team, during questionnaire development.
Tobacco
Information
Now, some questions on tobacco smoking. For these questions, please do not include use
of electronic cigarettes or vaping devices. We will ask about those later.
A3.13 Have you ever smoked cigarettes or tobacco at all, even just a few puffs? Please
Official
include pipes and cigars.
If asked, this does
not include marijuana / cannabis or electronic cigarettes.
the
1
Yes
2
No [go to Electronic cigarettes introduction before A3.21a]
.K Don’t know
.R Refused
under
A3.14 Have you ever smoked a total of more than
100 cigarettes in your whole life?
1
Yes
2
No [go to Electronic cigarettes introduction before A3.21a]
.K Don’t know
Released
.R Refused
NZHS Year 12 Adult Questionnaire
30
Document 1
[Showcard]
A3.15 How often do you now smoke?
Read response options. If more than one frequency given, code the highest one.
1
I don’t smoke now
2
At least once a day [go to tobacco products A3.17]
3
At least once a week [go to A3.17]
4
At least once a month [go to A3.17]
5
Less often than once a month [go to A3.17]
.K Don’t know [go to A3.17]
.R Refused [go to A3.17]
Ask next question, A3.16, if respondents are ex-smokers (A3.13=1 and A3.14=1 and
A3.15=1).
1982
[Showcard]
A3.16 How long ago did you stop smoking?
Act
1
Within the last month [go to number of quit attempts A3.21]
2
1 month to 3 months ago [go to A3.21]
3
4 months to 6 months ago [go to A3.21]
4
7 to 12 months ago [go to A3.21]
5
1 to 2 years ago [go to Electronic cigarettes introduction before A3.21a]
6
2 to 5 years ago [go to introduction before A3.21a]
7
Longer than 5 years ago [go to introduction before A3.21a]
Information
.K Don’t know [go to introduction before A3.21a]
.R Refused [go to introduction before A3.21a]
Ask next questions, A3.17 and A3.18, if respondents are current smokers (A3.15=2, 3, 4,
5) or didn’t answer the current smoker question (A3.15=.K, .R).
Official
[Showcard]
A3.17 Which of these products do you smoke the
most?
the
Read answers and code.
1
Tailor-made cigarettes – that is, manufactured cigarettes in a packet
2
Roll your owns using loose tobacco
under
3
Both tailor-mades and roll your owns
4
Pipes [go to times quit smoking A3.20]
5
Cigars [go to A3.20]
.K Don’t know
.R Refused
Released
NZHS Year 12 Adult Questionnaire
31
Document 1
A3.18 On average, how many cigarettes do you smoke a day?
Response option numbers are not displayed on CAPI screen.
Don’t initially prompt answer. Wait and code.
If respondent is unable to suggest an average, ask for the typical number of
cigarettes smoked in a week and divide by 7.
Round answer to nearest number if necessary, eg 2.5 cigarettes a day should be
rounded up to 3, that is, option ‘1–5 per day’. 10.4 cigarettes would be rounded down
to 10, that is, option ‘6–10 per day’.
1
Less than 1 per day
2
1–5 per day
3
6–10 per day
4
11–15 per day
5
16–20 per day
6
21–25 per day
1982
7
26–30 per day
8
31 or more a day
.K Don’t know
Act
.R Refused
Ask A3.20 if respondents are current smokers (A3.15=2, 3, 4, 5) or didn’t answer the
current smoker question (A3.15=.K or .R).
A3.20 In the last 12 months, how many times did you quit smoking for more than one
week?
Information
_____ times (range 0–51) [go to Electronic cigarettes introduction before A3.21a]
.K Don’t know [go to introduction before A3.21a]
.R Refused [go to introduction before A3.21a]
Official
Ask A3.21 if respondents are ex-smokers (A3.15=1) and quit smoking in the last 12
months (A3.16=1, 2, 3, 4).
the
A3.21 In the last 12 months, how many times did you quit smoking for more than one
week? Please include the time when you stopped smoking.
_____ times (range 1–51)
under
.K Don’t know
.R Refused
Released
NZHS Year 12 Adult Questionnaire
32
Document 1
Electronic cigarettes
Ask everyone A3.21a regardless of their smoking status.
Now I’l ask you about electronic cigarettes and vaping devices.
A3.21a Have you ever tried an electronic cigarette or vaping device, even just a puff or
‘vape’?
Electronic cigarettes or vaping devices, also known as e-cigs, vapes or personal
vaporizers, are battery-powered devices that heat a liquid to release vapour as
people inhale from them. The vapour may contain nicotine and may be flavoured.
1
Yes
2
No [go to Dietary habits introduction before A3.22a]
.K Don't know [go to introduction before A3.22a]
.R Refused [go to introduction before A3.22a]
1982
[Showcard]
Act
A3.21b How often do you now use electronic cigarettes or vaping devices?
Read response options. If more than one frequency given, code the highest one.
1
I don’t use them now
2
At least once a day
3
At least once a week
4
At least once a month
5
Less often than once a month
Information
.K Don’t know
.R Refused
Dietary habits
Official
Now, a couple of questions about eating fruit and vegetables.
the
Response option numbers are not displayed on the CAPI screen or showcards
for questions A3.22a and A3.23a.
[Picture Showcard]
under
A3.22a On
average, how many
servings of fruit do you eat per day? Please include all
fresh, frozen, canned and stewed fruit. Do
not include fruit juice or dried fruit. A
‘
serving’ = 1 medium piece
or 2 small pieces of fruit
or 1 cup of canned, frozen or
stewed fruit. For example, 1 apple + 2 small apricots = 2 servings.
If asked, include fruit smoothies.
[For VIP survey insert: You may need to scroll down to see all the answer options.]
Released
1
I don’t eat fruit
2
Less than 1 serving per day
3
1 serving per day
4
2 servings per day
5
3 servings per day
6
4 servings per day
7
5 servings per day
8
6 or more servings per day
.K Don’t know
.R Refused
NZHS Year 12 Adult Questionnaire
33
Document 1
[Picture Showcard]
A3.23a On
average, how many
servings of vegetables do you eat per day? Please include
all fresh, frozen and canned vegetables. Do
not include vegetable juices. A
‘
serving’ = ½ medium potato / similar sized kumara
or ½ cup cooked vegetables
or 1 cup of raw salad vegetables. For example, 5 servings could comprise of 1
medium potato + 1 cup of cooked vegetables + 1 cup of raw salad throughout the
day.
Remember to think about all meals and snacks.
[For VIP survey insert: You may need to scroll down to see all the answer options.]
1
I don’t eat vegetables
2
Less than 1 serving per day
3
1 serving per day
4
2 servings per day
1982
5
3 servings per day
6
4 servings per day
Act
7
5 servings per day
8
6 or more servings per day
.K Don’t know
.R Refused
Alcohol
Information
I will now ask you some questions about your use of alcoholic drinks.
A3.24 Have you had a drink containing alcohol in the last year?
1
Yes
Official
2
No [go to alcohol harm A3.33]
.K Don’t know [go to A3.33]
.R Refused [go to A3.33] the
A3.25 How often do you have a drink containing alcohol?
Don’t initially prompt answer. Wait and code.
under
1
Monthly or less
2
Up to 4 times a month
3
Up to 3 times a week
4
4 or more times a week
.K Don’t know
.R Refused
Released
NZHS Year 12 Adult Questionnaire
34
Document 1
[Showcard]
[Picture Showcard]
A3.26a Looking at the [For F2F insert: Showcard] [For VIP insert: options on the screen],
how many drinks containing alcohol do you have on a typical day when you are
drinking? [For VIP insert: You may need to scroll down to see the answer options.]
Response option numbers are not displayed on CAPI screen or showcards.
By one drink, I now mean one standard drink, that is, one can or stubbie of beer,
half a large bottle of beer, one small glass of wine or one shot of spirits.
[For F2F insert: This Picture Showcard [show Picture Showcard]] [For VIP insert:
The screen image] can help you estimate the number of standard drinks you have
drunk. It shows some examples of the number of standard drinks in different
alcoholic drinks.
Take average and round to nearest whole number if necessary, eg if respondent
1982
says 4 or 5, average is 4.5, round to nearest whole number = 5, that is, option ‘5 or
6’.
Act
1
1 or 2
2
3 or 4
3
5 or 6
4
7 to 9
5
10 or 11
6 12 or more
.K Don’t know
Information
.R Refused
The standard drinks picture showcard is reviewed annually in case there are any changes in
the market.
Official
Picture Showcard for A3.26a and A3.27a:
the
under
Released
NZHS Year 12 Adult Questionnaire
35
Document 1
[Showcard]
[Picture Showcard]
A3.27a Looking at the [For F2F survey insert: Showcard, and the Picture Showcard] [For
VIP survey insert: options on the screen, and the screen image], how often do you
have six or more standard drinks on one occasion? [For VIP insert: You may need
to scroll down to see the answer options.]
1
Never
2
Less than monthly
3
Monthly
4
Weekly
5
Daily or almost daily
.K Don’t know
.R Refused
1982
[Showcard]
A3.28 How often during the last year have you found that you were not able to stop drinking
once you had started?
Act
1
Never
2
Less than monthly
3
Monthly
4
Weekly
5
Daily or almost daily
.K Don’t know
Information
.R Refused
[Showcard]
A3.29 How often during the last year have you failed to do what was normally expected
from you because of drinking?
Official
1
Never
2
Less than monthly
the
3
Monthly
4
Weekly
5
Daily or almost daily
.K Don’t know under
.R Refused
[Showcard]
A3.30 How often during the last year have you needed a first drink in the morning to get
yourself going after a heavy drinking session?
Released
1
Never
2
Less than monthly
3
Monthly
4
Weekly
5
Daily or almost daily
.K Don’t know
.R Refused
NZHS Year 12 Adult Questionnaire
36
Document 1
[Showcard]
A3.31 How often during the last year have you had a feeling of guilt or remorse after
drinking?
1
Never
2
Less than monthly
3
Monthly
4
Weekly
5
Daily or almost daily
.K Don’t know
.R Refused
[Showcard]
A3.32 How often during the last year have you been unable to remember what happened
the night before because you had been drinking?
1982
1
Never
2
Less than monthly
Act
3
Monthly
4
Weekly
5
Daily or almost daily
.K Don’t know
.R Refused
The next two questions are about lifetime harm from drinking, so ask all respondents
Information
even if they have not had a drink containing alcohol in the last year.
[Showcard]
A3.33 Have you or someone else been injured as a result of your drinking?
Official
1
Yes, but not in the last year
2
Yes, during the last year
3
No
the
.K Don’t know
.R Refused
[Showcard]
under
A3.34 Has a relative or friend, or a doctor or other health worker, been concerned about
your drinking or suggested you cut down?
1
Yes, but not in the last year
2
Yes, during the last year
3
No
Released
.K Don’t know
.R Refused
NZHS Year 12 Adult Questionnaire
37
Document 1
Drugs
The next question is about your experience of using drugs. These substances can be
smoked, swallowed, snorted, inhaled, injected or taken in the form of pills.
Please do not include medicine that you have used for the purpose it was prescribed for, by
your doctor or nurse. Please
include prescribed medicine that you have taken for other
reasons, such as to get high, or taken more frequently or at a higher dose than specified.
Remember that everything you tell us will remain confidential.
[Showcard]
A3.37 Looking at the [For F2F survey insert: Showcard] [For VIP survey insert: options on
the screen], in the
past 12 months, have you used any of the following substances?
Please just read out the number next to the words. [For VIP survey insert: You may
need to scroll down to see all the answer options.]
1982
[Select all that apply]
Prompt: “any others?”
Act
Please do not include medication, such as medicinal cannabis, that is taken for
the purpose it was prescribed for and is taken as prescribed.
1
Cannabis (marijuana, hash, weed)
2
Cocaine
3
Ecstasy / MDMA
4
Amphetamine type stimulants, for example, ‘P’, speed, ice, Ritalin®
5
Inhalants, for example, NOS, glue, petrol, poppers
Information
6
Sedatives or sleeping pills, for example, Valium, diazepam
7
Hallucinogens, for example, LSD, mushrooms, ketamine
8
Opioids, for example, heroin, morphine, methadone, codeine
77 Other substances – please specify (for example, synthetic cannabinoids,
‘synnies’, GHB, GBL etc.)
_________________
Official
0
No, none of the above [cannot be selected with other options]
.K Don’t know
the
.R Refused
under
Released
NZHS Year 12 Adult Questionnaire
38
Document 1
Health status
Now some more questions about your health. Some of these questions may appear similar
but we need to ask them.
SF-12v2® Health Survey (Four-week Recall)
The following 12-question set is the SF-12v2® Health Survey © 1992, 2000, 2009
QualityMetric Incorporated and Medical Outcomes Trust. All rights reserved. SF-12® is a
registered trademark of Medical Outcomes Trust. (SF-12v2® Health Survey Standard
Interview Script, United States (English)).
Licensing rules for SF-12v2 require the copyright notice on each SF-12v2 screen: SF-
12v2® Health Survey © 1992, 2000, 2009 QualityMetric Incorporated and Medical
Outcomes Trust. All rights reserved. SF-12® is a registered trademark of Medical Outcomes
Trust. (SF-12v2® Health Survey Standard Interview Script, United States (English)).
1982
This first question is about your health
now.
Act
Please try to answer as accurately as you can.
[Showcard]
A4.01 In general, would you say your health is:
Read response options.
1
Excellent
Information
2
Very good
3
Good
4
Fair
5
Poor
.K Don’t know
Official
.R Refused
the
If respondent used a family or professional translator (A6.13=1 OR A6.14=1), skip to
FD1.01. Everyone else (A6.13=2 AND A6.14=2) go to introduction before A4.02.
Now I’m going to read a list of activities that you might do during a typical day.
under
As I read each item, please tell me if your health
now limits you a lot, limits you a little, or
does not limit you at all in these activities.
If respondent says they do not do these activities, then ask how limited they think they
would be if they tried to do them.
Released
NZHS Year 12 Adult Questionnaire
39
Document 1
SF-12v2® Health Survey © 1992, 2000, 2009 QualityMetric Incorporated and Medical
Outcomes Trust. All rights reserved. SF-12® is a registered trademark of Medical Outcomes
Trust. (SF-12v2® Health Survey Standard Interview Script, United States (English)).
[Showcard]
A4.02 Moderate activities, such as moving a table, pushing a vacuum cleaner, bowling or
playing golf. Does your health now limit you a lot, limit you a little, or not limit you at
all?
Read response options only if necessary.
1
Yes, limited a lot
2
Yes, limited a little
3
No, not limited at all
.K Don’t know
.R Refused
1982
[Showcard]
A4.03 Climbing several flights of stairs. Does your health now limit you a lot, limit you a
Act
little, or not limit you at all?
Read response options only if necessary.
1
Yes, limited a lot
2
Yes, limited a little
3
No, not limited at all
.K Don’t know
.R Refused
Information
The following two questions ask about your physical health and your daily activities.
[Showcard]
A4.04 During the
past four weeks, how much of the time have you accomplished less than
Official
you would like as a result of your physical health?
Read response options.
the
1
All of the time
2
Most of the time
3
Some of the time
4
A little of the time
under
5
None of the time
.K Don’t know
.R Refused
[Showcard]
A4.05 During the
past four weeks, how much of the time were you limited in the kind of
work or other regular daily activities you do as a result of your physical health?
Released
Read response options.
1
All of the time
2
Most of the time
3
Some of the time
4
A little of the time
5
None of the time
.K Don’t know
.R Refused
NZHS Year 12 Adult Questionnaire
40
Document 1
SF-12v2® Health Survey © 1992, 2000, 2009 QualityMetric Incorporated and Medical
Outcomes Trust. All rights reserved. SF-12® is a registered trademark of Medical Outcomes
Trust. (SF-12v2® Health Survey Standard Interview Script, United States (English)).
The following two questions ask about your emotions and your daily activities.
[Showcard]
A4.06 During the
past four weeks, how much of the time have you accomplished less than
you would like as a result of any emotional problems, such as feeling depressed or
anxious?
Read response options.
1
All of the time
2
Most of the time
3
Some of the time
1982
4
A little of the time
5
None of the time
.K Don’t know
Act
.R Refused
[Showcard]
A4.07 During the
past four weeks, how much of the time did you do work or other regular
daily activities less carefully than usual as a result of any emotional problems, such
as feeling depressed or anxious?
Read response options.
Information
1
All of the time
2
Most of the time
3
Some of the time
4
A little of the time
Official
5
None of the time
.K Don’t know
.R Refused
the
[Showcard]
A4.08 During the
past four weeks, how much did
pain interfere with your normal work,
including both work outside the home and housework? Did it interfere …
under
Read response options.
1
Not at all
2
A little bit
3
Moderately
4
Quite a bit
Released
5
Extremely
.K Don’t know
.R Refused
NZHS Year 12 Adult Questionnaire
41
Document 1
SF-12v2® Health Survey © 1992, 2000, 2009 QualityMetric Incorporated and Medical
Outcomes Trust. All rights reserved. SF-12® is a registered trademark of Medical Outcomes
Trust. (SF-12v2® Health Survey Standard Interview Script, United States (English)).
The next questions are about how you feel and how things have been with you during the
past four weeks.
As I read each statement, please give the one answer that comes closest to the way you
have been feeling; is it all the time, most of the time, some of the time, a little of the time, or
none of the time?
[Showcard]
A4.09 How much of the time during the
past four weeks, have you felt calm and peaceful?
Read response options only if necessary.
1982
1
All of the time
2
Most of the time
3
Some of the time
Act
4
A little of the time
5
None of the time
.K Don’t know
.R Refused
[Showcard]
A4.10 How much of the time during the
past four weeks, did you have a lot of energy?
Information
Read response options only if necessary.
1
All of the time
2
Most of the time
3
Some of the time
Official
4
A little of the time
5
None of the time
.K Don’t know
the
.R Refused
[Showcard]
A4.11 How much of the time during the
past four weeks, have you felt downhearted and
under
depressed?
Read response options only if necessary.
1
All of the time
2
Most of the time
3
Some of the time
Released
4
A little of the time
5
None of the time
.K Don’t know
.R Refused
NZHS Year 12 Adult Questionnaire
42
Document 1
SF-12v2® Health Survey © 1992, 2000, 2009 QualityMetric Incorporated and Medical
Outcomes Trust. All rights reserved. SF-12® is a registered trademark of Medical Outcomes
Trust. (SF-12v2® Health Survey Standard Interview Script, United States (English)).
[Showcard]
A4.12 During the
past four weeks, how much of the time has your physical health or
emotional problems interfered with your social activities like visiting with friends or
relatives? Has it interfered…
Read response options.
1
All of the time
2
Most of the time
3
Some of the time
4
A little of the time
5
None of the time
1982
.K Don’t know
.R Refused
Act
Functional difficulties – Washington Group Enhanced
Short Set
The next questions ask about difficulties you may have doing certain activities because of a
health problem.
Information
[Showcard]
FD1.01 Do you have difficulty seeing, even if wearing glasses?
1
No – no difficulty
2
Yes – some difficulty
Official
3
Yes – a lot of difficulty
4
Cannot do at all
.K Don’t know
the
.R Refused
[Showcard]
FD1.02 Do you have difficulty hearing, even if using a hearing aid?
under
1
No – no difficulty
2
Yes – some difficulty
3
Yes – a lot of difficulty
4
Cannot do at all
.K Don’t know
Released
.R Refused
[Showcard]
FD1.03 Do you have difficulty walking or climbing steps?
1
No – no difficulty
2
Yes – some difficulty
3
Yes – a lot of difficulty
4
Cannot do at all
.K Don’t know
.R Refused
NZHS Year 12 Adult Questionnaire
43
Document 1
[Showcard]
FD1.04 Do you have difficulty remembering or concentrating?
1
No – no difficulty
2
Yes – some difficulty
3
Yes – a lot of difficulty
4
Cannot do at all
.K Don’t know
.R Refused
[Showcard]
FD1.05 Do you have difficulty washing all over or dressing?
1
No – no difficulty
2
Yes – some difficulty
1982
3
Yes – a lot of difficulty
4
Cannot do at all
.K Don’t know
Act
.R Refused
[Showcard]
FD1.06 Using your usual language, do you have difficulty communicating, for example,
understanding or being understood?
1
No – no difficulty
Information
2
Yes – some difficulty
3
Yes – a lot of difficulty
4
Cannot do at all
.K Don’t know
.R Refused
Official
[Showcard]
FD1.07 Would you have difficulty lifting a two-litre bottle of water from waist to eye level?
the
1
No – no difficulty
2
Yes – some difficulty
3
Yes – a lot of difficulty
under
4
Cannot do at all
.K Don’t know
.R Refused
[Showcard]
FD1.08 Do you have difficulty using your hands and fingers, such as picking up small
Released
objects, or opening containers?
1
No – no difficulty
2
Yes – some difficulty
3
Yes – a lot of difficulty
4
Cannot do at all
.K Don’t know
.R Refused
NZHS Year 12 Adult Questionnaire
44
Document 1
[Showcard]
FD1.09 How often do you feel anxious, nervous or worried?
1
Daily
2
Weekly
3
Monthly
4
A few times a year
5
Never [go to FD1.11]
.K Don’t know [go to FD1.11]
.R Refused [go to FD1.11]
[Showcard]
FD1.10 Thinking about the last time you felt this way, how anxious, nervous or worried did
you feel?
1982
1
A little
2
A lot
3
Somewhere in between a little and a lot
Act
.K Don’t know
.R Refused
[Showcard]
FD1.11 How often do you feel depressed?
1
Daily
Information
2
Weekly
3
Monthly
4
A few times a year
5
Never [go to Mental health – K10 introduction before A4.13]
.K Don’t know [go to intro before A4.13]
Official
.R Refused [go to intro before A4.13]
[Showcard]
the
FD1.12 Thinking about the last time you felt this way, how depressed did you feel?
1
A little
2
A lot
under
3
Somewhere in between a little and a lot
.K Don’t know
.R Refused
Released
NZHS Year 12 Adult Questionnaire
45
Document 1
Mental health – K10
The next questions are again about how you have been feeling during the
past four weeks.
Some questions may sound similar to questions you have already answered.
[Showcard]
A4.13 During the past four weeks, how often did you feel tired out for no good reason –
would you say all of the time, most of the time, some of the time, a little of the time,
or none of the time?
1
All of the time
2
Most of the time
3
Some of the time
4
A little of the time
5
None of the time
.K Don’t know
1982
.R Refused
Act
[Showcard]
A4.14 During the past four weeks, how often did you feel nervous – all of the time, most of
the time, some of the time, a little of the time, or none of the time?
1
All of the time
2
Most of the time
3
Some of the time
4
A little of the time
Information
5
None of the time [go to feeling hopeless A4.16]
.K Don’t know [go to A4.16]
.R Refused [go to A4.16]
[Showcard]
Official
A4.15 During the past four weeks, how often did you feel so nervous that nothing could
calm you down?
the
1
All of the time
2
Most of the time
3
Some of the time
4
A little of the time
under
5
None of the time
.K Don’t know
.R Refused
[Showcard]
A4.16 During the past four weeks, how often did you feel hopeless?
Released
1
All of the time
2
Most of the time
3
Some of the time
4
A little of the time
5
None of the time
.K Don’t know
.R Refused
NZHS Year 12 Adult Questionnaire
46
Document 1
[Showcard]
A4.17 During the past four weeks, how often did you feel restless or fidgety?
1
All of the time
2
Most of the time
3
Some of the time
4
A little of the time
5
None of the time [go to feeling depressed A4.19]
.K Don’t know [go to A4.19]
.R Refused [go to A4.19]
[Showcard]
A4.18 During the past four weeks, how often did you feel so restless you could not sit still?
1
All of the time
2
Most of the time
1982
3
Some of the time
4
A little of the time
Act
5
None of the time
.K Don’t know
.R Refused
[Showcard]
A4.19 During the past four weeks, how often did you feel depressed?
1
All of the time
Information
2
Most of the time
3
Some of the time
4
A little of the time
5
None of the time [go to effort A4.21]
.K Don’t know [go to A4.21]
Official
.R Refused [go to A4.21]
the
[Showcard]
A4.20 How often did you feel so depressed that nothing could cheer you up?
1
All of the time
under
2
Most of the time
3
Some of the time
4
A little of the time
5
None of the time
.K Don’t know
.R Refused
Released
[Showcard]
A4.21 During the past four weeks, how often did you feel that everything was an effort?
1
All of the time
2
Most of the time
3
Some of the time
4
A little of the time
5
None of the time
.K Don’t know
.R Refused
NZHS Year 12 Adult Questionnaire
47
Document 1
[Showcard]
A4.22 During the past four weeks, how often did you feel worthless?
1
All of the time
2
Most of the time
3
Some of the time
4
A little of the time
5
None of the time
.K Don’t know
.R Refused
[Showcard]
AMH1.01a During the past four weeks, how often did you feel lonely?
1
All of the time
1982
2
Most of the time
3
Some of the time
4
A little of the time
Act
5
None of the time
.K Don’t know
.R Refused
Information
Official
the
under
Released
NZHS Year 12 Adult Questionnaire
48
Document 1
Mental health and substance use self-complete section
If the interview is being conducted with cognitive or language assistance from a family
member / caregiver / friend of the respondent (A6.12=1 OR A6.13=1), skip to Socio-
demographics. Everyone else (A6.12=2 AND A6.13=2) go to AMHIntro1.
AMHIntro1
[For F2F survey insert: Now, I’m going to hand the computer to you, so that you can answer
the next questions privately.]
[For VIP survey insert: The next questions are for you to answer privately. Your answers are
totally confidential and will not be seen by me, unless you ask me to help you.]
The interviewer can administer this section [For F2F survey insert: using showcards] but
only if privacy can be ensured (ie no one other than a professional translator can see or hear
the answers).
1982
[For VIP survey insert: If the respondent is happy for you to administer the questions,
select the ‘Unblock and hold’ checkbox.]
Act
1
Continue with this section (privacy ensured) [go to AMHIntro2]
2
Respondent refuses to continue / privacy not ensured [go to Socio-
demographics introduction before A5.01]
If AMHIntro1=2, display the following message: Are you sure you want to skip this
section? Click ‘OK’ to go back, or ‘Cancel’ to skip the section.
Information
START OF SELF-COMPLETE.
AMHIntro2
Some words in the survey will be underlined and will have a flag symbol next to them. This
Official
tells you that there is additional information available to help you answer the question.
Move the pointer over this word ⚐ or touch it with your finger to display the additional
the
information. To make the box disappear, move the pointer away or touch on another area of
the screen.
Now click ‘Next’.
under
AMHIntro3
Questions about your emotions, stress, mental health and substance use will begin on the
next screen.
Please let your interviewer know if you would like any assistance when completing this
Released
section.
Click ‘Next’ to begin.
NZHS Year 12 Adult Questionnaire
49
Document 1
Patient Health Questionnaire (GAD-7 and PHQ-9)
[Showcard]
PHQ1.16–PHQ1.22
Questions PHQ1.16 to PHQ1.22 fit on one screen for self-complete.
Over the last
2 weeks, how often have you been bothered by any of the following problems?
1. Not 2. Several 3. More than
4. Nearly
at all
days
half the days
every day
Feeling nervous, anxious or on edge
Not being able to stop or control
worrying
Worrying too much about different
things
1982
Trouble relaxing
Being so restless that it is hard to sit
Act
still
Becoming easily annoyed or irritable
Feeling afraid as if something awful
might happen
If one or more of PHQ1.16–PHQ1.22 are left blank, display the following pop-up
message: You have not answered every row. Click ‘OK’ to go back and select an answer for
Information
every question, OR click ‘Cancel’ to go to the next screen.
Official
the
under
Released
NZHS Year 12 Adult Questionnaire
50
Document 1
[Showcard]
PHQ1.28–PHQ1.36
Questions PHQ1.28 to PHQ1.36 fit on one screen for self-complete.
Over the last
2 weeks, how often have you been bothered by any of the following problems?
[For VIP survey insert: You may need to scroll down to see all the grid statements.]
1. Not
2. Several
3. More
4. Nearly
at all
days
than half
every day
the days
Little interest or pleasure in doing things
Feeling down, depressed, or hopeless
Trouble falling or staying asleep, or
sleeping too much
1982
Feeling tired or having little energy
Poor appetite or overeating
Act
Feeling bad about yourself – or that you
are a failure or have let yourself or your
family down
Trouble concentrating on things, such as
reading the newspaper or watching
television
Moving or speaking so slowly that other
Information
people could have noticed? Or the
opposite – being so fidgety or restless
that you have been moving around a lot
more than usual
Thoughts that you would be better off
Official
dead or of hurting yourself in some way
the
If one or more of PHQ1.28–PHQ1.36 are left blank, display the following pop-up
message: You have not answered every row. Click ‘OK’ to go back and select an answer for
every question, OR click ‘Cancel’ to go to the next screen.
Go to PHQ1.37 if any answers in PHQ1.16–PHQ1.22 were: ‘Several days’ OR ‘More than
under
half the days’ OR ‘Nearly every day’, OR any answers in PHQ1.28–PHQ1.36 were: ‘Several
days’ OR ‘More than half the days’ OR ‘Nearly every day’, otherwise go to AST1.01.
[Showcard]
PHQ1.37 Thinking about the problems you’ve reported in this section of the questionnaire
that have been bothering you…
Released
How difficult have these problems made it for you to do your work, take care of
things at home, or get along with other people?
1
Not difficult at all
2
Somewhat difficult
3
Very difficult
4
Extremely difficult
If PHQ1.37 is left blank, display the following pop-up message: You have not answered
this question. Click ‘OK’ to go back and select an answer, OR click ‘Cancel’ to go to the next
screen.
NZHS Year 12 Adult Questionnaire
51
Document 1
If PHQ1.36=2–4 go to AMH_ALERTa
AMH_ALERTa
If you are worried about yourself or having thoughts of hurting yourself, you need to reach
out and talk to someone who’s trained to help you straight away. There are a range of
organisations that can provide expert advice and support. The contact details for these
organisations are provided in the thank you card you will be [F2F insert: given] [VIP insert:
emailed (if you agree),] at the end of this interview.
Please click ‘Next’.
The Alcohol, Smoking and Substance Involvement
Screening Test (ASSIST)
The next questions are about your experience of using alcohol, tobacco products and other
drugs. These substances can be smoked, swallowed, snorted, inhaled, injected or taken in
1982
the form of pills.
Act
Please
do not include medicine that you have used
for the purpose it was prescribed for,
by your doctor. Please
include prescribed medicine that you have
taken for other
reasons, such as to get high, or taken more frequently or at a higher dose than specified.
Question numbers are not included with any ASSIST grid items as non-consecutive
numbering can occur with item selections.
Click ‘Next’ to begin.
Information
[Showcard]
AST1.01–AST1.10
In your
lifetime, which of the following substances have you
ever used?
[For VIP survey insert: You may need to scroll down to see all the grid statements.]
Official
Yes
No
Tobacco products
the
(cigarettes, chewing tobacco, cigars, etc)
Alcoholic beverages
(beer, wine, spirits, etc)
under
Cannabis
(marijuana, hash, weed, etc)
Cocaine
(coke, crack, etc)
Amphetamine type stimulants
(P, speed, ice, Ritalin®, ecstasy, MDMA, etc)
Released
Inhalants
(NOS, glue, petrol, poppers, etc)
Sedatives or sleeping pills
(Valium, diazepam, etc)
Hallucinogens
(LSD, mushrooms, ketamine, etc)
Opioids
(heroin, homebake, morphine, methadone, codeine, etc)
Other (synthetic cannabinoids, ‘synnies’, GHB, GBL, kava, etc.
[go to
[go to
You will be asked to specify these on the next screen)
AST1.10a]
AST1.11]
NZHS Year 12 Adult Questionnaire
52
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If all of AST1.01–AST1.10=No, display the following pop-up message: Your answers
indicate that you have never tried any of the substances mentioned in this grid; not even
when you were at school? If you did, please click ‘OK’ to go back and indicate which
substances you have used at any point in your life. If not, click ‘Cancel’ to go to the next
screen.
If one or more of AST1.01–AST1.10 are left blank, display the following pop-up message:
You have not answered every row. Click ‘OK’ to go back and select an answer for every
question, OR click ‘Cancel’ to go to the next screen.
If after pop-up message displayed, AST1.10 (Other)=Yes, go to AST1.10a.
Otherwise:
• If after pop-up message displayed, any of AST1.01–AST1.09=Yes, go to AST1.11–
AST1.20c.
• Everyone else (ie all AST1.01–AST1.10=No or missing) go to introduction before
1982
AMH1.01.
Display AST1.10a–AST1.10c on a new screen.
Act
AST1.10a–AST1.10c
Please specify the other substances that you have
ever used.
Write each substance in a separate box.
Other substance 1
Information
Other substance 2
Other substance 3
If there is no text entered into any of AST1.10a–c, display the following pop-up message:
You have not answered this question. Click ‘OK’ to go back and type in answers, OR click
Official
‘Cancel’ to go to the next screen.
the
If any of AST1.01–AST1.10=Yes after pop-up message displayed, ask AST1.11–
AST1.20c. Otherwise go to introduction before AMH1.01.
under
Released
NZHS Year 12 Adult Questionnaire
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[Showcard]
AST1.11–AST1.20c
Grid below should only display substances that a respondent has ever used, ie when
AST1.01, AST1.02, AST1.03, AST1.04, AST1.05, AST1.06, AST1.07, AST1.08, OR
AST1.09=Yes; OR when AST1.10a, AST1.10b, OR AST1.10c are populated.
In the
past three months, how often have you used the substances you mentioned?
[For VIP survey insert: You may need to scroll down to see all the grid statements.]
1.
2.
3.
4.
5. Daily or
Never
Once
Monthly Weekly almost
or twice
daily
Tobacco products
(cigarettes, chewing tobacco, cigars,
1982
etc)
Alcoholic beverages
Act
(beer, wine, spirits, etc)
Cannabis
(marijuana, hash, weed, etc)
Cocaine
(coke, crack, etc)
Amphetamine type stimulants
(P, speed, ice, Ritalin®, ecstasy,
Information
MDMA, etc)
Inhalants
(NOS, glue, petrol, poppers, etc)
Sedatives or sleeping pills
(Valium, diazepam, etc)
Official
Hallucinogens
(LSD, mushrooms, ketamine, etc) the
Opioids
(heroin, homebake, morphine,
methadone, codeine, etc)
If AST1.10a is populated, show
under
name of substance here
If AST1.10b is populated, show
name of substance here
If AST1.10c is populated, show
name of substance here
Released
If respondent has left any displayed substances blank (ie has not responded), show the
following pop-up message: You have not answered every row. Click ‘Previous’ to go back
and select an answer for every question, OR click ‘Next’ to go to the next screen.
If ‘Never’ OR there is no response to all substances displayed in AST1.11–AST1.20c,
skip to AST1.51–AST1.60c.
If answered: ‘Once or twice’, ‘Monthly’, ‘Weekly’, or ‘Daily or almost daily’, to any
displayed substances in AST1.11–AST1.20c, ask AST1.21 to AST1.50c for each substance
used in the past three months.
NZHS Year 12 Adult Questionnaire
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[Showcard]
AST1.21–AST1.30c
Grid below should:
• Display substances when AST1.11, AST1.12, AST1.13, AST1.14, AST1.15, AST1.16,
AST1.17, AST1.18, OR AST1.19, AST1.20a, AST1.20b, OR AST1.20c=‘Once or twice’,
‘Monthly’, ‘Weekly’, or ‘Daily or almost daily’.
• Not display substances when AST1.11–AST1.20c=‘Never’ OR there is no response.
During the
past three months, how often have you had a strong desire or urge to use the
substances you mentioned?
[For VIP survey insert: You may need to scroll down to see all the grid statements.]
1.
2.
3.
4.
5. Daily
Never Once
Monthly
Weekly
or
1982
or twice
almost
daily
Act
Tobacco products
(cigarettes, chewing tobacco, cigars,
etc)
Alcoholic beverages
(beer, wine, spirits, etc)
Cannabis
(marijuana, hash, weed, etc)
Information
Cocaine
(coke, crack, etc)
Amphetamine type stimulants
(P, speed, ice, Ritalin®, ecstasy,
MDMA, etc)
Official
Inhalants
(NOS, glue, petrol, poppers, etc) the
Sedatives or sleeping pills
(Valium, diazepam, etc)
Hallucinogens
under
(LSD, mushrooms, ketamine, etc)
Opioids
(heroin, homebake, morphine,
methadone, codeine, etc)
If AST1.20a is ‘Once or twice’,
‘Monthly’, ‘Weekly’, or ‘Daily or almost
daily’, show name of sub
Released stance here
If AST1.20b is ‘Once or twice’,
‘Monthly’, ‘Weekly’, or ‘Daily or almost
daily’, show name of substance here
If AST1.20c is ‘Once or twice’,
‘Monthly’, ‘Weekly’, or ‘Daily or almost
daily’, show name of substance here
If respondent has left any displayed substances blank (ie has not responded), display the
following pop-up message: You have not answered every row. Click ‘Previous’ to go back
and select an answer for every question, OR click ‘Next’ to go to the next screen.
NZHS Year 12 Adult Questionnaire
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[Showcard]
AST1.31–AST1.40c
Grid below should:
• Display substances when AST1.11, AST1.12, AST1.13, AST1.14, AST1.15, AST1.16,
AST1.17, AST1.18, OR AST1.19, AST1.20a, AST1.20b, OR AST1.20c=‘Once or twice’,
‘Monthly’, ‘Weekly’, or ‘Daily or almost daily’.
• Not display substances when AST1.11–AST1.20c=‘Never’ OR there is no response.
During the
past three months, how often has your use of the substances you mentioned
led to health, social, legal or financial problems?
[For VIP survey insert: You may need to scroll down to see all the grid statements.]
1.
2.
3.
4.
5. Daily
Never
Once
Monthly
Weekly
or
1982
or
almost
twice
daily
Act
Tobacco products
(cigarettes, chewing tobacco, cigars,
etc)
Alcoholic beverages
(beer, wine, spirits, etc)
Cannabis
(marijuana, hash, weed, etc)
Information
Cocaine
(coke, crack, etc)
Amphetamine type stimulants
(P, speed, ice, Ritalin®, ecstasy,
MDMA, etc)
Official
Inhalants
(NOS, glue, petrol, poppers, etc) the
Sedatives or sleeping pills
(Valium, diazepam, etc)
Hallucinogens
(LSD, mushrooms, ketamine, etc)
under
Opioids
(heroin, homebake, morphine,
methadone, codeine, etc)
If AST1.20a is ‘Once or twice’,
‘Monthly’, ‘Weekly’, or ‘Daily or almost
daily’, show name of substance here
Released
If AST1.20b is ‘Once or twice’,
‘Monthly’, ‘Weekly’, or ‘Daily or almost
daily’, show name of substance here
If AST1.20c is ‘Once or twice’,
‘Monthly’, ‘Weekly’, or ‘Daily or almost
daily’, show name of substance here
If respondent has left any displayed substances blank (ie has not responded), display the
following pop-up message: You have not answered every row. Click ‘Previous’ to go back
and select an answer for every question, OR click ‘Next’ to go to the next screen.
NZHS Year 12 Adult Questionnaire
56
Document 1
[Showcard]
AST1.41–AST1.50c
Grid below should:
• Display substances when AST1.12, AST1.13, AST1.14, AST1.15, AST1.16, AST1.17,
AST1.18, OR AST1.19, AST1.20a, AST1.20b, OR AST1.20c=‘Once or twice’, ‘Monthly’,
‘Weekly’, or ‘Daily or almost daily’.
• Not display this question for Tobacco, AST1.11=‘Once or twice’, ‘Monthly’, ‘Weekly’, or
‘Daily or almost daily’.
• Not display substances when AST1.11–AST1.20c=‘Never’ OR there is no response.
During the
past three months, how often have you failed to do what was normally expected
of you because of your use of the substances you mentioned?
[For VIP survey insert: You may need to scroll down to see all the grid statements.]
1.
2. Once
3.
4.
5. Daily or
1982
Never or twice
Monthly Weekly
almost daily
Tobacco products
Act
(cigarettes, chewing tobacco,
cigars, etc)
Alcoholic beverages
(beer, wine, spirits, etc)
Cannabis
(marijuana, hash, weed, etc)
Cocaine
Information
(coke, crack, etc)
Amphetamine type stimulants
(P, speed, ice, Ritalin®, ecstasy,
MDMA, etc)
Inhalants
Official
(NOS, glue, petrol, poppers, etc)
Sedatives or sleeping pills
the
(Valium, diazepam, etc)
Hallucinogens
(LSD, mushrooms, ketamine, etc)
under
Opioids
(heroin, homebake, morphine,
methadone, codeine, etc)
If AST1.20a is ‘Once or twice’,
‘Monthly’, ‘Weekly’, or ‘Daily or
almost daily’, show name of
substance here
Released
If AST1.20b is ‘Once or twice’,
‘Monthly’, ‘Weekly’, or ‘Daily or
almost daily’, show name of
substance here
If AST1.20c is ‘Once or twice’,
‘Monthly’, ‘Weekly’, or ‘Daily or
almost daily’, show name of
substance here
If respondent has left any displayed substances blank (ie has not responded), display the
following pop-up message: You have not answered every row. Click ‘Previous’ to go back
and select an answer for every question, OR click ‘Next’ to go to the next screen.
NZHS Year 12 Adult Questionnaire
57
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[Showcard]
AST1.51–AST1.60c
Grid below should only display substances that a respondent has ever used, ie when
AST1.01, AST1.02, AST1.03, AST1.04, AST1.05, AST1.06, AST1.07, AST1.08, OR
AST1.09=Yes; OR when AST1.10a, AST1.10b, OR AST1.10c are populated.
Has a friend or relative or anyone else
ever expressed concern about your use of the
substances you mentioned?
[For VIP survey insert: You may need to scroll down to see all the grid statements.]
1. No,
2. Yes, in
3. Yes, but
never
the past 3
not in the
months
past 3
months
1982
Tobacco products
(cigarettes, chewing tobacco, cigars, etc)
Act
Alcoholic beverages
(beer, wine, spirits, etc)
Cannabis
(marijuana, hash, weed, etc)
Cocaine
(coke, crack, etc)
Amphetamine type stimulants
Information
(P, speed, ice, Ritalin®, ecstasy, MDMA, etc)
Inhalants
(NOS, glue, petrol, poppers, etc)
Sedatives or sleeping pills
Official
(Valium, diazepam, etc)
Hallucinogens
(LSD, mushrooms, ketamine, etc) the
Opioids
(heroin, homebake, morphine, methadone,
codeine, etc)
under
If AST1.10a is populated, show name of
substance here
If AST1.10b is populated, show name of
substance here
If AST1.10c is populated, show name of
substance here
Released
If respondent has left any displayed substances blank (ie has not responded), display the
following pop-up message: You have not answered every row. Click ‘Previous’ to go back
and select an answer for every question, OR click ‘Next’ to go to the next screen.
NZHS Year 12 Adult Questionnaire
58
Document 1
[Showcard]
AST1.61–AST1.70c
Grid below should only display substances that a respondent has ever used, ie when
AST1.01, AST1.02, AST1.03, AST1.04, AST1.05, AST1.06, AST1.07, AST1.08, OR
AST1.09=Yes; OR when AST1.10a, AST1.10b, OR AST1.10c are populated.
Have you
ever tried and failed to control, cut down or stop using the substances you
mentioned?
[For VIP survey insert: You may need to scroll down to see all the grid statements.]
1. No,
2. Yes, in the
3. Yes, but not
never
past 3 months
in the past 3
months
Tobacco products
1982
(cigarettes, chewing tobacco, cigars, etc)
Alcoholic beverages
Act
(beer, wine, spirits, etc)
Cannabis
(marijuana, hash, weed, etc)
Cocaine
(coke, crack, etc)
Amphetamine type stimulants
(P, speed, ice, Ritalin®, ecstasy, MDMA, etc)
Information
Inhalants
(NOS, glue, petrol, poppers, etc)
Sedatives or sleeping pills
(Valium, diazepam, etc)
Official
Hallucinogens
(LSD, mushrooms, ketamine, etc)
Opioids
the
(heroin, homebake, morphine, methadone,
codeine, etc)
If AST1.10a is populated, show name of
under
substance here
If AST1.10b is populated, show name of
substance here
If AST1.10c is populated, show name of
substance here
Released
If respondent has left any displayed substances blank (ie has not responded), display the
following pop-up message: You have not answered every row. Click ‘Previous’ to go back
and select an answer for every question, OR click ‘Next’ to go to the next screen.
NZHS Year 12 Adult Questionnaire
59
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[Showcard]
AST1.71
Have you
ever used any drug by injection (non-medical use only)?
1
No, never
2
Yes, in the past 3 months
3
Yes, but not in the past 3 months
If AST1.71 is left blank, display the following pop-up message: You have not answered
this question. Click ‘Previous’ to go back and select an answer, OR click ‘Next’ to go to the
next screen.
Use of services and informal help for mental health and
substance use
1982
This section is about your contact with health professionals and other people for any
concerns you might have had about your
emotions, stress, mental health, or substance
use.
Act
By substance use, we mean use of alcohol or drugs. Please don’t include tobacco products.
Please note that when you see underlined words followed by a flag symbol, you can touch
on them for more information.
Click ‘Next’ to begin.
Information
[Showcard]
AMH1.01 In the
past 12 months, did you go to any of the following
self-help groups for
concerns about your emotions, stress, mental health, or substance use ⚐? Please
don’t include Internet support groups.
Official
[Select all that apply]
⚐ Tool tip: By substance use, we mean use of alcohol or drugs. Please don’t
the
include tobacco products.
1
An emotional or mental health self-help group, such as a group for eating
disorders, bipolar disorder, or bereavement (death of a loved one)
under
2
An alcohol or drug use self-help group, such as Alcoholics Anonymous, or
Narcotics Anonymous
3
Other
4
No, none of the above
.K I don’t know
.R Prefer not to say
Released
AMH1.02a In the
past 12 months, did you call or text a telephone
helpline for concerns
about your emotions, stress, mental health, or substance use ⚐?
⚐ Tool tip: By substance use, we mean use of alcohol or drugs. Please don’t
include tobacco products.
1
Yes
2
No
.K I don’t know
.R Prefer not to say
NZHS Year 12 Adult Questionnaire
60
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AMH1.03 In the
past 12 months, have you had
counselling for your mental health or
substance use ⚐, that lasted 30 minutes or longer? Please don’t include
counselling from friends or family.
⚐ Tool tip: By substance use, we mean use of alcohol or drugs. Please don’t
include tobacco products.
1
Yes
2
No
.K I don’t know
.R Prefer not to say
[Showcard]
AMH1.04b In the
past 12 months, did you use any
online resources to get information,
help or support for concerns about your emotions, stress, mental health, or
substance use ⚐?
1982
[For VIP survey insert: You may need to scroll down to see all the answer
Act
options.]
[Select all that apply]
⚐ Tool tip: By substance use, we mean use of alcohol or drugs. Please don’t
include tobacco products.
1
Yes, to learn about symptoms, diagnosis, causes, treatments, or medication
side effects
Information
2
Yes, to find out where to get help
3
Yes, to discuss with others through forums, support groups or online social
networks
4
Yes, to get online therapy, such as e-therapy or online counselling
5
Yes, to use a mental health and wellbeing app
Official
6
Other
7
No, did not use online resources to get information, help or support for
concerns about my emotions, stress, mental health, or substance use ⚐
the
.K I don’t know
.R Prefer not to say
AMH1.05 In the
past 12 months, were you
prescribed medication or taking prescription
under
medication for your emotions, stress, mental health, or substance use ⚐?
⚐ Tool tip: By substance use, we mean use of alcohol or drugs. Please don’t
include tobacco products.
1
Yes
2
No
Released
.K I don’t know
.R Prefer not to say
NZHS Year 12 Adult Questionnaire
61
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[Showcard]
AMH1.06 In the
past 12 months, did you use any of the following
complementary or
alternative therapies for concerns about your emotions, stress, mental health, or
substance use ⚐?
[For VIP survey insert: You may need to scroll down to see all the answer
options.]
[Select all that apply]
⚐ Tool tip: By substance use, we mean use of alcohol or drugs. Please don’t
include tobacco products.
1
Massage
2
Exercise, or movement therapy
3
Herbal medicine, such as Chinese or Western
4
Spiritual, psychic or energy healing
1982
5
Rongoā Māori, Mirimiri, or other traditional Māori healing
6
Traditional Pacific healing
7
Relaxation, meditation, mindfulness training, yoga or guided imagery
Act
8
Acupuncture
9
Osteopathic or chiropractic treatment
10 Hypnosis
11 Other
12 No, none of the above
.K I don’t know
.R Prefer not to say
Information
[Showcard]
AMH1.07a In the
past 12 months, have you consulted any of the following people for
concerns about your emotions, stress, mental health, or substance use ⚐?
Official
[For VIP survey insert: You may need to scroll down to see all the answer
options.]
[Select all that apply] the
⚐ Tool tip: By substance use, we mean use of alcohol or drugs. Please don’t
include tobacco products.
⚐ Tool tip: A peer support worker is someone who is employed to use their lived
under
experience of mental health or addiction difficulties to assist others with their
recovery.
1
GP
2
Nurse
3
Psychiatrist or other medical specialist
4
Social worker
Released
5
Psychologist, Counsellor or Psychotherapist
6
Teacher
7
Religious or spiritual advisor, like a Minister, Priest or Tohunga
8
Kaumātua or Tohunga
9
Family, whānau, partner and/or friends
10 Peer support worker
11 Other person
12 No, none of the above
.K I don’t know
.R Prefer not to say
NZHS Year 12 Adult Questionnaire
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[Showcard]
AMH1.08 In the
past 12 months, have you received help for concerns about your emotions,
stress, mental health, or substance use ⚐, from any of the following?
[For VIP survey insert: You may need to scroll down to see all the answer options.]
[Select all that apply]
⚐ Tool tip: By substance use, we mean use of alcohol or drugs. Please don’t
include tobacco products.
⚐ Tool tip: Youth ‘one-stop-shops’ provide primary health care (including drop-in
services) plus a range of other services for young people. They use a youth
development and holistic approach to health.
1
Hospital emergency department or an after-hours medical centre
2
Hospital ward
3
Crisis mental health team
1982
4
Māori health service (including Māori mental health or addictions services)
5
Community mental health or addictions service (including hospital outpatient
Act
appointments)
6
Other community support services, such as a youth ‘one-stop-shop’ ⚐
7
Programme in prison or a youth justice centre
8
Other [Specify]
_________________
9
No, none of the above
.K I don’t know
.R Prefer not to say
Information
AMH1.09 In the
past 12 months, have you stayed,
overnight or longer, in a hospital or a
residential treatment centre ⚐ for concerns about your emotions, stress, mental
health, or substance use ⚐?
⚐ Tool tip: A residential treatment centre, sometimes called a rehab, is a live-in
Official
health care facility providing therapy for substance use, mental illness, or other
behavioural problems. the
⚐ Tool tip: By substance use, we mean use of alcohol or drugs. Please don’t
include tobacco products.
1
Yes
under
2
No
.K I don’t know
.R Prefer not to say
Released
NZHS Year 12 Adult Questionnaire
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Unmet need and barriers accessing mental health and
addictions services
AMH1.10 In the
past 12 months, did you ever feel that you needed professional help for
your emotions, stress, mental health, or substance use ⚐, but you
didn’t receive
that help? This could have been because of personal reasons (for example, it
cost too much) or reasons you couldn’t control (for example, no appointments
available).
⚐ Tool tip: By substance use, we mean use of alcohol or drugs. Please don’t
include tobacco products.
1
Yes
2
No [go to AMH_Thank you]
.K I don’t know [go to AMH_Thank you]
.R Prefer not to say [go to AMH_Thank you]
1982
[Showcard]
AMH1.11a Thinking about the
most recent time when you felt you needed professional
Act
help but didn’t receive it, why was that?
[For VIP survey insert: You may need to scroll down to see all the answer
options.]
[Select all that apply]
1
Wanted to handle it alone and/or with the support of family, whānau and
friends
Information
2
Couldn’t spare the time
3
Costs too much
4
Problems with transportation or childcare
5
Unsure where to go or who to see
Official
6
Couldn't get an appointment at a suitable time
7
Time taken to get an appointment too long
8
Available services did not meet my cultural or language needs
the
9
Health professionals unhelpful or unwilling to help
10 Not satisfied with available services
11 Didn't think treatment would work
12 Concerned what others might think
under
13 Another reason [Specify]
_________________
.K I don’t know
.R Prefer not to say
New screen.
AMH_Thank you.
That is the end of the self-complete section. Thank you for answering these questions.
Released
Please click ‘Next’.
AMH_ALERTb
If you wish to talk to someone about anything that has been covered in the survey, there are
a range of organisations that can provide expert advice and support. The contact details for
these organisations are provided in the thank you card you will be [F2F insert: given] [VIP
insert: emailed (if you agree),] at the end of this interview.
The interviewer will continue the questionnaire; please click ‘Next’. [For F2F survey insert:
Please return the computer to the interviewer and they will continue the questionnaire.
END OF SELF-COMPLETE SECTION.
NZHS Year 12 Adult Questionnaire
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Socio-demographics
Now, I am going to ask you some general questions about you and your household. The
answers to these questions help us to check that we have selected a representative sample
of New Zealanders to participate in this survey, and sometimes these things can affect our
health.
Date of birth
A5.01 Firstly, what is your date of birth?
Interviewer read back date of birth to check it is correct.
To update a previously-recorded date, click on the date picker, select the month
and year from the drop-down lists, then
click on the correct day.
Display message: This means you are X years old.
1982
_____ Day (range 1–31)
_____ Month (range Jan–Dec)
Act
_____ Year (range [current year minus 120]–[current year minus 15]) [go to Ethnic
group(s) A5.03]
.R Refused
Calculated age must be ≥15 years. If less than 15, display message: Age cannot be less
than 15.
Ask next question if date of birth refused (A5.01=.R).
Information
A5.02 Would you mind telling me your age?
_____ years (range 15–120)
.R Refused
Official
Ethnic group(s)
the
[Showcard]
A5.03 Which ethnic group or groups do you belong to?
[For VIP survey insert: You may need to scroll down to see all the answer options.]
under
[Select all that apply]
If ‘Other – Specify’ is selected you wil be asked to specify the other ethnic groups
on the next screen.
1
New Zealand European
2
Māori
Released
3
Samoan
4
Cook Island Māori
5
Tongan
6
Niuean
7
Chinese
8
Indian
77 Other [Specify] _______________ [Three “Other” ethnic groups to be asked
about on a new screen and programmed from the codefile from StatsNZ,
Ethnicity New Zealand Standard Classification 2005 V2.1.0]
.K Don’t know
.R Refused
NZHS Year 12 Adult Questionnaire
65
Document 1
[Showcard]
A5.05 Which country were you born in?
[For VIP survey insert: You may need to scroll down to see all the answer options.]
When selecting ‘Other’ you are able to enter a historic name of the country. The
codefile wil recognise this and assign it to the same category as the country’s
present name.
1
New Zealand [go to language A5.07]
2
Australia
3
England
4
China (People’s Republic of)
5
India
6
South Africa
7
Samoa
1982
8
Cook Islands
77 Other [Specify the name of the country]
_________________
[Programme from the codefile from StatsNZ. Can only specify one country]
Act
.K Don’t know
.R Refused
A5.06 In what year did you arrive to live in New Zealand?
Record 4 digit date, eg 1967.
If year is earlier than year of birth, display message: Consistency check Answer must
be ≥ year of birth
Information
given at A5.01. Go back to A5.01 (Date of birth). Go back to A5.06.
_____ (range [current year minus 120]–[current year])
.K Don’t know
.R Refused
Official
[Showcard]
A5.07 In which languages could you have a conversation about a lot of everyday things?
the
[Select all that apply]
If ‘Other language – Specify’ is selected, the respondent will be asked to specify
the other languages on the next screen.
under
1
English
2
Māori
3
Samoan
4
NZ sign language
77 Other language, eg Gujarati, Cantonese, Greek – please specify
_________________ [Three “Other” languages possible]
Released
[Programme from the codefile from StatsNZ]
.K Don’t know
.R Refused
NZHS Year 12 Adult Questionnaire
66
Document 1
Education
Now, some questions about your education.
[Showcard]
A5.14 What is your highest secondary school qualification?
[For VIP survey insert: You may need to scroll down to see all the answer options.]
1
None
2
NZ School Certificate in one or more subjects
or National Certificate level 1
or NCEA level 1
3
NZ Sixth Form Certificate in one or more subjects
or National Certificate level 2
or NZ UE before 1986 in one or more subjects
1982
or NCEA level 2
4
NZ Higher School Certificate
Act
or Higher Leaving Certificate
or NZ University Bursary / Scholarship
or National Certificate level 3
or NCEA level 3
or NZ Scholarship level 4
5
Other secondary school qualification
gained in New Zealand [Specify]
______________________
6
Other secondary school qualification
gained overseas
Information
.K Don’t know
.R Refused
Official
the
under
Released
NZHS Year 12 Adult Questionnaire
67
Document 1
[Showcard]
A5.15 What is your highest completed qualification?
[For VIP survey insert: You may need to scroll down to see all the answer options.]
0
None
1
National Certificate level 1
2
National Certificate level 2
3
National Certificate level 3
4
National Certificate level 4
5
Trade Certificate
6
Diploma or Certificate level 5
7
Advanced Trade Certificate
8
Diploma or Certificate level 6
9
Teachers Certificate / Diploma
1982
10 Nursing Diploma
11 Bachelor
12 Bachelor Hons
Act
13 Postgraduate Certificate / Diploma
14 Masters Degree
15 PhD
77 Other [Specify]
_________________
.K Don’t know
.R Refused
Information
If A5.14=2, 3, 4, 5, 6 (secondary school qualification completed) AND A5.15=0 (no
highest completed qualification), display message: Consistency check In question A5.14
you recorded that the respondent had completed a secondary school qualification, but in
A5.15 you recorded that they haven’t completed a qualification. Verify answers with
respondent. Go back to A5.14. Go back to A5.15.
Official
the
under
Released
NZHS Year 12 Adult Questionnaire
68
Document 1
Income sources
The next few questions ask about your sources of income.
[Showcard]
A5.16 In the last 12 months, what are all the ways that you yourself got income? Please do
not count loans because they are not income.
[Select all that apply]
Probe “any other?” until no other type of income support mentioned.
All loans, including student loans, should not be counted.
[For VIP survey insert: You may need to scroll down to see all the answer options.]
1
Wages, salaries, commissions, bonuses etc, paid by an employer
2
Self-employment, or business you own and work in
3
Interest, dividends, rent, other investments
1982
4
Regular payments from ACC or a private work accident insurer
5
NZ Superannuation or Veterans Pension
Act
6
Other superannuation, pensions, annuities (other than NZ Superannuation,
Veterans Pension or War Pension)
7
Jobseeker Support
8
Sole Parent Support
9
Supported Living Payment
10 Student allowance
11 Other government benefits, government income support payments, war
pensions, or paid parental leave
Information
12 Other sources of income
17 No source of income during that time
.K Don’t know
.R Refused
Official
the
under
Released
NZHS Year 12 Adult Questionnaire
69
Document 1
Income
[Showcard]
A5.23 Looking at the [For F2F survey insert: Showcard] [For VIP survey insert: options on
the screen (you may need to scroll down)], what is the total income that
you
yourself got from
all sources, before tax or anything was taken out of it, in the last
12 months? Please read out the number next to the income group.]
If you know your weekly or fortnightly income
after tax, [For F2F insert: I have a
Showcard ⚐ that] [For VIP insert: the screen image] can help you work out your
annual income
before tax.
1
Loss
2
Zero income
3
$1 – $5,000
4
$5,001 – $10,000
1982
5
$10,001 – $15,000
6
$15,001 – $20,000
Act
7
$20,001 – $25,000
8
$25,001 – $30,000
9
$30,001 – $35,000
10 $35,001 – $40,000
11 $40,001 – $50,000
12 $50,001 – $60,000
13 $60,001 – $70,000
14 $70,001 – $100,000
Information
15 $100,001 – $150,000 [programme A5.24=8 and go to A5.17]
16 $150,001 or more [programme A5.24=8 and go to A5.17]
.K Don’t know
.R Refused
Official
The showcard, to calculate annual income (before tax), will need updating if there are any
changes to the tax rates. This should be reviewed annually during questionnaire
the
development.
[Showcard]
A5.24 Looking at the [For F2F survey insert: Showcard] [For VIP survey insert: options on
under
the screen], what is the total income that
your household got from all sources,
before tax or anything was taken out of it, in the last 12 months? Please read out the
number next to the income group.
1
Loss
2
Zero income
3
$1 – $20,000
Released
4
$20,001 – $30,000
5
$30,001 – $50,000
6
$50,001 – $70,000
7
$70,001 – $100,000
8
$100,001 or more
.K Don’t know
.R Refused
NZHS Year 12 Adult Questionnaire
70
Document 1
Employment
[Showcard]
A5.17 Which of these statements best describes your
current work situation:
1
Working in paid employment (includes self-employment)
2
Not in paid work, and looking for a job [go to work without pay A5.19]
3
Not in paid work, and not looking for a job (for any reason, such as
being retired, a homemaker, caregiver, or full-time student) [go to A5.19]
77 Other [Specify]
_________________ [go to A5.19]
.K Don’t know [go to A5.19]
.R Refused [go to A5.19]
A5.18 How many hours a week do you
usually work?
Record to nearest hour.
1982
_____ hours (range 1–120)
.K Don’t know
Act
.R Refused
[Showcard]
A5.19 In the last 4 weeks, which of these have you done,
without pay?
[For VIP survey insert: You may need to scroll down to see all the answer options.]
[Select all that apply]
Information
1
Household work, cooking, repairs, gardening, etc, for
my own household
2
Looked after a child who is a member of
my household
3
Looked after a member of
my household who is ill or has a disability
4
Looked after a child (who does
not live in my household)
5
Helped someone who is ill or has a disability (who does
not live in my
Official
household)
6
Other voluntary work for or through any organisation, group or marae
the
7
Studied for 20 hours or more per week at school or any other place
8
Studied for less than 20 hours per week at school or any other place
9
None of these
.K Don’t know under
.R Refused
Medical insurance
Now, I’l ask you about medical insurance.
Released
A5.20 Are you covered by any health or medical insurance?
1
Yes
2
No [go to Housing introduction before A5.28a]
.K Don’t know [go to introduction before A5.28a]
.R Refused [go to introduction before A5.28a]
NZHS Year 12 Adult Questionnaire
71
Document 1
[Showcard]
A5.21 What type of health or medical insurance is that?
If hospital
plus one or two other services, eg 4 free GP visits per year, code as
Other and record details of policy.
1
Comprehensive, covering day-to-day costs such as GP fees and pharmacy
charges, as well as private hospital care
2
Hospital only
77 Other [Specify]
_________________
.K Don’t know
.R Refused
[Showcard]
A5.22 And who pays for this health or medical insurance?
Please ensure respondent reads all response options before choosing.
1982
1
Self or family members
2
Partly self or family and partly employer
Act
3
Paid for by employer or employer of family member
4
Paid for by some other person or agency
.K Don’t know
.R Refused
Housing
Information
Now, some questions about housing.
A5.28a Do you, or anyone else who lives here, hold this house / flat in a family trust?
Help Text: What is a family trust?
A family trust is a legal way to protect and hold family assets. In the context
Official
of this question, a house could be a family asset. The house is owned by a
group of people, not an individual (this group of people are the nominated
the
trustees. These may or may not be family members).
The aim of the trust is to preserve the assets (such as a house) in the
interests of present and/or future family members (or nominated
under
beneficiaries). The family trust arrangement will be set out in a legal
document, usually called a trust deed.
Either the nominated beneficiary or nominated trustee of the family trust
can ‘hold’ the house / flat in a family trust.
Charitable trusts should not be included, only family trusts and other types
Released
of private trusts.
If a house is owned by a company or business, select “No” for this
question.
1
Yes [go to bedrooms A5.30]
2
No
.K Don’t know
.R Refused
NZHS Year 12 Adult Questionnaire
72
Document 1
A5.29 Do you, or anyone else who lives here, own or partly own this dwelling, with or
without a mortgage?
1
Yes [go to bedrooms A5.30]
2
No
.K Don’t know
.R Refused
[Showcard]
A5.29a Who owns this house / flat?
1
Private person, trust or business
2
Local Authority or City Council
3
Kāinga Ora (formerly Housing New Zealand Corporation)
4
Other state-owned corporation or state-owned enterprise, or government
1982
department or ministry
.K Don’t know
.R Refused
Act
A5.30 How many bedrooms are there in this dwelling? Please include rooms or sleepouts
that are furnished as bedrooms and any caravans that this household uses as a
bedroom.
Count: Any room furnished as a bedroom even if no one is using it.
Sleepouts or caravans if they are next to the house / flat, and are furnished as a
bedroom.
Information
Don't count: Any other room (eg living room) used as a bedroom UNLESS the only
bedroom facilities are in that room.
_____
bedrooms (range 1–20)
.K Don’t know
Official
.R Refused
[Picture Showcard]
the
A5.30a Counting those bedrooms, how many rooms are there in this dwelling? Please
include all the rooms listed under ‘Count’ on the [For F2F insert: Showcard.] [For
VIP insert: screen.] Do not include the rooms listed under ‘DON’T count’. [For VIP
survey insert: You may need to scroll down.]
under
If necessary, help the respondent to identify the rooms that should be counted. If
they are uncertain about a particular room, and give their permission, you could
view that room in order to help them.
If a dwelling is built in an open-plan style, then room equivalents should be
counted as if they had walls between them.
Room equivalents should not be counted for one-roomed dwellings (ie bed-
Released
sitting rooms). A one-roomed dwelling should be counted as having one room only.
If number of rooms is fewer than number given in A5.30, display message: Consistency
check Answer must be ≥ number of bedrooms given at A5.30. Go back to A5.30. Go back
to A5.30a.
_____ rooms (range 1–100)
.K Don’t know
.R Refused
NZHS Year 12 Adult Questionnaire
73
Document 1
Sexual identity self-complete section
A5.30bIntro
The next question is for you to answer on your own. If you need help, I can show you what
to do.
I can also read the question out, and you can answer by calling out the option number
[For F2F survey insert: from the showcard].
START OF SELF-COMPLETE.
[Showcard]
A5.30b Which of the following options best describes how you think of yourself?
1
Heterosexual or straight
2
Gay or lesbian
1982
3
Bisexual
4
Other
Act
.K I don’t know
.R Prefer not to say
New screen.
Thank you for completing that question; please click ‘Next’. [For F2F survey insert: Please
return the computer to the interviewer and they will ask you the last group of questions.]
Information
END OF SELF-COMPLETE SECTION.
Official
the
under
Released
NZHS Year 12 Adult Questionnaire
74
Document 1
Household composition
Ask next questions, A5.31 and A5.35, if there is more than 1 person in household
(Occupants in household screener>1).
Gender and age
A5.31 I would now like to enter some information about the
other people who live with you,
as this can impact on your health. Please confirm the initials, ages and genders of all
the people who usually live in this household.
The following questions cover the initials, age, gender and relationship of
every
member of the household.
Update fields or add / delete occupants below as required.
Occupant grid pre-populated with information from household screener.
Provide three response options for gender: male, female, another gender.
1982
Occupant Name
ID
Age
Gender
Act
Relationships
The next questions are about relationships in your household.
The following questions cover the relationships between
every member of the household.
Information
Ask the relationships between every household member one-way. Eg if a father Matt is
asked the relationship to his son James, there’s no need to also ask James his relationship
to his father as it will be derived.
[Showcard]
Official
A5.35
If dealing with respondent’s relationships, insert:
the
What is [Name’s] relationship to you?
Include natural, step, adopted and foster relationships.
Otherwise insert:
What is [Name’s] relationship to [Name]?
under
Include natural, step, adopted and foster relationships.
1
Spouse or partner
2
Child (eg daughter)
3
Parent (eg mother)
4
Sibling (eg brother)
Released
5
Grandchild
6
Grandparent
7
Great-grandchild
8
Great-grandparent
9
Nephew or niece
10
Uncle or aunt
11
Other relative
12
Unrelated
.K
Don’t know
.R
Refused
Perform the following soft edit checks on all coded relationship pairs.
NZHS Year 12 Adult Questionnaire
75
Document 1
Edit
Description
Error Message
Check
E1
A person is unlikely to have more than
[Name] is recorded as already having a spouse or
one spouse / partner in a household.
partner. Please verify that [Name] is another
spouse / partner of [Name].
E2
A person is unlikely to be living with more [Name] is recorded as already having two
than two parents at one time.
parents. Please verify that [Name] is another
parent of [Name].
E3
A person is unlikely to have a
This household spans at least 4 generations.
relationship of parent to one household
Please verify this with respondent and if this is not
member and a relationship of grandchild
correct, please select 'Go to' to review the
to another household member.
relationships in the household.
E4
It is unlikely that a person aged less than
[Name] is less than 15 years and is recorded as
15 years would be unrelated to all
being unrelated to any other household member.
household members.
Please verify this response.
1982
E5
It is unlikely that a person aged less than
[Name] is less than 15 years of age and is
15 years would be a spouse of another
recorded as the spouse/partner of [Name]. Please
Act
household member.
verify this response.
E6
It is unlikely that a person aged less than
[Name] is less than 15 years of age and is
15 years would be a parent of another
recorded as the parent of [Name]. Please verify
household member.
this response.
E7
A person aged less than 30 years is
[Name] is less than 30 years of age and recorded
unlikely to be the grandparent of another
as the grandparent of [Name]. Please verify this
household member.
response.
E8
A person aged less than 45 years is
[Name] is less than 45 years of age and recorded
Information
unlikely to be the great-grandparent of
as the great-grandparent of [Name]. Please verify
another household member.
this response.
E9
It is unlikely that a child is older than a
[Name] is younger than [Name] but is recorded as
parent.
their parent. Please verify this response.
Official
E10
It is unlikely that a child is older than their [Name] is younger than [Name] but is recorded as
grandparent.
their grandparent. Please verify this response.
the
E11
It is unlikely that a child is older than their [Name] is younger than [Name] but is recorded as
great-grandparent.
their great-grandparent. Please verify this
response.
E12
A person aged over 70 years is unlikely
[Name] is over 70 years of age and is recorded as
to have a relationship of niece or nephew the niece or nephew of [Name]. Please verify this
under
to another household member.
response.
E13
A person aged over 50 years is unlikely
[Name] is over 50 years of age and is recorded as
to be the grandchild of another
the grandchild of [Name]. Please verify this
household member.
response.
E14
A person aged over 30 years is unlikely
[Name] is over 30 years of age and is recorded as
to be the great-grandchild of another
the great-grandchild of [Name]. Please verify this
Released
household member.
response.
E15
A person aged over 70 years is unlikely
[Name] is over 70 years of age and is recorded as
to be the child / foster child / stepchild of
the child / foster child / stepchild of [Name].
another household member.
Please verify this response.
E16
A parent is likely to be at least 13 years
[Name] is recorded as the parent of [Name] but is
older than their child.
less than 13 years older than them. Please verify
this response.
E17
It is unlikely that the age gap between
[Name] is recorded as [Name's] brother / sister,
siblings would be greater than 40 years.
but is over 40 years older than them. Please
verify this response.
NZHS Year 12 Adult Questionnaire
76
Document 1
Exit
Thank you for participating in this survey. The Ministry of Health is very grateful that you
have given your time to provide this important information to them. Before we finish, I would
like to ask you a few more questions. Please note that any information you give me from
now on will
not be stored with your answers to the survey.
Recontact information for quality control
I would now like to collect some recontact information from you. This is so that my
Supervisor can call you in the next few weeks if there are any queries about the completion
of this survey, or to check that you are happy with the way the interview was conducted.
A6.01 Is there a landline phone that my Supervisor can call you on?
1982
1
Yes [Specify] _________________ [only accept landline number format]
2
No
Act
A6.02 Do you have a cell phone number we could reach you on?
1
Yes [Specify] _________________ [only accept cell number format]
2
No
A6.03 Do you have an email address, in case we cannot contact you by telephone?
Information
1
Yes [Specify] _________________ [only accept email format]
2
No
Recontact information for follow-up research
Official
A6.04 I would now like to ask if you would be happy to be contacted within the next five
years about the possibility of answering other health questions of importance to the
the
Ministry of Health? Saying yes to this question won’t commit you to taking part in any
further research; it just means we can contact you to ask.
1
Yes, you can contact me and ask if I want to help again
under
2
No, don’t contact me to help again [go to Data linkage introduction before A6.08]
If A6.01, A6.02 and A6.03 all=2 go to A6.06, otherwise go to A6.05.
A6.05 To recontact you for other health questions of importance to the Ministry of Health,
can we use the same phone number and email address you provided before?
Released
1
Yes [go to name and address A6.07]
2
No
A6.06 What phone number(s) and email address can we use to recontact you?
1
Landline number: ____________________ [only accept landline number format]
2
Cell phone number: ______________________ [only accept cell number format]
3
Email address: ______________________________ [only accept email format]
4
Do not record phone number(s) or email / Refused
NZHS Year 12 Adult Questionnaire
77
Document 1
A6.07 Could I please also record your name and address? Remember that these details will
never be stored with your survey answers, to ensure that your survey results will
always be anonymous.
1
Yes, record my name and address
a. First name: ___________________________________ [mandatory field]
b. Middle name: _______________________________________________
c. Surname: _________________________________________________
d. Street number and name: ________________________ [mandatory field]
e. Suburb: ______________________________________ [mandatory field]
f.
City: _________________________________________ [mandatory field]
g. Postcode: _________________________________________________
2
No, do
not record my name and address / Refused
1982
Consent for data linkage
Act
The Ministry of Health would like to ask for your permission to combine the valuable
information you have provided in this survey, with other information routinely collected by
government agencies, for research. Combining the answers you have just given with other
information, such as education, income and housing, will help us to develop new ways to
improve the health and wellbeing of all New Zealanders.
To combine the information, the Ministry of Health needs your permission to use your name,
address, gender and date of birth details. The Ministry is bound by the Privacy Act, and
Information
these details will be kept secure and only used by approved staff for data linking. Your
name, address and date of birth will be removed before the combined information is made
available to approved researchers. The combined information will only be used for research
purposes.
Official
A6.08 Are you willing for your survey results to be linked with other information routinely
collected by government agencies?
the
1
Yes
2
No [go to Interviewer observation introduction before A6.16]
under
Released
NZHS Year 12 Adult Questionnaire
78
Document 1
A6.10 Can I please record your name, address, date of birth and gender for data linking?
Please note:
• Your name, address, and date of birth will remain confidential and can only be
accessed by approved staff at the Ministry of Health or Statistics New Zealand,
for the purpose of linking data held by government agencies
• These details will be removed when the data has been linked (only the month
and year of birth will be retained)
• You have the right to change or access your personal details (ie name, address
and date of birth).
To update a previously-recorded date, click on the date picker, select the month
and year from the drop-down lists, then
click on the correct day.
1
Yes
a. First name: ___________________________________ [mandatory field]
1982
b. Middle name: _______________________________________________
c. Surname: ____________________________________ [mandatory field]
Act
d. Street number and name: ________________________ [mandatory field]
e. Suburb: ______________________________________ [mandatory field]
f.
City: _________________________________________ [mandatory field]
g. Postcode: _________________________________________________
h. Date of birth: ___ (range [current year minus 120]–[current year minus 15])
[mandatory field]
Information
i.
Gender: ______________________________________ [mandatory field]
2
No, don’t record any of these details
If first name, surname, address, date of birth, or gender not provided, display the
Official
following message: In order to help us link your data, would you mind providing your full
name, address, date of birth and gender?
the
If only one initial provided for either first or last name, display the following message: In
order to help us link your data, would you mind providing your full first and last name, rather
than initials?
If two or more names entered into first or last name field, display the following message:
Two or more names entered into a single field, please check and use the middle name field
under
if applicable.
If date of birth recorded at A6.10≠A5.01, display the following message: Data linkage date
of birth (dd/mm/yyyy) does not match date of birth recorded earlier in the survey
(dd/mm/yyyy). Please check with respondent.
Released
Interviewer observations – setting and assistance
Complete following observations without asking the respondent:
A6.16 Record if other people were in the room during any part of the questionnaire.
[Select all that apply]
1
Spouse / partner
2
Parent(s)
3
Other adult(s)
4
Child(ren)
5
Completed alone in room
NZHS Year 12 Adult Questionnaire
79
Document 1
A6.17 Did the interviewer help the respondent complete any of the self-complete questions?
1 Yes, to a small extent
2 Yes, to a moderate extent
3 Yes, to a large extent
4 Yes, totally (interviewer completed all self-complete questions)
5 No, not at all
Respondent burden assessment self-complete section
The next questions will ask you about your experience of the survey process. [For VIP:
These questions are for you to answer on your own.] [For F2F: I will turn the computer
towards you, so you can answer the questions privately.]
START OF SELF-COMPLETE.
1982
AR1.01 Please rate on a scale of 1–5, where 1 is Absolutely NOT Acceptable and 5 is
Act
Highly Acceptable:
1
2
3
4
5
(Absolutely
(Highly
NOT
Acceptable)
Acceptable)
Survey length
Information
The number of questions
Complexity of questions
Intrusiveness of questions
Official
If VIP survey, ask AR1.05 and AR1.06.
AR1.05 These next questions ask about your experience of taking part
online.
the
Please rate the following statements on a scale of 1–5, where 1 is Strongly
Disagree and 5 is Strongly Agree:
under
1
2
3
4
5
(Strongly
(Strongly
Disagree)
Agree)
It was easy to book an
appointment
The survey website was easy to
Released
use
It was easy to communicate with
the interviewer
I felt comfortable to provide
honest answers
Overall, I enjoyed taking part
online
NZHS Year 12 Adult Questionnaire
80
Document 1
AR1.06 Did you encounter any problems with making an appointment, or taking part online?
1
Yes [Specify]
__________________
2
No
AR1.02 Would you take part in the New Zealand Health Survey again?
1
Yes [go to AR1.04]
2
No [go to AR1.03]
AR1.03 Please indicate why you would not take part again:
[Select all that apply]
1
Took too long
2
Too many questions
1982
3
Questions were too personal
4
Questions were not relevant
5
Survey was too repetitive
Act
6
Lost interest
7
Other [Specify]
_________________
AR1.04 Are there any other comments you would like to make about taking part in the
survey?
Information
1
Yes [Specify]
__________________
2
No
New screen.
Official
Thank you for answering those questions; please click ‘Next’. [For F2F: Please hand the
computer back.]
the
END OF SELF-COMPLETE SECTION.
For VIP, go to Thank you.
under
The rest of the questionnaire is collected in the Sample Manager tool.
Released
NZHS Year 12 Adult Questionnaire
81
Document 1
Health measurements
Height
Now, I would like to measure your height.
For cis-female respondents (sex is female, AD.01a=2 AND gender is female, AD.01b=2)
aged 15–54 years, ask the following question.
AM.1 Firstly, I need to ask if you are pregnant at the moment?
1
Yes, respondent is pregnant [skip to Thank you section]
Say “We can skip this section then”.
2
No, respondent not pregnant [Continue]
1982
.K Don’t know [go to first height measurement]
.R Refused [go to first height measurement]
Act
Please stand with your back to the door / wall. Put your feet together and move them back
until your heels touch the door / wall. Stand up straight and look straight ahead.
If head is not in Frankfort Plane say…
Please raise / lower your chin. Take a deep breath and hold it.
Take measurement when breath is held and say it aloud.
Information
That’s fine, you can breathe normally now and step away from the door / wall.
AM.2 1st reading 0.000 (m) (range 0.600m–2.300m)
.R
Respondent refused to have height recorded
Official
777 Respondent unable to have height recorded (eg chairbound, too unsteady on
feet, in pain etc.)
Check any measurements that fall below the 1st percentile or above the 99th percentile.
the
Weight
under
Wait until it turns zero. Please step onto the centre of the scale with your weight on both
feet. Relax [take reading]. Thank you. You can step off now.
AM.3 1st reading 000.0 (kg) (range 10.0kg–210.0kg)
.R
Respondent refused to have weight recorded
777 Respondent unable to have weight recorded (eg chairbound, too unsteady on
Released
feet, in pain etc.)
Check any measurements that fall below the 1st percentile or above the 99th percentile.
Waist
Please stand in a relaxed position. Take the end of the tape, pass it around your waist and
hand it back to me. Please help me to position the tape at the level of your waist. Good, now
just breathe normally [take measurement at end of breath out]. Thank you.
AM.4 1st reading 000.0 (cm) (range 10.0cm–200.0cm)
NZHS Year 12 Adult Questionnaire
82
Document 1
.R
Respondent refused to have waist circumference recorded
997 Respondent unable to have waist circumference recorded
Check any measurements that fall below the 1st percentile or above the 99th percentile.
Computer to repeat prompts as above and automatically does calculation to indicate if
third reading is required. If more than 1% difference between first and second reading, a
third reading is required.
1982
Act
Information
Official
the
under
Released
NZHS Year 12 Adult Questionnaire
83
Document 1
Thank you
On behalf of the Ministry of Health, thank you once again for talking with me about your
health.
[For F2F: Here is a small gift from the Ministry in recognition of your time.
Give Thank You card and koha.
Inside the card is a list of phone numbers you can call if you would like more information or
advice. If you’d prefer, I can arrange for this to be emailed to you along with the consent
form(s).]
[For VIP: We would like to email you a Thank you card (with a list of phone numbers you can
call if you would like more information or advice), along with the consent form(s).]
1982
If you’d rather not receive these items, that’s completely fine.
Act
1
Yes, please email to me
[Specify]
_______________ [only accept email format]
2
No, don’t email
End survey for households with no persons aged under 15 years.
Child health component
Information
For households with child aged 0 to 14 years.
As we discussed at the beginning of this survey, we would also like to interview the legal
guardian of [randomly selected child’s name], that is the person who has day-to-day
responsibility for the care of [Name]. Is that you?
Official
1
Yes [go to child health questionnaire]
2
No ask to speak to legal guardian.
the
Record following details:
1
Child health questionnaire completed
2
Child health questionnaire still to be completed
under
Released
NZHS Year 12 Adult Questionnaire
84
Document 2
1982
Act
New Zealand Health Survey
Information
Child Questionnaire (Year 12)
1 July 2022 – 30 June 2023
Official
the
under
In field July 2022
Released
Document 2
Table of Contents
Overview and programming information ............................................................... 4 Informed consent ..................................................................................................... 6 Initial demographics ................................................................................................ 8 Long-term health conditions ................................................................................. 10
Health conditions ................................................................................................. 10
Neurodiversity ...................................................................................................... 11
Oral health ........................................................................................................... 12
Interviewer observations – language assistance .................................................. 12
Health status ........................................................................................................... 13
General health question ....................................................................................... 13
Child Functioning Module ..................................................................................... 13
1982
Health service utilisation ....................................................................................... 16
Usual primary health care provider ...................................................................... 16
General practitioners ............................................................................................ 17
Act
Nurses at general practices and medical centres ................................................ 18
Emergency department ........................................................................................ 19
Specialist doctors ................................................................................................. 20
Dental health care workers .................................................................................. 21
Health behaviours and risk factors ....................................................................... 22
Perception of child’s weight .................................................................................. 22
Breastfeeding ....................................................................................................... 22
Information
Dietary habits ....................................................................................................... 24
Physical activity .................................................................................................... 26
Screen time .......................................................................................................... 27
Sleep .................................................................................................................... 28
Official
Tooth brushing ..................................................................................................... 28
Response to child’s misbehaviour ........................................................................ 29
the
Behaviour and mental health self-complete section ........................................... 31
Strengths and Difficulties Questionnaire (SDQ) for 2–4 year olds ....................... 32
Strengths and Difficulties Questionnaire (SDQ) for 5–10 year olds ..................... 33
Strengths and Difficulties Questionnaire (SDQ) for 11–14 year olds ................... 34
under
Use of services and informal help for mental health and substance use ............. 35
Unmet need and barriers accessing mental health and addictions services ........ 39
Parental stress ..................................................................................................... 40
Household food security ....................................................................................... 42 Socio-demographics .............................................................................................. 45
Date of birth ......................................................................................................... 45
Released
Ethnic group(s) ..................................................................................................... 45
Medical insurance ................................................................................................ 46
Interviewer observation – if adult questionnaire completed .................................. 47
Extra questions if adult questionnaire has not yet been completed ..................... 47
Interviewer observation – if both adult / child survey respondent ......................... 49
Extra questions if primary caregiver was
not the NZHS adult respondent ........... 50
Household composition ........................................................................................ 52
Gender and age ................................................................................................... 52
Relationships ....................................................................................................... 52
Exit ........................................................................................................................... 54
Recontact information for quality control .............................................................. 54
NZHS Year 12 Child Questionnaire
2
Document 2
Recontact information for follow-up research ....................................................... 54
Consent for data linkage ...................................................................................... 55
Interviewer observations – setting ........................................................................ 57
Respondent burden assessment self-complete section ....................................... 57
Health measurements ............................................................................................ 59
Height ................................................................................................................... 60
Weight .................................................................................................................. 60
Waist .................................................................................................................... 60
Thank you ............................................................................................................... 61
1982
Act
Information
Official
the
under
Released
NZHS Year 12 Child Questionnaire
3
Document 2
Overview and programming information
Design
Approximately 5,000 primary caregivers of children aged 0–14 are interviewed face-to-face each year
for the New Zealand Health Survey. Interviews are administered using computer-assisted personal
interviewing (CAPI). Key topics include long-term health conditions, heath status and behaviours,
health service utilisation and patient experience. Anthropometric measurements (height, weight and
waist circumference) are also taken. NZHS collects information that cannot be obtained more effectively
or efficiently through other means, such as by analyses of hospital administrative records, disease
registries or epidemiological research.
Text Format
Examples
1982
Black
Text read by interviewer: introductions,
The next set of questions is about nurses
questions / question options
who work at general practices and medical
Act
centres
Blue
Showcard note positioned above a question [Showcard]
Multiple response allowed for a question
[Select all that apply]
Instructional text specifically for interviewers Round to nearest hour
Other [Specify]
Information
Text read verbatim to respondents
Prompt: “any others?”
Interviewer observations: section completed
Complete following observations without
unobtrusively (solely) by interviewer
asking the respondent
Official
Tool tips, with a ⚐ symbol, contain
Here is a list of examples of specialist
the
information that only appears if the mouse
doctors ⚐
pointer hovers over the underlined words, or
if underlined words are touched with a finger
under
Green
Copyright / attribution, displayed on screen
© Robert Goodman, 2005
as a requirement of usage
Purple
Text specifically for questionnaire readers,
The toothpaste picture showcard needs
not displayed on screen
updating if there are any major changes in
the market
Released
Red
Programmer information, instructions, alerts
Limit to children <2 years
and headings, not displayed on screen
Abbreviations used in programming text
Respondent interviewed in person by
F2F
Face-to-face
interviewer
Survey tool enabling remote interviewing via
VIP
Virtual Interface Platform
computer software
NZHS Year 12 Child Questionnaire
4
Document 2
Key Edit Checks
Description
Type
Single and multiple-
For each question, only one answer can be selected, except for
Hard edit
choice responses
multiple-choice questions, represented by the instruction [Select
all that apply].
Exclusive answer
Don't know, Refused / Prefer not to say, Doesn’t apply, None of
Hard edit
options
the above, None, and No treatment are all exclusive responses,
ie they cannot be selected in conjunction with other responses.
Range checks
For numeric response questions, the data entered must fall within
Hard edit
a certain range. Range checks prompt interviewers to change an
answer falling outside the pre-set range parameters. For
example, a person cannot enter an amount more than $199.00 for
the cost of GP visits.
1982
Confirmation
For some questions, the survey prompts the interviewer to check
Soft edit
Act
checks
a response which may be unlikely, or which may be incompatible
with previous answers. For example, a child is unlikely to usually
sleep for less than 6 hours in a 24 hour period.
Consistency
Some checks enforce consistency of responses between
Hard edit
checks
questions. When edit checks are triggered, the interviewer or
respondent must go back and change their answer to ensure
response consistency. For example, reporting that the child was
Information
born in a maternity ward in the past year is only a valid answer if
the child is less than one year old.
Completeness
For some of the grid-style questions, where multiple items /
Hard edit
checks
statements are combined into a table, each row must contain a
Official
response. For example, relationship information is captured for
every pair of occupants in a household. This is recorded in a grid
format and each row must be completed.
the
Hard edit checks require the interviewer to change the data they have entered before continuing. Soft
edit checks provide an opportunity to check a response, and if applicable, change the data entered
before continuing; however, the original response entered can also be retained.
under
Showcards
Showcard tablet
Answer options are visible for some questions on a separate tablet device
which the respondent views during the survey.
Released
Response option
Selected options are allocated numbers allowing respondents to discretely
numbering
provide a response; ie to call out a number opposed to the descriptive text.
NZHS Year 12 Child Questionnaire
5
Document 2
Year 12 Modules
Disability
Disability measured by the UNICEF Child Functioning Module for 5–14 year
olds – as amended by Stats NZ Tatauranga Aotearoa for the 2019/20
Household Economic Survey (HES).
Behaviour and
• Strengths and Difficulties Questionnaire (SDQ) with three age groups: 2–4
mental health self-
year olds, 5–10 year olds, and 11–14 year olds, focusing on how children
complete section
behave and function day-to-day, and the Parental stress section, centring
on how parents or caregivers are coping day-to-day.
• Mental health services: use, unmet need, and barriers to access.
Household food
A focus on households in New Zealand and the financial resources to
security
purchase food items, for everyday purposes and social occasions.
1982
Act
Information
Official
the
under
Released
NZHS Year 12 Child Questionnaire
6
Document 2
Informed consent
Before we begin, I need to check that:
• You have read and understand the information pamphlet on the New Zealand Health
Survey. You know you can ask questions at any time and you can contact CBG
Health Research or the Ministry of Health if you want further information.
• You know that you can stop the interview at any time and you don’t have to answer
every question. There is no disadvantage to you if you don’t want to take part, or if
you choose to stop at any time.
• You know that your participation in the New Zealand Health Survey is confidential
and no information that could identify you will ever be used in any reports. All your
answers are protected by the Privacy Act 2020.
CC.01 You agree to take part in the New Zealand Health Survey on behalf of a child aged 0-
1982
14, for whom you are the parent / legal guardian.
1
Yes
Act
2
No
If CC.01=2, display message: Consent must be obtained before continuing. Check
response. If consent is not given, exit survey and thank them for their time.
CC.02 You agree for parts of this survey to be audio recorded for quality monitoring and you
understand that any recording will be anonymous.
Information
1
Yes
2
No
Official
the
under
Released
NZHS Year 12 Child Questionnaire
7
Document 2
Initial demographics
[For VIP survey insert: Before we begin, can I please check that you are in a private space,
where our conversation will not be overheard?
If the answer is ‘No’, request that the respondent find a private space before you
continue. Alternatively, rearrange the interview to a time when the respondent will have
privacy.
I’l just explain some key features of this video interview:
• Three types of questions will be asked: questions that include an option list for you to
select from; yes or no questions that do not include an option list; and questions that
are more personal, that you can complete yourself.
• To pause the survey at any time, just click the pause button at the top right of the
1982
screen. To turn off your camera or microphone, select the camera or microphone
icons below the video feed. If you need help with your audio or video, using
headphones, or help with anything else, just let me know.]
Act
New screen.
To start, I will need to enter some general information about the child that has been
randomly selected for the survey, so that I only ask questions which are applicable to their
gender and age.
Information
CD.01 To begin, could you tell me the child’s
first name?
If respondent wil not provide the child’s name, initials are acceptable.
Record name. [Child’s name recorded]
.R Refused
Official
[Showcard]
CD.021 What gender is [Name]? the
A child’s gender may be different from their sex at birth. Gender is a person’s
sense of being male, female, or another gender such as non-binary.
1
Male
under
2
Female
3 Another gender – please specify, if you are comfortable doing so [Other screen
text: (leave blank if they do not wish to specify)] [Allow blank if respondent does
not volunteer any detail] [To be programmed from the codefile from StatsNZ
after interview – ie NOT by respondent / interviewer]
Released
NZHS Year 12 Child Questionnaire
8
Document 2
CD.03 I need to know / confirm [Name's] age as the questions I ask depend on their age.
I need to know their age so that only questions that apply are asked.
Record age under 2 years in months; and age >=2 years in years.
Only one field should be completed.
If Don’t know or Refused selected, display message: I really need to know [Name’s] age
in order to proceed with the questionnaire. Go back and enter age. If respondent still cannot
or won’t give the age, end interview and thank respondent for their time.
CD.03a Age _____ months (range 0–23)
CD.03b Age _____ years (range 2–14)
.K Don’t know
.R Refused
1982
Error message if both month and year selected: Can't have values for both month and
year.
Act
CD.03c Age group
Interviewer records age group.
1
Birth–11 months
2
12–23 months (1 year old)
3
Information
2–4 years
4
5–9 years
5
10–14 years
If age and age group do not match, display message: Consistency check Age and age
Official
group do not match. Verify answer with respondent. Go back to CD.03 (Age).
the
under
Released
NZHS Year 12 Child Questionnaire
9
Document 2
Long-term health conditions
The next questions are about
long-term health conditions [Name] may have. A long-term
health condition is a
physical or mental illness that has lasted, or is expected to last, for
more than six months. The symptoms may come and go or be present all the time.
If child <5 years
add… Some of the next questions may not apply to [Name], but please
try to answer anyway.
Health conditions
C1.01 Have you ever been told by a doctor that [Name] has asthma?
1
Yes
2
No [go to eczema C1.03]
.K Don’t know [go to C1.03]
1982
.R Refused [go to C1.03]
[Showcard]
Act
C1.02 What treatments does [Name]
now have for asthma?
[Select all that apply]
1
No treatment
2
Inhaler
3
Medicines, tablets or pills
77 Something else
Information
.K Don’t know
.R Refused
C1.03 Have you ever been told by a doctor that [Name] has eczema?
Official
1
Yes
2
No [go to Neurodiversity C1.09]
.K Don’t know [go to C1.09]
the
.R Refused [go to C1.09]
[Showcard]
C1.04 What treatments does [Name]
now have for eczema?
under
[Select all that apply]
1
No treatment
2
Medicines, tablets or pills
3
Cream or ointment
77 Something else
Released
.K Don’t know
.R Refused
Go to Neurodiversity questions (C1.09–C1.16) for children aged 2–14 years. Go to
Interviewer observations (C6.13) for children aged from birth to 11 months. Go to Oral health
introduction before C1.17 for children aged 12–23 months.
NZHS Year 12 Child Questionnaire
10
Document 2
Neurodiversity
C1.09 Have you ever been told by a doctor that [Name] has autism spectrum disorder?
Include Asperger’s syndrome.
1
Yes
2
No [go to attention deficit disorder C1.15]
.K Don’t know [go to C1.15]
.R Refused [go to C1.15]
[Showcard]
C1.10 What treatments does [Name]
now have for autism spectrum disorder?
[Select all that apply]
Include Asperger’s syndrome.
1
No treatment
1982
2
Medicines, tablets or pills
3
Counselling
Act
77 Something else
.K Don’t know
.R Refused
C1.15 Have you ever been told by a doctor that [Name] has attention deficit hyperactivity
disorder (ADHD)?
Include attention deficit disorder (ADD).
Information
1
Yes
2
No [go to Oral health introduction before C1.17]
.K Don’t know [go to introduction before C1.17]
.R Refused [go to introduction before C1.17]
Official
[Showcard]
C1.16 What treatments does [Name]
now have for ADHD?
the
[Select all that apply]
Include attention deficit disorder (ADD).
1
No treatment
under
2
Medicines, tablets or pills
3
Counselling
77 Something else
.K Don’t know
.R Refused
Released
NZHS Year 12 Child Questionnaire
11
Document 2
Oral health
Go to Oral health questions (C1.17–C1.18a) for children aged 1–14 years. Go to
Interviewer observations introduction before C6.13 for children aged <1 year.
The next questions are about [Name’s] teeth, gums and mouth. When I say dental health
care worker, I mean dentists, dental therapists (formerly known as dental nurses) as well as
any dental health specialists such as orthodontists.
C1.17 Have any of [Name’s] teeth been removed by a dental health care worker because of
tooth decay, an abscess or infection? Do not include teeth lost for other reasons
such as injury, crowded mouth or orthodontics.
Includes teeth that were removed while overseas (as well as in New Zealand).
Includes baby teeth
ONLY if removed because of tooth decay, an abscess or
infection.
1982
1
Yes
2
No [go to health of mouth C1.18a]
Act
.K Don’t know [go to C1.18a]
.R Refused [go to C1.18a]
C1.18 Were any of these teeth removed in the last 12 months?
1
Yes
2
No
.K Don’t know
Information
.R Refused
[Showcard]
C1.18a How would you describe the health of [Name’s]
teeth or mouth?
Official
1
Excellent
2
Very good
the
3
Good
4
Fair
5
Poor
.K Don’t know
.R Refused under
Interviewer observations – language assistance
Complete following observations without asking the respondent:
C6.13 Interview is being conducted with
language assistance from a
family member /
Released
friend of respondent.
Only code ‘Yes’ if the respondent has required more than a couple of questions to
be interpreted.
1
Yes
2
No
C6.14 Interview is being conducted with
language assistance from a
professional
translator.
1
Yes
2
No
NZHS Year 12 Child Questionnaire
12
Document 2
Health status
Ask all respondents C1.19.
General health question
This question is about [Name’s] general health.
Please try to answer as accurately as you can.
[Showcard]
C1.19 In general, would you say [Name’s] health is:
Read response options.
1
Excellent
2
Very good
3
Good
1982
4
Fair
5
Poor
Act
.K Don’t know
.R Refused
Child Functioning Module
Go to the next question for children aged 5–14 years. Go to Health service utilisation
before C2.01a for children aged 0–4 years.
Information
[Showcard]
CF1.01 Does [Name] have difficulty seeing, even if wearing glasses?
1
No – no difficulty
2
Yes – some difficulty
Official
3
Yes – a lot of difficulty
4
Cannot do at all
.K Don’t know
the
.R Refused
[Showcard]
CF1.02 Does [Name] have difficulty hearing sounds like people's voices or music, even if
under
using a hearing aid?
1
No – no difficulty
2
Yes – some difficulty
3
Yes – a lot of difficulty
4
Cannot do at all
.K Don’t know
Released
.R Refused
[Showcard]
CF1.03 Compared with children of the same age, does [Name] have difficulty walking 100
metres on level ground? That would be about the length of a rugby field.
1
No – no difficulty
2
Yes – some difficulty
3
Yes – a lot of difficulty
4
Cannot do at all
.K Don’t know
.R Refused
NZHS Year 12 Child Questionnaire
13
Document 2
[Showcard]
CF1.04 Does [Name] have difficulty with self-care such as feeding or dressing
themselves?
1
No – no difficulty
2
Yes – some difficulty
3
Yes – a lot of difficulty
4
Cannot do at all
.K Don’t know
.R Refused
[Showcard]
CF1.05 Using their usual language, does [Name] have difficulty communicating, for
example, understanding or being understood?
1982
1
No – no difficulty
2
Yes – some difficulty
3
Yes – a lot of difficulty
Act
4
Cannot do at all
.K Don’t know
.R Refused
[Showcard]
CF1.06 Compared with children of the same age, does [Name] have difficulty learning
things?
Information
1
No – no difficulty
2
Yes – some difficulty
3
Yes – a lot of difficulty
4
Cannot do at all
Official
.K Don’t know
.R Refused
the
[Showcard]
CF1.07 Compared with children of the same age, does [Name] have difficulty remembering
things?
under
1
No – no difficulty
2
Yes – some difficulty
3
Yes – a lot of difficulty
4
Cannot do at all
.K Don’t know
.R Refused
Released
[Showcard]
CF1.08 Does [Name] have difficulty concentrating on an activity that they enjoy doing?
1
No – no difficulty
2
Yes – some difficulty
3
Yes – a lot of difficulty
4
Cannot do at all
.K Don’t know
.R Refused
NZHS Year 12 Child Questionnaire
14
Document 2
[Showcard]
CF1.09 Does [Name] have difficulty accepting changes in their routine?
1
No – no difficulty
2
Yes – some difficulty
3
Yes – a lot of difficulty
4
Cannot do at all
.K Don’t know
.R Refused
[Showcard]
CF1.10 Compared with children of the same age, does [Name] have difficulty controlling
their behaviour?
1
No – no difficulty
1982
2
Yes – some difficulty
3
Yes – a lot of difficulty
4
Cannot do at all
Act
.K Don’t know
.R Refused
[Showcard]
CF1.11 Does [Name] have difficulty making friends?
1
No – no difficulty
Information
2
Yes – some difficulty
3
Yes – a lot of difficulty
4
Cannot do at all
.K Don’t know
.R Refused
Official
[Showcard]
CF1.12 How often does [Name] seem very anxious, nervous, or worried?
the
1
Daily
2
Weekly
3
Monthly
under
4
A few times a year
5
Never
.K Don’t know
.R Refused
[Showcard]
Released
CF1.13 How often does [Name] seem very sad or depressed?
1
Daily
2
Weekly
3
Monthly
4
A few times a year
5
Never
.K Don’t know
.R Refused
NZHS Year 12 Child Questionnaire
15
Document 2
Health service utilisation
The next set of questions is about the use of health care services in
New Zealand for
[Name].
Usual primary health care provider
C2.01a Do you have a
general practice or medical centre that you
usually go to when
[Name] is feeling unwell or is injured?
Do not include emergency department (ED).
1
Yes
2
No [go to General practitioner introduction before C2.12a]
.K Don’t know [go to introduction before C2.12a]
.R Refused [go to introduction before C2.12a]
1982
From now on, we’l call this place [Name’s]
usual medical centre.
Act
C2.03 Is [Name’s] usual medical centre the same place that
you usually go to when you
are feeling unwell or injured?
1
Yes
2
No
.K Don’t know
.R Refused
Information
C2.04 Has [Name]
been to their usual medical centre in the
last 12 months, about their
own health?
1
Yes
Official
2
No [go to General practitioner introduction before C2.12a]
.K Don’t know [go to introduction before C2.12a]
.R Refused [go to introduction before C2.12a]
the
[Showcard]
C2.011 At [Name’s]
usual medical centre, has [Name] had an appointment with any of the
following health care workers about their own health, in the
past 12 months?
under
[Select all that apply]
1 GP (general practitioner or family doctor)
2 Nurse
3 Physiotherapist
4 Mental health professional (eg psychologist or counsellor)
5 Dietitian
Released
77 Another health care worker [Specify]
________________
0 None of the above
.K Don’t know
.R Refused
If C2.04=1 and C2.011=0, display message: Consistency check In question C2.04 you
recorded that they had visited their usual medical centre, but in C2.011 you recorded that
they have not had an appointment at their medical centre. Verify answers with respondent.
Go back to C2.04. Go back to C2.011.
NZHS Year 12 Child Questionnaire
16
Document 2
General practitioners
These next questions are about [Name] seeing a general practitioner (GP) or family doctor.
This can be at their
usual medical centre or
somewhere else.
GP – utilisation
C2.12a How many times did [Name] see a GP in the past 12 months? This may have been
about their physical health, or their mental or emotional health.
_____ times (range 1–99)
0
Hasn’t seen a GP in last 12 months [go to GP – barriers to access C2.27]
If C2.011=1 and C2.12a=0, display message: Consistency check In question C2.011
you recorded that they had visited a GP at their usual medical centre, but in C2.12a you
recorded that they haven’t seen a GP. Verify answers with respondent. Go back to C2.011.
1982
Go back to C2.12a.
Act
.K Don’t know [go to C2.27]
.R Refused [go to C2.27]
C2.15 Thinking about [Name’s] last visit to a GP, what were you charged for that visit?
Record amount in dollars and cents, eg $60=60.00.
If respondent says between two amounts, record the average in dollars and cents
(eg between $40 and $50: record 45.00).
If free enter 0.00.
Information
If respondent says an amount greater than $199, record as $199.00.
Can give an estimate if exact amount unknown.
$___.___ (range 0.00–199.00)
Official
.K Don’t know
.R Refused
the
GP – barriers to access
C2.27 In the past 12 months, was there a time when [Name] had a medical problem but did
not visit or talk to a GP because of cost?
under
1
Yes
2
No
.K Don’t know
.R Refused
Released
NZHS Year 12 Child Questionnaire
17
Document 2
[Showcard]
C2.270 In the
past 12 months, was there a time when [Name] had a
medical problem but
did not visit a GP for any of the following reasons?
[For VIP survey insert: You may need to scroll down to see all the answer options.]
[Select all that apply]
Read each response option aloud and allow respondents to respond to each
option.
Please exclude not visiting a GP because of cost.
1
Time taken to get an appointment too long
2
Owed money to the medical centre
3
Dislike or fear of the GP
4
Difficult to take time off work
5
No transport or too far to travel
1982
6
Could not arrange childcare (for other children) or care for a dependent adult
An adult who is ill or disabled.
7
Didn’t have a carer, support person or interpreter to go with you
Act
77 Another reason [Specify]
_________________
0
None of the above
.K Don’t know
.R Refused
C2.30 In the past 12 months, was there a time when [Name] got a prescription but you did
not collect one or more prescription items from the pharmacy or chemist because of
Information
cost?
1
Yes
2
No
.K Don’t know
Official
.R Refused
the
Nurses at general practices and medical centres
The next set of questions is about nurses who work at general practices and medical
centres.
under
Please do
not include nurses who may have visited [Name] at home or school or nurses
[Name] saw in a hospital. Also, don’t include midwives or dental nurses.
C2.36a In the past 12 months, has [Name] seen a nurse at a general practice or medical
centre? This may have been about their physical health, or their mental or
emotional health.
Released
1
Yes
2
No [go to emergency department introduction before C2.59]
If C2.011=2 and C2.36a=2, display message: Consistency check In question C2.011
you recorded that they had visited a nurse at their usual medical centre, but in C2.36a you
recorded that they haven’t seen a nurse. Verify answers with respondent. Go back to
C2.011. Go back to C2.36a.
.K Don’t know [go to introduction before C2.59]
.R Refused [go to introduction before C2.59]
NZHS Year 12 Child Questionnaire
18
Document 2
C2.37a How many times in the past 12 months did [Name] see a nurse
as part of a GP
consultation? This includes seeing the nurse before or after seeing the GP.
If none enter 0.
_____ times (range 0–99)
.K Don’t know
.R Refused
C2.38a How many times in the past 12 months did [Name] see a nurse
without seeing a
GP at the same visit?
If none enter 0.
_____ times (range 0–99)
.K Don’t know
.R Refused
1982
If C2.36a=1 and C2.37a=0 and C2.38a=0, display message: Consistency check If
C2.36a=1 (saw a nurse), then number of times at C2.37a OR C2.38a should be >=1. Go
Act
back to C2.36a OR go back to C2.37a OR go back to C2.38a.
Emergency department
The next questions are about [Name’s] use of emergency departments at public hospitals.
C2.59 In the past 12 months, how many times did [Name] go to an emergency department
Information
at a public hospital about their own health?
_____ times (range 0–99) [if 0 go to Specialist doctors introduction before C2.720]
.K Don’t know [go to introduction before C2.720]
.R Refused [go to introduction before C2.720]
Official
[Showcard]
the
C2.620
Thinking about [Name’s] last visit to an emergency department, what were
all the
reasons [Name] went?
[Select all that apply]
Read each response option aloud and allow respondents to respond to each
option.
under
If respondent says they were taken by ambulance or sent by someone such as a
GP, Option 1 should be selected.
1
Condition appeared serious / life threatening; or sent by GP
2
GP or after-hours too expensive
3
Time of day / day of week (outside of usual medical centre hours)
Released
4
Time taken to get an appointment was too long at usual medical centre
77 Another reason [Specify]
_________________
.K Don’t know [go to Specialist doctors introduction before C2.720]
.R Refused [go to introduction before C2.720]
NZHS Year 12 Child Questionnaire
19
Document 2
Ask next question if more than one of the Options 1–4/77 selected in C2.620. Only show
responses that were selected in C2.620 (as well as .K and .R).
[Showcard]
C2.630
What was the
main reason you took [Name] to a hospital emergency department?
1
Condition appeared serious / life threatening; or sent by GP
2
GP or after-hours too expensive
3
Time of day / day of week (outside of usual medical centre hours)
4
Time taken to get an appointment was too long at usual medical centre
77 Another reason ([pipe through response from C2.620)
.K Don’t know
.R Refused
1982
Specialist doctors
The next few questions are about specialist doctors. By specialist I mean the kind of doctor
Act
that people go to for a particular health condition, problem or service, not a GP. [Name] may
have seen the specialist in a hospital or at their private rooms or clinic.
Specialist – utilisation
C2.720
In the
past five years, has a doctor
referred [Name] to a
specialist?
Select 'Yes' even if they did not visit the specialist.
Here is a list of examples of specialist doctors ⚐:
Information
Cardiologist
Ophthalmologist
Clinical geneticist
Orthopaedic Surgeon
Dermatologist
Paediatrician
Official
Diabetologist
Paediatric surgeon
Ear, nose and throat specialist
Plastic surgeon
General surgeon
Psychiatrist
the
Immunologist (allergy specialist)
Respiratory medicine specialist
Neurologist
Urologist
1
Yes
under
2
No [go to Dental health care workers introduction before C2.80]
.K Don’t know [go to introduction before C2.80]
.R Refused [go to introduction before C2.80]
Released
NZHS Year 12 Child Questionnaire
20
Document 2
Specialist – barriers to access
[Showcard]
C2.730 In the
past five years, was there a time when a doctor
referred [Name] to a
specialist but [Name] did not go for any of the following reasons?
[For VIP survey insert: You may need to scroll down to see all the answer options.]
[Select all that apply]
Read each response option aloud and allow respondents to respond to each
option.
1
Cost
2
Dislike or fear of the treatment
3
Difficult to take time off work
4
No transport or too far to travel
5
Could not arrange childcare (for other children) or care for a dependent adult
An adult who is ill or disabled
1982
6
Didn’t have a carer, support person or interpreter to go with you
7
Hospital or specialist doctor didn't accept the referral
Act
8
No longer needed or issue was resolved
77 Another reason [Specify]
_________________
0 None of the above
.K Don’t know
.R Refused
Dental health care workers
Information
Go to the following questions for children aged 1–14 years. Go to Breastfeeding C3.02 for
children aged 0–23 months.
These next questions are about dental health care services [Name]
has used in
New
Zealand. When I say “dental health care worker”, I mean dentists, dental therapists (formerly
Official
known as dental nurses), dental hygienists, as well as any dental health specialists such as
orthodontists.
the
Dental health care workers – utilisation
[Showcard]
C2.80 How long has it been since [Name] last visited a dental health care worker, for any
under
reason?
1
Within the past year (less than 12 months ago)
2
Within the past two years (more than 1 year but less than 2 years ago)
3
Within the past five years (more than 2 years but less than 5 years ago)
4
Five or more years ago
5
Has never seen a dental health care worker
Released
.K Don’t know
.R Refused
Dental health care workers – barriers to access
C2.83a In the last 12 months, have you avoided taking [Name] to a dental health care
worker because of the cost?
1
Yes
2
No
.K Don’t know
.R Refused
NZHS Year 12 Child Questionnaire
21
Document 2
Health behaviours and risk factors
The next section is about things that can influence [Name’s] health.
Perception of child’s weight
Go to the next question for children aged 2–14 years. Go to Breastfeeding C3.02 for
children aged 0–23 months.
[Showcard]
C3.01 On a scale of one to five, where one is very underweight and five is very
overweight, how do you view the weight of [Name]?
1
Very underweight
2
Underweight
1982
3
Neither underweight nor overweight
4
Overweight
5
Very overweight
Act
.K Don’t know
.R Refused
Ask all respondents Breastfeeding questions C3.02 to C3.04.
Breastfeeding
Information
C3.02 Has [Name] ever been breastfed?
‘Expressed’ milk is to be counted as being breastfed.
1
Yes
2
No [if child aged 0–4 years go to C3.05, if aged 5+ years go to Dietary habits
Official
C3.06a]
.K Don’t know [if 0–4 years go to C3.05, if 5+ years go to C3.06a]
.R Refused [if 0–4 years go to C3.05, if 5+ years go to C3.06a]
the
C3.03 What age was [Name] when they stopped being breastfed?
Less than 1 week old, code “years” as 0, “months” as 0, and “weeks” as 0.
If stil being breastfed, code as “Not applicable”.
under
‘Expressed’ milk is to be counted as being breastfed.
All fields (years, months and weeks) must be completed.
_____ years (range 0–9) _____ months (range 0–11) _____ weeks (range 0–51)
.N Not applicable
.K Don’t know
Released
.R Refused
If C3.03>=CD.03+1 (age + 1 year / 1 month), display message: You recorded that the
child stopped breastfeeding at an age that is older than their current age. Verify answer with
respondent. Click ‘OK’ to go back and change answer or ‘Cancel’ to continue.
NZHS Year 12 Child Questionnaire
22
Document 2
C3.04 What age was [Name] when they were given any drink or food other than breast
milk?
This includes water, formula and other types of milk, but does not include
prescribed medicines.
Less than 1 week old, code “weeks” as 0 and “months” as 0.
If breastfeeding exclusively, code as “Not applicable”.
All fields (months and weeks) must be completed.
_____ months (range 0–11) _____ weeks (range 0–51)
.N Not applicable
.K Don’t know
.R Refused
If C3.04>=CD.03+1 (age + 1 year / 1 month), display message: You recorded that the
child was given drink or food other than breast milk at an age that is older than their current
1982
age. Verify answer with respondent. Click ‘OK’ to go back and change answer or ‘Cancel’ to
continue.
Act
Go to the next question C3.05 for children aged 0–4 years. Go to Dietary habits C3.06a
for children aged >4 years.
C3.05 At what age was
[Name] first given solids?
If child not yet given solids, code as “Not applicable”.
All fields (months and weeks) must be completed.
Information
_____ months (range 0–11) _____ weeks (range 0–51)
.N Not applicable
.K Don’t know
.R Refused
Official
If C3.05>=CD.03+1 (age + 1 year / 1 month), display message: You recorded that the
child was first given solids at an age that is older than their current age. Verify answer with
respondent. Click ‘OK’ to go back and change answer or ‘Cancel’ to continue.
the
under
Released
NZHS Year 12 Child Questionnaire
23
Document 2
Dietary habits
Go to the following dietary habits questions for children aged 2–14 years. Go to the
screen time questions (C3.12–C3.13a) for children aged 6 months to <2 years. Go to the
sleep question (C3.13b) for children aged <6 months.
Response option numbers are not displayed on CAPI screen or showcards for questions
C3.06a–C3.10a.
[Picture Showcard]
C3.06a On
average, how many
servings of fruit does [Name] eat per day? Please include
all fresh, frozen, canned and stewed fruit. Do
not include fruit juice or dried fruit. A
‘
serving’ = 1 medium piece
or 2 small pieces of fruit
or 1 cup of canned, frozen or
stewed fruit. For example, 1 apple + 2 small apricots = 2 servings.
[For VIP survey insert: You may need to scroll down to see all the answer options.]
1982
If asked, include fruit smoothies.
Act
1
They don’t eat fruit
2
Less than 1 serving per day
3
1 serving per day
4
2 servings per day
5
3 servings per day
6
4 servings per day
7
5 servings per day
8
6 or more servings per day
Information
.K Don’t know
.R Refused
[Picture Showcard]
C3.07a
Official
On
average, how many
servings of vegetables does [Name] eat per day? Please
include all fresh, frozen and canned vegetables. Do
not include vegetable juices. A
‘
serving’ = ½ medium potato / similar sized kumara
or ½ cup cooked vegetables
or
the
1 cup of raw salad vegetables. For example, 5 servings could comprise of 1
medium potato + 1 cup of cooked vegetables + 1 cup of raw salad throughout the
day.
Remember to think about all meals and snacks.
under
[For VIP survey insert: You may need to scroll down to see all the answer options.]
1
They don’t eat vegetables
2
Less than 1 serving per day
3
1 serving per day
Released
4
2 servings per day
5
3 servings per day
6
4 servings per day
7
5 servings per day
8
6 or more servings per day
.K Don’t know
.R Refused
NZHS Year 12 Child Questionnaire
24
Document 2
[Showcard]
C3.08a How often does [Name] have breakfast? [Name] may have had breakfast anywhere,
such as at home, school, day-care or a café.
Includes both weekends and weekdays.
Include breakfast drinks such as smoothies and shakes, but not other drinks. For
example, only having a glass of milk or cup of tea should not be counted as having
breakfast.
Breakfast is usually the first meal of the day, eaten within 2 hours of getting up.
1
Never
2
Less than once per week
3
1–2 times per week
4
3–4 times per week
5
5–6 times per week
6
7 or more times per week
1982
.K Don’t know
.R Refused
Act
[Picture Showcard]
C3.09a How often does [Name] eat food, such as fish and chips, burgers, fried chicken or
pizza, that has been purchased from a
fast food place or
takeaway shop? Think
about snacks as well as mealtimes.
Please don’t include other fast food and takeaways such as sushi, wraps or curries.
Information
[For VIP survey insert: You may need to scroll down to see all the answer options.]
If respondent asks, only include fast food and takeaways that are high in fat and
salt. Other examples are hot dogs, chicken nuggets and deep-fried food.
1
Never
Official
2
Less than once per week
3
1–2 times per week
4
3–4 times per week the
5
5–6 times per week
6
7 or more times per week
.K Don’t know
.R Refused under
Released
NZHS Year 12 Child Questionnaire
25
Document 2
[Picture Showcard]
C3.10a How often does [Name] drink soft drinks, fizzy drinks, sports drinks or energy
drinks? Please don’t include diet or reduced sugar varieties.
[For VIP survey insert: You may need to scroll down to see all the answer options.]
Includes soft and fizzy drinks, which are carbonated, such as Coca-Cola,
lemonade and ginger beer, sports drinks such as Powerade and Mizone, and
energy drinks such as ‘V’ and Red Bull.
Excludes diet or reduced sugar varieties, sparkling water, flavoured waters (eg
H2Go), fruit juices and drinks made from cordial, concentrate or powder.
1
Never
2
Less than once per week
3
1–2 times per week
4
3–4 times per week
1982
5
5–6 times per week
6
7 or more times per week
.K Don’t know
Act
.R Refused
Physical activity
Go to the next question (C3.11) for children aged 5–14 years. Go to the screen time
questions (C3.12–C3.13a) for children aged 6 months–4 years. Go to the sleep question
(C3.13b) for children aged <6 months.
Information
[Showcard]
C3.11 How does [Name] usually get to and from school?
[For VIP survey insert: You may need to scroll down to see all the answer options.]
Official
[Select all that apply]
Code walking bus as “Walk” and carpool as “Car or taxi”.
the
Code push scooter (non-motorised) as “Skate or other physical activity”.
1
Walk
2
Bike
under
3
Skate or other physical activity
4
Car or taxi
5
School bus or school van
6
Public transport
77 Other [Specify] _________________
0
Not applicable, for example, is home schooled
.K Don’t know
Released
.R Refused
NZHS Year 12 Child Questionnaire
26
Document 2
Screen time
Go to the next four questions about screen time for children aged 6 months–14 years
(CD.03a=6–23 months OR CD.03b=2–14 years).
C3.12 What is the average amount of time [Name] spends watching TV
each weekday?
This could be anywhere, not just in your home, and includes DVDs / videos but does
not include games.
Round to nearest hour.
Include television programmes, videos and movies watched on any device. Include
those accessed online (eg via YouTube) and on-demand (eg via Netflix).
_____
hours (range 0–24)
.K Don’t know
.R Refused
1982
If C3.12>=10 hours, display message: A person is unlikely to watch TV for an average of
10 or more hours per day. Verify answer with respondent. Click 'OK' to go back and change
Act
answer or 'Cancel' to continue.
C3.12a What is the average amount of time [Name] spends
each weekday looking at a
screen doing things
other than watching TV or videos? For example, playing video
games or browsing the Internet. This does
not include time spent at school or on
homework.
Round to nearest hour.
Include activities on a tablet, computer, electronic gaming device or other hand-
Information
held electronic device such as a smart phone.
Include texting, emailing and using social media.
Don’t count time reported in the previous question.
_____
hours (range 0–24)
Official
.K Don’t know
.R Refused
the
If C3.12a>=10 hours, display message: A person is unlikely to look at a screen for an
average of 10 or more hours per day. Verify answer with respondent. Click 'OK' to go back
and change answer or 'Cancel' to continue.
under
C3.13 What is the average amount of time [Name] spends watching TV
in the weekend?
Again, this could be anywhere, not just in your home and includes DVDs / videos but
does not include games.
Round to nearest hour.
Record total hours over
both Saturday and Sunday.
Include television programmes, videos and movies watched on any device.
Released
Include those accessed online (eg via YouTube) and on-demand (eg via Netflix).
_____ hours (range 0–48)
.K Don’t know
.R Refused
If C3.13>=20 hours, display message: A person is unlikely to watch TV for an average of
20 or more hours over a weekend. Verify answer with respondent. Click 'OK' to go back and
change answer or 'Cancel' to continue.
NZHS Year 12 Child Questionnaire
27
Document 2
C3.13a What is the average amount of time [Name] spends
in the weekend looking at a
screen doing things
other than watching TV or videos? For example, playing video
games or browsing the Internet. This does
not include time spent at school or on
homework.
Round to nearest hour.
Record total hours over
both Saturday and Sunday.
Include activities on a tablet, computer, electronic gaming device or other hand-
held electronic device such as a smart phone.
Include texting, emailing and using social media.
Don’t count time reported in the previous question.
_____
hours (range 0–48)
.K Don’t know
.R Refused
1982
If C3.13a>=20 hours, display message: A person is unlikely to look at a screen for an
average of 20 or more hours over a weekend. Verify answer with respondent. Click 'OK' to
go back and change answer or 'Cancel' to continue.
Act
Ask all respondents the next questions.
Sleep
C3.13b How many hours of sleep does [Name] usually get in a 24 hour period, including
all
naps and sleeps?
Information
Enter whole numbers. Round 30 minutes or more up to the next whole hour and
round 29 or fewer minutes down.
_____ hours (range 1–24)
.K Don’t know
Official
.R Refused
the
If C3.13b<6 hours, display message: A child is unlikely to usually sleep less than 6 hours
in a 24 hour period. Verify answer with respondent. Click ‘OK’ to go back and change
answer or ‘Cancel’ to continue.
under
For children aged 2–14 years only:
If C3.13b>14 hours, display message: A child is unlikely to usually sleep more than 14
hours in a 24 hour period. Verify answer with respondent. Click ‘OK’ to go back and change
answer or ‘Cancel’ to continue.
Tooth brushing
Released
[Showcard]
C3.13c How often are [Name’s]
teeth brushed?
0
Never [go to Response to child’s misbehaviour C3.15]
1
Less than once a day
2
Once a day
3
Twice a day
4
More than twice a day
5 No natural teeth [go to Response to child’s misbehaviour C3.15]
.K Don’t know
.R Refused
NZHS Year 12 Child Questionnaire
28
Document 2
[Picture Showcard]
C3.13d Looking at the [For F2F insert: Showcard] [For VIP insert: options on the screen],
what type of toothpaste does [Name] usually use?
[For VIP survey insert: You may need to scroll down to see the answer options.]
If respondent is unsure about what type of toothpaste is used, and give their
permission, you could ask to see the toothpaste that is currently used.
• Standard fluoride packaging might include: “0.221% sodium fluoride”, “0.76%
sodium monofluorophosphate”, “1000–1450 ppm” and/or “fluoride toothpaste”.
Homemade toothpaste or baking soda should be coded as ‘Doesn’t use
toothpaste / no toothpaste available in the house’.
1
Standard fluoride toothpaste
3
Non-fluoridated toothpaste
1982
4
Doesn’t use toothpaste / no toothpaste available in house
.K Don’t know
Act
.R Refused
The toothpaste picture showcard needs updating if there are any major changes in the
market. This should be reviewed annually, in consultation with the Ministry’s oral health
team, during questionnaire development.
Response to child’s misbehaviour Information
[Showcard]
C3.15 Thinking back over the
past four weeks, when [Name] misbehaved, which of the
following, if any, have you done? Just read out the number next to the words.
Official
[For VIP survey insert: You may need to scroll down to see all the answer options.]
[Select all that apply]
Prompt: “any others?”
the
1
Made them go without something or miss out on something
2
Yelled at them
3
Explained or discussed why they should not do it
under
4
Physical punishment, such as smacking
5
Told them off
6
Sent them to the bedroom or other place in the house
7
Ignored their behaviour
8
Something else
0
My child has not misbehaved during the past 4 weeks
Released
.N My child is too young to misbehave Limit to children <2 years.
.K Don’t know
.R Refused
NZHS Year 12 Child Questionnaire
29
Document 2
[Showcard]
C3.16a Using the scale on the [For F2F survey insert: Showcard] [For VIP survey insert:
screen], to what extent do you disagree or agree with the following statement:]
There are certain circumstances when it’s alright for parents to use physical
punishment, such as smacking, with children. Just read out the number next to the
words.
1
Strongly disagree
2
Disagree
3
Neither disagree nor agree
4
Agree
5
Strongly agree
.K Don’t know
.R Refused
1982
Act
Information
Official
the
under
Released
NZHS Year 12 Child Questionnaire
30
Document 2
Behaviour and mental health self-complete section
If the interview is being conducted with language assistance from a family member /
friend of the respondent (C6.13=1), or language assistance from a professional translator
(C6.14=1) skip to Household food security (CFS1.01). Everyone else go to CDWIntro.
CDWIntro
[For F2F survey insert: Now, I’m going to hand the computer to you, so that you can answer
the next questions privately.]
[For VIP survey insert: The next questions are for you to answer privately. Your answers are
totally confidential and will not be seen by me, unless you ask me to help you.]
The interviewer can administer this section [For F2F survey insert: using showcards] but
only if privacy can be ensured.
[For VIP survey insert: If the respondent is happy for you to administer the questions
1982
select the ‘Unblock and hold’ checkbox.]
Act
1
Continue with this section [go to CDW2.01]
2
Skip this section because privacy isn’t ensured
[go to introduction before
CFS1.01]
If CDWIntro=2, display the following message: You have chosen to skip this section. Click
‘OK’ to go back, or ‘Cancel’ to skip the section.
For each SDQ screen, if one or more items are left blank, display the following pop-up
Information
message: You have not answered every row. Click ‘OK’ to go back and select an answer for
every question, OR click ‘Cancel’ to go to the next screen.
Licensing rules for the SDQ require the copyright notice on each SDQ screen: © Robert
Goodman, 2005
Official
START OF SELF-COMPLETE.
the
under
Released
NZHS Year 12 Child Questionnaire
31
Document 2
Strengths and Difficulties Questionnaire (SDQ) for 2–4 year
olds
Children aged ≥2 and <5 years go to this version of SDQ (CDW2.01 to CDW2.25).
Questions CDW2.01 to CDW2.25 to fit over three screens for self-complete.
The three introductory sentences should be included on each screen.
[Showcard]
CDW2.01–2.25 For each item, please mark the box for Not true, Somewhat true or
Certainly true.
It would help us if you answered all items as best you can, even if you are
not absolutely certain.
Please give your answers on the basis of [Name’s] behaviour over the
last six months.
1982
[For VIP survey insert: You may need to scroll down to see all the grid
statements.]
Act
1.
2.
3.
Not
Somewhat Certainly
true
true
true
Considerate of other people’s feelings
Restless, overactive, cannot stay still for long
Often complains of headaches, stomach-aches or sickness
Information
Shares readily with other children, for example toys, treats, pencils
Often loses temper
Rather solitary, prefers to play alone
Generally well behaved, usually does what adults request
Official
Many worries or often seems worried
the
Helpful if someone is hurt, upset or feeling ill
Constantly fidgeting or squirming
Has at least one good friend
Often fights with other children or bullies them
under
Often unhappy, depressed or tearful
Generally liked by other children
Easily distracted, concentration wanders
Nervous or clingy in new situations, easily loses confidence
Kind to younger children
Released
Often argumentative with adults
Picked on or bullied by other children
Often offers to help others (parents, teachers, other children)
Can stop and think things out before acting
Can be spiteful to others
Gets along better with adults than with other children
Many fears, easily scared
Good attention span, sees tasks through to the end
Go to introduction before CMH1.01a.
NZHS Year 12 Child Questionnaire
32
Document 2
Strengths and Difficulties Questionnaire (SDQ) for 5–10
year olds
Children aged ≥5 and <11 years go to this version of SDQ (CDW3.01 to
CDW3.25).
Questions CDW3.01 to CDW3.25 fit over three screens for self-complete.
The three introductory sentences should display on each screen.
[Showcard]
CDW3.01–3.25 For each item, please mark the box for Not true, Somewhat true or
Certainly true.
It would help us if you answered all items as best you can, even if you are
not absolutely certain.
Please give your answers on the basis of [Name’s] behaviour over the
last six months or this school year.
1982
[For VIP survey insert: You may need to scroll down to see all the grid
statements.]
Act
1.
2.
3.
Not
Somewhat Certainly
true
true
true
Considerate of other people’s feelings
Restless, overactive, cannot stay still for long
Often complains of headaches, stomach-aches or sickness
Information
Shares readily with other children, for example toys, treats, pencils
Often loses temper
Rather solitary, prefers to play alone
Generally well behaved, usually does what adults request
Official
Many worries or often seems worried
the
Helpful if someone is hurt, upset or feeling ill
Constantly fidgeting or squirming
Has at least one good friend
Often fights with other children or bullies them
under
Often unhappy, depressed or tearful
Generally liked by other children
Easily distracted, concentration wanders
Nervous or clingy in new situations, easily loses confidence
Kind to younger children
Released
Often lies or cheats
Picked on or bullied by other children
Often volunteers to help others (parents, teachers, other children)
Thinks things out before acting
Steals from home, school or elsewhere
Gets along better with adults than with other children
Many fears, easily scared
Good attention span, sees work through to the end
Go to introduction before CMH1.01a.
NZHS Year 12 Child Questionnaire
33
Document 2
Strengths and Difficulties Questionnaire (SDQ) for 11–14
year olds
Children aged ≥11 and <15 years go to this version of SDQ (CDW4.01 to CDW4.25).
Questions CDW4.01 to CDW4.25 to fit over three screens for self-complete.
The three introductory sentences should be included on each screen.
[Showcard]
CDW4.01–4.25 For each item, please mark the box for Not true, Somewhat true or
Certainly true.
It would help us if you answered all items as best you can, even if you are
not absolutely certain.
Please give your answers on the basis of [Name’s] behaviour over the
last six months or this school year.
1982
[For VIP survey insert: You may need to scroll down to see all the grid
Act
statements.]
1.
2.
3.
Not
Somewhat Certainly
true
true
true
Considerate of other people’s feelings
Restless, overactive, cannot stay still for long
Often complains of headaches, stomach-aches or sickness
Information
Shares readily with other youth, for example books, games, food
Often loses temper
Would rather be alone than with other youth
Official
Generally well behaved, usually does what adults request
Many worries or often seems worried
the
Helpful if someone is hurt, upset or feeling ill
Constantly fidgeting or squirming
Has at least one good friend
under
Often fights with other youth or bullies them
Often unhappy, depressed or tearful
Generally liked by other young people
Easily distracted, concentration wanders
Nervous in new situations, easily loses confidence
Released
Kind to younger children
Often lies or cheats
Picked on or bullied by other young people
Often volunteers to help others (parents, teachers, children)
Thinks things out before acting
Steals from home, school or elsewhere
Gets along better with adults than with other young people
Many fears, easily scared
Good attention span, sees tasks through to the end
NZHS Year 12 Child Questionnaire
34
Document 2
Use of services and informal help for mental health and
substance use
Children aged <2 years go to Parental stress introduction before CPS1.01.
Children aged 2–14 years go to the following mental health service use questions.
This section is about [Name’s] contact with health professionals and other people for
concerns about [Name’s]
emotions, behaviour, stress, mental health, or substance use.
By substance use, we mean use of alcohol or drugs. Please don’t include tobacco products.
Only include the following introductory sentence for children aged 2–9 years (not 10–14
years):
We realise that young children are unlikely to have substance use problems, but we are
using the same questions for all children for consistency.
1982
Click ‘Next’ to begin.
Act
CMH1.01a During the
past 12 months, did you call or text a telephone
helpline for
concerns about [Name’s]
emotions, behaviour, stress, mental health, or
substance use ⚐?
⚐ Tool tip: By substance use, we mean use of alcohol or drugs. Please don’t
include tobacco products.
1
Yes
Information
2
No
.K I don’t know
.R Prefer not to say
Children aged 10–14 years go to next question CMH1.02a; children aged 2–9 years go to
Official
CMH1.04b.
the
CMH1.02a During the
past 12 months, did [Name]
call or text a telephone
helpline for
concerns about their emotions, behaviour, stress, mental health, or substance
use ⚐?
⚐ Tool tip: By substance use, we mean use of alcohol or drugs. Please don’t
under
include tobacco products.
1
Yes
2
No
.K I don’t know
.R Prefer not to say
Released
NZHS Year 12 Child Questionnaire
35
Document 2
CMH1.03 In the
past 12 months, has [Name] had
counselling for mental health or
substance use ⚐, that lasted 30 minutes or longer? Please don’t include
counselling from friends or family.
⚐ Tool tip: By substance use, we mean use of alcohol or drugs. Please don’t
include tobacco products.
1
Yes
2
No
.K I don’t know
.R Prefer not to say
[Showcard]
CMH1.04b During the
past 12 months, did you use any
online resources to get
information, help or support for concerns about [Name’s] emotions, behaviour,
stress, mental health, or substance use ⚐?
1982
[For VIP survey insert: You may need to scroll down to see all the answer
Act
options.]
[Select all that apply]
⚐ Tool tip: By substance use, we mean use of alcohol or drugs. Please don’t
include tobacco products.
1
Yes, to learn about symptoms, diagnosis, causes, treatments, or medication
side effects
Information
2
Yes, to find out where to get help
3
Yes, to discuss with others through forums, support groups or online social
networks
4
Yes, to use a mental health and wellbeing app
5
Other
Official
6
No, did not use online resources to get information, help or support for
concerns about their emotions, behaviour, stress, mental health, or
substance use ⚐ the
.K I don’t know
.R Prefer not to say
CMH1.05 In the
past 12 months, was [Name]
prescribed medication or taking prescription
under
medication for their emotions, behaviour, stress, mental health, or substance use
⚐?
⚐ Tool tip: By substance use, we mean use of alcohol or drugs. Please don’t
include tobacco products.
1
Yes
Released
2
No
.K I don’t know
.R Prefer not to say
NZHS Year 12 Child Questionnaire
36
Document 2
[Showcard]
CMH1.06 In the
past 12 months, did [Name] use any of the following
complementary or
alternative therapies for concerns about their emotions, behaviour, stress,
mental health, or substance use ⚐?
[For VIP survey insert: You may need to scroll down to see all the answer options.]
[Select all that apply]
⚐ Tool tip: By substance use, we mean use of alcohol or drugs. Please don’t
include tobacco products.
1
Massage
2
Exercise, or movement therapy
3
Herbal medicine, such as Chinese or Western
4
Spiritual, psychic or energy healing
1982
5
Rongoā Māori, Mirimiri, or other traditional Māori healing
6
Traditional Pacific healing
Act
7
Relaxation, meditation, mindfulness training, yoga or guided imagery
8
Acupuncture
9
Osteopathic or chiropractic treatment
10 Hypnosis
11 Other
12 No, none of the above
.K I don’t know
Information
.R Prefer not to say
[Showcard]
CMH1.07 In the
past 12 months, did you consult with any of the following, for concerns
about [Name’s] emotions, behaviour, stress, mental health, or substance use ⚐?
Official
[For VIP survey insert: You may need to scroll down to see all the answer options.]
the
[Select all that apply]
⚐ Tool tip: By substance use, we mean use of alcohol or drugs. Please don’t
include tobacco products.
under
1
GP
2
Nurse at a medical centre
3
Plunket, Wellchild or Tamariki Ora Nurse
4
School or District Nurse
5
Paediatrician, Psychiatrist, or other medical specialist
6
Social worker
7
Psychologist, Counsellor, or Psychotherapist
Released
8
Teacher
9
Religious or spiritual advisor, like a Minister, Priest or Tohunga
10 Kaumātua or Tohunga
11 Family, whānau, partner and/or friends
12 Other person
13 No, none of the above
.K I don’t know
.R Prefer not to say
NZHS Year 12 Child Questionnaire
37
Document 2
[Showcard]
CMH1.08 In the
past 12 months, did [Name] receive help for concerns about their
emotions, behaviour, stress, mental health, or substance use ⚐ from any of the
following?
[For VIP survey insert: You may need to scroll down to see all the answer options.]
[Select all that apply]
⚐ Tool tip: By substance use, we mean use of alcohol or drugs. Please don’t
include tobacco products.
⚐ Tool tip: Youth ‘one-stop-shops’ provide primary health care (including drop-in
services) plus a range of other services for young people. They use a youth
development and holistic approach to health.
1
Hospital emergency department or an after-hours medical centre [go to
CMH1.11]
1982
2
Crisis mental health team [go to CMH1.11]
3
Māori health service (including Māori mental health or addictions services) [go
Act
to CMH1.09]
4
Community mental health or addictions service (including hospital outpatient
appointments) [go to CMH1.09]
5
Other community support services, such as a youth ‘one-stop-shop’ ⚐ [go to
CMH1.11]
6
Other [Specify]
_________________ [go to CMH1.11]
7
No, none of the above [go to CMH1.11] Information
.K I don’t know [go to CMH1.11]
.R Prefer not to say [go to CMH1.11]
The following set of two questions (CMH1.09 and CMH1.10) will be asked for question
CMH1.08 response options 3 and 4 respectively (ie up to two times). Others proceed to
Official
question CMH1.11.
CMH1.09 Did the [enter ‘Māori health service’ OR ‘community mental health or addictions
the
service’ from CMH1.08] provide emotional or practical support for you in your role
as a parent? If you have only had an update about your child’s condition or
progress, please don’t count this.
under
1
Yes
2
No
.K I don’t know
.R Prefer not to say
[Showcard]
Released
CMH1.10 Who was present at the last visit to the [enter ‘Māori health service’ OR
‘community mental health or addictions service’ from CMH1.08]?
1
Child alone
2
Parent(s) / caregiver(s) only
3
Child and one or more support people, such as parents, family / whānau and
close friends
4
Other
.K I don’t know
.R Prefer not to say
NZHS Year 12 Child Questionnaire
38
Document 2
Unmet need and barriers accessing mental health and
addictions services
CMH1.11 In the
past 12 months, did you ever feel that [Name]
needed professional help for
their emotions, behaviour, stress, mental health, or substance use ⚐, but
they
didn’t receive that help? This could have been because of personal reasons (for
example, it cost too much) or reasons you couldn’t control (for example, no
appointments available).
⚐ Tool tip: By substance use, we mean use of alcohol or drugs. Please don’t
include tobacco products.
1
Yes
2
No [go to Parental stress introduction before CPS1.01]
.K I don’t know [go to introduction before CPS1.01]
.R Prefer not to say [go to introduction before CPS1.01]
1982
If response 1 selected in CMH1.11, ask CMH1.12a, otherwise go to Parental stress
Act
introduction before CPS1.01.
[Showcard]
CMH1.12a Thinking about the
most recent time when you felt [Name]
needed professional
help, but didn’t receive it, why was that?
[For VIP survey insert: You may need to scroll down to see all the answer
options.]
Information
[Select all that apply]
1
Wanted to handle it alone and/or with the support of family, whānau and
friends
2
Couldn’t spare the time Official
3
Costs too much
4
Problems with transportation or childcare
the
5
Unsure where to go or who to see
6
Couldn’t get an appointment at a suitable time
7
Time taken to get an appointment too long
8
Available services did not meet cultural or language needs
under
9
Health professionals unhelpful or unwilling to help
10 Not satisfied with available services
11 Didn't think treatment would work
12 Concerned what others might think
13 Another reason [Specify]
_________________
.K I don’t know
.R Prefer not to say
Released
NZHS Year 12 Child Questionnaire
39
Document 2
All children aged 0–14 years go to Parental stress questions.
Parental stress
The next five questions are about how
you may have felt while looking after [Name].
[Showcard]
CPS1.01 In general, how well do you feel you are coping with the day-to-day demands of
raising children?
1
Very well
2
Well
3
Somewhat well
4
Not very well
5
Not very well at all
1982
.K I don’t know
.R Prefer not to say
Act
Now can you please think about the
past month. [Showcard]
CPS1.02 During the
past month, how often have you felt [Name] is much harder to care for
than most children the same age?
1
Never
Information
2
Rarely
3
Sometimes
4
Usually
5
Always
.K I don’t know
Official
.R Prefer not to say
the
[Showcard]
CPS1.03 During the
past month, how often have you felt [Name] does things that
really bother you a lot?
under
1
Never
2
Rarely
3
Sometimes
4
Usually
5
Always
.K I don’t know
.R Prefer not to say
Released
[Showcard]
CPS1.04 During the
past month, how often have you felt angry with [Name]?
1
Never
2
Rarely
3
Sometimes
4
Usually
5
Always
.K I don’t know
.R Prefer not to say
NZHS Year 12 Child Questionnaire
40
Document 2
CPS1.05 Is there someone that you can turn to for day-to-day emotional support with
raising children? This can be any person, including your husband or wife or
partner.
1
Yes
2
No
.K I don’t know
.R Prefer not to say
New screen.
Thank you for completing those questions; please click ‘Next’. [For F2F survey insert: Please
return the computer to the interviewer and they will continue the questionnaire.]
END OF SELF-COMPLETE SECTION.
1982
Act
Information
Official
the
under
Released
NZHS Year 12 Child Questionnaire
41
Document 2
Household food security
I now want to ask you some questions about particular foods you choose, and the buying of
food or gifting of food. We are interested in whether you feel you always have sufficient
resources to have the food you need for yourself and the people you live with. We are not
concerned with your budget, or how you spend money, but we are more interested in finding
out about how people get the food that they need for their household to eat and share.
There are eight statements about food security. Ask the respondent to consider each
statement and respond. In each case "we" refers to the household.
A household can be one person who lives alone, or two or more people who live together
and share facilities (such as for cooking) in a private dwelling.
If required, respondent can read out the number next to the answer on the showcard /
screen.
[Showcard]
1982
CFS1.01 First of all, we know that some people can’t afford to eat properly and we are
interested in whether you think your household has enough money to eat properly.
Act
It’s what you think eating properly is – not what I think or anyone else thinks.
We can afford to eat properly.
1
Always
2
Sometimes
3
Never
.K Don’t know
Information
.R Refused
[Showcard]
CFS1.02 We are interested in whether you run out of basics, like bread, potatoes, etc
because you do not have enough money. We are NOT referring to treats or
Official
special foods.
the
Food runs out in our household due to lack of money.
How often has this been true for your household over the past year?
under
1
Often
2
Sometimes
3
Never
.K Don’t know
.R Refused
Released
NZHS Year 12 Child Questionnaire
42
Document 2
[Showcard]
CFS1.03 Now we are interested in whether a lack of money leads you to sometimes have
smaller meals than you would like or whether a lack of money means there isn’t
enough food for seconds or you sometimes skip meals?
We eat less because of lack of money.
How often has this been true for your household over the past year?
1
Often
2
Sometimes
3
Never
.K Don’t know
.R Refused
1982
[Showcard]
CFS1.04 Now we are going to talk about the variety of foods you eat. By variety, we mean
the number of different kinds of food you have.
Act
The variety of foods we are able to eat is limited by a lack of money.
How often has this been true for your household over the past year?
1
Often
2
Sometimes
Information
3
Never
.K Don’t know
.R Refused
[Showcard]
Official
CFS1.05 Some people rely on support and assistance from others for supplying their
regular food and we are interested in finding out how many people fall into this
group.
the
We rely on others to provide food and/or money for food, for our household,
when we don’t have enough money.
under
How often has this been true for your household over the past year?
1
Often
2
Sometimes
3
Never
.K Don’t know
Released
.R Refused
NZHS Year 12 Child Questionnaire
43
Document 2
[Showcard]
CFS1.06 Also, some people have to rely on other sources of help such as food grants or
food banks.
We make use of special food grants or food banks when we do not have
enough money for food.
How often has this been true for your household over the past year?
1
Often
2
Sometimes
3
Never
.K Don’t know
.R Refused
[Showcard]
1982
CFS1.07 We know that some people get quite stressed and worried about providing enough
food even though they don’t actually go without food.
Act
I feel stressed because of not having enough money for food.
How often has this been true for your household over the past year?
1
Often
2
Sometimes
3
Never
Information
.K Don’t know
.R Refused
[Showcard]
CFS1.08 We recognise that for some people food and sharing with others is important, to
Official
the point that they don’t have enough food for themselves. In this question we are
only interested in social situations that are gatherings within, or outside, the
the
household. As a result people may find themselves stressed/whakamā
(embarrassed) about their koha (gift) when providing food for others.
I feel stressed because I can’t provide the food I want for social occasions.
under
How often has this been true for your household over the past year?
1
Often
2
Sometimes
3
Never
.K Don’t know
Released
.R Refused
If all CFS1.01–CFS1.08=3, display message: Can I just check: earlier I recorded that you
can ‘never’ afford to eat properly. Is this correct? If incorrect, go back to CFS1.01 and
change answer (and then cycle through CFS1.02–CFS1.08). If correct, select ‘Continue’.
If all CFS1.01–CFS1.08=1, display message: Can I just check: earlier I recorded that you
can ‘always’ afford to eat properly. Is this correct? If incorrect, go back to CFS1.01 and
change answer (and then cycle through CFS1.02–CFS1.08). If correct, select ‘Continue’.
NZHS Year 12 Child Questionnaire
44
Document 2
Socio-demographics
Now, we need to collect some general information about [Name]. The answers to these
questions help us to check that we have selected a representative sample of New Zealand
children to participate in this survey, and sometimes these things can affect children’s health.
Date of birth
C4.01 What is [Name’s] date of birth?
Interviewer read back date of birth to check it is correct.
To update a previously-recorded date, click on the date picker, select the month
and year from the drop-down lists, then
click on the correct day.
Display message: This means [Name] is X years old.
_____ Day (range 1–31)
1982
_____ Month (range Jan–Dec)
_____ Year (range [current year minus 15]–[current year])
Act
.R Refused
Ethnic group(s)
[Showcard]
C4.03 Which ethnic group or groups does [Name] belong to?
Information
[For VIP survey insert: You may need to scroll down to see all the answer options.]
[Select all that apply]
If ‘Other – Specify’ is selected, you will be asked to specify the other ethnic groups
on the next screen.
Official
1
New Zealand European
2
Māori
the
3
Samoan
4
Cook Island Māori
5
Tongan
6
Niuean
7
Chinese
under
8
Indian
77 Other [Specify] _____________ [Three “Other” ethnic groups to be asked about
on a new screen and programmed from the codefile from StatsNZ, Ethnicity New
Zealand Standard Classification 2005 V2.1.0]
.K Don’t know
.R Refused
Released
NZHS Year 12 Child Questionnaire
45
Document 2
[Showcard]
C4.05 Which country was [Name] born in?
[For VIP survey insert: You may need to scroll down to see all the answer options.]
When selecting ‘Other’ you are able to enter a historic name of the country. The
codefile wil recognise this and assign it to the same category as the country’s
present name.
1
New Zealand [go to Medical insurance introduction before C4.06a]
2
Australia
3
England
4
China (People’s Republic of)
5
India
6
South Africa
7
Samoa
1982
8
Cook Islands
77 Other [Specify the name of the country] _____________
[Programme from the codefile from StatsNZ. Can only specify one country]
Act
.K Don’t know
.R Refused
C4.06 In what year did [Name] arrive to live in New Zealand?
Record 4 digit date, eg 2017.
If year is earlier than year of birth, display message: Consistency check Answer must
Information
be >= year of birth given at C4.01. Go back to C4.01 (Date of birth). Go back to C4.06.
_____ year (range [current year minus 15]–[current year])
.K Don’t know
.R Refused
Official
Medical insurance
the
Now I’l ask you about medical insurance.
C4.06a Is [Name] covered by any health or medical insurance?
under
1
Yes
2
No
.K Don’t know
.R Refused
Released
NZHS Year 12 Child Questionnaire
46
Document 2
Interviewer observation – if adult questionnaire completed
Complete following observation without asking the respondent:
CQ1 Has the adult questionnaire been completed?
1
Yes [go to CQ2 interviewer observation]
2
No – to be completed
another day, or
may not be completed (adult declined)
[continue with questions from C4.17 – Extra questions if adult questionnaire had
not yet been completed]
3
No – to be completed
directly after this survey [go to CQ2 interviewer
observation]
1982
Extra questions if adult questionnaire has not yet been
Act
completed
Income
[Showcard]
C4.17 Looking at the [For F2F survey insert: Showcard] [For VIP insert: options on the
screen], what is the total income that
your household got from all sources, before
Information
tax or anything was taken out of it, in the last 12 months? Please read out the number
next to the income group.
1
Loss
2
Zero income
Official
3
$1 – $20,000
4
$20,001 – $30,000
5
$30,001 – $50,000
the
6
$50,001 – $70,000
7
$70,001 – $100,000
8
$100,001 or more
.K Don’t know under
.R Refused
Released
NZHS Year 12 Child Questionnaire
47
Document 2
Housing
Now some questions about housing.
C4.17a Do you, or anyone else who lives here, hold this house / flat in a family trust?
Help Text: What is a family trust?
A family trust is a legal way to protect and hold family assets. In the context
of this question, a house could be a family asset. The house is owned by a
group of people, not an individual (this group of people are the nominated
trustees. These may or may not be family members).
The aim of the trust is to preserve the assets (such as a house) in the
interests of present and/or future family members (or nominated
beneficiaries). The family trust arrangement will be set out in a legal
document, usually called a trust deed.
1982
Either the nominated beneficiary or nominated trustee of the family trust
can ‘hold’ the house / flat in a family trust.
Act
Charitable trusts should not be included, only family trusts and other types
of private trusts.
If a house is owned by a company or business, select No for this
question.
1
Yes [go to bedrooms C4.19]
Information
2
No
.K Don’t know
.R Refused
C4.18 Do you, or anyone else who lives here, own or partly own this dwelling, with or
Official
without a mortgage?
1
Yes [go to bedrooms C4.19]
the
2
No
.K Don’t know
.R Refused
under
[Showcard]
C4.18a Who owns this house / flat?
1
Private person, trust or business
2
Local Authority or City Council
3
Kāinga Ora (formerly Housing New Zealand Corporation)
Released
4
Other state-owned corporation or state-owned enterprise, or government
department or ministry
.K Don’t know
.R Refused
NZHS Year 12 Child Questionnaire
48
Document 2
C4.19 How many bedrooms are there in this dwelling? Please include rooms or sleepouts
that are furnished as bedrooms and any caravans that this household uses as a
bedroom.
Count: Any room furnished as a bedroom even if no one is using it.
Sleepouts or caravans if they are next to the house / flat and are furnished as a
bedroom.
Don't count: Any other room (eg living room) used as a bedroom UNLESS the
only bedroom facilities are in that room.
_____
bedrooms (range 1–20)
.K Don’t know
.R Refused
[Picture Showcard]
C4.19a Counting those bedrooms, how many rooms are there in this dwelling? Please
1982
include all the rooms listed under ‘Count’ on the [For F2F insert: Showcard.] [For
VIP insert: screen.] Do not include the rooms listed under ‘DON’T count’.]
Act
[For VIP survey insert: You may need to scroll down.]
If necessary, help the respondent to identify the rooms that should be counted. If
they are uncertain about a particular room, and give their permission, you could
view that room in order to help them.
If a dwelling is built in an open-plan style, then room equivalents should be
counted as if they had walls between them.
Room equivalents should not be counted for one-roomed dwellings (ie bed-
Information
sitting rooms). A one-roomed dwelling should be counted as having one room only.
If number of rooms is fewer than number given in C4.19, display message: Consistency
check Answer must be >= number of bedrooms given at C4.19. Go back to C4.19. Go
back to C4.19a.
Official
_____ rooms (range 1–100)
.K Don’t know
the
.R Refused
Interviewer observatio
under
n – if both adult / child survey
respondent
Complete following observation without asking the respondent:
CQ2 Is the adult who answered this child questionnaire, also selected as the NZHS adult
respondent?
Released
1
Yes [go to Household composition C4.24]
2
No [continue with questions: introduction before secondary school qualification
C4.20 to introduction before Relationships C4.28]
NZHS Year 12 Child Questionnaire
49
Document 2
Extra questions if primary caregiver was not the NZHS
adult respondent
Now, a few questions about you.
[Showcard]
C4.20 What is your highest secondary school qualification?
[For VIP survey insert: You may need to scroll down to see all the answer options.]
1
None
2
NZ School Certificate in one or more subjects
or National Certificate level 1
or NCEA level 1
3
NZ Sixth Form Certificate in one or more subjects
1982
or National Certificate level 2
or NZ UE before 1986 in one or more subjects
or NCEA level 2
Act
4
NZ Higher School Certificate
or Higher Leaving Certificate
or NZ University Bursary / Scholarship
or National Certificate level 3
or NCEA level 3
or NZ Scholarship level 4
5
Other secondary school qualification
gained in New Zealand
Information
[Specify]
_______________
6
Other secondary school qualification
gained overseas
.K Don’t know
.R Refused
Official
the
under
Released
NZHS Year 12 Child Questionnaire
50
Document 2
[Showcard]
C4.21 What is your highest completed qualification?
[For VIP survey insert: You may need to scroll down to see all the answer options.]
0
None
1
National Certificate level 1
2
National Certificate level 2
3
National Certificate level 3
4
National Certificate level 4
5
Trade Certificate
6
Diploma or Certificate level 5
7
Advanced Trade Certificate
8
Diploma or Certificate level 6
9
Teachers Certificate / Diploma
1982
10 Nursing Diploma
11 Bachelor
12 Bachelor Hons
Act
13 Postgraduate Certificate / Diploma
14 Masters Degree
15 PhD
77 Other [Specify] _________________
.K Don’t know
.R Refused
Information
If C4.20=2, 3, 4, 5, 6 (secondary school qualification completed) AND C4.21=0 (no
highest completed qualification), display message: Consistency check In question C4.20
you recorded that the respondent had completed a secondary school qualification, but in
C4.21 you recorded that they haven’t completed a qualification. Verify answers with
respondent. Go back to C4.20. Go back to C4.21.
Official
[Showcard]
C4.22 Which of these statements best describes your
current work situation:
the
1
Working in paid employment (includes self-employment)
2
Not in paid work, and looking for a job [go to Household composition C4.24]
3
Not in paid work, and not looking for a job (for any reason, such as
under
being retired, a homemaker, caregiver, or full-time student) [go to Household
composition C4.24]
77 Other [Specify]
_________________ [go to Household composition C4.24]
.K Don’t know [go to Household composition C4.24]
.R Refused [go to Household composition C4.24]
Released
C4.23 How many hours a week do you
usually work?
Round to nearest hour.
_____ hours (range 1–120)
.K Don’t know
.R Refused
NZHS Year 12 Child Questionnaire
51
Document 2
Household composition
Ask next questions, C4.24 and C4.28, if there is more than 1 person in household
(Occupants in household screener>1).
Gender and age
C4.24 I would now like to enter some information about the
other people who live in this
household as this can affect [Name’s] health. Please confirm the initials, ages and
genders of all the people who usually live in this household.
The following questions cover the initials, age, gender and relationship of
every member of the household.
Update fields or add / delete occupants below as required.
Occupant grid pre-populated with information from household screener.
Provide three response options for gender: male, female, another gender.
1982
Occupant Name
ID
Age
Gender
Act
Relationships
The next questions are about relationships in your household.
The following questions cover the relationships between
every member of the household.
Information
Ask the relationships between every household member one-way. Eg if a father Matt is
asked the relationship to his son James, there’s no need to also ask James his relationship
to his father as it will be derived.
[Showcard]
Official
C4.28
If dealing with respondent’s relationships, insert:
What is [Name’s] relationship to you?
the
Include natural, step, adopted and foster relationships.
Otherwise insert:
What is [Name’s] relationship to [Name]?
under
Include natural, step, adopted and foster relationships.
1
Spouse or partner
2
Child (eg daughter)
3
Parent (eg father)
4
Sibling (eg brother)
5
Grandchild
Released
6
Grandparent
7
Great-grandchild
8
Great-grandparent
9
Nephew or niece
10
Uncle or aunt
11
Other relative
12
Unrelated
.K
Don’t know
.R
Refused
Perform the following soft edit checks on all coded relationship pairs.
NZHS Year 12 Child Questionnaire
52
Document 2
Edit
Description
Error Message
Check
E1
A person is unlikely to have more than
[Name] is recorded as already having a spouse or
one spouse / partner in a household.
partner. Please verify that [Name] is another
spouse / partner of [Name].
E2
A person is unlikely to be living with more [Name] is recorded as already having two
than two parents at one time.
parents. Please verify that [Name] is another
parent of [Name].
E3
A person is unlikely to have a
This household spans at least 4 generations.
relationship of parent to one household
Please verify this with respondent and if this is not
member and a relationship of grandchild
correct, please select 'Go to' to review the
to another household member.
relationships in the household.
E4
It is unlikely that a person aged less than
[Name] is less than 15 years and is recorded as
15 years would be unrelated to all
being unrelated to any other household member.
household members.
Please verify this response.
1982
E5
It is unlikely that a person aged less than
[Name] is less than 15 years of age and is
15 years would be a spouse of another
recorded as the spouse/partner of [Name]. Please
Act
household member.
verify this response.
E6
It is unlikely that a person aged less than
[Name] is less than 15 years of age and is
15 years would be a parent of another
recorded as the parent of [Name]. Please verify
household member.
this response.
E7
A person aged less than 30 years is
[Name] is less than 30 years of age and recorded
unlikely to be the grandparent of another
as the grandparent of [Name]. Please verify this
household member.
response.
E8
A person aged less than 45 years is
[Name] is less than 45 years of age and recorded
Information
unlikely to be the great-grandparent of
as the great-grandparent of [Name]. Please verify
another household member.
this response.
E9
It is unlikely that a child is older than a
[Name] is younger than [Name] but is recorded as
parent.
their parent. Please verify this response.
Official
E10
It is unlikely that a child is older than their [Name] is younger than [Name] but is recorded as
grandparent.
their grandparent. Please verify this response.
the
E11
It is unlikely that a child is older than their [Name] is younger than [Name] but is recorded as
great-grandparent.
their great-grandparent. Please verify this
response.
E12
A person aged over 70 years is unlikely
[Name] is over 70 years of age and is recorded as
to have a relationship of niece or nephew the niece or nephew of [Name]. Please verify this
under
to another household member.
response.
E13
A person aged over 50 years is unlikely
[Name] is over 50 years of age and is recorded as
to be the grandchild of another
the grandchild of [Name]. Please verify this
household member.
response.
E14
A person aged over 30 years is unlikely
[Name] is over 30 years of age and is recorded as
to be the great-grandchild of another
the great-grandchild of [Name]. Please verify this
Released
household member.
response.
E15
A person aged over 70 years is unlikely
[Name] is over 70 years of age and is recorded as
to be the child / foster child / stepchild of
the child / foster child / stepchild of [Name].
another household member.
Please verify this response.
E16
A parent is likely to be at least 13 years
[Name] is recorded as the parent of [Name] but is
older than their child.
less than 13 years older than them. Please verify
this response.
E17
It is unlikely that the age gap between
[Name] is recorded as [Name's] brother / sister,
siblings would be greater than 40 years.
but is over 40 years older than them. Please
verify this response.
NZHS Year 12 Child Questionnaire
53
Document 2
Exit
Thank you for talking with me about [Name’s] health. The Ministry of Health is very grateful
that you have given your time to provide this important information to them. Before we finish,
I would like to ask you a few more questions. Please note that any information you give me
from now on will
not be stored with your answers to the survey.
Recontact information for quality control
I would now like to collect some recontact information from you. This is so that my
Supervisor can call you in the next few weeks if there are any queries about the completion
of this survey or to check that you are happy with the way the interview was conducted.
C6.01 Is there a landline phone that my Supervisor can call you on?
1982
1
Yes [Specify] _________________ [only accept landline number format]
2
No
Act
C6.02 Do you have a cell phone number we could reach you on?
1
Yes [Specify] _________________ [only accept cell number format]
2
No
C6.03 Do you have an email address, in case we cannot contact you by telephone?
Information
1
Yes [Specify] _________________ [only accept email format]
2
No
Recontact information for follow-up research
Official
C6.04 I would now like to ask if you would be happy to be contacted within the next five
years about the possibility of [Name] being involved in follow-up health research of
the
importance to the Ministry of Health? Saying yes to this question won’t commit you or
[Name] to taking part in any further research, it just means we can contact you to ask.
1
Yes, you can contact me and ask if I want to help again
under
2
No, don’t contact me to help again [go to Data linkage introduction before C6.09]
If C6.01, C6.02 and C6.03 all=2 go to C6.06, otherwise go to C6.05.
C6.05 To recontact you for other health questions of importance to the Ministry of Health,
can we use the same phone number and email address you provided before?
Released
1
Yes [go to name and address C6.07]
2
No
C6.06 What phone number(s) and email address can we use to recontact you?
1
Landline number: ____________________ [only accept landline number format]
2
Cell phone number: ______________________ [only accept cell number format]
3
Email address: ______________________________ [only accept email format]
4
Do not record phone number(s) or email / Refused
NZHS Year 12 Child Questionnaire
54
Document 2
C6.07 Could I please also record your name and address? Remember that these details will
never be stored with your survey answers, to ensure that your survey results will
always be anonymous.
1
Yes, record my name and address
a. First name: ___________________________________ [mandatory field]
b. Surname: _________________________________________________
c. Street number and name: ________________________ [mandatory field]
d. Suburb: ______________________________________ [mandatory field]
e. City: _________________________________________ [mandatory field]
f.
Postcode: __________________________________________________
2
No, do
not record my name and address / Refused
C6.08 Could I also record [Name’s] full name and their address?
1982
Interviewer to update address if different to parent / guardian address.
1
Yes, record child’s name and address
Act
a. First name: ___________________________________ [mandatory field]
b. Middle name: _______________________________________________
c. Surname: _________________________________________________
d. Street number and name: ________________________ [mandatory field]
e. Suburb: ______________________________________ [mandatory field]
f.
City: _________________________________________ [mandatory field]
g. Postcode: _________________________________________________
Information
2
No, do not record child’s name and address / Refused
Consent for data linkage Official
The Ministry of Health would like to ask for your permission to combine the valuable
information you have provided about [Name] in this survey, with other information routinely
the
collected by government agencies. Combining the answers you have just given with other
information, such as education, income and housing, will help us to develop new ways to
improve the health and wellbeing of all New Zealanders.
under
To combine the information, the Ministry of Health needs your permission to use [Name’s]
name, address, gender and date of birth details. The Ministry is bound by the Privacy Act,
and these details will be kept secure and only used by approved staff for data linking.
[Name’s]
name, address and date of birth will be removed before the combined information
is made available to approved researchers. The combined information will only be used for
research purposes.
Released
C6.09 Are you willing for [Name’s] survey results to be linked with other information
routinely collected by government agencies?
1
Yes
2
No [go to Interviewer observations introduction before C6.15]
NZHS Year 12 Child Questionnaire
55
Document 2
C6.11 Can I please record [Name’s] name, address, date of birth and gender for data
linking? Please note:
• [Name’s] name, address, and date of birth will remain confidential and can only
be accessed by approved staff at the Ministry of Health or Statistics New
Zealand, for the purpose of linking data held by government agencies
• These details will be removed when the data has been linked (only the month
and year of birth will be retained)
• You have the right to change or access [Name’s] personal details (ie name,
address and date of birth).
To update a previously-recorded date, click on the date picker, select the month
and year from the drop-down lists, then
click on the correct day.
1
Yes
a. First name: ___________________________________ [mandatory field]
1982
b. Middle name: _______________________________________________
c. Surname: ____________________________________ [mandatory field]
Act
d. Street number and name: ________________________ [mandatory field]
e. Suburb: ______________________________________ [mandatory field]
f.
City: _________________________________________ [mandatory field]
g. Postcode: _________________________________________________
h. Date of birth: ____ (range [current year minus 15]–[current year])
[mandatory field]
Information
i.
Gender: ______________________________________ [mandatory field]
2
No, don’t record any of these details
If first name, surname, address, date of birth, or gender not provided, display the following
Official
message: In order to help us link [Name’s] data, would you mind providing [Name’s] full
name, address, date of birth and gender?
the
If only one initial provided for either first or last name, display the following message: In
order to help us link [Name’s] data, would you mind providing [Name’s] full first and last
name, rather than initials?
If two or more names entered into first or last name field, display the following message:
under
Two or more names entered into a single field, please check and use the middle name field
if applicable.
If date of birth recorded at C6.11≠C4.01, display the following message: Data linkage
date of birth (dd/mm/yyyy) does not match date of birth recorded earlier in the survey
(dd/mm/yyyy). Please check with respondent.
Released
NZHS Year 12 Child Questionnaire
56
Document 2
Interviewer observations – setting
Complete following observations without asking the respondent:
C6.15 Record if other people were in the room during any part of the questionnaire.
[Select all that apply]
1
Spouse / partner
2
Parent(s)
3
Other adult(s)
4
Child who took part in survey
5
Other child(ren)
6
Completed alone in room
Respondent burden assessment self-complete section
1982
The next questions will ask you about your experience of the survey process. [For VIP:
These questions are for you to answer on your own.] [For F2F: I will turn the computer
Act
towards you, so you can answer the questions privately.]
START OF SELF-COMPLETE.
CR1.01 Please rate on a scale of 1–5, where 1 is Absolutely NOT Acceptable and 5 is
Highly Acceptable:
Information
1
2
3
4
5
Absolutely
Highly
NOT
Acceptable
Acceptable
Survey length
Official
The number of questions
Complexity of questions
the
Intrusiveness of questions
If VIP Survey and CQ1=2 (adult survey not yet completed) or CQ2=2 (adult survey
under
completed, but by different person to child survey), ask CR1.05 and CR1.06.
CR1.05 These next questions ask about your experience of taking part
online.
Please rate the following statements on a scale of 1–5, where 1 is Strongly
Disagree and 5 is Strongly Agree:
Released
1
2
3
4
5
Strongly
Strongly
Disagree
Agree
It was easy to book an appointment
The survey website was easy to
use
It was easy to communicate with
the interviewer
I felt comfortable to provide honest
answers
Overall, I enjoyed taking part online
NZHS Year 12 Child Questionnaire
57
Document 2
CR1.06 Did you encounter any problems with making an appointment, or taking part online?
1
Yes [Specify]
__________________
2
No
CR1.02 Would you take part in the New Zealand Health Survey again?
1
Yes [go to CR1.04]
2
No [go to CR1.03]
CR1.03 Please indicate why you would not take part again:
[Select all that apply]
1
Took too long
2
Too many questions
1982
3
Questions were too personal
4
Questions were not relevant
5
Survey was too repetitive
Act
6
Lost interest
7
Other [Specify]
_________________
CR1.04 Are there any other comments you would like to make about taking part in the
survey?
1
Yes [Specify] __________________ Information
2
No
Thank you for answering those questions; please click ‘Next’. [For F2F: Please hand the
computer back.]
Official
END OF SELF-COMPLETE SECTION.
New screen.
the
For VIP, go to Thank you.
The rest of the questionnaire is collected in the Sample Manager tool.
under
Released
NZHS Year 12 Child Questionnaire
58
Document 2
Health measurements
If the measurements section is completed first (eg after the adult measurements and
before the child interview) ask:
Could you please tell me which of these age groups [Name] belongs to?
Age is asked as these questions depend on the child’s age.
1
Birth–11 months
2
12–23 months (1 year old)
3
2–4 years
4
5–9 years
5
10–14 years
.K Don’t know
.R Refused
1982
If the measurements section is completed at the end of the child questionnaire:
If child is aged 0–23 months old say: That’s the end of the questionnaire. [go to Thank
Act
you section].
If child aged 2–4 years old say: That’s the end of the questionnaire. I would now like to
measure [Name’s] height and weight.
Is this a good time for me to get measurements from [Name]?
1
Yes
2
No [MAKE A TIME TO VISIT WHEN CHILD IS HOME]
Information
If child aged 5+ years old say: That’s the end of the questionnaire. I would now like to
measure [Name’s] height, weight and waist circumference.
Official
Is this a good time for me to get measurements from [Name]?
1
Yes
the
2
No [MAKE A TIME TO VISIT WHEN CHILD IS HOME]
To child:
While I’m setting up the equipment, could you please remove your shoes and
any
heavy clothing so that we get the measurements right… Thank you.
under
For children aged 5–14, say: I am now going to take three measurements from you:
height, weight and waist, in that order.
For children aged 2–4, say: I am now going to take two measurements from you: height
and weight, in that order.
Released
I'm then going to take those measurements again, and if any of the second measures are
not close enough to the first ones, I'll measure you for a third time.
NZHS Year 12 Child Questionnaire
59
Document 2
Height
If aged 2 years and over.
Now I would like to measure your height.
Please stand with your back to the door / wall. Put your feet together and move them back
until your heels touch the door / wall. Stand up straight and look straight ahead.
If head is not in Frankfort Plane say…
Please raise / lower your chin. Take a deep breath and hold it.
Take measurement when breath is held and say it aloud.
That’s fine, you can breathe normally now and step away from the door / wall.
CM1.0 1st reading 0.000 (m)
1982
.R
Respondent refused to have height recorded
777
Respondent unable to have height recorded (eg chairbound, too unsteady
on feet, in pain etc.)
Act
Check any measurements that fall below the 1st percentile or above the 99th percentile.
Weight
If aged 2 years and over.
Wait until it turns zero. Please step onto the centre of the scale with your weight on both feet.
Relax [take reading]. Thank you. You can step off now.
Information
CM2.0 1st reading 000.0 (kg)
.R
Respondent refused to have weight recorded
777
Respondent unable to have weight recorded (eg chairbound, too unsteady
Official
on feet, in pain etc.)
Check any measurements that fall below the 1st percentile or above the 99th percentile.
the
Waist
If aged 5 years and over.
under
Please stand in a relaxed position. Take the end of the tape, pass it around your waist and
hand it back to me. Please help me to position the tape at the level of your waist. Good, now
just breathe normally [take measurement at end of breath out]. Thank you.
CM3.0 1st reading 000.0 (cm)
Released
.R
Respondent refused to have waist circumference recorded
777
Respondent unable to have waist circumference recorded
Check any measurements that fall below the 1st percentile or above the 99th percentile.
Computer repeats prompts as above and automatically does calculation if 3rd reading is
required – if more than 1% difference between first and second reading, a third reading is
required.
NZHS Year 12 Child Questionnaire
60
Document 2
Thank you
On behalf of the Ministry of Health, thank you once again for talking with me about [Name’s]
health.
[For F2F: Here is a small gift from the Ministry in recognition of your time.
Give Thank You card and koha.
Inside the card is a list of phone numbers you can call if you would like more information or
advice. If you’d prefer, I can arrange for this to be emailed to you along with the consent
form(s).]
[For VIP: We would like to email you a Thank you card (with a list of phone numbers you can
call if you would like more information or advice), along with the consent form(s).]
1982
If you’d rather not receive these items, that’s completely fine.
Act
1
Yes, please email to me
[Specify]
_______________ [only accept email format]
2
No, don’t email
End survey.
Information
Official
the
under
Released
NZHS Year 12 Child Questionnaire
61
Document 3
1982
Act
New Zealand Health Survey
Information
Adult Questionnaire (Year 13)
1 July 2023 – 30 June 2024
Official
the
under
In field July 2023
Released
NZHS Year 13 Adult Questionnaire
1
Document 3
Table of Contents
Overview and programming information ............................................................... 4 Informed consent ..................................................................................................... 7 Initial demographics and overall wellbeing self-complete section ...................... 8
Age group ............................................................................................................... 8
Sex and gender ...................................................................................................... 8
Overall life satisfaction and family wellbeing ........................................................... 9
Long-term health conditions ................................................................................. 10
Heart disease ....................................................................................................... 10
Stroke ................................................................................................................... 11
Diabetes ............................................................................................................... 12
Asthma ................................................................................................................. 12
1982
Arthritis ................................................................................................................. 13
Chronic pain ......................................................................................................... 14
Migraines .............................................................................................................. 15
Act
Hysterectomy self-complete section ..................................................................... 16
Oral health ............................................................................................................ 16
Interviewer observations – language / cognitive assistance ............................. 18 Health service utilisation ....................................................................................... 19
Usual primary health care provider ....................................................................... 19
General practitioners ............................................................................................ 20
Nurses at general practices and medical centres ................................................. 22
Information
Emergency department ........................................................................................ 23
Dental health care workers ................................................................................... 24
Getting help for mental health and substance use issues ..................................... 25
Health behaviours and risk factors ....................................................................... 28
Official
High blood pressure .............................................................................................. 28
High cholesterol .................................................................................................... 28
the
Body size self-complete section............................................................................ 29
Physical activity .................................................................................................... 30
Sleep .................................................................................................................... 33
Tooth brushing ...................................................................................................... 34
under
Tobacco ................................................................................................................ 36
Vaping and electronic cigarettes ........................................................................... 40
Dietary habits ........................................................................................................ 42
Alcohol .................................................................................................................. 44
Drugs .................................................................................................................... 48
Health status ........................................................................................................... 51
Released
General health question ........................................................................................ 51
Functional difficulties – Washington Group Enhanced Short Set .......................... 51
Mental health – K10 .............................................................................................. 54
Socio-demographics .............................................................................................. 57
Date of birth .......................................................................................................... 57
Ethnic group(s) ..................................................................................................... 57
Country of birth and languages ............................................................................. 58
Racial discrimination ............................................................................................. 59
Education .............................................................................................................. 62
Income sources .................................................................................................... 64
NZHS Year 13 Adult Questionnaire
2
Document 3
Income self-complete section ............................................................................... 65
Work and study ..................................................................................................... 67
Medical insurance ................................................................................................. 68
Housing ................................................................................................................ 69
Sexual identity self-complete section .................................................................... 70
Exit ........................................................................................................................... 71
Recontact information for quality control ............................................................... 71
Recontact information for follow-up research ....................................................... 71
Consent for data linkage ....................................................................................... 72
Interviewer observations – setting and assistance ............................................... 73
Respondent burden assessment self-complete section ........................................ 74
Household composition ........................................................................................ 76
Gender and age .................................................................................................... 76
Relationships ........................................................................................................ 76
1982
Health measurements ............................................................................................ 78
Blood pressure ..................................................................................................... 78
Act
Height ................................................................................................................... 80
Weight .................................................................................................................. 80
Waist ..................................................................................................................... 81
Thank you ............................................................................................................... 82
Child health component ........................................................................................ 82
Information
Official
the
under
Released
NZHS Year 13 Adult Questionnaire
3
Document 3
Overview and programming information
Design
Each year for the New Zealand Health Survey, approximately 14,000 adults are interviewed face-to-
face (in person) and remotely using computer software (a virtual interface platform). Interviews are
administered using a combination of computer-assisted personal interviewing (CAPI) and computer-
assisted self-interviewing (CASI). Key topics include long-term health conditions, health status and
behaviours and health service utilisation. Anthropometric measurements (height, weight and waist
circumference) and blood pressure are also taken. NZHS collects information that cannot be obtained
more effectively or efficiently through other means, such as by analyses of hospital administrative
records, disease registries or epidemiological research.
Text Format
Examples
1982
Black
Text read by interviewer or respondent:
The next set of questions is about nurses who
Act
introductions, questions / question options
work at general practices and medical centres
Blue
Showcard note positioned above a question [Showcard]
Multiple response allowed for a question
[Select all that apply]
Instructional text specifically for interviewers Record to nearest hour
Other [Specify]
Information
Text read verbatim to respondents
Say “We can skip this section then”
Interviewer observations: section completed
Complete following observations without
unobtrusively (solely) by interviewer
asking the respondent
Official
Tool tips or Showcards with a ⚐ symbol,
Here is a list of examples of specialist
contain information that only appears if the
doctors ⚐
the
mouse pointer hovers over the underlined
words, or if underlined words are touched
with a finger
under
Purple
Text specifically for questionnaire readers,
Toothpaste picture showcard needs updating if
not displayed on screen
there are any major changes in the market
Red
Programmer information, instructions, alerts
Calculated age must be ≥15 years
and headings, not displayed on screen
Released
Abbreviations used in programming text
Respondent interviewed in person by
F2F
Face-to-face
interviewer
Survey tool enabling remote interviewing via
VIP
Virtual Interface Platform
computer software
NZHS Year 13 Adult Questionnaire
4
Document 3
Key Edit Checks
Description
Type
Single and multiple-
For each question, only one answer can be selected, except
Hard edit
choice responses
for multiple-choice questions, represented by the instruction
[Select all that apply].
Exclusive answer
Don't know, Refused / Prefer not to say, Doesn’t apply, None
Hard edit
options
of the above, None, and No treatment are all exclusive
responses, ie they cannot be selected in conjunction with other
responses.
Range checks
For numeric response questions, the data entered must fall
Hard edit
within a certain range. Range checks prompt interviewers to
change an answer falling outside the pre-set range
parameters. For example, a person cannot enter an amount 1982
more than $199.00 for the cost of GP visits.
Confirmation checks
For some questions, the survey prompts the interviewer to
Act Soft edit
check a response which may be unlikely, or which may be
incompatible with previous answers. For example, a person is
unlikely to usually sleep for less than 4 hours in a 24 hour
period.
Consistency checks
Some checks enforce consistency of responses between
Hard edit
questions. When edit checks are triggered, the interviewer or
Information
respondent must go back and change their answer to ensure
response consistency. For example, if a person reports that
they have used an emergency department (ED) in the past 12
months, when they are later asked to report the number of
times they have used an ED, this response must be greater
than zero.
Official
Completeness checks
For some of the grid-style questions, where multiple items /
the
Hard edit
statements are combined into a table, each row must contain a
response. For example, relationship information is captured for
every pair of occupants in a household. This is recorded in a
grid format and each row must be completed.
under
Hard edit checks require the interviewer / respondent to change the data they have entered before
continuing. Soft edit checks provide an opportunity to check a response, and if applicable, change the
data entered before continuing; however, the original response entered can also be retained.
Released
Showcards
Showcard tablet
Answer options are visible for some questions on a separate tablet device
which the respondent views during the survey.
Response option
Selected options are allocated numbers allowing respondents to discretely
numbering
provide a response; ie to call out a number opposed to the descriptive text.
NZHS Year 13 Adult Questionnaire
5
Document 3
Year 13 Modules
Perceived body size
The three perceived body size questions provide alternatives to the physical
measurement of height and weight.
Washington Group
The six extra items in the Washington Group Enhanced Short Set
Enhanced Short Set
supplement the existing six items of the Washington Group Short Set in the
core questionnaire.
Migraine clip-on
Five questions on migraines to determine the prevalence of migraines and
compare to rates of being diagnosed with migraine.
Tobacco and vaping
The core and module questions have been mixed to make the questions
flow. Core questions start with ‘A’ and module questions start with ‘TOB’.
Racial discrimination
These six questions focus on how respondents may be viewed by others in
1982
terms of their ethnicity, how often respondents may think about their
ethnicity, and whether they have experienced discrimination because of their
ethnicity.
Act
Information
Official
the
under
Released
NZHS Year 13 Adult Questionnaire
6
Document 3
Informed consent
Before we begin, I need to check that:
• You have read and understand the information pamphlet on the New Zealand Health
Survey. You know you can ask questions at any time and you can contact Reach
Aotearoa or the Ministry of Health if you want further information.
• You know that you can stop the interview at any time and you don’t have to answer
every question. There is no disadvantage to you if you don’t want to take part, or if
you choose to stop at any time.
• You know that your participation in the New Zealand Health Survey is confidential
and no information that could identify you will ever be used in any reports. All your
answers are protected by the Privacy Act 2020.
AC.01 You agree to take part in the New Zealand Health Survey on behalf of: 1982
1
Yourself [Only display for respondents aged 15 years and over]
2
An adult who is unable to provide consent, and for whom you have Enduring
Act
Power of Attorney for their personal care and welfare, or for whom you are the
welfare guardian [Only display for respondents aged 16 years and over]
3
A person aged 15 years whom you are the parent / legal guardian of [Only
display for respondents aged 15 years]
If AC.01=1 and respondent is 15 years of age, ask AC.02:
Information
AC.02 Has the parent / legal guardian of the survey respondent consented to them taking
part?
1
Yes
2
No
Official
If AC.02=2, display message: Consent must be provided by a parent / legal guardian
for 15 year old respondents to complete the survey themselves. Please obtain consent
the
before continuing.
AC.03 You agree for parts of this survey to be audio recorded for quality monitoring and you
understand that any recording will be anonymous.
under
1
Yes
2
No
Released
NZHS Year 13 Adult Questionnaire
7
Document 3
Initial demographics and overall wellbeing self-
complete section
[For VIP survey insert: Before we begin, can I please check that you are in a private space,
where our conversation will not be overheard?
If the answer is ‘No’, request that the respondent find a private space before you
continue. Alternatively, rearrange the interview to a time when the respondent will have
privacy.
I’l just explain some key features of this video interview:
• Three types of questions will be asked: questions that include an option list for you to
select from; yes or no questions that do not include an option list; and questions that
are more personal, that you can complete yourself.
1982
• To pause the survey at any time, just click the pause button at the top right of the
screen. To turn off your camera or microphone, select the camera or microphone
Act
icons below the video feed. If you need help with your audio or video, using
headphones, or help with anything else, just let me know.]
New screen.
The first section asks about age group, sex, gender, and wellbeing. Age group and sex are
asked here so that only questions which apply to you are asked in the survey.
These questions are for you to answer on your own. [For F2F survey insert: I will turn the
Information
computer towards you, so you can answer the questions privately.] If you need help, I can
show you what to do.
I can also read the questions out, and you can answer by calling out the option number
[For F2F survey insert: from the Showcard] that best applies to you.
Official
START OF SELF-COMPLETE.
the
Age group
[Showcard]
AD.02 Which of these age groups do you belong to?
under
1
15–19 years
2
20–24 years
3
25–34 years
4
35–44 years
5
45–54 years
6
55–64 years
Released
7
65–74 years
8
75+ years
Sex and gender
[Showcard]
AD.01a At birth, what was your sex recorded as?
1
Male
2
Female
3
Another term
NZHS Year 13 Adult Questionnaire
8
Document 3
[Showcard]
AD.01b What is your gender?
A person's gender may be different from their sex at birth. Gender refers to a
person's social and personal identity as male, female, or another gender such as
non-binary.
1
Male
2
Female
3
Another gender please specify, if you are comfortable doing so [Other screen
text: (leave blank if you do not wish to specify)] [Allow blank if respondent does
not volunteer any detail] [To be programmed from the codefile from StatsNZ
after interview – ie NOT by respondent / interviewer]
Overall life satisfaction and family wellbeing
1982
[Showcard]
AMH2.01 This is a general question about your life as a whole these days. This includes all
Act
areas of your life.
Where zero is completely dissatisfied, and ten is completely satisfied, how do you
feel about your life as a whole?
_____ (range 0–10)
.K I don’t know
.R Prefer not to say
Information
[Showcard]
AMH2.02 Now, a question about your family. Please think in general about how your family
is doing.
Official
Where zero means extremely badly and ten means extremely well, how would you
rate how your family is doing these days?
the
If necessary: Include all areas of life for your family.
If necessary: Your 'family' is the group of people you think of as your family.
_____ (range 0–10)
under
11 I don’t have any family
12 I can’t define my family
.K I don’t know
.R Prefer not to say
New screen.
Released
Thank you for answering these questions; please click ‘Next’. [For F2F survey insert:
Please return the computer to the interviewer and they will continue the questionnaire.]
END OF SELF-COMPLETE SECTION.
NZHS Year 13 Adult Questionnaire
9
Document 3
Long-term health conditions
The next section of the Health Survey is about
long-term health conditions you may have.
A long-term health condition is a
physical or mental condition that has lasted, or is
expected to last, for
more than six months. The symptoms may come and go, or be
present all the time.
Heart disease
The first few questions are about heart disease. Please
do not include high blood pressure
or high blood cholesterol here, as I will ask you about those later.
A1.01 Have you ever been told by a doctor that you have had a heart attack?
1
Yes
1982
2
No [go to angina A1.04]
.K Don’t know [go to A1.04]
Act
.R Refused [go to A1.04]
A1.02 Have you ever been admitted to hospital with a heart attack?
1
Yes
2
No [go to angina A1.04]
.K Don’t know [go to A1.04]
.R Refused [go to A1.04]
Information
A1.03 Was this in the last 12 months?
1
Yes
2
No
Official
.K Don’t know
.R Refused
the
A1.04 Have you ever been told by a doctor that you have angina?
If clarification is required, angina is typically chest pain when you walk or do
exercise.
under
1
Yes
2
No
.K Don’t know
.R Refused
A1.05 Have you ever been told by a doctor that you have heart failure? That is,
Released
inadequate heart pumping, or a build-up of fluid in the lungs or legs.
1
Yes
2
No
.K Don’t know
.R Refused
NZHS Year 13 Adult Questionnaire
10
Document 3
A1.06 Have you ever been told by a doctor that you have any other heart disease? Please
include problems with heart rhythm and heart valves, but not high blood pressure or
high cholesterol.
1
Yes
2
No
.K Don’t know
.R Refused
Ask A1.07 if respondent answered ‘Yes’ to one or more of A1.01, A1.04, A1.05 or A1.06.
Everyone else go to Stroke A1.10.
[Showcard]
A1.07 What treatments do you
now have for your heart condition(s)?
[Select all that apply]
1982
Probe “Any others?” until no other treatment mentioned.
Don’t include surgery the respondent has had or is scheduled to have in the
future.
Act
1
No treatment [cannot be selected with other options]
2
Aspirin
3
Other medicines, tablets or pills (including spray under the tongue, patches on
the skin and blood thinners)
4
Diet
5
Exercise
Information
77 Other [Specify]
_________________
.K Don’t know
.R Refused
A1.09 Have you ever had bypass surgery or angioplasty for your heart condition(s)?
Official
If asked: Angioplasty is a procedure that helps improve your blood supply to the
heart muscle. A tube is inserted into one of your arteries through an incision in your
groin, wrist or arm. The doctor then directs the tube into a blocked or narrow heart
the
artery, which expands the artery and allows the blood to flow more easily to the
muscle. Often, a stent will be inserted at this time.
1
Yes
under
2
No
.K Don’t know
.R Refused
Stroke
Released
A1.10 Have you ever been told by a doctor that you have had a
stroke? Please do not
include “mini-stroke” or transient ischaemic attack (or TIA).
1
Yes
2
No [go to Diabetes A1.12]
.K Don’t know [go to A1.12]
.R Refused [go to A1.12]
NZHS Year 13 Adult Questionnaire
11
Document 3
[Showcard]
A1.11 What treatments do you
now have for your stroke?
[Select all that apply]
1
No treatment [cannot be selected with other options]
2
Aspirin
3
Other medicines, tablets or pills
4
Diet
5
Exercise or rehabilitation (include speech therapy, occupational therapy,
physiotherapy)
77 Other [Specify]
_________________
.K Don’t know
.R Refused
1982
Diabetes
A1.12 Have you ever been told by a doctor that you have diabetes?
Act
If respondent’s sex is female (AD.01a=2) insert: Please do
not include diabetes
during pregnancy.
1
Yes
2
No [go to Asthma A1.15]
.K Don’t know [go to A1.15]
.R Refused [go to A1.15]
Information
A1.13 How old were you when you were first told by a doctor that you had diabetes?
If from birth record 0.
_____ years (range 0–120)
.K Don’t know
Official
.R Refused
the
[Showcard]
A1.14 What treatments do you
now have for your diabetes?
[Select all that apply]
under
1
No treatment [cannot be selected with other options]
2
Insulin injections
3
Medicines, tablets or pills
4
Diet
5
Exercise
77 Other [Specify]
_________________
.K Don’t know
Released
.R Refused
Asthma
A1.15 Have you ever been told by a doctor that you have asthma?
1
Yes
2
No [go to Arthritis A1.18]
.K Don’t know [go to A1.18]
.R Refused [go to A1.18]
NZHS Year 13 Adult Questionnaire
12
Document 3
A1.16 In the last 12 months, have you had an attack of asthma?
1
Yes
2
No
.K Don’t know
.R Refused
[Showcard]
A1.17 What treatments do you
now have for asthma?
[Select all that apply]
1
No treatment [cannot be selected with other options]
2
Inhalers
3
Medicines, tablets or pills
77 Other [Specify]
_________________
1982
.K Don’t know
.R Refused
Act
Arthritis
A1.18 Have you ever been told by a doctor that you have arthritis? Please include
gout,
lupus and psoriatic arthritis.
1
Yes
2
No [go to Chronic pain A1.29]
Information
.K Don’t know [go to A1.29]
.R Refused [go to A1.29]
[Showcard]
A1.19 What kind of arthritis was that? Official
[Select all that apply]
the
1
Rheumatoid
2
Osteoarthritis
3
Gout
4
Psoriatic
under
5
Systemic lupus erythematosus (SLE)
77 Other [Specify]
_________________
.K Don’t know [go to treatments A1.21]
.R Refused [go to A1.21]
Ask A1.20 if respondent has more than one kind of arthritis in A1.19.
Released
[Showcard]
A1.20 Which kind of arthritis affects you most?
1
Rheumatoid
2
Osteoarthritis
3
Gout
4
Psoriatic
5
Systemic lupus erythematosus (SLE)
77 Other ([pipe through response from A1.19=77])
.K Don’t know
.R Refused
NZHS Year 13 Adult Questionnaire
13
Document 3
[Showcard]
A1.21 What treatments do you
now have for arthritis?
[Select all that apply]
Don’t include surgery the respondent has had or is scheduled to have in the
future.
1
No treatment [cannot be selected with other options]
2
Medicines, tablets or pills (including painkillers)
3
Exercise or physiotherapy
4
Injections
5
Diet
77 Other [Specify]
_________________
.K Don’t know
.R Refused
1982
A1.22 Have you ever had an operation or surgery because of your arthritis?
1
Yes
Act
2
No
.K Don’t know
.R Refused
[Showcard]
A1.22a Are you now limited in any way, in your usual activities, because of arthritis
symptoms?
Information
1
Yes, limited a lot
2
Yes, limited a little
3
No, not limited at all
.K Don’t know
Official
.R Refused
the
Chronic pain
A1.29 Do you experience chronic pain? This is pain that is present almost every day, but
the intensity of the pain may vary. Please only include pain that has lasted, or is
under
expected to last, for
more than six months.
This includes chronic pain that is reduced by treatment.
1
Yes
2
No
.K Don’t know
.R Refused
Released
NZHS Year 13 Adult Questionnaire
14
Document 3
Migraines
M1.50 Have you had a headache in the
last three months?
1
Yes [go to A1.51]
2
No [go to A1.54]
.K Don’t know [go to A1.54]
.R Refused [go to A1.54]
M1.51 Has a headache limited your activities for
a day or more in the
last three months?
Activities refers to work, study, play or other things you need to do in the day.
1
Yes
2
No
.K Don’t know
.R Refused
1982
M1.52 Are you nauseated or sick to your stomach when you have a headache?
Act
If respondent answers ‘sometimes’, code this as ‘yes’.
1
Yes
2
No
.K Don’t know
.R Refused
M1.53 Does light bother you when you have a headache?
Information
If respondent answers ‘sometimes’, code this as ‘yes’.
1
Yes
2
No
.K Don’t know
Official
.R Refused
the
L1.29g Have you ever been told by a doctor that you have migraines?
1
Yes
2
No
under
.K Don’t know
.R Refused
Released
NZHS Year 13 Adult Questionnaire
15
Document 3
Hysterectomy self-complete section
Ask L1.29t if sex is female (AD.01a=2) and aged 20 years and over (AD.02≠1). Otherwise
go to Oral health introduction.
The next question is for you to answer on your own. If you need help, I can show you what
to do.
I can also read the question out, and you can answer by calling out the option number.
START OF SELF-COMPLETE.
L1.29t Have you had a hysterectomy, that is, when your uterus or womb is removed?
1
Yes
2
No
.K I don’t know
1982
.R Prefer not to say
Act
New screen.
Thank you for answering this question; please click ‘Next’. [For F2F survey insert: Please
return the computer to the interviewer and they will continue the questionnaire.]
END OF SELF-COMPLETE SECTION.
Oral health
Information
The next questions are about your teeth, gums and mouth. When I say dental health care
worker, I mean dentists, dental therapists (used to be called dental nurses), as well as any
dental health specialists such as orthodontists.
Official
A1.30 How many of your teeth have been removed by a dental health care worker because of
tooth decay, an abscess, infection or gum disease? Do not include teeth lost for other
the
reasons such as injury, crowded mouth or orthodontics.
Includes teeth that were removed while overseas (as well as in New Zealand).
Includes baby teeth and wisdom teeth
ONLY if removed because of tooth decay,
an abscess, infection or gum disease.
Most adults grow 32 teeth in total.
under
_____ teeth (range 0–32) [if 0 teeth removed, go to health of mouth A1.31a]
99 All of my teeth have been removed because of tooth decay or gum disease
.K Don’t know [go to A1.31a]
.R Refused [go to A1.31a]
Released
A1.31 Were any of these teeth removed in the last 12 months?
1 Yes
2
No
.K Don’t know
.R Refused
NZHS Year 13 Adult Questionnaire
16
Document 3
Ask all respondents following question, A1.31a.
[Showcard]
A1.31a How would you describe the health of your teeth or mouth?
1
Excellent
2
Very good
3
Good
4
Fair
5
Poor
.K Don’t know
.R Refused
1982
Act
Information
Official
the
under
Released
NZHS Year 13 Adult Questionnaire
17
Document 3
Interviewer observations – language / cognitive
assistance
Complete following observations without asking the respondent:
If the survey is completed on behalf of the respondent by someone with EPOA (Enduring
Power of Attorney), or by the respondent’s welfare guardian (AC.01=2), auto code A6.13=2
and A6.12=2 and go to A6.14.
A6.13 Interview is being conducted with
language assistance from a
family member /
friend of respondent.
Only code ‘Yes’ if the respondent has required more than a couple of questions to
be interpreted.
1
Yes
1982
2
No
Act
A6.12 Interview is being conducted with
cognitive assistance from a
family member /
caregiver.
Only code ‘Yes’ if the respondent has required more than a couple of questions to
be answered completely on their behalf.
1
Yes
2
No
Information
A6.14 Interview is being conducted with
language assistance from a
professional
translator.
1
Yes
2
No
Official
the
under
Released
NZHS Year 13 Adult Questionnaire
18
Document 3
Health service utilisation
The next set of questions is about your use of health care services, for your
own health, in
New Zealand.
Usual primary health care provider
A2.01 Do you have a
general practice or medical centre that you
usually go to when you
are feeling unwell or are injured?
Do not include emergency department (ED).
1
Yes
2
No [go to General practitioners introduction before A2.13a]
.K Don’t know [go to introduction before A2.13a]
.R Refused [go to introduction before A2.13a]
1982
From now on, we’l call this place your
usual medical centre.
Act
A2.03a Have you been to your usual medical centre, for your
own health, in the
past 12
months?
1
Yes
2
No [go to General practitioner introduction before A2.13a]
.K Don’t know [go to introduction before A2.13a]
.R Refused [go to introduction before A2.13a]
Information
[Showcard]
A2.040
At your
usual medical centre have you had an appointment with any of the
following health care workers about your own health, in the
past 12 months?
[Select all that apply]
Official
1 GP (general practitioner or family doctor)
2 Nurse
the
3 Physiotherapist
4 Mental health professional (eg psychologist or counsellor)
5 Dietitian
77 Another health care worker [Specify]
________________
under
0 None of the above [cannot be selected with other options]
.K Don’t know
.R Refused
If A2.03a=1 and A2.040=0, display message: Consistency check In question A2.03a
you recorded that the respondent had visited their usual medical centre, but in A2.040 you
Released
recorded that they have not had an appointment at their medical centre. Verify answers with
respondent. Go back to A2.03a or change this response.
NZHS Year 13 Adult Questionnaire
19
Document 3
General practitioners
These next questions are about seeing general practitioners (GPs) or family doctors.
This
can be at your
usual medical centre or
somewhere else.
GP – utilisation
A2.13a How many times did you see a GP in the past 12 months? This may have been
about your physical health, or your mental or emotional health.
_____ times (range 1–99)
0
Haven’t seen a GP in last 12 months [go to GP – barriers to access A2.33a]
.K Don’t know [go to A2.33a]
.R Refused [go to A2.33a]
1982
If A2.040=1 and A2.13a=0, display message: Consistency check In question A2.040
you recorded that the respondent had visited a GP at their usual medical centre, but in
A2.13a you recorded that they haven’t seen a GP. Verify answers with respondent. Go back
Act
to A2.040 or change this response.
A2.16 Thinking about your last visit to a GP, what were you charged for that visit?
Record amount in dollars and cents, eg $60=60.00.
If respondent says between two amounts, record the average in dollars and cents
(eg between $40 and $50: record 45.00).
Information
If free enter 0.00.
If respondent says an amount greater than $199, record as $199.00.
Can give an estimate if exact amount unknown.
$___.___ (range 0.00–199.00) Official
.K Don’t know
.R Refused
the
GP – barriers to access
A2.33a In the past 12 months, was there a time when you had a medical problem but did
not visit a GP because of cost?
under
1
Yes
2
No
.K Don’t know
.R Refused
Released
NZHS Year 13 Adult Questionnaire
20
Document 3
[Showcard]
A2.360 In the
past 12 months, was there a time when you had a
medical problem but did
not visit a GP for any of the following reasons?
[For VIP survey insert: You may need to scroll down to see all the answer options.]
[Select all that apply]
Read each response option aloud and allow respondents to respond to each
option.
Please exclude not visiting a GP because of cost.
1
Time taken to get an appointment too long
2
Owed money to the medical centre
3
Dislike or fear of the GP
4
Difficult to take time off work
5
No transport or too far to travel
1982
6
Could not arrange childcare or care for a dependent adult An adult who is ill
or disabled
7
Didn’t have a carer, support person or interpreter to go with you
Act
77 Another reason [Specify]
_________________
0
None of the above [cannot be selected with other options]
.K Don’t know
.R Refused
A2.35a In the past 12 months, was there a time when you got a prescription for yourself,
but did not collect one or more prescription items from the pharmacy or chemist
Information
because of cost?
1
Yes
2
No
.K Don’t know
Official
.R Refused
the
under
Released
NZHS Year 13 Adult Questionnaire
21
Document 3
Nurses at general practices and medical centres
The next set of questions is about nurses who work at general practices and medical
centres.
Please do
not include nurses who may have visited you at home or seen you in a hospital.
Also, don’t include midwives or dental nurses.
A2.41a In the past 12 months, have you seen a nurse at a general practice or medical
centre, about your own health? This may have been about your physical health, or
your mental or emotional health.
1
Yes
2
No [go to emergency department introduction before A2.69]
.K Don’t know [go to introduction before A2.69]
.R Refused [go to introduction before A2.69]
1982
If A2.040=2 and A2.41a=2, display message: Consistency check In question A2.040
Act
you recorded that the respondent had visited a nurse at their usual medical centre, but in
A2.41a you recorded that they haven’t seen a nurse. Verify answers with respondent. Go
back to A2.040 or change this response.
A2.42a How many times in the past 12 months did you see a nurse
as part of a GP
consultation? This includes seeing the nurse before or after seeing the GP.
If none enter 0.
_____ times (range 0–99)
Information
.K Don’t know
.R Refused
If A2.42a is more than A2.13a, display message: Consistency check: The number of
times respondent saw a nurse as part of a GP consultation in the past 12 months (A2.42a)
Official
should not be more than the number of times they saw a GP in the past 12 months (A2.13a).
Go back to A2.13a or change this response.
the
A2.43a How many times in the past 12 months did you see a nurse
without seeing a GP at
the same visit?
If none enter 0.
under
_____ times (range 0–99)
.K Don’t know
.R Refused
If A2.41a=1 and A2.42a=0 and A2.43a=0, display message: Consistency check If
A2.41a=1 (saw a nurse), then number of times at A2.42a OR A2.43a should be >=1. Go
Released
back to A2.41a OR go back to A2.42a OR change this response.
NZHS Year 13 Adult Questionnaire
22
Document 3
Emergency department
The next questions are about your use and experience of emergency departments at public
hospitals for your
own health.
A2.69 In the past 12 months, how many times did you go to an emergency department at a
public hospital about your own health?
_____ times (range 0–99) [if 0 go to Dental healthcare workers introduction before
A2.91]
.K Don’t know [go to Dental healthcare workers introduction before A2.91]
.R Refused [go to Dental healthcare workers introduction before A2.91]
[Showcard]
A2.720
Thinking about your last visit to an emergency department for your own health, what
were
all the reasons you went?
1982
[Select all that apply]
Read each response option aloud and allow respondents to respond to each
option.
Act
If respondent says they were taken by ambulance or sent by someone such as a
GP, Option 1 should be selected.
1
Condition appeared serious / life threatening; or sent by GP
2
GP or after-hours too expensive
3
Time of day / day of week (outside of usual medical centre hours)
4
Time taken to get an appointment was too long at usual medical centre
Information
77 Another reason [Specify]
_________________
.K Don’t know [go to Dental health care workers introduction before A2.91]
.R Refused [go to Dental health care workers introduction before A2.91]
Ask next question if more than one of the Options 1–4/77 selected in A2.720. Only show
Official
responses that were selected in A2.720 (as well as .K and .R).
[Showcard]
the
A2.730 What was the
main reason you went to a hospital emergency department?
1
Condition appeared serious / life threatening; or sent by GP
2
GP or after-hours too expensive
under
3
Time of day / day of week (outside of usual medical centre hours)
4
Time taken to get an appointment was too long at usual medical centre
77 Another reason ([pipe through response from A2.720])
.K Don’t know
.R Refused
Released
NZHS Year 13 Adult Questionnaire
23
Document 3
Dental health care workers
These next questions are about dental health care services you have used in
New Zealand.
When I say “dental health care worker”, I mean dentists, dental therapists (used to be called
dental nurses), dental hygienists, as well as any dental health specialists such as
orthodontists.
Dental health care workers – utilisation
[Showcard]
A2.91 How long has it been since you last visited a dental health care worker about your
own dental health, for any reason?
1
Within the past year (less than 12 months ago)
1982
2
Within the past two years (more than 1 year but less than 2 years ago)
3
Within the past five years (more than 2 years but less than 5 years ago)
Act
4
Five or more years ago
5
Have never seen a dental health care worker
.K Don’t know
.R Refused
[Showcard]
A2.95 Which of the following statements best describes the regularity of your consultations
with a dental health care worker?
Information
1
I visit a dental health care worker at least every two years for a check up
2
I visit a dental health care worker for check-ups regularly, but with intervals of
more than two years
3
I only visit a dental health care worker when I have a toothache or other similar
Official
trouble
4
I never visit a dental health care worker
the
.K Don’t know
.R Refused
under
Dental health care workers – barriers to access
A2.95a In the last 12 months, have you avoided going to a dental health care worker
because of the cost?
1
Yes
2
No
.K Don’t know
Released
.R Refused
NZHS Year 13 Adult Questionnaire
24
Document 3
Getting help for mental health and substance use issues
This section is about your contact with health professionals and other people for any
concerns you might have about your
emotions, stress, mental health, or substance use.
By substance use, we mean use of alcohol or drugs. Please don’t include tobacco products.
[Showcard]
AMH1.07a In the
past 12 months, have you consulted any of the following people for
concerns about your
emotions, stress, mental health, or substance use?
[For VIP survey insert: You may need to scroll down to see all the answer
options.]
[Select all that apply]
By substance use, we mean use of alcohol or drugs. Please don’t include
tobacco products.
1982
Please include all modes of consultation with a person (eg, on the phone,
text, messaging apps).
Act
A peer support worker is someone who is employed to use their lived
experience of mental health or addiction difficulties to assist others with their
recovery.
1
GP
2
Nurse
3
Psychiatrist or other medical specialist
4
Social worker
Information
5
Psychologist, counsellor or psychotherapist
6
Teacher
7
Religious or spiritual advisor, like a minister, priest or tohunga
8
Kaumātua or tohunga
9
Family, whānau, partner and/or friends
Official
10 Peer support worker
11 Other person
the
12 No, none of the above [cannot be selected with other options]
.K Don’t know
.R Refused
under
Released
NZHS Year 13 Adult Questionnaire
25
Document 3
[Showcard]
AMH1.08 In the
past 12 months, have you received help for concerns about your
emotions, stress, mental health, or substance use, from any of the following?
[For VIP survey insert: You may need to scroll down to see all the answer
options.]
[Select all that apply]
By substance use, we mean use of alcohol or drugs. Please don’t include
tobacco products.
Youth ‘one-stop-shops’ provide primary health care (including drop-in services)
plus a range of other services for young people. They use a youth development
and holistic approach to health.
1
Hospital emergency department or an after-hours medical centre
2
Hospital ward
1982
3
Crisis mental health team
4
Māori health service (including Māori mental health or addictions services)
5
Community mental health or addictions service (including hospital outpatient
Act
appointments)
6
Other community support services, such as a youth ‘one-stop-shop’
7
Programme in prison or a youth justice centre
8
Other [Specify]
_________________
9
No, none of the above [cannot be selected with other options]
.K Don’t know
.R Refused
Information
AMH1.10 In the
past 12 months, did you ever feel that you needed professional help for
your
emotions, stress, mental health, or substance use, but
you
didn’t
receive that help? This could have been because of personal reasons (for
example, it cost too much) or reasons you couldn’t control (for example, no
Official
appointments available).
By substance use, we mean use of alcohol or drugs. Please don’t include
the
tobacco products.
1
Yes
2
No [go to Health behaviours and risk factors introduction before A3.01]
.K Don’t know [go to introduction before A3.01]
under
.R Refused [go to introduction before A3.01]
Released
NZHS Year 13 Adult Questionnaire
26
Document 3
[Showcard]
AMH1.11a Thinking about the
most recent time when you felt you needed professional
help but didn’t receive it, why was that?
[For VIP survey insert: You may need to scroll down to see all the answer
options.]
[Select all that apply]
1
Wanted to handle it alone and/or with the support of family, whānau and
friends
2
Couldn’t spare the time
3
Costs too much
4
Problems with transportation or childcare
5
Unsure where to go or who to see
6
Couldn't get an appointment at a suitable time
1982
7
Time taken to get an appointment too long
8
Available services did not meet my cultural or language needs
Act
9
Health professionals unhelpful or unwilling to help
10 Not satisfied with available services
11 Didn't think treatment would work
12 Concerned what others might think
13 Another reason [Specify]
_________________
.K Don’t know
.R Refused
Information
Official
the
under
Released
NZHS Year 13 Adult Questionnaire
27
Document 3
Health behaviours and risk factors
The next section is about things that can influence your health.
High blood pressure
A3.01 Have you ever been told by a doctor that you have high blood pressure?
If respondent is female [AD.01a=2], insert: Please do not include high blood
pressure you may have had during pregnancy.
1
Yes
2
No [go to High cholesterol A3.03]
.K Don’t know [go to A3.03]
.R Refused [go to A3.03]
1982
A3.02 Are you currently taking pills regularly for high blood pressure?
1
Yes
Act
2
No
.K Don’t know
.R Refused
High cholesterol
A3.03 Have you ever been told by a doctor that you have high cholesterol levels in your
Information
blood?
1
Yes
2
No [go to Body size introduction before DH1.19]
.K Don’t know [go to introduction before DH1.19]
Official
.R Refused [go to introduction before DH1.19]
the
A3.04 Are you currently taking pills regularly for high cholesterol?
1
Yes
2
No
under
.K Don’t know
.R Refused
Released
NZHS Year 13 Adult Questionnaire
28
Document 3
Body size self-complete section
The next few questions about weight and height are for you to answer on your own. If you
need help, I can show you what to do.
I can also read the questions out, and you can answer by calling out the option number.
START OF SELF-COMPLETE.
[Showcard]
DH1.19 On a scale of one to five, where one is very underweight and five is very
overweight, how do
you view your weight?
1
Very underweight
2
Underweight
3
Neither underweight nor overweight
4
Overweight
1982
5
Very overweight
6 Currently pregnant [Only show this option for cis-female respondents (sex is
female, AD.01a=2 AND gender is female, AD.01b=2) aged 15–54 years].
Act
[Pregnant respondents skip to Physical Activity introduction before A3.06]
.K I don’t know
.R Prefer not to say
[Showcard]
BS3.01 How tall are you without shoes?
Please enter answer using just one type of unit.
Information
Data to be converted to m (0.000 m).
1 ____ centimetres (range 60–250)
2 ____ metres (range 0.6–2.5)
3 ____ feet (range 2–8) and ____ inches (range 0–11)
Official
.K I don’t know
.R Prefer not to say
the
[Showcard]
BS3.02 How much do you weigh?
Please enter answer using just one type of unit.
under
Data to be converted to kg (000.0kg).
1 ____ kilograms (range 6–250)
2 ____ stones (range 1–40) and ____ pounds (range 0–13)
3 ____ pounds (range 14–550)
.K I don’t know
Released
.R Prefer not to say
New screen.
Thank you for completing this section; please click ‘Next’. [For F2F survey insert: Please
return the computer to the interviewer and they will continue the questionnaire.]
END OF SELF-COMPLETE SECTION.
NZHS Year 13 Adult Questionnaire
29
Document 3
Physical activity
I’m now going to ask you about the time you spent being
physically active in the last 7
days, from last [enter day] to yesterday. Do not include activity undertaken today.
By ‘active’ I mean doing anything using your muscles. Think about activities at work, school
or home, getting from place to place, and any activities you did for exercise, sport, recreation
or leisure.
I will ask you separately about brisk walking, moderate activities, and vigorous activities.
A3.06 During the last 7 days, on how many days did you
walk at a brisk pace – a brisk
pace is a pace at which you are breathing harder than normal? This includes walking
at work, walking to travel from place to place, and any other walking that you did
solely for recreation, sport, exercise or leisure.
1982
Think
only about walking done for at least 10 minutes at a time.
Act
_____ days per week (range 0–7) [if A3.06=0 go to moderate activity A3.08]
.K Don’t know [go to A3.08]
.R Refused [go to A3.08]
A3.07 How much time did you typically spend walking at a brisk pace on
each of those
days?
If respondent cannot provide a typical duration, record the average time per day.
All fields (hours and minutes) must be completed.
Information
_____
hours (range 0–24) _____ minutes (range 0–59) If under 10 minutes,
display message: Total time must be >=10 mins.
.K Don’t know
Official
.R Refused
If A3.07>=8 hours, display message: A person is unlikely to walk at a brisk pace (breathe
the
harder than normal) for 8 or more hours per day. Go back to question A3.07 and verify
answer with respondent.
[Picture Showcard]
under
A3.08 During the last 7 days, on how many days did you do
moderate physical activities?
‘Moderate’ activities make you breathe harder than normal, but only a little – like
carrying light loads, bicycling at a regular pace, or other activities like those shown on
the [For F2F insert: Showcard.] [For VIP insert: screen image (you may need to scroll
down).] Do not include walking of any kind.
Think
only about those physical activities done for at least 10 minutes at a time.
Released
Activities shown on the Showcard / screen image are examples of moderate
activity. Many other activities may fall into this category.
Activities on the Moderate Activity Showcard / screen image and Vigorous Activity
Showcard / screen image can be interchangeable. If a respondent defines an activity
as being moderate, even though it is on the Vigorous Activity Showcard / screen
image, it should be included here.
_____ days per week (range 0–7) [if A3.08=0 go to vigorous activity A3.10]
.K Don’t know [go to A3.10]
.R Refused [go to A3.10]
NZHS Year 13 Adult Questionnaire
30
Document 3
Picture Showcard for A3.08
Carrying light loads
Badminton (social)
Electrical work
Ballroom dancing
Farming
Bowls (indoor, outdoor / lawn)
Heavy gardening (digging,
Cricket (outdoors – batting and
weeding, raking, planting, pruning,
bowling)
clearing section)
Heavy cleaning (sweeping,
Cycling (recreational – less than
cleaning windows, moving furniture) 15km/hr – not mountain biking)
House renovation
Deer hunting
Machine tooling (operating lathe,
Doubles tennis
punch press, drilling, welding)
Lawn mowing (manual mower)
Exercising at home (not gym)
1982
Plastering
Golf
Plumbing
Horse Riding / Equestrian
Act
Kayaking – slow
Kapa haka practice
Skate boarding
Waiata-a-ringa
Surfing / body boarding
Yachting / sailing / dingy sailing
A3.09 How much time did you typically spend on
each of those days doing moderate
physical activities?
Information
If respondent cannot provide a typical duration, record the average time per day.
All fields (hours and minutes) must be completed.
_____ hours (range 0–24) _____ minutes (range 0–59) If under 10 minutes,
Official
display message: Total time must be >=10 mins.
.K Don’t know
.R Refused
the
If A3.09>=8 hours, display message: A person is unlikely to do moderate physical activity
(breathe harder than normal) for 8 or more hours per day. Go back to question A3.09 and
verify answer with respondent.
under
If A3.09=A3.07, display message: A person is unlikely to spend exactly the same amount
of time brisk walking as they do moderate activity each day. Go back to question A3.07 or
A3.09 and verify answer with respondent.
[Picture Showcard]
Released
NZHS Year 13 Adult Questionnaire
31
Document 3
A3.10 During the last 7 days, on how many days did you do
vigorous physical activities?
‘Vigorous’ activities make you breathe a lot harder than normal (‘huff and puff’) – like
heavy lifting, digging, aerobics, fast bicycling, or other activities like those shown on
the [For F2F insert: Showcard.] [For VIP insert: screen image. You may need to
scroll down.]
Think
only about those physical activities done for at least 10 minutes at a time.
Activities shown on the Showcard / screen image are examples of vigorous
activity. Many other activities may fall into this category.
Activities on the Vigorous Activity Showcard / screen image and Moderate Activity
Showcard / screen image can be interchangeable. If a respondent defines an activity
as being vigorous, even though it is on the Moderate Activity Showcard / screen
image, it should be included here.
1982
_____ days per week (range 0–7) [if A3.10=0 go to all activities A3.12]
.K Don’t know [go to A3.12]
.R Refused [go to A3.12]
Act
Picture Showcard for A3.10
Carrying heavy loads
Boxing
Forestry
Aerobics
Heavy construction
Kayaking – fast
Digging ditches
Athletics (track and field)
Information
Chopping or sawing wood
Aquarobics
Skiing
Taiaha
Badminton (competitive)
Haka
Basketball
Official
Rowing
Soccer
Cricket – indoors (batting and
Judo, karate, other martial arts
the bowling)
Mountain biking
Rock climbing
Cycling – recreational (not mountain
Cycling (competitive)
biking) – more than 15 km/hr
under
Rugby union
Rugby league
Exercise classes – going to the gym
Hockey
(other than for aerobics) / weight
training
Race walking
Netball
Table tennis (competitive)
Volleyball
Released
Running / jogging / cross country
Softball (running and pitching only)
Singles tennis
Squash
Touch rugby
Surf life saving
Tramping
Swimming (competitive)
Triathlon
Water Polo
NZHS Year 13 Adult Questionnaire
32
Document 3
A3.11 How much time did you typically spend on
each of those days doing vigorous
physical activities?
If respondent cannot provide a typical duration, record the average time per day.
All fields (hours and minutes) must be completed.
_____ hours (range 0–24) _____ minutes (range 0–59) If under 10 minutes,
display message: Total time must be >=10 mins.
.K Don’t know
.R Refused
If A3.11>=4 hours, display message: A person is unlikely to do vigorous activity (huff and
puff) for 4 or more hours per day. Go back to question A3.11 and verify answer with
respondent.
A3.12 Thinking about all your activities over the last 7 days (including brisk walking), on
1982
how many days did you engage in:
•
at least 30 minutes of moderate activity (including brisk walking) that made
you breathe a little harder than normal, OR
Act
•
at least 15 minutes of vigorous activity that made you breathe a lot harder
than normal (‘huff and puff’)?
_____ days per week (range 0–7)
.K Don’t know
.R Refused
Information
Sleep
Now, a question about sleep.
A3.12a How many hours of sleep do you usually get in a 24 hour period, including
all naps
Official
and sleeps?
Enter whole numbers. Round 30 minutes or more up to the next whole hour and
the
round 29 or fewer minutes down.
_____ hours (range 1–24)
.K Don’t know under
.R Refused
If A3.12a<4 hours, display message: A person is unlikely to usually sleep less than 4
hours in a 24 hour period. Verify answer with respondent.
If A3.12a>12 hours, display message: A person is unlikely to usually sleep more than 12
hours in a 24 hour period. Verify answer with respondent.
Released
Ask next two tooth brushing questions, A3.12b and A3.12c, only if respondent has natural
teeth, that is, A1.30 not equal to 99.
NZHS Year 13 Adult Questionnaire
33
Document 3
Tooth brushing
Now, a couple of questions about tooth brushing.
[Showcard]
A3.12b How often do you brush your teeth?
0
Never [go to Tobacco introduction before A3.13]
1
Less than once a day
2
Once a day
3
Twice a day
4
More than twice a day
5 No natural teeth [go to introduction before A3.13]
.K Don’t know
.R Refused
1982
Act
Information
Official
the
under
Released
NZHS Year 13 Adult Questionnaire
34
Document 3
[Picture Showcard]
A3.12c Looking at the [For F2F insert: Showcard] [For VIP insert: options on the screen],
what type of toothpaste do you usually use?
[For VIP survey insert: You may need to scroll down to see the answer options.]
If respondent is unsure about what type of toothpaste is used, and give their
permission, you could ask to see the toothpaste that is currently used.
• Standard fluoride packaging might include: “0.221% sodium fluoride”, “0.76%
sodium monofluorophosphate”, “1000–1450 ppm” and/or “fluoride toothpaste”.
Homemade toothpaste or baking soda should be coded as ‘Don’t use toothpaste
/ no toothpaste available in the house’.
1
Standard fluoride toothpaste
3
Non-fluoridated toothpaste
1982
4
Don’t use toothpaste / no toothpaste available in house
.K Don’t know
Act
.R Refused
Picture Showcard for A3.12c
1. Standard fluoride toothpaste
Information
Official
the
under
Released
3. Non-fluoridated toothpaste
4. Don’t use toothpaste / no toothpaste available in house
NZHS Year 13 Adult Questionnaire
35
Document 3
Tobacco
Now, some questions on tobacco smoking. For these questions, please do not include the
use of vaping devices or electronic cigarettes. We will ask about those later.
A3.13 Have you ever smoked cigarettes or tobacco at all, even just a few puffs? Please
include pipes and cigars.
If asked, this does
not include marijuana / cannabis or vaping / electronic
cigarettes.
1
Yes
2
No [go to SHS TOB4.02a]
.K Don’t know
.R Refused
A3.14 Have you ever smoked a total of more than
100 cigarettes in your whole life?
1982
1
Yes
Act
2
No
.K Don’t know
.R Refused
Information
Official
the
under
Released
NZHS Year 13 Adult Questionnaire
36
Document 3
[Showcard]
A3.15 How often do you now smoke?
Read response options. If more than one frequency given, code the highest one.
1
I don’t smoke now [go to Initiation and uptake TOB1.01]
2
At least once a day
3
At least once a week
4
At least once a month
5
Less often than once a month
.K Don’t know
.R Refused
Ask next question, A3.18, if respondents smoke (A3.15=2, 3, 4, 5) or didn’t answer the
question about how often they smoke (A3.15=.K, .R).
1982
A3.18 On average, how many cigarettes do you smoke a day?
Response option numbers are not displayed on CAPI screen.
Don’t initially prompt answer. Wait and code.
Act
If respondent is unable to suggest an average, ask for the typical number of
cigarettes smoked in a week and divide by 7.
Round answer to nearest number if necessary, eg 2.5 cigarettes a day should be
rounded up to 3, that is, option ‘1–5 per day’. 10.4 cigarettes would be rounded down
to 10, that is, option ‘6–10 per day’.
1
Less than 1 per day
Information
2
1–5 per day
3
6–10 per day
4
11–15 per day
5
16–20 per day
6
21–25 per day
Official
7
26–30 per day
8
31 or more a day
.K Don’t know
the
.R Refused
under
Released
NZHS Year 13 Adult Questionnaire
37
Document 3
Initiation and uptake
Ask everyone TOB1.01 who had ever smoked cigarettes or tobacco at all even just a few
puffs (A3.13=1)
Others (A3.13 = 2, .K, .R) go to ‘Exposure to second-hand smoke in adults’, question
TOB4.02a
TOB1.01 At what age did you try your first cigarette?
If asked, this includes any type of tobacco product eg cigar, rollies
_____ years (range 0-110)
.K Don’t know
.R Refused
Ask TOB1.03a for respondents who have smoked a total of more than 100 cigarettes in
their lifetime (A3.14 = 1).
1982
Others (A3.14 =2, .K, .R) go to ‘Exposure to second-hand smoke in adults’, question
TOB4.02a
Act
[Showcard]
TOB1.03a
At what age did you
start smoking
daily?
Daily means at least once a day.
Enter answer in years. If respondent doesn’t know exactly, get their best estimate.
If respondents smoke daily (A3.15=2), then the response option ‘I have never
smoked daily’ wil not appear on the screen.
Information
.N I have never smoked daily [Do not display for daily smokers (A3.15=2)]
_____ years (range 0-110) [Must be ≥ TOB1.01]
.K Don’t know
.R Refused
Official
consistency check, if responses 'I have never smoked daily', 'Don't know' or 'Refused' is
selected, AND year entered, error message to be displayed ‘I have never smoked daily,
Don't Know and Refused can't be selected if entering an answer’.
the
Quitting smoking
Ask A3.16 if respondents no longer smoke (A3.13=1 and A3.14=1 and A3.15=1).
[Showcard]
under
A3.16 How long ago did you stop smoking?
1
Within the last month
2
1 month to 3 months ago
3
4 months to 6 months ago
4
7 to 12 months ago
Released
5
1 to 2 years ago
6
2 to 5 years ago
7
Longer than 5 years ago
.K Don’t know
.R Refused
NZHS Year 13 Adult Questionnaire
38
Document 3
Ask A3.20b if respondents are current smokers (A3.15=2, 3, 4, 5) or didn’t answer the
current smoker question (A3.15 = K or R); or if they stopped smoking in the last 12 months
(A3.16=1, 2, 3, 4).
A3.20b In the
last 12 months, how many times did you try to quit smoking?
If respondent stopped smoking in the last 12 months, they should include that.
If respondent doesn’t know exactly, get their best estimate.
_____ times (range 0–365) [If A3.16 = 1,2,3,4, then response can’t be ‘0’]
.K Don’t know
.R Refused
Ask A3.20a if respondents tried to quit smoking once or more in the last 12 months
(A3.20b ≥ 1)
A3.20a How many of those times were for a week or more?
1982
If respondent stopped smoking in the last 12 months, they should include that.
If respondent doesn’t know exactly, get their best estimate.
Act
_____ times (range 0–51) [If A3.20a > A3.20b, display note that the interviewer
needs to check with the respondent and modify response
accordingly]
.K Don’t know
.R Refused
Ask TOB3.02a if respondents tried to quit smoking once or more in the last 12
Information
months (A3.20b ≥ 1)
[Showcard]
TOB3.02a What, if anything, did you use to help you quit smoking during your
last quit
attempt? Please say all that apply.
Official
Medicines given as examples in response option 3 are also known as
Varenicline, Bupropion and Nortriptyline.
the
Rongoā Māori is traditional Māori healing, which encompasses herbal
remedies, physical therapies and spiritual healing.
Face-to-face stop smoking services include online face-to-face conversations.
They may also see clients in schools and the workplace.
under
[Multiple response]
1 Vaping or e-cigarettes
2
Nicotine replacement therapies (eg patches, gum)
3
Medicines (eg Champix, Zyban and Norpress)
4
Rongoā Māori (eg plant remedies, mirimiri)
5
Quitline
Released
6 Face-to-face stop smoking service (eg in the community, hospital)
7
Support from friends and whānau
77 Other [Specify] ________________
0
I did it on my own [cannot be selected with other options]
.K Don’t know
.R Refused
NZHS Year 13 Adult Questionnaire
39
Document 3
Exposure to second-hand smoke
Ask everyone, regardless of their smoking status
TOB4.02a Does
anyone smoke while
inside your home?
This is not limited to people who live in the home.
1
Yes
2
No
.K Don't know
.R Refused
TOB4.03a Does
anyone smoke while travelling in a car or van with you?
This is not limited to people that you usually travel with.
1982
1
Yes
2
No
.K Don't know
Act
.R Refused
Vaping and electronic cigarettes
Ask everyone A3.21a regardless of their smoking status.
Now I’l ask you about vaping devices and electronic cigarettes. I’l be using the term ‘vaping
devices’ to cover both. If you vape cannabis on its own, please don’t include this, because
Information
we will ask about cannabis later.
Cannabis is also known as marijuana, THC, hash, and weed.
A3.21a Have you ever tried using a vaping device, even just once?
Official
Vaping devices or electronic cigarettes, also known as vapes or e-cigarettes, are
the
battery-powered devices that heat a liquid to release vapour as people inhale from
them. The liquid/juice may contain nicotine and may be flavoured.
1
Yes
under
2
No [go to Dietary habits introduction before A3.22a]
.K Don't know [go to introduction before A3.22a]
.R Refused [go to introduction before A3.22a]
TOB 8.01
Have you ever used vaping devices at least
once a week for a
month or longer?
1
Yes
Released
2
No
.K Don’t know
.R Refused
NZHS Year 13 Adult Questionnaire
40
Document 3
Ask A3.21b for those who have ever tried vaping/e-cigarettes (A3.21a = 1)
[Showcard]
A3.21b How often do you now use vaping devices?
1
I don’t use them now (go to stop vaping question TOB8.02)
2
At least once a day
3
At least once a week
4
At least once a month
5
Less often than once a month
.K Don’t know
.R Refused
Ask TOB4.10a if respondent currently vapes (A3.21b= 2,3,4, 5), or doesn’t respond to the
frequency of vaping question (A3.21b = .K, .R)
1982
[Showcard]
TOB4.10a Why do you use vaping devices? Please say all that apply.
Act
[Multiple response]
1. Less harmful than smoking
2. To reduce or quit smoking
3. A stop smoking service or healthcare worker suggested it
4. Cheaper than tobacco
5. Easier to get than tobacco
6. People around me do it
Information
7. More acceptable to others than smoking
8. More satisfying than smoking
9. I enjoy them
10. I like the flavours
Official
11. I can’t go without it
12. To cope with stress, anxiety, or depression
77. Other – please specify ________________
the
.K Don't know
.R Refused
Ask TOB 8.02 if respondent has been a regular vaper (TOB8.01 = 1) but doesn’t vape
under
now (A3.21b = 1).
All other respondents [go to Dietary habits introduction before A3.22a]
[Showcard]
TOB 8.02 How long ago did you stop vaping?
Released
1
Within the last month
2
1 month to 12 months ago
3
More than 1 year ago
.K Don’t know
.R Refused
NZHS Year 13 Adult Questionnaire
41
Document 3
Dietary habits
Now, a couple of questions about eating fruit and vegetables.
Response option numbers are not displayed on the CAPI screen or showcards
for questions A3.22a and A3.23a.
[Picture Showcard]
A3.22a On
average, how many
servings of fruit do you eat per day? Please include all
fresh, frozen, canned and stewed fruit. Do
not include fruit juice or dried fruit. A
‘
serving’ = 1 medium piece
or 2 small pieces of fruit
or 1 cup of canned, frozen or
stewed fruit. For example, 1 apple + 2 small apricots = 2 servings.
If asked, include fruit smoothies.
[For VIP survey insert: You may need to scroll down to see all the answer options.]
1982
1
I don’t eat fruit
2
Less than 1 serving per day
3
1 serving per day
Act
4
2 servings per day
5
3 servings per day
6
4 servings per day
7
5 servings per day
8
6 or more servings per day
.K Don’t know
.R Refused
Information
Picture Showcard for 3.22a
Official
the
under
Released
NZHS Year 13 Adult Questionnaire
42
Document 3
[Picture Showcard]
A3.23a On
average, how many
servings of vegetables do you eat per day? Please include
all fresh, frozen and canned vegetables. Do
not include vegetable juices. A
‘
serving’ = ½ medium potato / similar sized kumara
or ½ cup cooked vegetables
or 1 cup of raw salad vegetables. For example, 5 servings could comprise of 1
medium potato + 1 cup of cooked vegetables + 1 cup of raw salad throughout the
day.
Remember to think about all meals and snacks.
[For VIP survey insert: You may need to scroll down to see all the answer options.]
1
I don’t eat vegetables
2
Less than 1 serving per day
3
1 serving per day
4
2 servings per day
1982
5
3 servings per day
6
4 servings per day
Act
7
5 servings per day
8
6 or more servings per day
.K Don’t know
.R Refused
Picture Showcard for 13.23a
Information
Official
the
under
Released
NZHS Year 13 Adult Questionnaire
43
Document 3
Alcohol
I will now ask you some questions about your use of alcoholic drinks.
A3.24 Have you had a drink containing alcohol in the last year?
1
Yes
2
No [go to alcohol harm A3.33]
.K Don’t know [go to A3.33]
.R Refused [go to A3.33]
A3.25 How often do you have a drink containing alcohol?
Don’t initially prompt answer. Wait and code.
1
Monthly or less
2
Up to 4 times a month
1982
3
Up to 3 times a week
4
4 or more times a week
Act
.K Don’t know
.R Refused
Information
Official
the
under
Released
NZHS Year 13 Adult Questionnaire
44
Document 3
[Showcard]
[Picture Showcard]
A3.26a Looking at the [For F2F insert: Showcard] [For VIP insert: options on the screen],
how many drinks containing alcohol do you have on a typical day when you are
drinking? [For VIP insert: You may need to scroll down to see the answer options.]
Response option numbers are not displayed on CAPI screen or showcards.
By one drink, I now mean one standard drink, that is, one can or stubbie of beer,
half a large bottle of beer, one small glass of wine or one shot of spirits.
[For F2F insert: This Picture Showcard [show Picture Showcard]] [For VIP insert:
The screen image] can help you estimate the number of standard drinks you have
drunk. It shows some examples of the number of standard drinks in different
alcoholic drinks.
Take average and round to nearest whole number if necessary, eg if respondent
1982
says 4 or 5, average is 4.5, round to nearest whole number = 5, that is, option ‘5 or
6’.
Act
1
1 or 2
2
3 or 4
3
5 or 6
4
7 to 9
5
10 or 11
6 12 or more
.K Don’t know
Information
.R Refused
The standard drinks picture showcard is reviewed annually in case there are any changes in
the market.
Official
Picture Showcard for A3.26a and A3.27a:
the
under
Released
NZHS Year 13 Adult Questionnaire
45
Document 3
[Showcard]
[Picture Showcard]
A3.27a Looking at the [For F2F survey insert: Showcard, and the Picture Showcard] [For
VIP survey insert: options on the screen, and the screen image], how often do you
have six or more standard drinks on one occasion? [For VIP insert: You may need
to scroll down to see the answer options.]
1
Never
2
Less than monthly
3
Monthly
4
Weekly
5
Daily or almost daily
.K Don’t know
.R Refused
1982
[Showcard]
A3.28 How often during the last year have you found that you were not able to stop drinking
once you had started?
Act
1
Never
2
Less than monthly
3
Monthly
4
Weekly
5
Daily or almost daily
.K Don’t know
Information
.R Refused
[Showcard]
A3.29 How often during the last year have you failed to do what was normally expected
from you because of drinking?
Official
1
Never
2
Less than monthly
the
3
Monthly
4
Weekly
5
Daily or almost daily
.K Don’t know under
.R Refused
[Showcard]
A3.30 How often during the last year have you needed a first drink in the morning to get
yourself going after a heavy drinking session?
Released
1
Never
2
Less than monthly
3
Monthly
4
Weekly
5
Daily or almost daily
.K Don’t know
.R Refused
NZHS Year 13 Adult Questionnaire
46
Document 3
[Showcard]
A3.31 How often during the last year have you had a feeling of guilt or remorse after
drinking?
1
Never
2
Less than monthly
3
Monthly
4
Weekly
5
Daily or almost daily
.K Don’t know
.R Refused
[Showcard]
A3.32 How often during the last year have you been unable to remember what happened
the night before because you had been drinking?
1982
1
Never
2
Less than monthly
Act
3
Monthly
4
Weekly
5
Daily or almost daily
.K Don’t know
.R Refused
The next two questions are about lifetime harm from drinking, so ask all respondents
Information
even if they have not had a drink containing alcohol in the last year.
[Showcard]
A3.33 Have you or someone else been injured as a result of your drinking?
Official
1
Yes, but not in the last year
2
Yes, during the last year
3
No
the
.K Don’t know
.R Refused
[Showcard]
under
A3.34 Has a relative or friend, or a doctor or other health worker, been concerned about
your drinking or suggested you cut down?
1
Yes, but not in the last year
2
Yes, during the last year
3
No
Released
.K Don’t know
.R Refused
NZHS Year 13 Adult Questionnaire
47
Document 3
Drugs
The next questions are about your experience of using drugs. These substances can be
smoked, swallowed, snorted, inhaled, injected or taken in the form of pills.
Please do not include medicine that you have used for the purpose it was prescribed for, by
your doctor or nurse. Please
include prescribed medicine that you have taken for other
reasons, such as to get high, or taken more frequently or at a higher dose than specified.
Remember that everything you tell us will remain confidential.
[Showcard]
A3.37 Looking at the [For F2F survey insert: Showcard] [For VIP survey insert: options on
the screen], in the
past 12 months, have you used any of the following substances?
Please just read out the number next to the words. [For VIP survey insert: You may
need to scroll down to see all the answer options.]
1982
[Select all that apply]
Prompt: “any others?”
Act
Please do not include medication, such as medicinal cannabis, that is taken for
the purpose it was prescribed for and is taken as prescribed.
1
Cannabis, for example, marijuana, hash, weed [go to A3.39]
2
Cocaine
3
Ecstasy / MDMA
4
Amphetamine type stimulants, for example, ‘P’, speed, ice, Ritalin®
5
Inhalants, for example, NOS, glue, petrol, poppers
Information
6
Sedatives or sleeping pills, for example, Valium, diazepam
7
Hallucinogens, for example, LSD, mushrooms, ketamine
8
Opioids, for example, heroin, morphine, methadone, codeine
77 Other substances [Specify]
(for example, synthetic cannabinoids, ‘synnies’,
GHB, GBL, kava etc)
_________________
Official
0
No, none of the above [cannot be selected with other options]
.K Don’t know
the
.R Refused
A3.38 In your
life, have you
ever used cannabis?
Do not include synthetic cannabinoids.
under
Do not include cannabis that has been prescribed by your doctor or nurse and is
taken as prescribed.
1 Yes [go to A3.43]
2
No [go to Health status introduction before A4.01]
.K Don’t know [go to introduction before A4.01]
.R Refused [go to introduction before A4.01]
Released
NZHS Year 13 Adult Questionnaire
48
Document 3
[Showcard]
A3.39 In the
past three months, how often have you used cannabis?
Do not include synthetic cannabinoids.
Do not include cannabis that has been prescribed by your doctor or nurse and is
taken as prescribed.
1 Never [go to A3.43]
2
Once or twice
3
Monthly
4
Weekly
5
Daily or almost daily
.K Don’t know
.R Refused
[Showcard]
1982
A3.40 During the
past three months, how often have you had a strong desire or urge to
use cannabis?
Do not include mild or fleeting desire to use cannabis, or a desire to use because
Act
an opportunity arose (for example,
do not include if a respondent was offered
cannabis and experienced a desire to use cannabis as a result, but did not have a
desire to use beforehand).
1 Never
2
Once or twice
3
Monthly
Information
4
Weekly
5
Daily or almost daily
.K Don’t know
.R Refused
Official
[Showcard]
A3.41 During the
past three months, how often has your use of cannabis led to health,
social, legal or financial problems?
the
This may include problems such as forgetting to do things, difficulty paying
attention or getting motivated, problems getting organised, feeling depressed or
anxious.
under
1 Never
2
Once or twice
3
Monthly
4
Weekly
5
Daily or almost daily
.K Don’t know
Released
.R Refused
NZHS Year 13 Adult Questionnaire
49
Document 3
[Showcard]
A3.42 During the
past three months, how often have you failed to do what was
normally expected of you because of your use of cannabis?
This may include situations such as problems keeping up at work, missing or
falling behind at school or university or failing to maintain usual family or relationship
commitments (eg house cleaning or paying bills).
1
Never
2
Once or twice
3
Monthly
4
Weekly
5
Daily or almost daily
.K Don’t know
.R Refused
1982
[Showcard]
A3.43 Has a friend or relative or anyone else
ever expressed concern about your use of
cannabis?
Act
Concern can include things such as discussion, questioning, pestering, advice,
worry or anger expressed by someone towards the respondent.
This question is asked of everyone who has ever used cannabis, even if only used
occasionally.
1 No, never
2
Yes, in the past 3 months
Information
3
Yes, but not in the past 3 months
.K Don’t know
.R Refused
[Showcard]
Official
A3.44 Have you ever
tried and
failed to control, cut down or stop using cannabis?
This question is about serious unsuccessful attempts to control, cut down or stop,
rather than just passing thoughts of cutting down or half-hearted efforts. Successful
the
attempts to cut down should
not be recorded.
If a respondent has made several attempts to cut down and was successful
eventually, record the last unsuccessful attempt (eg someone that successfully
stopped using cannabis 3 months ago, but had several failed attempts prior to that
under
would be recorded as ‘Yes, but not in the past 3 months’).
This question is asked of everyone who has ever used cannabis, even if only used
occasionally.
1
No, never
2
Yes, in the past 3 months
Released
3
Yes, but not in the past 3 months
.K Don’t know
.R Refused
NZHS Year 13 Adult Questionnaire
50
Document 3
Health status
Ask all respondents A4.01.
General health question
This first question is about your health
now.
Please try to answer as accurately as you can.
[Showcard]
A4.01 In general, would you say your health is:
Read response options.
1
Excellent
1982
2
Very good
3
Good
4
Fair
Act
5
Poor
.K Don’t know
.R Refused
Functional difficulties – Washington Group Enhanced
Short Set
Information
The next questions ask about difficulties you may have doing certain activities because of a
health problem.
[Showcard]
Official
FD1.01 Do you have difficulty seeing, even if wearing glasses?
1
No – no difficulty
the
2
Yes – some difficulty
3
Yes – a lot of difficulty
4
Cannot do at all
.K Don’t know under
.R Refused
[Showcard]
FD1.02 Do you have difficulty hearing, even if using a hearing aid?
1
No – no difficulty
Released
2
Yes – some difficulty
3
Yes – a lot of difficulty
4
Cannot do at all
.K Don’t know
.R Refused
NZHS Year 13 Adult Questionnaire
51
Document 3
[Showcard]
FD1.03 Do you have difficulty walking or climbing steps?
1
No – no difficulty
2
Yes – some difficulty
3
Yes – a lot of difficulty
4
Cannot do at all
.K Don’t know
.R Refused
[Showcard]
FD1.04 Do you have difficulty remembering or concentrating?
1
No – no difficulty
2
Yes – some difficulty
1982
3
Yes – a lot of difficulty
4
Cannot do at all
.K Don’t know
Act
.R Refused
[Showcard]
FD1.05 Do you have difficulty washing all over or dressing?
1
No – no difficulty
2
Yes – some difficulty
Information
3
Yes – a lot of difficulty
4
Cannot do at all
.K Don’t know
.R Refused
Official
[Showcard]
FD1.06 Using your usual language, do you have difficulty communicating, for example,
understanding or being understood?
the
1
No – no difficulty
2
Yes – some difficulty
3
Yes – a lot of difficulty
under
4
Cannot do at all
.K Don’t know
.R Refused
[Showcard]
FD1.07 Would you have difficulty lifting a two-litre bottle of water from waist to eye level?
Released
1
No – no difficulty
2
Yes – some difficulty
3
Yes – a lot of difficulty
4
Cannot do at all
.K Don’t know
.R Refused
NZHS Year 13 Adult Questionnaire
52
Document 3
[Showcard]
FD1.08 Do you have difficulty using your hands and fingers, such as picking up small
objects, or opening containers?
1
No – no difficulty
2
Yes – some difficulty
3
Yes – a lot of difficulty
4
Cannot do at all
.K Don’t know
.R Refused
[Showcard]
FD1.09 How often do you feel anxious, nervous or worried?
1982
1
Daily
2
Weekly
3
Monthly
Act
4
A few times a year
5
Never [go to FD1.11]
.K Don’t know [go to FD1.11]
.R Refused [go to FD1.11]
[Showcard]
FD1.10 Thinking about the last time you felt this way, how anxious, nervous or worried did
Information
you feel?
1
A little
2
A lot
3
Somewhere in between a little and a lot
Official
.K Don’t know
.R Refused
the
[Showcard]
FD1.11 How often do you feel depressed?
1
Daily
under
2
Weekly
3
Monthly
4
A few times a year
5
Never [go to Mental health – K10 introduction before A4.13]
.K Don’t know [go to intro before A4.13]
.R Refused [go to intro before A4.13]
Released
[Showcard]
FD1.12 Thinking about the last time you felt this way, how depressed did you feel?
1
A little
2
A lot
3
Somewhere in between a little and a lot
.K Don’t know
.R Refused
NZHS Year 13 Adult Questionnaire
53
Document 3
Mental health – K10
The next questions are again about how you have been feeling during the
past four weeks.
Some questions may sound similar to questions you have already answered.
[Showcard]
A4.13 During the past four weeks, how often did you feel tired out for no good reason –
would you say all of the time, most of the time, some of the time, a little of the time,
or none of the time?
1
All of the time
2
Most of the time
3
Some of the time
4
A little of the time
5
None of the time
.K Don’t know
1982
.R Refused
Act
[Showcard]
A4.14 During the past four weeks, how often did you feel nervous – all of the time, most of
the time, some of the time, a little of the time, or none of the time?
1
All of the time
2
Most of the time
3
Some of the time
4
A little of the time
Information
5
None of the time [go to feeling hopeless A4.16]
.K Don’t know [go to A4.16]
.R Refused [go to A4.16]
[Showcard]
Official
A4.15 During the past four weeks, how often did you feel so nervous that nothing could
calm you down?
the
1
All of the time
2
Most of the time
3
Some of the time
4
A little of the time
under
5
None of the time
.K Don’t know
.R Refused
[Showcard]
A4.16 During the past four weeks, how often did you feel hopeless?
Released
1
All of the time
2
Most of the time
3
Some of the time
4
A little of the time
5
None of the time
.K Don’t know
.R Refused
NZHS Year 13 Adult Questionnaire
54
Document 3
[Showcard]
A4.17 During the past four weeks, how often did you feel restless or fidgety?
1
All of the time
2
Most of the time
3
Some of the time
4
A little of the time
5
None of the time [go to feeling depressed A4.19]
.K Don’t know [go to A4.19]
.R Refused [go to A4.19]
[Showcard]
A4.18 During the past four weeks, how often did you feel so restless you could not sit still?
1
All of the time
2
Most of the time
1982
3
Some of the time
4
A little of the time
Act
5
None of the time
.K Don’t know
.R Refused
[Showcard]
A4.19 During the past four weeks, how often did you feel depressed?
1
All of the time
Information
2
Most of the time
3
Some of the time
4
A little of the time
5
None of the time [go to effort A4.21]
.K Don’t know [go to A4.21]
Official
.R Refused [go to A4.21]
the
[Showcard]
A4.20 How often did you feel so depressed that nothing could cheer you up?
1
All of the time
under
2
Most of the time
3
Some of the time
4
A little of the time
5
None of the time
.K Don’t know
.R Refused
Released
[Showcard]
A4.21 During the past four weeks, how often did you feel that everything was an effort?
1
All of the time
2
Most of the time
3
Some of the time
4
A little of the time
5
None of the time
.K Don’t know
.R Refused
NZHS Year 13 Adult Questionnaire
55
Document 3
[Showcard]
A4.22 During the past four weeks, how often did you feel worthless?
1
All of the time
2
Most of the time
3
Some of the time
4
A little of the time
5
None of the time
.K Don’t know
.R Refused
[Showcard]
AMH1.01a During the past four weeks, how often did you feel lonely?
1
All of the time
1982
2
Most of the time
3
Some of the time
4
A little of the time
Act
5
None of the time
.K Don’t know
.R Refused
Information
Official
the
under
Released
NZHS Year 13 Adult Questionnaire
56
Document 3
Socio-demographics
Now, I am going to ask you some general questions about you and your household. The
answers to these questions help us to check that we have selected a representative sample
of New Zealanders to participate in this survey, and sometimes these things can affect our
health.
Date of birth
A5.01 Firstly, what is your date of birth?
Interviewer read back date of birth to check it is correct.
To update a previously-recorded date, click on the date picker, select the month
and year from the drop-down lists, then
click on the correct day.
Display message: This means you are X years old.
1982
_____ Day (range 1–31)
_____ Month (range Jan–Dec)
Act
_____ Year (range [current in-field year minus 120]–[current in-field year minus 15])
[go to Ethnic group(s) A5.03]
.R Refused
Calculated age must be ≥15 years. If less than 15, display message: Age cannot be less
than 15.
Ask next question if date of birth refused (A5.01=.R).
Information
A5.02 Would you mind telling me your age?
_____ years (range 15–120)
.R Refused
Official
Ethnic group(s)
the
[Showcard]
A5.03 Which ethnic group or groups do you belong to?
[For VIP survey insert: You may need to scroll down to see all the answer options.]
under
[Select all that apply]
If ‘Other – Specify’ is selected you wil be asked to specify the other ethnic groups
on the next screen.
1
New Zealand European
2
Māori
Released
3
Samoan
4
Cook Island Māori
5
Tongan
6
Niuean
7
Chinese
8
Indian
77 Other [Specify] _______________ [Three “Other” ethnic groups to be asked
about on a new screen and programmed from the codefile from StatsNZ,
Ethnicity New Zealand Standard Classification 2005 V2.1.0]
.K Don’t know
.R Refused
NZHS Year 13 Adult Questionnaire
57
Document 3
Country of birth and languages
[Showcard]
A5.05 Which country were you born in?
[For VIP survey insert: You may need to scroll down to see all the answer options.]
When selecting ‘Other’ you are able to enter a historic name of the country. The
codefile wil recognise this and assign it to the same category as the country’s
present name.
1
New Zealand [go to language A5.07]
2
Australia
3
England
4
China (People’s Republic of)
5
India
6
South Africa
1982
7
Samoa
8
Cook Islands
Act
77 Other [Specify the name of the country]
_________________
[Programme from the codefile from StatsNZ. Can only specify one country]
.K Don’t know
.R Refused
A5.06 In what year did you arrive to live in New Zealand?
Record 4 digit date, eg 1967.
Information
If year is earlier than year of birth, display message: Consistency check Answer must
be ≥ year of birth given at A5.01. Year of arrival cannot be before date of birth. Please
correct year of arrival or use the Back [F2F] or Previous [VIP] button to go back to A5.01 and
correct date of birth.
Official
_____ (range [current in-field year minus 120]–[current in-field year])
.K Don’t know
the
.R Refused
under
Released
NZHS Year 13 Adult Questionnaire
58
Document 3
[Showcard]
A5.07 In which languages could you have a conversation about a lot of everyday things?
[Select all that apply]
If ‘Other language – Specify’ is selected, the respondent wil be asked to specify
the other languages on the next screen.
1
English
2
Māori
3
Samoan
4
NZ sign language
77 Other language, eg Gujarati, Cantonese, Greek – please specify
_________________ [Three “Other” languages possible]
[Programme from the codefile from StatsNZ]
.K Don’t know
.R Refused
1982
Racial discrimination
Act
[Showcard]
R5.08 Now I will ask you some questions about
reactions to your ethnicity. How do
other
people usually classify you in New Zealand?
[Select all that apply]
1
New Zealand European
2
Māori
3
Samoan
Information
4
Cook Island Māori
5
Tongan
6
Niuean
7
Chinese
8
Indian
Official
77 Other [Specify] _________________ [Three “Other” ethnic groups possible]
[Programme from the codefile from StatsNZ]
the
.K Don’t know
.R Refused
[Showcard]
R5.09 How often do you think about your ethnicity? Would you say never, once a year,
under
once a month, once a week, once a day, once an hour, or constantly?
1
Never
2
At least once a year
3
At least once a month
4
At least once a week
Released
5
At least once a day
6
At least once an hour
7
Constantly
.K Don’t know
.R Refused
NZHS Year 13 Adult Questionnaire
59
Document 3
[Showcard]
R5.10 Have you ever been a victim of an ethnically motivated attack (verbal or physical
abuse to you or your property)
in New Zealand?
[Select all that apply]
If respondent selects option 1 only, probe to see if option 2 also applies (and vice
versa if only option 2 is selected).
If respondent selects option 3 only, probe to see if option 4 also applies (and vice
versa if only option 4 is selected).
1
Yes, verbal – within the past 12 months
2
Yes, verbal – more than 12 months ago
3
Yes, physical – within the past 12 months
4
Yes, physical – more than 12 months ago
5
No [cannot be selected with other options]
.K Don’t know
1982
.R Refused
[Showcard]
Act
R5.11 Have you ever been treated unfairly (for example, kept waiting or treated differently)
by a health professional (that is, a doctor, nurse, dentist etc)
because of your
ethnicity in New Zealand?
[Select all that apply]
If respondent selects option 1 only, probe to see if option 2 also applies (and vice
versa if only option 2 is selected).
Information
1
Yes, within the past 12 months
2
Yes, more than 12 months ago
3
No [cannot be selected with other options]
4
Not applicable – have never tried to visit a health professional in New Zealand
[cannot be selected with other options]
Official
.K Don’t know
.R Refused
the
[Showcard]
R5.12 Have you ever been treated unfairly at work or been refused a job
because of your
ethnicity in New Zealand?
[Select all that apply]
under
If respondent selects option 1 only, probe to see if option 2 also applies (and vice
versa if only option 2 is selected).
1
Yes, within the past 12 months
2
Yes, more than 12 months ago
3
No [cannot be selected with other options]
Released
4
Not applicable – have never had a job or tried to find a job in New Zealand [cannot
be selected with other options]
.K Don’t know
.R Refused
NZHS Year 13 Adult Questionnaire
60
Document 3
[Showcard]
R5.13 Have you ever been treated unfairly when renting or buying housing
because of
your ethnicity in New Zealand?
[Select all that apply]
If respondent selects option 1 only, probe to see if option 2 also applies (and vice
versa if only option 2 is selected).
1
Yes, within the past 12 months
2
Yes, more than 12 months ago
3
No [cannot be selected with other options]
4
Not applicable – have never tried to rent or buy a house in New Zealand [cannot
be selected with other options]
.K Don’t know
.R Refused
1982
Act
Information
Official
the
under
Released
NZHS Year 13 Adult Questionnaire
61
Document 3
Education
Now, some questions about your education.
[Showcard]
A5.14 What is your highest secondary school qualification?
[For VIP survey insert: You may need to scroll down to see all the answer options.]
1
None
2
NZ School Certificate in one or more subjects
or National Certificate level 1
or NCEA level 1
3
NZ Sixth Form Certificate in one or more subjects
or National Certificate level 2
or NZ UE before 1986 in one or more subjects
1982
or NCEA level 2
4
NZ Higher School Certificate
Act
or NZ University Bursary / Scholarship
or National Certificate level 3
or NCEA level 3
or NZ Scholarship level 4
5
Other secondary school qualification
gained in New Zealand [Specify]
______________________
6
Other secondary school qualification
gained overseas
.K Don’t know
Information
.R Refused
Official
the
under
Released
NZHS Year 13 Adult Questionnaire
62
Document 3
[Showcard]
A5.15 What is your highest completed qualification?
[For VIP survey insert: You may need to scroll down to see all the answer options.]
0
None
1
National Certificate level 1
2
National Certificate level 2
3
National Certificate level 3
4
National Certificate level 4
5
Trade Certificate
6
Diploma or Certificate level 5
7
Advanced Trade Certificate
8
Diploma or Certificate level 6
9
Teachers Certificate / Diploma
1982
10 Nursing Diploma
11 Bachelor
12 Bachelor Hons
Act
13 Postgraduate Certificate / Diploma
14 Masters Degree
15 PhD or other doctoral degree
77 Other [Specify]
_________________
.K Don’t know
.R Refused
Information
If A5.14=2, 3, 4, 5, 6 (secondary school qualification completed) AND A5.15=0 (no
highest completed qualification), display message: Consistency check In question A5.14
you recorded that the respondent had completed a secondary school qualification, but in
A5.15 you recorded that they haven’t completed a qualification. Verify answers with
respondent.
Official
the
under
Released
NZHS Year 13 Adult Questionnaire
63
Document 3
Income sources
The next few questions ask about your sources of income.
[Showcard]
A5.16 In the last 12 months, what are all the ways that you yourself got income? Please do
not count loans because they are not income.
[Select all that apply]
Probe “any other?” until no other type of income support mentioned.
All loans, including student loans, should not be counted.
[For VIP survey insert: You may need to scroll down to see all the answer options.]
1
Wages, salaries, commissions, bonuses etc, paid by an employer
2
Self-employment, or business you own and work in
3
Interest, dividends, rent, other investments
1982
4
Regular payments from ACC or a private work accident insurer
5
NZ Superannuation or Veteran’s Pension
Act
6
Other superannuation, pensions, annuities (other than NZ Superannuation,
Veteran’s Pension or war pensions)
7
Jobseeker Support
8
Sole Parent Support
9
Supported Living Payment
10 Student Allowance
11 Other government benefits, government income support payments, war
pensions, paid parental leave or Disability Allowance
Information
12 Other sources of income, including support payments from people who do not
live in the household
17 No source of income during that time [cannot be selected with other options]
.K Don’t know
.R Refused
Official
the
under
Released
NZHS Year 13 Adult Questionnaire
64
Document 3
Income self-complete section
The following income questions are for you to answer on your own. [For F2F survey insert: I
will turn the computer towards you, so you can answer the questions privately.] If you need
help, I can show you what to do.
I can also read the questions out, and you can answer by calling out the option number
[For F2F survey insert: from the Showcard] that best applies to you.
All loans, including student loans, should not be counted.
START OF SELF-COMPLETE.
[Showcard]
A5.23a Looking at the [For F2F survey insert: Showcard] [For VIP survey insert: options on
the screen (you may need to scroll down)], what is the total income that
you
yourself got from
all sources, before tax or anything was taken out of it, in the last
12 months? Please read out the number next to the income group.
1982
If you know your weekly or fortnightly income
after tax, [For F2F insert: I have a
Act
Showcard ⚐ that] [For VIP insert: the screen image] can help you work out your
annual income
before tax.
1
Loss
2
Zero income
3
$1 – $10,000
4
$10,001 – $15,000
5
$15,001 – $20,000
Information
6
$20,001 – $25,000
7
$25,001 – $30,000
8
$30,001 – $35,000
9
$35,001 – $40,000
10 $40,001 – $50,000
Official
11 $50,001 – $60,000
12 $60,001 – $70,000 the
13 $70,001 – $100,000
14 $100,001 – $200,000
15 $200,001 or more [programme A5.24a=6 and go to A5.25]
.K I don’t know
under
.R Prefer not to say
The Showcard (tool tip) to calculate annual income (before tax), will need updating if there
are any changes to the tax rates. This should be reviewed annually during questionnaire
development.
Tool tip for weekly and fortnightly income.
Released
After tax
Before tax
Weekly income $
Fortnightly income $
Annual income $
0–86
0–172
0–5,000
87–172
173–344
5,001–10,000
173–256
345–512
10,001–15,000
257–335
513–670
15,001–20,000
336–414
671–828
20,001–25,000
415–493
829–986
25,001–30,000
NZHS Year 13 Adult Questionnaire
65
Document 3
494–573
987–1,146
30,001–35,000
574–652
1,147–1,304
35,001–40,000
653–805
1,305–1,610
40,001–50,000
806–939
1,611–1,878
50,001–60,000
940–1,074
1,879–2,148
60,001–70,000
1,075–1,459
2,149–2,918
70,001–100,000
1,460–2,102
2,919–4,204
100,001–150,000
2,103–2,721
4,205–5,442
150,001–200,000
2,722+
5,443+
200,001+
[Showcard]
A5.24a Looking at the [For F2F survey insert: Showcard] [For VIP survey insert: options on
the screen], what is the total income that
your household got from all sources,
before tax or anything was taken out of it, in the last 12 months? Please read out
the number next to the income group.
1982
1
$30,000 or less
Act
2
$30,001 – $70,000
3
$70,001 – $100,000
4
$100,001 – $150,000
5
$150,001 – $200,000
6
$200,001 or more
.K I don’t know
.R Prefer not to say
Information
[Showcard]
A5.25 How well does your household’s total income meet the cost of basic needs such as
food, clothing and housing. Would you say it’s not enough, only just enough, enough,
or more than enough?
If people operate separately (eg flatting), please ask them to answer about their
Official
individual situation.
the
1
Not enough
2
Only just enough
3
Enough
4
More than enough
under
.K I don’t know
.R Prefer not to say
New screen.
Thank you for answering those questions; please click ‘Next’. [For F2F: Please hand the
computer back.]
Released
END OF SELF-COMPLETE SECTION.
NZHS Year 13 Adult Questionnaire
66
Document 3
Work and study
[Showcard]
A5.17 Which of these statements best describes your
current work situation:
1
Working in paid employment (includes self-employment)
2
Not in paid work, and looking for a job [go to work without pay A5.19a]
3
Not in paid work, and not looking for a job (for any reason, such as
being retired, a homemaker, caregiver, or full-time student) [go to A5.19a]
77 Other [Specify]
_________________ [go to A5.19a]
.K Don’t know [go to A5.19a]
.R Refused [go to A5.19a]
A5.18 How many hours a week do you
usually work?
Record to nearest hour.
1982
_____ hours (range 1–120)
.K Don’t know
Act
.R Refused
[Showcard]
A5.19a In the last 4 weeks, which of these have you done,
without pay?
[For VIP survey insert: You may need to scroll down to see all the answer options.]
[Select all that apply]
Information
1
Household work, cooking, repairs, gardening, etc, for
my own household
2
Looked after a child who is a member of
my household
3
Looked after a member of
my household who is ill or disabled
4
Looked after a child (who does
not live in my household)
5
Helped someone who is ill or disabled (who does
not live in my household)
Official
6
Other help or voluntary work for or through any organisation, group or marae
0
None of these [cannot be selected with other options]
the
.K Don’t know
.R Refused
[Showcard]
under
A5.19b Are you attending, studying or enrolled at school or any other place of education?
1
Yes – full-time (20 hours or more a week)
2
Yes – part-time (less than 20 hours a week
3
No – neither
.K Don’t know
Released
.R Refused
NZHS Year 13 Adult Questionnaire
67
Document 3
Medical insurance
Now, I’l ask you about medical insurance.
A5.20 Are you covered by any health or medical insurance?
1
Yes
2
No [go to Housing introduction before A5.28b]
.K Don’t know [go to introduction before A5.28b]
.R Refused [go to introduction before A5.28b]
[Showcard]
A5.21 What type of health or medical insurance is that?
If hospital
plus one or two other services, eg 4 free GP visits per year, code as
Other and record details of policy.
1982
1
Comprehensive, covering day-to-day costs such as GP fees and pharmacy
charges, as well as private hospital care
Act
2
Hospital only
77 Other [Specify]
_________________
.K Don’t know
.R Refused
[Showcard]
A5.22 And who pays for this health or medical insurance?
Please ensure respondent reads all response options before choosing.
Information
1
Self or family members
2
Partly self or family and partly employer
3
Paid for by employer or employer of family member
4
Paid for by some other person or agency
Official
.K Don’t know
.R Refused
the
under
Released
NZHS Year 13 Adult Questionnaire
68
Document 3
Housing
Now, some questions about housing.
[Showcard]
A5.28b Looking at the [For F2F survey insert: Showcard] [For VIP insert: options on the
screen], do you, or anyone else who lives here:
⚐ Tool tip for ‘family trust’: A family trust is a special way of owning assets such as
a home. The home is owned by a legal entity, not an individual or group of people.
The family trust arrangement will be set out in a legal document, usually called a
trust deed. If your home is partly in a family trust and partly owned, select ‘Hold this
dwelling in a family trust’.
⚐Tool tip for ‘own or partly own’: What counts as owning or partly owning this
dwelling? The following situations count as owning:
1982
• You or someone else here owns the dwelling, even if you don’t own the land.
• You purchased the dwelling under unit title, stratum title or composite
leasehold (ie, there are multiple owners).
Act
• You purchased the dwelling under license to occupy. This may include self-
care villas, townhouses, apartments, or units in a retirement complex.
• The dwelling you own is a moveable dwelling such as a caravan, boat, tent or
motorhome even if you bought it under hire purchase or some other financial
loan agreement.
If you have a ‘license to occupy’ select ‘Own or partly own this dwelling’.
Information
Select ‘Neither of these’ if you are occupying this dwelling under a rent-to-buy or
similar agreement.
Read response options.
Official
1
Hold this dwelling in a family trust [go to rooms A5.29c]
the
2
Own or partly own this dwelling, with or without a mortgage [go to rooms
A5.29c]
3
Neither of these, for example renting
.K Don’t know
.R Refused under
[Showcard]
A5.29b Who owns this house / flat?
1
Private person, trust or business
2
Local Authority or City Council
Released
3
Kāinga Ora (formerly Housing New Zealand)
4
Other state-owned corporation or state-owned enterprise, or government
department or ministry
5
Iwi, hapū or Māori land trust
6
Other community housing provider
.K Don’t know
.R Refused
NZHS Year 13 Adult Questionnaire
69
Document 3
[Showcard]
A5.29c How many of each of the following rooms are there in this house or flat?
If this dwelling has no rooms of that type, enter ‘0’ (all fields must be filled).
Count any open-plan rooms as separate rooms. For example, a kitchen-dining
room is two separate rooms.
_____ Bedrooms, including any sleepouts furnished as bedrooms [range 0–99]
_____ Lounges, living rooms or family rooms [range 0–99]
_____ Dining rooms [range 0–99]
_____ Kitchens [range 0–99]
_____ Conservatories you can sit in [range 0–99]
_____ Studies, studios, hobby rooms [range 0–99]
.K Don’t know
.R Refused
1982
Sexual identity self-complete section
Act
The next question is for you to answer on your own. If you need help, I can show you what
to do.
I can also read the question out, and you can answer by calling out the option number
[For F2F survey insert: from the Showcard].
START OF SELF-COMPLETE.
[Showcard]
Information
A5.30b Which of the following options best describes how you think of yourself?
1
Heterosexual or straight
2
Gay or lesbian
3
Bisexual
Official
4
Another identity please specify, if you are comfortable doing so [Other screen
text: (leave blank if you do not wish to specify)] [Allow blank if respondent does
the
not volunteer any detail] [To be programmed from the codefile from StatsNZ
after interview – ie NOT by respondent / interviewer]
.K I don’t know
.R Prefer not to say
under
New screen.
Thank you for completing that question; please click ‘Next’. [For F2F survey insert: Please
return the computer to the interviewer and they will ask you the last group of questions.]
END OF SELF-COMPLETE SECTION.
Released
NZHS Year 13 Adult Questionnaire
70
Document 3
Exit
Thank you for participating in this survey. The Ministry of Health is very grateful that you
have given your time to provide this important information to them. Before we finish, I would
like to ask you a few more questions. Please note that any information you give me from
now on will
not be stored with your answers to the survey.
Recontact information for quality control
I would now like to collect some recontact information from you. This is so that my
Supervisor can call you in the next few weeks if there are any queries about the completion
of this survey, or to check that you are happy with the way the interview was conducted.
A6.01 Is there a landline phone that my Supervisor can call you on?
1982
1
Yes [Specify] _________________ [only accept landline number format]
2
No
Act
A6.02 Do you have a cell phone number we could reach you on?
1
Yes [Specify] _________________ [only accept cell number format]
2
No
A6.03 Do you have an email address, in case we cannot contact you by telephone?
Information
1
Yes [Specify] _________________ [only accept email format]
2
No
Recontact information for follow-up research
Official
A6.04 I would now like to ask if you would be happy to be contacted within the next five
years about the possibility of answering other health questions of importance to the
the
Ministry of Health? Saying yes to this question won’t commit you to taking part in any
further research; it just means we can contact you to ask.
1
Yes, you can contact me and ask if I want to help again
under
2
No, don’t contact me to help again [go to Data linkage introduction before A6.08]
If A6.01, A6.02 and A6.03 all=2 go to A6.06, otherwise go to A6.05.
A6.05 To recontact you for other health questions of importance to the Ministry of Health,
can we use the same phone number and email address you provided before?
Released
1
Yes [go to name and address A6.07]
2
No
A6.06 What phone number(s) and email address can we use to recontact you?
1
Landline number: ____________________ [only accept landline number format]
2
Cell phone number: ______________________ [only accept cell number format]
3
Email address: ______________________________ [only accept email format]
4
Do not record phone number(s) or email / Refused
NZHS Year 13 Adult Questionnaire
71
Document 3
A6.07 Could I please also record your name and address? Remember that these details will
never be stored with your survey answers, to ensure that your survey results will
always be anonymous.
1
Yes, record my name and address
a. First name: ___________________________________ [mandatory field]
b. Middle name: _______________________________________________
c. Surname: _________________________________________________
d. Street number and name: ________________________ [mandatory field]
e. Suburb: ______________________________________ [mandatory field]
f.
City: _________________________________________ [mandatory field]
g. Postcode: _________________________________________________
2
No, do
not record my name and address / Refused
1982
Consent for data linkage
Act
The Ministry of Health would like to ask for your permission to combine the valuable
information you have provided in this survey, with other information routinely collected by
government agencies, for research. Combining the answers you have just given with other
information, such as education, income and housing, will help us to develop new ways to
improve the health and wellbeing of all New Zealanders.
To combine the information, the Ministry of Health needs your permission to use your name,
address, gender and date of birth details. The Ministry is bound by the Privacy Act, and
Information
these details will be kept secure and only used by approved staff for data linking. Your
name, address and date of birth will be removed before the combined information is made
available to approved researchers. The combined information will only be used for research
purposes.
Official
A6.08 Are you willing for your survey results to be linked with other information routinely
collected by government agencies?
the
1
Yes
2
No [go to Interviewer observation introduction before A6.16]
under
Released
NZHS Year 13 Adult Questionnaire
72
Document 3
A6.10 Can I please record your name, address, date of birth and gender for data linking?
Please note:
• Your name, address, and date of birth will remain confidential and can only be
accessed by approved staff at the Ministry of Health or Statistics New Zealand,
for the purpose of linking data held by government agencies
• These details will be removed when the data has been linked (only the month
and year of birth will be retained)
• You have the right to change or access your personal details (ie name, address
and date of birth).
To update a previously-recorded date, click on the date picker, select the month
and year from the drop-down lists, then
click on the correct day.
1
Yes
a. First name: ___________________________________ [mandatory field]
1982
b. Middle name: _______________________________________________
c. Surname: ____________________________________ [mandatory field]
Act
d. Street number and name: ________________________ [mandatory field]
e. Suburb: ______________________________________ [mandatory field]
f.
City: _________________________________________ [mandatory field]
g. Postcode: _________________________________________________
h. Date of birth: (range [current in-field year minus 120]–[current in-field year
minus 15]) [mandatory field]
Information
i.
Gender: ______________________________________ [mandatory field]
2
No, don’t record any of these details
If first name, surname, address, date of birth, or gender not provided, display the
Official
following message: In order to help us link your data, would you mind providing your full
name, address, date of birth and gender?
the
If only one initial provided for either first or last name, display the following message: In
order to help us link your data, would you mind providing your full first and last name, rather
than initials?
If two or more names entered into first or last name field, display the following message:
Two or more names entered into a single field, please check and use the middle name field
under
if applicable.
If date of birth recorded at A6.10≠A5.01, display the following message: Data linkage date
of birth (dd/mm/yyyy) does not match date of birth recorded earlier in the survey
(dd/mm/yyyy). Please check with respondent.
Released
Interviewer observations – setting and assistance
Complete following observations without asking the respondent:
A6.16 Record if other people were in the room during any part of the questionnaire.
[Select all that apply]
1
Spouse / partner
2
Parent(s)
3
Other adult(s)
4
Child(ren)
5
Completed alone in room
NZHS Year 13 Adult Questionnaire
73
Document 3
A6.17 Did the interviewer help the respondent complete any of the self-complete questions?
1 Yes, to a small extent
2 Yes, to a moderate extent
3 Yes, to a large extent
4 Yes, totally (interviewer completed all self-complete questions)
5 No, not at all
Respondent burden assessment self-complete section
The next questions will ask you about your experience of the survey process. [For VIP:
These questions are for you to answer on your own.] [For F2F: I will turn the computer
towards you, so you can answer the questions privately.]
START OF SELF-COMPLETE.
1982
AR1.01 Please rate on a scale of 1–5, where 1 is Absolutely NOT Acceptable and 5 is
Act
Highly Acceptable:
1
2
3
4
5
(Absolutely
(Highly
NOT
Acceptable)
Acceptable)
Survey length
Information
The number of questions
Complexity of questions
Intrusiveness of questions
Official
If VIP survey, ask AR1.05 and AR1.06.
AR1.05 These next questions ask about your experience of taking part
online.
the
Please rate the following statements on a scale of 1–5, where 1 is Strongly
Disagree and 5 is Strongly Agree:
under
1
2
3
4
5
(Strongly
(Strongly
Disagree)
Agree)
It was easy to book an
appointment
The survey website was easy to
Released
use
It was easy to communicate with
the interviewer
I felt comfortable to provide
honest answers
Overall, I enjoyed taking part
online
NZHS Year 13 Adult Questionnaire
74
Document 3
AR1.06 Did you encounter any problems with making an appointment, or taking part online?
1
Yes [Specify]
__________________
2
No
AR1.02 Would you take part in the New Zealand Health Survey again?
1
Yes [go to AR1.04]
2
No [go to AR1.03]
AR1.03 Please indicate why you would not take part again:
[Select all that apply]
1
Took too long
2
Too many questions
1982
3
Questions were too personal
4
Questions were not relevant
5
Survey was too repetitive
Act
6
Lost interest
7
Other [Specify]
_________________
AR1.04 Are there any other comments you would like to make about taking part in the
survey?
Information
1
Yes [Specify]
__________________
2
No
New screen.
Official
Thank you for answering those questions; please click ‘Next’. [For F2F: Please hand the
computer back.]
the
END OF SELF-COMPLETE SECTION.
For VIP, go to Thank you.
under
The rest of the questionnaire is collected in the Sample Manager tool.
Released
NZHS Year 13 Adult Questionnaire
75
Document 3
Household composition
Ask next questions, A5.31 and A5.35, if there is more than 1 person in household
(Occupants in household screener>1).
Gender and age
A5.31 I would now like to enter some information about the
other people who live with you,
as this can impact on your health. Please confirm the initials, ages and genders of all
the people who usually live in this household.
The following questions cover the initials, age, gender and relationship of
every
member of the household.
Update fields or add / delete occupants below as required.
Occupant grid pre-populated with information from household screener.
Provide three response options for gender: male, female, another gender.
1982
Occupant Name
ID
Age
Gender
Act
Relationships
The next questions are about relationships in your household.
The following questions cover the relationships between
every member of the household.
Information
Ask the relationships between every household member one-way. Eg if a father Matt is
asked the relationship to his son James, there’s no need to also ask James his relationship
to his father as it will be derived.
[Showcard]
Official
A5.35
If dealing with respondent’s relationships, insert:
What is [Name’s] relationship to you?
the
Include natural, step, adopted and foster relationships.
Otherwise insert:
What is [Name’s] relationship to [Name]?
under
Include natural, step, adopted and foster relationships.
1
Spouse or partner
2
Child (eg daughter)
3
Parent (eg mother)
4
Sibling (eg brother)
Released
5
Grandchild
6
Grandparent
7
Great-grandchild
8
Great-grandparent
9
Nephew or niece
10
Uncle or aunt
11
Other relative
12
Unrelated
.K
Don’t know
.R
Refused
Perform the following soft edit checks on all coded relationship pairs.
NZHS Year 13 Adult Questionnaire
76
Document 3
Edit
Description
Error Message
Check
E1
A person is unlikely to have more than
[Name] is recorded as already having a spouse or
one spouse / partner in a household.
partner. Please verify that [Name] is another
spouse / partner of [Name].
E2
A person is unlikely to be living with more [Name] is recorded as already having two
than two parents at one time.
parents. Please verify that [Name] is another
parent of [Name].
E3
A person is unlikely to have a
This household spans at least 4 generations.
relationship of parent to one household
Please verify this with respondent and if this is not
member and a relationship of grandchild
correct, please select 'Go to' to review the
to another household member.
relationships in the household.
E4
It is unlikely that a person aged less than
[Name] is less than 15 years and is recorded as
15 years would be unrelated to all
being unrelated to any other household member.
household members.
Please verify this response.
1982
E5
It is unlikely that a person aged less than
[Name] is less than 15 years of age and is
15 years would be a spouse of another
recorded as the spouse/partner of [Name]. Please
Act
household member.
verify this response.
E6
It is unlikely that a person aged less than
[Name] is less than 15 years of age and is
15 years would be a parent of another
recorded as the parent of [Name]. Please verify
household member.
this response.
E7
A person aged less than 30 years is
[Name] is less than 30 years of age and recorded
unlikely to be the grandparent of another
as the grandparent of [Name]. Please verify this
household member.
response.
E8
A person aged less than 45 years is
[Name] is less than 45 years of age and recorded
Information
unlikely to be the great-grandparent of
as the great-grandparent of [Name]. Please verify
another household member.
this response.
E9
It is unlikely that a child is older than a
[Name] is younger than [Name] but is recorded as
parent.
their parent. Please verify this response.
Official
E10
It is unlikely that a child is older than their [Name] is younger than [Name] but is recorded as
grandparent.
their grandparent. Please verify this response.
the
E11
It is unlikely that a child is older than their [Name] is younger than [Name] but is recorded as
great-grandparent.
their great-grandparent. Please verify this
response.
E12
A person aged over 70 years is unlikely
[Name] is over 70 years of age and is recorded as
to have a relationship of niece or nephew the niece or nephew of [Name]. Please verify this
under
to another household member.
response.
E13
A person aged over 50 years is unlikely
[Name] is over 50 years of age and is recorded as
to be the grandchild of another
the grandchild of [Name]. Please verify this
household member.
response.
E14
A person aged over 30 years is unlikely
[Name] is over 30 years of age and is recorded as
to be the great-grandchild of another
the great-grandchild of [Name]. Please verify this
Released
household member.
response.
E15
A person aged over 70 years is unlikely
[Name] is over 70 years of age and is recorded as
to be the child / foster child / stepchild of
the child / foster child / stepchild of [Name].
another household member.
Please verify this response.
E16
A parent is likely to be at least 13 years
[Name] is recorded as the parent of [Name] but is
older than their child.
less than 13 years older than them. Please verify
this response.
E17
It is unlikely that the age gap between
[Name] is recorded as [Name's] brother / sister,
siblings would be greater than 40 years.
but is over 40 years older than them. Please
verify this response.
NZHS Year 13 Adult Questionnaire
77
Document 3
Health measurements
Blood pressure
Now I would like to take your blood pressure.
For cis-female respondents (sex is female, AD.01a=2 AND gender is female, AD.01b=2)
aged 15–54 years, ask the following question.
AM.1 Firstly, I need to ask if you are pregnant at the moment?
1
Yes, respondent is pregnant [skip to Thank you section]
Say “We can skip this section then”.
2
No, respondent not pregnant [go to first blood pressure measurement]
1982
.K Don’t know [go to first blood pressure measurement]
.R Refused [go to first blood pressure measurement]
Act
I will now take your blood pressure using an automated blood pressure monitor.
Before we take the blood pressure measurement you need to have been sitting quietly for
five minutes. You cannot have eaten, drunk or smoked during this time. You will need to sit
with your feet flat on the floor and with your back against the back of the chair, and have
your left arm straight on the table.
Information
Select the cuff size and attach to the respondent’s left arm.
During the measurement the cuff will inflate three times, once every minute. You will feel
some pressure on your arm while this is happening. You should not move or talk during the
test and it is important to stay relaxed. Official
Do you have any questions before we begin?
the
Now I will start the machine.
First reading
under
ABP_1A
__/__/__
Systolic blood pressure (mmHG) (range 30–300)
ABP_1B
__/__/__
Diastolic blood pressure (mmHG) (range 30–200)
Hard edit: Systolic1 must be >Diastolic1
Soft edit: Systolic1 minus Diastolic2 is <20 or >100
ABP_1C
__/__/__
Heart Rate (in beats per minute) (range 30–200)
Released
Second reading
ABP_2A
__/__/__
Systolic blood pressure (mmHG) (range 30–300)
ABP_2B
__/__/__
Diastolic blood pressure (mmHG) (range 30–200)
Hard edit: Systolic2 must be >Diastolic2
Soft edit: Systolic2 minus Diastolic2 is <20 or >100
ABP_2C
__/__/__
Heart Rate (in beats per minute) (range 30–200)
NZHS Year 13 Adult Questionnaire
78
Document 3
Third reading
ABP_3A
__/__/__
Systolic blood pressure (mmHG) (range 30–300)
Soft edit: Systolic1=Systolic2=Systolic3
ABP_3B
__/__/__
Diastolic blood pressure (mmHG) (range 30–200)
Hard edit: Systolic3 must be >Diastolic3
Soft edit: Systolic3 minus Diastolic3 is <20 or >100
Soft edit: Diastolic3=Diastolic2=Diastolic1
ABP_3C
__/__/__
Heart Rate (in beats per minute) (range 30–200)
778 Right arm used
779 Not obtained – cuff too small or too
large
780 Not obtained – error reading
781 Not obtained – other problem with equipment
1982
782 Not obtained – respondent anxious / nervous
783 Not obtained – medical exclusion eg paralysis
.R
Respondent refused to have blood pressure recorded
Act
I will write your blood pressure results on a measurement card for you to keep.
Tablet automatically generates the blood pressure results and script based on lowest
systolic and lowest diastolic reading from the last two readings.
Results
Systolic
Diastolic
Information
1: Ideal
<130
and
<80
2: Raised
130–169
or
80–99
3: Very raised
170 or more
or
100 or more
Read the exact script about the respondent’s blood pressure results from the tablet
Official
screen. If they have any questions about their results, advise them to consult their doctor.
the
Your Blood Pressure reading is ____/____ (mmHg)
1:
“Your blood pressure is within the ideal range”.
2:
“Your blood pressure is a
bit high today”.
under
“Some people wil have results that are higher than ideal but this may not mean you have a
health problem. Your blood pressure results can vary from day-to-day and are influenced by
many things. We recommend you discuss these results with your usual doctor or health
professional”.
3: “Your blood pressure is
high today”.
Released
“Some people wil have results that are higher than ideal but this may not mean you have a
health problem. Your blood pressure results can vary from day-to-day and are influenced by
many things. We recommend you discuss these results with your usual doctor or health
professional
in the next few days”.
I am now going to take three measurements from you – height, weight, and waist – in that
order. I’m then going to take those measurements again, and if any of the second measures
are not close enough to the first ones, I’l measure you for a third time. While I’m setting up
the equipment, could you please remove your shoes and all heavy outer clothing so we can
obtain accurate measurements… Thank you.
NZHS Year 13 Adult Questionnaire
79
Document 3
Height
Now, I would like to measure your height.
Please stand with your back to the door / wall. Put your feet together and move them back
until your heels touch the door / wall. Stand up straight and look straight ahead.
If head is not in Frankfort Plane say…
Please raise / lower your chin. Take a deep breath and hold it.
Take measurement when breath is held and say it aloud.
That’s fine, you can breathe normally now and step away from the door / wall.
AM.2 1st reading 0.000 (m) (range 0.600m–2.300m)
.R
Respondent refused to have height recorded
1982
777 Respondent unable to have height recorded (eg chairbound, too unsteady on
feet, in pain etc)
Act
Check any measurements that fall below the 1st percentile or above the 99th percentile.
Weight
Wait until it turns zero. Please step onto the centre of the scale with your weight on both
feet. Relax [take reading]. Thank you. You can step off now.
AM.3 1st reading 000.0 (kg) (range 10.0kg–210.0kg)
Information
.R
Respondent refused to have weight recorded
777 Respondent unable to have weight recorded (eg chairbound, too unsteady on
feet, in pain etc)
Official
Check any measurements that fall below the 1st percentile or above the 99th percentile.
the
under
Released
NZHS Year 13 Adult Questionnaire
80
Document 3
Waist
Please stand in a relaxed position. Take the end of the tape, pass it around your waist and
hand it back to me. Please help me to position the tape at the level of your waist. Good, now
just breathe normally [take measurement at end of breath out]. Thank you.
AM.4 1st reading 000.0 (cm) (range 10.0cm–200.0cm)
.R
Respondent refused to have waist circumference recorded
997 Respondent unable to have waist circumference recorded
Check any measurements that fall below the 1st percentile or above the 99th percentile.
Computer to repeat prompts as above and automatically does calculation to indicate if
third reading is required. If more than 1% difference between first and second reading, a
third reading is required.
1982
Act
Information
Official
the
under
Released
NZHS Year 13 Adult Questionnaire
81
Document 3
Thank you
On behalf of the Ministry of Health, thank you once again for talking with me about your
health.
[For F2F: Here is a small gift from the Ministry in recognition of your time.
Give Thank You card and koha.
Inside the card is a list of phone numbers you can call if you would like more information or
advice. If you’d prefer, I can arrange for this to be emailed to you along with the consent
form(s).]
[For VIP: We would like to email you a Thank you card (with a list of phone numbers you can
call if you would like more information or advice), along with the consent form(s).]
1982
If you’d rather not receive these items, that’s completely fine.
Act
1
Yes, please email to me
[Specify]
_______________ [only accept email format]
2
No, don’t email
End survey for households with no persons aged under 15 years.
Child health component
Information
For households with child aged 0 to 14 years.
As we discussed at the beginning of this survey, we would also like to interview the legal
guardian of [randomly selected child’s name], that is the person who has day-to-day
responsibility for the care of [Name]. Is that you?
Official
1
Yes [go to child health questionnaire]
2
No ask to speak to legal guardian.
the
Record following details:
1
Child health questionnaire completed
2
Child health questionnaire still to be completed
under
Released
NZHS Year 13 Adult Questionnaire
82
Document 4
New Zealand Health Survey
Child Questionnaire (Year 13)
1 July 2023 – 30 June 2024
under the Official Information Act 1982
Released
In field July 2023
Document 4
Table of Contents
Overview and programming information ............................................................... 4 Informed consent ..................................................................................................... 7 Initial demographics ................................................................................................ 8 Long-term health conditions ................................................................................. 10
Asthma ................................................................................................................. 10
Eczema ................................................................................................................ 10
Neurodiversity ...................................................................................................... 11
Oral health ........................................................................................................... 12
Interviewer observations – language assistance ................................................ 13 Health status ........................................................................................................... 14
General health question ....................................................................................... 14
1982
Child Functioning Module ..................................................................................... 14 Health service utilisation ....................................................................................... 18
Usual primary health care provider ...................................................................... 18
Act
General practitioners ............................................................................................ 19
Nurses at general practices and medical centres ................................................ 20
Emergency department ........................................................................................ 21
Dental health care workers .................................................................................. 22
Getting help for mental health and substance use issues .................................... 23
Health behaviours and risk factors ....................................................................... 26
Perception of child’s weight .................................................................................. 26
Information
Breastfeeding ....................................................................................................... 26
Dietary habits ....................................................................................................... 28
Physical activity .................................................................................................... 33
Screen time .......................................................................................................... 34
Official
Sleep .................................................................................................................... 35
Tooth brushing ..................................................................................................... 35
the
Exposure to second-hand smoke ......................................................................... 37
Response to child’s misbehaviour ........................................................................ 38
Child behaviour and parenting self-complete section ........................................ 39
Strengths and Difficulties Questionnaire (SDQ) for 2–4 year olds ....................... 40
under
Strengths and Difficulties Questionnaire (SDQ) for 5–10 year olds ..................... 41
Strengths and Difficulties Questionnaire (SDQ) for 11–14 year olds ................... 42
Parental stress ....................................................................................................... 43 Household food security ....................................................................................... 45 Socio-demographics .............................................................................................. 48
Date of birth ......................................................................................................... 48
Released
Ethnic group(s) ..................................................................................................... 48
Country of birth .................................................................................................... 49
Medical insurance ................................................................................................ 50
Interviewer observation – if adult questionnaire completed .................................. 50
Extra questions if adult questionnaire has not yet been completed ..................... 51
Interviewer observation – if both adult / child survey respondent ......................... 53
Extra questions if primary caregiver was
not the NZHS adult respondent ........... 54
Exit ........................................................................................................................... 56
Recontact information for quality control .............................................................. 56
Recontact information for follow-up research ....................................................... 56
Consent for data linkage ...................................................................................... 57
NZHS Year 13 Child Questionnaire
2
Document 4
Interviewer observations – setting ........................................................................ 59
Respondent burden assessment self-complete section ....................................... 59
Household composition ........................................................................................ 61 Gender and age ...................................................................................................... 61
Relationships ....................................................................................................... 61
Health measurements ............................................................................................ 63
Height ................................................................................................................... 64
Weight .................................................................................................................. 64
Waist .................................................................................................................... 64
Thank you ............................................................................................................... 65
1982
Act
Information
Official
the
under
Released
NZHS Year 13 Child Questionnaire
3
Document 4
Overview and programming information
Design
Each year for the New Zealand Health Survey, approximately 5,000 primary caregivers of children aged
0–14 are interviewed face-to-face (in person) and remotely using computer software (a virtual interface
platform). Interviews are administered using computer-assisted personal interviewing (CAPI) and
computer-assisted self-interviewing (CASI). Key topics include long-term health conditions, health
status and behaviours and health service utilisation. Anthropometric measurements (height, weight and
waist circumference) are also taken. NZHS collects information that cannot be obtained more effectively
or efficiently through other means, such as by analyses of hospital administrative records, disease
registries or epidemiological research.
1982
Text Format
Examples
Black
Text read by interviewer: introductions,
The next set of questions is about nurses
Act
questions / question options
who work at general practices and medical
centres
Blue
Showcard note positioned above a question [Showcard]
Multiple response allowed for a question
[Select all that apply]
Instructional text specifically for interviewers Round to nearest hour
Information
Other [Specify]
Text read verbatim to respondents
Prompt: “any others?”
Interviewer observations: section completed
Complete following observations without
Official
unobtrusively (solely) by interviewer
asking the respondent
the
Tool tips, with a ⚐ symbol, contain
Here is a list of examples of specialist
information that only appears if the mouse
doctors ⚐
pointer hovers over the underlined words, or
if underlined words are touched with a finger
under
Green
Copyright / attribution, displayed on screen
© Robert Goodman, 2005
as a requirement of usage
Purple
Text specifically for questionnaire readers,
The toothpaste picture showcard needs
not displayed on screen
updating if there are any major changes in
the market
Released
Red
Programmer information, instructions, alerts
Limit to children <2 years
and headings, not displayed on screen
Abbreviations used in programming text
Respondent interviewed in person by
F2F
Face-to-face
interviewer
Survey tool enabling remote interviewing via
VIP
Virtual Interface Platform
computer software
NZHS Year 13 Child Questionnaire
4
Document 4
Key Edit Checks
Description
Type
Single and multiple-
For each question, only one answer can be selected, except for
Hard edit
choice responses
multiple-choice questions, represented by the instruction [Select
all that apply].
Exclusive answer
Don't know, Refused / Prefer not to say, Doesn’t apply, None of
Hard edit
options
the above, None, and No treatment are all exclusive responses,
ie they cannot be selected in conjunction with other responses.
Range checks
For numeric response questions, the data entered must fall within
Hard edit
a certain range. Range checks prompt interviewers to change an
answer falling outside the pre-set range parameters. For
example, a person cannot enter an amount more than $199.00 for
the cost of GP visits.
1982
Confirmation
For some questions, the survey prompts the interviewer to check
Soft edit
Act
checks
a response which may be unlikely, or which may be incompatible
with previous answers. For example, a child is unlikely to usually
sleep for less than 6 hours in a 24 hour period.
Consistency
Some checks enforce consistency of responses between
Hard edit
checks
questions. When edit checks are triggered, the interviewer or
respondent must go back and change their answer to ensure
response consistency. For example, reporting that the child was
Information
born in a maternity ward in the past year is only a valid answer if
the child is less than one year old.
Completeness
For some of the grid-style questions, where multiple items /
Hard edit
checks
statements are combined into a table, each row must contain a
Official
response. For example, relationship information is captured for
every pair of occupants in a household. This is recorded in a grid
format and each row must be completed.
the
Hard edit checks require the interviewer to change the data they have entered before continuing. Soft
edit checks provide an opportunity to check a response, and if applicable, change the data entered
before continuing; however, the original response entered can also be retained.
under
Showcards
Showcard tablet
Answer options are visible for some questions on a separate tablet device
which the respondent views during the survey.
Released
Response option
Selected options are allocated numbers allowing respondents to discretely
numbering
provide a response; ie to call out a number opposed to the descriptive text.
NZHS Year 13 Child Questionnaire
5
Document 4
Year 13 Modules
Disability
Disability measured by the UNICEF Child Functioning Module for 5–14 year
olds – as amended by Stats NZ Tatauranga Aotearoa for the 2019/20
Household Economic Survey (HES).
Smoke exposure
Two questions on exposure to second-hand smoke in the home and car for 0–
14 year olds.
Child behaviour
Strengths and Difficulties Questionnaire (SDQ) with three age groups: 2–4 year
and parenting
olds, 5–10 year olds, and 11–14 year olds, focusing on how children behave
and function day-to-day, and the Parental stress section (0+ year olds),
centring on how parents or caregivers are coping day-to-day.
1982
Act
Information
Official
the
under
Released
NZHS Year 13 Child Questionnaire
6
Document 4
Informed consent
Before we begin, I need to check that:
• You have read and understand the information pamphlet on the New Zealand Health
Survey. You know you can ask questions at any time and you can contact Reach
Aotearoa or the Ministry of Health if you want further information.
• You know that you can stop the interview at any time and you don’t have to answer
every question. There is no disadvantage to you if you don’t want to take part, or if
you choose to stop at any time.
• You know that your participation in the New Zealand Health Survey is confidential
and no information that could identify you will ever be used in any reports. All your
answers are protected by the Privacy Act 2020.
CC.01 You agree to take part in the New Zealand Health Survey on behalf of a child aged 0-
1982
14, for whom you are the parent / legal guardian.
1
Yes
Act
2
No
If CC.01=2, display message: Consent must be obtained before continuing. Check
response. If consent is not given, exit survey and thank them for their time.
CC.02 You agree for parts of this survey to be audio recorded for quality monitoring and you
understand that any recording will be anonymous.
Information
1
Yes
2
No
Official
the
under
Released
NZHS Year 13 Child Questionnaire
7
Document 4
Initial demographics
[For VIP survey insert: Before we begin, can I please check that you are in a private space,
where our conversation will not be overheard?
If the answer is ‘No’, request that the respondent find a private space before you
continue. Alternatively, rearrange the interview to a time when the respondent will have
privacy.
I’l just explain some key features of this video interview:
• Three types of questions will be asked: questions that include an option list for you to
select from; yes or no questions that do not include an option list; and questions that
are more personal, that you can complete yourself.
• To pause the survey at any time, just click the pause button at the top right of the
1982
screen. To turn off your camera or microphone, select the camera or microphone
icons below the video feed. If you need help with your audio or video, using
headphones, or help with anything else, just let me know.]
Act
New screen.
To start, I will ask some general information about the child that has been randomly selected
for the survey, so that I only ask questions which are applicable to their age.
CD.01 Could you tell me the child’s
first name?
Information
If respondent wil not provide the child’s name, initials are acceptable.
Record name. [Child’s name recorded]
.R Refused
Official
[Showcard]
CD.021 What gender is [Name]?
A child’s gender may be different from their sex at birth. Gender is a person’s
the
sense of being male, female, or another gender such as non-binary.
1
Male
2
Female
under
3 Another gender – please specify, if you are comfortable doing so [Other screen
text: (leave blank if they do not wish to specify)] [Allow blank if respondent does
not volunteer any detail] [To be programmed from the codefile from StatsNZ
after interview – ie NOT by respondent / interviewer]
Released
NZHS Year 13 Child Questionnaire
8
Document 4
CD.03 I need to know / confirm [Name's] age as the questions I ask depend on their age.
I need to know their age so that only questions that apply are asked.
Record age under 2 years in months; and age >=2 years in years.
Only one field should be completed.
If Don’t know or Refused selected, display message: I really need to know
[Name’s] age in order to proceed with the questionnaire. Select ‘Back’ [F2F] or
‘Previous’ [VIP] to go back and enter age. If respondent stil cannot or won’t give the
age, end interview and thank respondent for their time.
CD.03a Age _____ months (range 0–23)
CD.03b Age _____ years (range 2–14)
.K Don’t know
.R Refused
1982
Error message if both month and year selected: Only one field should be completed.
Can't have values for both month and year.
Act
CD.03c Age group
Interviewer records age group.
1
Birth–11 months
2
12–23 months (1 year old)
Information
3
2–4 years
4
5–9 years
5
10–14 years
If age and age group do not match, display message: Consistency check Age and age
Official
group do not match. Verify answer with respondent. Go back to CD.03 (Age).
the
under
Released
NZHS Year 13 Child Questionnaire
9
Document 4
Long-term health conditions
The next questions are about
long-term health conditions [Name] may have. A long-term
health condition is a
physical or mental condition that has lasted, or is expected to last, for
more than six months. The symptoms may come and go or be present all the time.
If child <5 years
add… Some of the next questions may not apply to [Name], but please
try to answer anyway.
Asthma
C1.01 Have you ever been told by a doctor or nurse that [Name] has asthma?
1
Yes
2
No [go to eczema C1.03]
.K Don’t know [go to C1.03]
1982
.R Refused [go to C1.03]
[Showcard]
Act
C1.02 What treatments does [Name]
now have for asthma?
[Select all that apply]
1
No treatment [cannot be selected with other options]
2
Inhaler
3
Medicines, tablets or pills
77 Something else
Information
.K Don’t know
.R Refused
Eczema
Official
C1.03 Have you ever been told by a doctor or nurse that [Name] has eczema?
the
1
Yes
2
No [go to Neurodiversity C1.09]
.K Don’t know [go to C1.09]
.R Refused [go to C1.09]
under
[Showcard]
C1.04 What treatments does [Name]
now have for eczema?
[Select all that apply]
1
No treatment [cannot be selected with other options]
2
Medicines, tablets or pills
Released
3
Cream or ointment
77 Something else
.K Don’t know
.R Refused
Go to Neurodiversity questions (C1.09–C1.16) for children aged 2–14 years. Go to
Interviewer observations introduction (C6.13) for children aged from birth to 11 months. Go
to Oral health introduction before C1.17 for children aged 12–23 months.
NZHS Year 13 Child Questionnaire
10
Document 4
Neurodiversity
C1.09 Have you ever been told by a doctor that [Name] has autism spectrum disorder?
Include Asperger’s syndrome.
1
Yes
2
No [go to attention deficit disorder C1.15]
.K Don’t know [go to C1.15]
.R Refused [go to C1.15]
[Showcard]
C1.10 What treatments does [Name]
now have for autism spectrum disorder?
[Select all that apply]
Include Asperger’s syndrome.
1
No treatment [cannot be selected with other options]
1982
2
Medicines, tablets or pills
3
Counselling
Act
77 Something else
.K Don’t know
.R Refused
C1.15 Have you ever been told by a doctor that [Name] has attention deficit hyperactivity
disorder (ADHD)?
Include attention deficit disorder (ADD).
Information
1
Yes
2
No [go to Oral health introduction before C1.17]
.K Don’t know [go to introduction before C1.17]
.R Refused [go to introduction before C1.17]
Official
[Showcard]
C1.16 What treatments does [Name]
now have for ADHD?
the
[Select all that apply]
Include attention deficit disorder (ADD).
1
No treatment [cannot be selected with other options]
under
2
Medicines, tablets or pills
3
Counselling
77 Something else
.K Don’t know
.R Refused
Released
NZHS Year 13 Child Questionnaire
11
Document 4
Oral health
Go to Oral health questions (C1.17–C1.18a) for children aged 1–14 years. Go to
Interviewer observations introduction before C6.13 for children aged <1 year.
The next questions are about [Name’s] teeth, gums and mouth. When I say dental health
care worker, I mean dentists, dental therapists (used to be called dental nurses) as well as
any dental health specialists such as orthodontists.
C1.17 Have any of [Name’s] teeth been removed by a dental health care worker because of
tooth decay, an abscess or infection? Do not include teeth lost for other reasons
such as injury, crowded mouth or orthodontics.
Includes teeth that were removed while overseas (as well as in New Zealand).
Includes baby teeth
ONLY if removed because of tooth decay, an abscess or
infection.
1982
1
Yes
2
No [go to health of mouth C1.18a]
Act
.K Don’t know [go to C1.18a]
.R Refused [go to C1.18a]
C1.18 Were any of these teeth removed in the last 12 months?
1
Yes
2
No
.K Don’t know
Information
.R Refused
[Showcard]
C1.18a How would you describe the health of [Name’s]
teeth or mouth?
Official
1
Excellent
2
Very good
the
3
Good
4
Fair
5
Poor
.K Don’t know under
.R Refused
Released
NZHS Year 13 Child Questionnaire
12
Document 4
Interviewer observations – language assistance
Complete following observations without asking the respondent:
C6.13 Interview is being conducted with
language assistance from a
family member /
friend of respondent.
Only code ‘Yes’ if the respondent has required more than a couple of questions to
be interpreted.
1
Yes
2
No
C6.14 Interview is being conducted with
language assistance from a
professional
translator.
1
Yes
1982
2
No
Act
Information
Official
the
under
Released
NZHS Year 13 Child Questionnaire
13
Document 4
Health status
Ask all respondents C1.19.
General health question
This question is about [Name’s] health
now.
Please try to answer as accurately as you can.
[Showcard]
C1.19 In general, would you say [Name’s] health is:
Read response options.
1
Excellent
1982
2
Very good
3
Good
4
Fair
Act
5
Poor
.K Don’t know
.R Refused
Child Functioning Module
Information
Go to the next question CF1.01 for children aged 5–14 years. Go to Health service
utilisation introduction before C2.01a for children aged 0–4 years.
[Showcard]
CF1.01 Does [Name] have difficulty seeing, even if wearing glasses?
Official
1
No – no difficulty
the
2
Yes – some difficulty
3
Yes – a lot of difficulty
4
Cannot do at all
.K Don’t know
.R Refused under
[Showcard]
CF1.02 Does [Name] have difficulty hearing sounds like people's voices or music, even if
using a hearing aid?
1
No – no difficulty
Released
2
Yes – some difficulty
3
Yes – a lot of difficulty
4
Cannot do at all
.K Don’t know
.R Refused
NZHS Year 13 Child Questionnaire
14
Document 4
[Showcard]
CF1.03 Compared with children of the same age, does [Name] have difficulty walking 100
metres on level ground? That would be about the length of a rugby field.
1
No – no difficulty
2
Yes – some difficulty
3
Yes – a lot of difficulty
4
Cannot do at all
.K Don’t know
.R Refused
[Showcard]
CF1.04 Does [Name] have difficulty with self-care such as feeding or dressing
themselves?
1982
1
No – no difficulty
2
Yes – some difficulty
3
Yes – a lot of difficulty
Act
4
Cannot do at all
.K Don’t know
.R Refused
[Showcard]
CF1.05 Using their usual language, does [Name] have difficulty communicating, for
example, understanding or being understood?
Information
1
No – no difficulty
2
Yes – some difficulty
3
Yes – a lot of difficulty
4
Cannot do at all
Official
.K Don’t know
.R Refused
the
[Showcard]
CF1.06 Compared with children of the same age, does [Name] have difficulty learning
things?
under
1
No – no difficulty
2
Yes – some difficulty
3
Yes – a lot of difficulty
4
Cannot do at all
.K Don’t know
.R Refused
Released
[Showcard]
CF1.07 Compared with children of the same age, does [Name] have difficulty remembering
things?
1
No – no difficulty
2
Yes – some difficulty
3
Yes – a lot of difficulty
4
Cannot do at all
.K Don’t know
.R Refused
NZHS Year 13 Child Questionnaire
15
Document 4
[Showcard]
CF1.08 Does [Name] have difficulty concentrating on an activity that they enjoy doing?
1
No – no difficulty
2
Yes – some difficulty
3
Yes – a lot of difficulty
4
Cannot do at all
.K Don’t know
.R Refused
[Showcard]
CF1.09 Does [Name] have difficulty accepting changes in their routine?
1
No – no difficulty
2
Yes – some difficulty
1982
3
Yes – a lot of difficulty
4
Cannot do at all
.K Don’t know
Act
.R Refused
[Showcard]
CF1.10 Compared with children of the same age, does [Name] have difficulty controlling
their behaviour?
1
No – no difficulty
Information
2
Yes – some difficulty
3
Yes – a lot of difficulty
4
Cannot do at all
.K Don’t know
.R Refused
Official
[Showcard]
CF1.11 Does [Name] have difficulty making friends?
the
1
No – no difficulty
2
Yes – some difficulty
3
Yes – a lot of difficulty
under
4
Cannot do at all
.K Don’t know
.R Refused
[Showcard]
CF1.12 How often does [Name] seem very anxious, nervous, or worried?
Released
1
Daily
2
Weekly
3
Monthly
4
A few times a year
5
Never
.K Don’t know
.R Refused
NZHS Year 13 Child Questionnaire
16
Document 4
[Showcard]
CF1.13 How often does [Name] seem very sad or depressed?
1
Daily
2
Weekly
3
Monthly
4
A few times a year
5
Never
.K Don’t know
.R Refused
1982
Act
Information
Official
the
under
Released
NZHS Year 13 Child Questionnaire
17
Document 4
Health service utilisation
The next set of questions is about the use of health care services in
New Zealand for
[Name].
Usual primary health care provider
C2.01a Do you have a
general practice or medical centre that you
usually go to when
[Name] is feeling unwell or is injured?
Do not include emergency department (ED).
1
Yes
2
No [go to General practitioner introduction before C2.12a]
.K Don’t know [go to General practitioner introduction before C2.12a]
.R Refused [go to General practitioner introduction before C2.12a]
1982
From now on, we’l call this place [Name’s]
usual medical centre.
Act
C2.03 Is [Name’s] usual medical centre the same place that
you usually go to when you
are feeling unwell or injured?
1
Yes
2
No
.K Don’t know
.R Refused
Information
C2.04 Has [Name]
been to their usual medical centre in the
last 12 months, about their
own health?
1
Yes
Official
2
No [go to General practitioner introduction before C2.12a]
.K Don’t know [go to introduction before C2.12a]
the
.R Refused [go to introduction before C2.12a]
[Showcard]
C2.011 At [Name’s]
usual medical centre, has [Name] had an appointment with any of the
under
following health care workers about their own health, in the
past 12 months?
[Select all that apply]
1 GP (general practitioner or family doctor)
2 Nurse
3 Physiotherapist
4 Mental health professional (eg psychologist or counsellor)
Released
5 Dietitian
77 Another health care worker [Specify]
________________
0 None of the above [cannot be selected with other options]
.K Don’t know
.R Refused
If C2.04=1 and C2.011=0, display message: Consistency check In question C2.04 you
recorded that they had visited their usual medical centre, but in C2.011 you recorded that
they have not had an appointment at their medical centre. Verify answers with respondent.
Go back to C2.04 or change this response.
NZHS Year 13 Child Questionnaire
18
Document 4
General practitioners
These next questions are about [Name] seeing a general practitioner (GP) or family doctor.
This can be at their
usual medical centre or
somewhere else.
GP – utilisation
C2.12a How many times did [Name] see a GP in the past 12 months? This may have been
about their physical health, or their mental or emotional health.
_____ times (range 1–99)
0
Hasn’t seen a GP in last 12 months [go to GP – barriers to access C2.27]
.K Don’t know [go to C2.27]
.R Refused [go to C2.27]
1982
If C2.011=1 and C2.12a=0, display message: Consistency check In question C2.011
you recorded that they had visited a GP at their usual medical centre, but in C2.12a you
recorded that they haven’t seen a GP. Verify answers with respondent. Go back to C2.011.
Act
Go back to C2.12a.
C2.15 Thinking about [Name’s] last visit to a GP, what were you charged for that visit?
Record amount in dollars and cents, eg $60=60.00.
If respondent says between two amounts, record the average in dollars and cents
(eg between $40 and $50: record 45.00).
If free enter 0.00.
Information
If respondent says an amount greater than $199, record as $199.00.
Can give an estimate if exact amount unknown.
$___.___ (range 0.00–199.00)
.K Don’t know
Official
.R Refused
the
GP – barriers to access
C2.27 In the past 12 months, was there a time when [Name] had a medical problem but did
not visit or talk to a GP because of cost?
under
1
Yes
2
No
.K Don’t know
.R Refused
Released
NZHS Year 13 Child Questionnaire
19
Document 4
[Showcard]
C2.270 In the
past 12 months, was there a time when [Name] had a
medical problem but
did not visit a GP for any of the following reasons?
[For VIP survey insert: You may need to scroll down to see all the answer options.]
[Select all that apply]
Read each response option aloud and allow respondents to respond to each
option.
Please exclude not visiting a GP because of cost.
1
Time taken to get an appointment too long
2
Owed money to the medical centre
3
Dislike or fear of the GP
4
Difficult to take time off work
5
No transport or too far to travel
1982
6
Could not arrange childcare (for other children) or care for a dependent adult
An adult who is ill or disabled.
7
Didn’t have a carer, support person or interpreter to go with you
Act
77 Another reason [Specify]
_________________
0
None of the above [cannot be selected with other options]
.K Don’t know
.R Refused
C2.30 In the past 12 months, was there a time when [Name] got a prescription but you did
not collect one or more prescription items from the pharmacy or chemist because of
Information
cost?
1
Yes
2
No
.K Don’t know
Official
.R Refused
the
Nurses at general practices and medical centres
The next set of questions is about nurses who work at general practices and medical
centres.
under
Please do
not include nurses who may have visited [Name] at home or school or nurses
[Name] saw in a hospital. Also, don’t include midwives or dental nurses.
C2.36a In the past 12 months, has [Name] seen a nurse at a general practice or medical
centre? This may have been about their physical health, or their mental or
Released
emotional health.
1
Yes
2
No [go to emergency department introduction before C2.59]
.K Don’t know [go to introduction before C2.59]
.R Refused [go to introduction before C2.59]
If C2.011=2 and C2.36a=2, display message: Consistency check In question C2.011
you recorded that they had visited a nurse at their usual medical centre, but in C2.36a you
recorded that they haven’t seen a nurse. Verify answers with respondent. Go back to
C2.36a. Go back to C2.011.
NZHS Year 13 Child Questionnaire
20
Document 4
C2.37a How many times in the past 12 months did [Name] see a nurse
as part of a GP
consultation? This includes seeing the nurse before or after seeing the GP.
If none enter 0.
_____ times (range 0–99)
.K Don’t know
.R Refused
If C2.37a is more than C2.12a, display message: Consistency check: The number of
times child saw a nurse as part of a GP consultation in the past 12 months (C2.37a) should
not be more than the number of times they saw a GP in the past 12 months (C2.12a). Go
back to C2.12a or change this response.
C2.38a How many times in the past 12 months did [Name] see a nurse
without seeing a
GP at the same visit?
1982
If none enter 0.
_____ times (range 0–99)
Act
.K Don’t know
.R Refused
If C2.36a=1 and C2.37a=0 and C2.38a=0, display message: Consistency check If
C2.36a=1 (saw a nurse), then number of times at C2.37a OR C2.38a should be >=1. Go
back to C2.36a OR go back to C2.37a OR change this response.
Information
Emergency department
The next questions are about [Name’s] use of emergency departments at public hospitals.
Official
C2.59 In the past 12 months, how many times did [Name] go to an emergency department
at a public hospital about their own health?
the
_____ times (range 0–99) [if 0 go to Dental health care workers introduction before
C2.80
]
.K Don’t know [go to introduction before C2.80
]
.R Refused [go to introduction before C2.80
]
under
[Showcard]
C2.620
Thinking about [Name’s] last visit to an emergency department, what were
all the
reasons [Name] went?
[Select all that apply]
Read each response option aloud and allow respondents to respond to each
Released
option.
If respondent says they were taken by ambulance or sent by someone such as a
GP, Option 1 should be selected.
1
Condition appeared serious / life threatening; or sent by GP
2
GP or after-hours too expensive
3
Time of day / day of week (outside of usual medical centre hours)
4
Time taken to get an appointment was too long at usual medical centre
77 Another reason [Specify]
_________________
.K Don’t know [go to dental health care workers introduction before C2.80
]
.R Refused [go to introduction before C2.80
]
NZHS Year 13 Child Questionnaire
21
Document 4
Ask next question if more than one of the Options 1–4/77 selected in C2.620. Only show
responses that were selected in C2.620 (as well as .K and .R).
[Showcard]
C2.630
What was the
main reason you took [Name] to a hospital emergency department?
1
Condition appeared serious / life threatening; or sent by GP
2
GP or after-hours too expensive
3
Time of day / day of week (outside of usual medical centre hours)
4
Time taken to get an appointment was too long at usual medical centre
77 Another reason ([pipe through response from C2.620])
.K Don’t know
.R Refused
1982
Dental health care workers
Act
Go to the following introduction for children aged 1–14 years. Go to Health behaviours
and risk factors introduction before C3.01 for children aged 0–11 months.
These next questions are about dental health care services [Name]
has used in
New
Zealand. When I say “dental health care worker”, I mean dentists, dental therapists (used to
be called dental nurses), dental hygienists, as well as any dental health specialists such as
orthodontists.
Information
Dental health care workers – utilisation
[Showcard]
C2.80 How long has it been since [Name] last visited a dental health care worker, for any
reason?
Official
1
Within the past year (less than 12 months ago)
2
Within the past two years (more than 1 year but less than 2 years ago)
the
3
Within the past five years (more than 2 years but less than 5 years ago)
4
Five or more years ago
5
Has never seen a dental health care worker
.K Don’t know under
.R Refused
Released
Dental health care workers – barriers to access
C2.83a In the last 12 months, have you avoided taking [Name] to a dental health care
worker because of the cost?
1
Yes
2
No
.K Don’t know
.R Refused
NZHS Year 13 Child Questionnaire
22
Document 4
Getting help for mental health and substance use issues
Children aged <2 years go to Health behaviours and risk factors introduction before
C3.01.
Children aged 2–14 years go to the following mental health service use questions.
This section is about [Name’s] contact with health professionals and other people for any
concerns about [Name’s]
emotions, behaviour, stress, mental health, or substance use.
By substance use, we mean use of alcohol or drugs. Please don’t include tobacco products.
Only include the following introductory sentence for children aged 2–9 years (not 10–14
years):
We realise that young children are unlikely to have substance use problems. We are using
the same questions for all children for consistency.
1982
[Showcard]
CMH1.07a In the
past 12 months, did you consult with any of the following, for concerns
Act
about [Name’s]
emotions, behaviour, stress, mental health, or substance
use?
[For VIP survey insert: You may need to scroll down to see all the answer
options.]
[Select all that apply]
By substance use, we mean use of alcohol or drugs. Please don’t include
tobacco products.
Information
1
GP
2
Nurse (include nurses at a medical centre as well as Plunket, Wellchild,
Tamariki Ora, school and district nurses)
3
Paediatrician, psychiatrist or other medical specialist
Official
4
Social worker
5
Psychologist, counsellor or psychotherapist
the
6
Teacher
7
Religious or spiritual advisor, like a minister, priest or tohunga
8
Kaumātua or tohunga
9
Family, whānau, partner and/or friends
under
10 Other person
11 No, none of the above [cannot be selected with other options]
.K Don’t know
.R Refused
Released
NZHS Year 13 Child Questionnaire
23
Document 4
[Showcard]
CMH1.08 In the
past 12 months, did [Name] receive help for concerns about their
emotions, behaviour, stress, mental health, or substance use from any of the
following?
[For VIP survey insert: You may need to scroll down to see all the answer
options.]
[Select all that apply]
By substance use, we mean use of alcohol or drugs. Please don’t include
tobacco products.
Youth ‘one-stop-shops’ provide primary health care (including drop-in services)
plus a range of other services for young people. They use a youth development
and holistic approach to health.
1
Hospital emergency department or an after-hours medical centre 1982
2
Crisis mental health team
3
Māori health service (including Māori mental health or addictions services)
4
Community mental health or addictions service (including hospital outpatient
Act
appointments)
5
Other community support services, such as a youth ‘one-stop-shop’
6
Other [Specify]
_________________
7
No, none of the above [cannot be selected with other options]
.K Don’t know
.R Refused
Information
CMH1.11 In the
past 12 months, did you ever feel that [Name]
needed professional help for
their
emotions, behaviour, stress, mental health, or substance use, but
they
didn’t receive that help? This could have been because of personal reasons (for
example, it cost too much) or reasons you couldn’t control (for example, no
appointments available).
Official
By substance use, we mean use of alcohol or drugs. Please don’t include
tobacco products.
the
1
Yes
2
No [go to Health behaviours and risk factors introduction before C3.01]
.K Don’t know [go to Health behaviours and risk factors introduction before
C3.01] under
.R Refused [go to Health behaviours and risk factors introduction before C3.01]
Released
NZHS Year 13 Child Questionnaire
24
Document 4
[Showcard]
CMH1.12a Thinking about the
most recent time when you felt [Name]
needed professional
help, but didn’t receive it, why was that?
[For VIP survey insert: You may need to scroll down to see all the answer
options.]
[Select all that apply]
1
Wanted to handle it alone and/or with the support of family, whānau and
friends
2
Couldn’t spare the time
3
Costs too much
4
Problems with transportation or childcare
5
Unsure where to go or who to see
6
Couldn’t get an appointment at a suitable time
1982
7
Time taken to get an appointment too long
8
Available services did not meet cultural or language needs
Act
9
Health professionals unhelpful or unwilling to help
10 Not satisfied with available services
11 Didn't think treatment would work
12 Concerned what others might think
13 Another reason [Specify]
_________________
.K Don’t know
.R Refused
Information
Official
the
under
Released
NZHS Year 13 Child Questionnaire
25
Document 4
Health behaviours and risk factors
The next section is about things that can influence [Name’s] health.
Perception of child’s weight
Go to the next question for children aged 2–14 years. Go to Breastfeeding C3.02 for
children aged 0–23 months.
[Showcard]
C3.01 On a scale of one to five, where one is very underweight and five is very
overweight, how do you view the weight of [Name]?
1
Very underweight
2
Underweight
1982
3
Neither underweight nor overweight
4
Overweight
Act
5
Very overweight
.K Don’t know
.R Refused
Ask all respondents Breastfeeding questions C3.02 to C3.04.
Breastfeeding
Information
C3.02 Has [Name] ever been breastfed?
‘Expressed’ milk is to be counted as being breastfed.
1
Yes
Official
2
No [if child aged 0–4 years go to C3.05, if aged 5+ years go to Dietary habits
C3.06a]
the
.K Don’t know [if 0–4 years go to C3.05, if 5+ years go to C3.06a]
.R Refused [if 0–4 years go to C3.05, if 5+ years go to C3.06a]
C3.03 What age was [Name] when they stopped being breastfed?
under
Less than 1 week old, code “years” as 0, “months” as 0, and “weeks” as 0.
If stil being breastfed, code as “Not applicable”.
‘Expressed’ milk is to be counted as being breastfed.
All fields (years, months and weeks) must be completed.
_____ years (range 0–9) _____ months (range 0–11) _____ weeks (range 0–51)
.N Not applicable
Released
.K Don’t know
.R Refused
If C3.03>=CD.03+1 (age + 1 year / 1 month), display message: You recorded that the
child stopped breastfeeding at an age that is older than their current age. Go back to
previous question and verify answer with respondent.
NZHS Year 13 Child Questionnaire
26
Document 4
C3.04 What age was [Name] when they were given any drink or food other than breast
milk?
This includes water, formula and other types of milk, but does not include
prescribed medicines.
Less than 1 week old, code “weeks” as 0 and “months” as 0.
If breastfeeding exclusively, code as “Not applicable”.
All fields (months and weeks) must be completed.
_____ months (range 0–11) _____ weeks (range 0–51)
.N Not applicable
.K Don’t know
.R Refused
If C3.04>=CD.03+1 (age + 1 year / 1 month), display message: You recorded that the
child was given drink or food other than breast milk at an age that is older than their current
1982
age. Go back to previous question and verify answer with respondent.
Go to the next question C3.05 for children aged 0–4 years. Go to Dietary habits C3.06a
Act
for children aged >4 years.
C3.05 At what age was
[Name] first given solids?
If child not yet given solids, code as “Not applicable”.
All fields (months and weeks) must be completed.
_____ months (range 0–11) _____ weeks (range 0–51)
Information
.N Not applicable
.K Don’t know
.R Refused
If C3.05>=CD.03+1 (age + 1 year / 1 month), display message: You recorded that the
Official
child was first given solids at an age that is older than their current age. Go back to previous
question and verify answer with respondent.
the
under
Released
NZHS Year 13 Child Questionnaire
27
Document 4
Dietary habits
Go to the following dietary habits questions for children aged 2–14 years. Go to the
screen time questions (C3.12–C3.13a) for children aged 6 months to <2 years. Go to the
sleep question (C3.13b) for children aged <6 months.
Response option numbers are not displayed on CAPI screen or showcards for questions
C3.06a–C3.10a.
[Picture Showcard]
C3.06a On
average, how many
servings of fruit does [Name] eat per day? Please include
all fresh, frozen, canned and stewed fruit. Do
not include fruit juice or dried fruit. A
‘
serving’ = 1 medium piece
or 2 small pieces of fruit
or 1 cup of canned, frozen or
stewed fruit. For example, 1 apple + 2 small apricots = 2 servings.
[For VIP survey insert: You may need to scroll down to see all the answer options.]
1982
If asked, include fruit smoothies.
Act
1
They don’t eat fruit
2
Less than 1 serving per day
3
1 serving per day
4
2 servings per day
5
3 servings per day
6
4 servings per day
7
5 servings per day
8
6 or more servings per day
Information
.K Don’t know
.R Refused
Picture Showcard for C3.06a
Official
the
under
Released
NZHS Year 13 Child Questionnaire
28
Document 4
[Picture Showcard]
C3.07a On
average, how many
servings of vegetables does [Name] eat per day? Please
include all fresh, frozen and canned vegetables. Do
not include vegetable juices. A
‘
serving’ = ½ medium potato / similar sized kumara
or ½ cup cooked vegetables
or 1 cup of raw salad vegetables. For example, 5 servings could comprise of 1
medium potato + 1 cup of cooked vegetables + 1 cup of raw salad throughout the
day.
Remember to think about all meals and snacks.
[For VIP survey insert: You may need to scroll down to see all the answer options.]
1
They don’t eat vegetables
2
Less than 1 serving per day
3
1 serving per day
1982
4
2 servings per day
5
3 servings per day
6
4 servings per day
Act
7
5 servings per day
8
6 or more servings per day
.K Don’t know
.R Refused
Picture Showcard for C3.07a
Information
Official
the
under
Released
NZHS Year 13 Child Questionnaire
29
Document 4
[Showcard]
C3.08a How often does [Name] have breakfast? [Name] may have had breakfast anywhere,
such as at home, school, day-care or a café.
Includes both weekends and weekdays.
Include breakfast drinks such as smoothies and shakes, but not other drinks. For
example, only having a glass of milk or cup of tea should not be counted as having
breakfast.
Breakfast is usually the first meal of the day, eaten within 2 hours of getting up.
1
Never
2
Less than once per week
3
1–2 times per week
4
3–4 times per week
5
5–6 times per week
6
7 or more times per week
1982
.K Don’t know
.R Refused
Act
Information
Official
the
under
Released
NZHS Year 13 Child Questionnaire
30
Document 4
[Picture Showcard]
C3.09a How often does [Name] eat food, such as fish and chips, burgers, fried chicken or
pizza, that has been purchased from a
fast food place or
takeaway shop? Think
about snacks as well as mealtimes.
Please don’t include other fast food and takeaways such as sushi, wraps or curries.
[For VIP survey insert: You may need to scroll down to see all the answer options.]
If respondent asks, only include fast food and takeaways that are high in fat and
salt. Other examples are hot dogs, chicken nuggets and deep-fried food.
1
Never
2
Less than once per week
3
1–2 times per week
4
3–4 times per week
1982
5
5–6 times per week
6
7 or more times per week
.K Don’t know
Act
.R Refused
Picture Showcard for C3.09a
Information
Official
the
under
Released
NZHS Year 13 Child Questionnaire
31
Document 4
[Picture Showcard]
C3.10a How often does [Name] drink soft drinks, fizzy drinks, sports drinks or energy
drinks? Please don’t include diet or reduced sugar varieties.
[For VIP survey insert: You may need to scroll down to see all the answer options.]
Includes soft and fizzy drinks, which are carbonated, such as Coca-Cola,
lemonade and ginger beer, sports drinks such as Powerade and Mizone, and
energy drinks such as ‘V’ and Red Bull.
Excludes diet or reduced sugar varieties, sparkling water, flavoured waters (eg
H2Go), fruit juices and drinks made from cordial, concentrate or powder.
1
Never
2
Less than once per week
3
1–2 times per week
4
3–4 times per week
1982
5
5–6 times per week
6
7 or more times per week
.K Don’t know
Act
.R Refused
Picture Showcard for C3.10a
Information
Official
the
under
Released
NZHS Year 13 Child Questionnaire
32
Document 4
Physical activity
Go to the next question (C3.11) for children aged 5–14 years. Go to the screen time
questions (C3.12–C3.13a) for children aged 6 months–4 years. Go to the sleep question
(C3.13b) for children aged <6 months.
[Showcard]
C3.11 How does [Name] usually get to and from school?
[For VIP survey insert: You may need to scroll down to see all the answer options.]
[Select all that apply]
Code walking bus as “Walk” and carpool as “Car or taxi”.
Code push scooter (non-motorised) as “Skate or other physical activity”.
1
Walk
1982
2
Bike
3
Skate or other physical activity
4
Car or taxi
Act
5
School bus or school van
6
Public transport
77 Other [Specify] _________________
0
Not applicable, for example, is home schooled
.K Don’t know
.R Refused
Information
Official
the
under
Released
NZHS Year 13 Child Questionnaire
33
Document 4
Screen time
Go to the next four questions about screen time for children aged 6 months–14 years
(CD.03a=6–23 months OR CD.03b=2–14 years).
C3.12 What is the average amount of time [Name] spends watching TV
each weekday?
This could be anywhere, not just in your home, and includes DVDs / videos but does
not include games.
Round to nearest hour.
Include television programmes, videos and movies watched on any device. Include
those accessed online (eg via YouTube) and on-demand (eg via Netflix).
_____
hours (range 0–24)
.K Don’t know
.R Refused
1982
If C3.12>=10 hours, display message: A person is unlikely to watch TV for an average of
10 or more hours per day. Go back to previous question and verify answer with respondent.
Act
C3.12a What is the average amount of time [Name] spends
each weekday looking at a
screen doing things
other than watching TV or videos? For example, playing video
games or browsing the Internet. This does
not include time spent at school or on
homework.
Round to nearest hour.
Include activities on a tablet, computer, electronic gaming device or other hand-
held electronic device such as a smart phone.
Information
Include texting, emailing and using social media.
Don’t count time reported in the previous question.
_____
hours (range 0–24)
.K Don’t know
Official
.R Refused
the
If C3.12a>=10 hours, display message: A person is unlikely to look at a screen for an
average of 10 or more hours per day. Go back to previous question and verify answer with
respondent.
under
C3.13 What is the average amount of time [Name] spends watching TV
in the weekend?
Again, this could be anywhere, not just in your home and includes DVDs / videos but
does not include games.
Round to nearest hour.
Record total hours over
both Saturday and Sunday.
Include television programmes, videos and movies watched on any device.
Include those accessed online (eg via YouTube) and on-demand (eg via Netflix).
Released
_____ hours (range 0–48)
.K Don’t know
.R Refused
If C3.13>=20 hours, display message: A person is unlikely to watch TV for an average of
20 or more hours over a weekend. Go back to previous question and verify answer with
respondent.
NZHS Year 13 Child Questionnaire
34
Document 4
C3.13a What is the average amount of time [Name] spends
in the weekend looking at a
screen doing things
other than watching TV or videos? For example, playing video
games or browsing the Internet. This does
not include time spent at school or on
homework.
Round to nearest hour.
Record total hours over
both Saturday and Sunday.
Include activities on a tablet, computer, electronic gaming device or other hand-
held electronic device such as a smart phone.
Include texting, emailing and using social media.
Don’t count time reported in the previous question.
_____
hours (range 0–48)
.K Don’t know
.R Refused
1982
If C3.13a>=20 hours, display message: A person is unlikely to look at a screen for an
average of 20 or more hours over a weekend. Go back to previous question and verify
answer with respondent.
Act
Ask all respondents the next questions.
Sleep
C3.13b How many hours of sleep does [Name] usually get in a 24 hour period, including
all
Information
naps and sleeps?
Enter whole numbers. Round 30 minutes or more up to the next whole hour and
round 29 or fewer minutes down.
_____ hours (range 1–24)
Official
.K Don’t know
.R Refused
the
If C3.13b<6 hours, display message: A child is unlikely to usually sleep less than 6 hours
in a 24 hour period. Go back to previous question and verify answer with respondent.
For children aged 2–14 years only:
under
If C3.13b>14 hours, display message: A child is unlikely to usually sleep more than 14
hours in a 24 hour period. Go back to previous question and verify answer with respondent.
Tooth brushing
Released
[Showcard]
C3.13c How often are [Name’s]
teeth brushed?
0
Never [go to Exposure to second-hand smoke introduction before CSHS1.01a]
1
Less than once a day
2
Once a day
3
Twice a day
4
More than twice a day
5 No natural teeth Exposure to second-hand smoke introduction before
CSHS1.01a]
.K Don’t know
.R Refused
NZHS Year 13 Child Questionnaire
35
Document 4
[Picture Showcard]
C3.13d Looking at the [For F2F insert: Showcard] [For VIP insert: options on the screen],
what type of toothpaste does [Name] usually use?
[For VIP survey insert: You may need to scroll down to see the answer options.]
If respondent is unsure about what type of toothpaste is used, and give their
permission, you could ask to see the toothpaste that is currently used.
• Standard fluoride packaging might include: “0.221% sodium fluoride”, “0.76%
sodium monofluorophosphate”, “1000–1450 ppm” and/or “fluoride toothpaste”.
Homemade toothpaste or baking soda should be coded as ‘Doesn’t use
toothpaste / no toothpaste available in the house’.
1
Standard fluoride toothpaste
3
Non-fluoridated toothpaste
1982
4
Doesn’t use toothpaste / no toothpaste available in house
.K Don’t know
Act
.R Refused
Picture Showcard for C3.13d
1. Standard fluoride toothpaste
Information
Official
the
under
Released
3. Non-fluoridated toothpaste
4. Doesn’t use toothpaste / no toothpaste available in house
NZHS Year 13 Child Questionnaire
36
Document 4
Exposure to second-hand smoke
Now we’l move onto a couple of questions about smoking.
CSHS1.01a
Does
anyone smoke while
inside your home?
This is not limited to people who live in the home.
1
Yes
2
No
.K
Don’t know
.R Refused
CSHS1.02a
Does
anyone smoke while travelling in a car or van with [Name] ?’
This is not limited to people that you usually travel with.
1
Yes
2
No
.K Don’t know
1982
.R Refused
Act
Information
Official
the
under
Released
NZHS Year 13 Child Questionnaire
37
Document 4
Response to child’s misbehaviour
[Showcard]
C3.15 Thinking back over the
past four weeks, when [Name] misbehaved, which of the
following, if any, have you done? Just read out the number next to the words.
[For VIP survey insert: You may need to scroll down to see all the answer options.]
[Select all that apply]
Prompt: “any others?”
1
Made them go without something or miss out on something
2
Yelled at them
3
Explained or discussed why they should not do it
4
Physical punishment, such as smacking
5
Told them off
6
Sent them to the bedroom or other place in the house
1982
7
Ignored their behaviour
8
Something else
Act
0
My child has not misbehaved during the past 4 weeks
.N My child is too young to misbehave Limit to children <2 years.
.K Don’t know
.R Refused
[Showcard]
C3.16a Using the scale on the [For F2F survey insert: Showcard] [For VIP survey insert:
screen], to what extent do you disagree or agree with the following statement:]
Information
There are certain circumstances when it’s alright for parents to use physical
punishment, such as smacking, with children. Just read out the number next to the
words.
Official
1
Strongly disagree
2
Disagree
the
3
Neither disagree nor agree
4
Agree
5
Strongly agree
.K Don’t know under
.R Refused
Released
NZHS Year 13 Child Questionnaire
38
Document 4
Child behaviour and parenting self-complete section
If the interview is being conducted:
• with language assistance from a family member / friend of the respondent (C6.13=1),
• or language assistance from a professional translator (C6.14=1)
• or for a child aged under two years
then
only show Option 2.
CDWIntro
[For F2F survey insert: Now, I’m going to hand the computer to you, so that you can answer
the next questions privately.]
[For VIP survey insert: The next questions are for you to answer privately. Your answers are
totally confidential and will not be seen by me, unless you ask me to help you.]
The interviewer can administer this section [For F2F survey insert: using showcards] but
1982
only if privacy can be ensured.
[For VIP survey insert: If the respondent is happy for you to administer the questions
Act
select the ‘Unblock and hold’ checkbox.]
1
Continue with this section [go to CDW2.01–2.25 for ages 2–4; go to
CDW3.01–3.25 for ages 5–10; go to CDW4.01–4.25 for ages 11–14]
2
Skip the child behaviour section because privacy isn’t ensured, the child is
aged under two years or the interview is being conducted with language
assistance (C6.13=1 OR C6.14=1) [go to introduction before CPS1.01]
Information
If CDWIntro=2, display the following message: You have chosen to skip this section. Click
‘Back’ [F2F] or ‘Previous’ [VIP] to go back, or continue with this section. [Do not show if child
aged <2 or if C6.13=1 OR C6.14=1]
Official
For each SDQ screen, if one or more items are left blank, display the following pop-up
message: You have not answered every row. Click ‘Back’ [F2F] or ‘Previous’ [VIP] to go
the
back and select an answer for each row, or continue with this section.
Licensing rules for the SDQ require the copyright notice on each SDQ screen: © Robert
Goodman, 2005
under
START OF SELF-COMPLETE.
Released
NZHS Year 13 Child Questionnaire
39
Document 4
Strengths and Difficulties Questionnaire (SDQ) for 2–4 year
olds
Children aged ≥2 and <5 years go to this version of SDQ (CDW2.01 to CDW2.25).
Questions CDW2.01 to CDW2.25 to fit over three screens for self-complete.
The three introductory sentences should be included on each screen.
[Showcard]
CDW2.01–2.25 For each item, please mark the box for Not true, Somewhat true or
Certainly true.
It would help us if you answered all items as best you can, even if you are
not absolutely certain.
Please give your answers on the basis of [Name’s] behaviour over the
last six months.
1982
[For VIP survey insert: You may need to scroll down to see all the grid
statements.]
Act
1.
2.
3.
Not
Somewhat Certainly
true
true
true
Considerate of other people’s feelings
Restless, overactive, cannot stay still for long
Often complains of headaches, stomach-aches or sickness
Information
Shares readily with other children, for example toys, treats, pencils
Often loses temper
Rather solitary, prefers to play alone
Generally well behaved, usually does what adults request
Official
Many worries or often seems worried
the
Helpful if someone is hurt, upset or feeling ill
Constantly fidgeting or squirming
Has at least one good friend
Often fights with other children or bullies them
under
Often unhappy, depressed or tearful
Generally liked by other children
Easily distracted, concentration wanders
Nervous or clingy in new situations, easily loses confidence
Kind to younger children
Released
Often argumentative with adults
Picked on or bullied by other children
Often offers to help others (parents, teachers, other children)
Can stop and think things out before acting
Can be spiteful to others
Gets along better with adults than with other children
Many fears, easily scared
Good attention span, sees tasks through to the end
Go to introduction before CPS1.01.
NZHS Year 13 Child Questionnaire
40
Document 4
Strengths and Difficulties Questionnaire (SDQ) for 5–10
year olds
Children aged ≥5 and <11 years go to this version of SDQ (CDW3.01 to
CDW3.25).
Questions CDW3.01 to CDW3.25 fit over three screens for self-complete.
The three introductory sentences should display on each screen.
[Showcard]
CDW3.01–3.25 For each item, please mark the box for Not true, Somewhat true or
Certainly true.
It would help us if you answered all items as best you can, even if you are
not absolutely certain.
Please give your answers on the basis of [Name’s] behaviour over the
last six months or this school year.
1982
[For VIP survey insert: You may need to scroll down to see all the grid
statements.]
Act
1.
2.
3.
Not
Somewhat Certainly
true
true
true
Considerate of other people’s feelings
Restless, overactive, cannot stay still for long
Often complains of headaches, stomach-aches or sickness
Information
Shares readily with other children, for example toys, treats, pencils
Often loses temper
Rather solitary, prefers to play alone
Generally well behaved, usually does what adults request
Official
Many worries or often seems worried
the
Helpful if someone is hurt, upset or feeling ill
Constantly fidgeting or squirming
Has at least one good friend
Often fights with other children or bullies them
under
Often unhappy, depressed or tearful
Generally liked by other children
Easily distracted, concentration wanders
Nervous or clingy in new situations, easily loses confidence
Kind to younger children
Released
Often lies or cheats
Picked on or bullied by other children
Often volunteers to help others (parents, teachers, other children)
Thinks things out before acting
Steals from home, school or elsewhere
Gets along better with adults than with other children
Many fears, easily scared
Good attention span, sees work through to the end
Go to introduction before CPS1.01.
NZHS Year 13 Child Questionnaire
41
Document 4
Strengths and Difficulties Questionnaire (SDQ) for 11–14
year olds
Children aged ≥11 and <15 years go to this version of SDQ (CDW4.01 to CDW4.25).
Questions CDW4.01 to CDW4.25 to fit over three screens for self-complete.
The three introductory sentences should be included on each screen.
[Showcard]
CDW4.01–4.25 For each item, please mark the box for Not true, Somewhat true or
Certainly true.
It would help us if you answered all items as best you can, even if you are
not absolutely certain.
Please give your answers on the basis of [Name’s] behaviour over the
last
1982
six months or this school year.
[For VIP survey insert: You may need to scroll down to see all the grid
Act
statements.]
1.
2.
3.
Not
Somewhat Certainly
true
true
true
Considerate of other people’s feelings
Restless, overactive, cannot stay still for long
Information
Often complains of headaches, stomach-aches or sickness
Shares readily with other youth, for example books, games, food
Often loses temper
Would rather be alone than with other youth
Official
Generally well behaved, usually does what adults request
Many worries or often seems worried
the
Helpful if someone is hurt, upset or feeling ill
Constantly fidgeting or squirming
Has at least one good friend
under
Often fights with other youth or bullies them
Often unhappy, depressed or tearful
Generally liked by other young people
Easily distracted, concentration wanders
Nervous in new situations, easily loses confidence
Released
Kind to younger children
Often lies or cheats
Picked on or bullied by other young people
Often volunteers to help others (parents, teachers, children)
Thinks things out before acting
Steals from home, school or elsewhere
Gets along better with adults than with other young people
Many fears, easily scared
Good attention span, sees tasks through to the end
NZHS Year 13 Child Questionnaire
42
Document 4
All children aged 0–14 years go to Parental stress introduction.
Parental stress
The next five questions are about how
you may have felt while looking after [Name].
[Showcard]
CPS1.01 In general, how well do you feel you are coping with the day-to-day demands of
raising children?
1
Very well
2
Well
3
Somewhat well
4
Not very well
5
Not very well at all
1982
.K I don’t know
.R Prefer not to say
Act
Now can you please think about the
past month. [Showcard]
CPS1.02 During the
past month, how often have you felt [Name] is much harder to care for
than most children the same age?
1
Never
Information
2
Rarely
3
Sometimes
4
Usually
5
Always
.K I don’t know
Official
.R Prefer not to say
the
[Showcard]
CPS1.03 During the
past month, how often have you felt [Name] does things that
really bother you a lot?
under
1
Never
2
Rarely
3
Sometimes
4
Usually
5
Always
.K I don’t know
.R Prefer not to say
Released
[Showcard]
CPS1.04 During the
past month, how often have you felt angry with [Name]?
1
Never
2
Rarely
3
Sometimes
4
Usually
5
Always
.K I don’t know
.R Prefer not to say
NZHS Year 13 Child Questionnaire
43
Document 4
CPS1.05 Is there someone that you can turn to for day-to-day emotional support with
raising children? This can be any person, including your husband or wife or
partner.
1
Yes
2
No
.K I don’t know
.R Prefer not to say
New screen.
Thank you for completing those questions; please click ‘Next’. [For F2F survey insert: Please
return the computer to the interviewer and they will continue the questionnaire.]
END OF SELF-COMPLETE SECTION.
1982
Act
Information
Official
the
under
Released
NZHS Year 13 Child Questionnaire
44
Document 4
All children aged 0–14 years go to Household food security introduction.
Household food security
I now want to ask you some questions about particular foods you choose, and the buying of
food or gifting of food. We are interested in whether you feel you always have sufficient
resources to have the food you need for yourself and the people you live with. We are not
concerned with your budget, or how you spend money, but we are more interested in finding
out about how people get the food that they need for their household to eat and share.
There are eight statements about food security. Ask the respondent to consider each
statement and respond. In each case "we" refers to the household.
A household can be one person who lives alone, or two or more people who live together
and share facilities (such as for cooking) in a private dwelling.
1982
If required, respondent can read out the number next to the answer on the showcard /
screen.
Act
[Showcard]
CFS1.01 First of all, we know that some people can’t afford to eat properly and we are
interested in whether you think your household has enough money to eat properly.
It’s what you think eating properly is – not what I think or anyone else thinks.
We can afford to eat properly.
1
Always
Information
2
Sometimes
3
Never
.K Don’t know
.R Refused
Official
[Showcard]
CFS1.02 We are interested in whether you run out of basics, like bread, potatoes, etc
the
because you do not have enough money. We are NOT referring to treats or
special foods.
Food runs out in our household due to lack of money.
under
How often has this been true for your household over the past year?
1
Often
2
Sometimes
3
Never
Released
.K Don’t know
.R Refused
NZHS Year 13 Child Questionnaire
45
Document 4
[Showcard]
CFS1.03 Now we are interested in whether a lack of money leads you to sometimes have
smaller meals than you would like or whether a lack of money means there isn’t
enough food for seconds or you sometimes skip meals?
We eat less because of lack of money.
How often has this been true for your household over the past year?
1
Often
2
Sometimes
3
Never
.K Don’t know
.R Refused
1982
[Showcard]
CFS1.04 Now we are going to talk about the variety of foods you eat. By variety, we mean
the number of different kinds of food you have.
Act
The variety of foods we are able to eat is limited by a lack of money.
How often has this been true for your household over the past year?
1
Often
2
Sometimes
Information
3
Never
.K Don’t know
.R Refused
[Showcard]
Official
CFS1.05 Some people rely on support and assistance from others for supplying their
regular food and we are interested in finding out how many people fall into this
group.
the
We rely on others to provide food and/or money for food, for our household,
when we don’t have enough money.
under
How often has this been true for your household over the past year?
1
Often
2
Sometimes
3
Never
.K Don’t know
Released
.R Refused
NZHS Year 13 Child Questionnaire
46
Document 4
[Showcard]
CFS1.06 Also, some people have to rely on other sources of help such as food grants or
food banks.
We make use of special food grants or food banks when we do not have
enough money for food.
How often has this been true for your household over the past year?
1
Often
2
Sometimes
3
Never
.K Don’t know
.R Refused
[Showcard]
1982
CFS1.07 We know that some people get quite stressed and worried about providing enough
food even though they don’t actually go without food.
Act
I feel stressed because of not having enough money for food.
How often has this been true for your household over the past year?
1
Often
2
Sometimes
3
Never
Information
.K Don’t know
.R Refused
[Showcard]
CFS1.08 We recognise that for some people food and sharing with others is important, to
Official
the point that they don’t have enough food for themselves. In this question we are
only interested in social situations that are gatherings within, or outside, the
the
household. As a result people may find themselves stressed/whakamā
(embarrassed) about their koha (gift) when providing food for others.
I feel stressed because I can’t provide the food I want for social occasions.
under
How often has this been true for your household over the past year?
1
Often
2
Sometimes
3
Never
.K Don’t know
Released
.R Refused
If all CFS1.01–CFS1.08=3, display message: Can I just check: earlier I recorded that you
can ‘never’ afford to eat properly. Is this correct? If incorrect, go back to CFS1.01 and
change answer (and then cycle through CFS1.02–CFS1.08).
If all CFS1.01–CFS1.08=1, display message: Can I just check: earlier I recorded that you
can ‘always’ afford to eat properly. Is this correct? If incorrect, go back to CFS1.01 and
change answer (and then cycle through CFS1.02–CFS1.08).
NZHS Year 13 Child Questionnaire
47
Document 4
Socio-demographics
Now, we need to collect some general information about [Name]. The answers to these
questions help us to check that we have selected a representative sample of New Zealand
children to participate in this survey, and sometimes these things can affect children’s health.
Date of birth
C4.01 What is [Name’s] date of birth?
Interviewer read back date of birth to check it is correct.
To update a previously-recorded date, click on the date picker, select the month
and year from the drop-down lists, then
click on the correct day.
Display message: This means [Name] is X years old.
1982
_____ Day (range 1–31)
_____ Month (range Jan–Dec)
_____ Year (range [current in-field year minus 15]–[current in-field year])
Act
.R Refused
Ethnic group(s)
[Showcard]
C4.03 Which ethnic group or groups does [Name] belong to?
Information
[For VIP survey insert: You may need to scroll down to see all the answer options.]
[Select all that apply]
If ‘Other – Specify’ is selected, you will be asked to specify the other ethnic groups
on the next screen.
Official
1
New Zealand European
2
Māori
the
3
Samoan
4
Cook Island Māori
5
Tongan
6
Niuean
under
7
Chinese
8
Indian
77 Other [Specify] _____________ [Three “Other” ethnic groups to be asked about
on a new screen and programmed from the codefile from StatsNZ, Ethnicity New
Zealand Standard Classification 2005 V2.1.0]
.K Don’t know
Released
.R Refused
NZHS Year 13 Child Questionnaire
48
Document 4
Country of birth
[Showcard]
C4.05 Which country was [Name] born in?
[For VIP survey insert: You may need to scroll down to see all the answer options.]
When selecting ‘Other’ you are able to enter a historic name of the country. The
codefile will recognise this and assign it to the same category as the country’s
present name.
1
New Zealand [go to Medical insurance introduction before C4.06a]
2
Australia
3 England
4 China (People’s Republic of)
5 India
6 South Africa
1982
7 Samoa
8 Cook Islands
Act
77 Other [Specify the name of the country] _____________
[Programme from the codefile from StatsNZ. Can only specify one country]
.K Don’t know
.R Refused
C4.06 In what year did [Name] arrive to live in New Zealand?
Record 4 digit date, eg 2017.
Information
_____ year (range [current in-field year minus 15]–[current in-field year])
.K Don’t know
.R Refused
If year is earlier than year of birth, display message: Consistency check Answer must
Official
be >= year of birth given at C4.01. Change the year arrived or use the ‘Back’ [F2F] or
‘Previous’ [VIP] button to go back to C4.01 and correct the date of birth.
the
under
Released
NZHS Year 13 Child Questionnaire
49
Document 4
Medical insurance
Now, I’l ask you about medical insurance.
C4.06a Is [Name] covered by any health or medical insurance?
1
Yes
2
No
.K Don’t know
.R Refused
Interviewer observation – if adult questionnaire completed
Complete following observation without asking the respondent:
1982
CQ1 Has the adult questionnaire been completed?
1
Yes [go to CQ2 interviewer observation]
Act
2
No – to be completed
another day, or
may not be completed (adult declined)
[continue with questions from C4.15 – Extra questions if adult questionnaire had
not yet been completed]
3
No – to be completed
directly after this survey [go to CQ2 interviewer
observation]
Information
Official
the
under
Released
NZHS Year 13 Child Questionnaire
50
Document 4
Extra questions if adult questionnaire has not yet been
completed
Income self-complete section
The following income questions are for you to answer on your own. [For F2F survey insert: I
will turn the computer towards you, so you can answer the questions privately.] If you need
help, I can show you what to do.
I can also read the questions out, and you can answer by calling out the option number
[For F2F survey insert: from the Showcard] that best applies to you.
All loans, including student loans, should not be counted.
START OF SELF-COMPLETE.
1982
[Showcard]
C4.15 Looking at the [For F2F survey insert: Showcard] [For VIP insert: options on the
Act
screen], what is the total income that
your household got from all sources, before
tax or anything was taken out of it, in the last 12 months? Please read out the number
next to the income group.
1
$30,000 or less
2
$30,001 – $70,000
3
$70,001 – $100,000
4
$100,001 – $150,000
Information
5
$150,001 – $200,000
6
$200,001 or more
.K I don’t know
.R Prefer not to say
Official
[Showcard]
C4.16 How well does your household’s total income meet the cost of basic needs such as
the
food, clothing and housing. Would you say it’s not enough, only just enough, enough,
or more than enough?
If people operate separately (eg flatting), ask them to answer about their individual
situation.
under
1
Not enough
2
Only just enough
3
Enough
4
More than enough
.K I don’t know
.R Prefer not to say
Released
New screen.
Thank you for answering those questions; please click ‘Next’. [For F2F: Please hand the
computer back.]
END OF SELF-COMPLETE SECTION.
NZHS Year 13 Child Questionnaire
51
Document 4
Housing
Now, some questions about housing.
[Showcard]
C4.17b Looking at the [For F2F survey insert: Showcard] [For VIP insert: options on the
screen], do you, or anyone else who lives here:
⚐ Tool tip for ‘family trust’: A family trust is a special way of owning assets such as
a home. The home is owned by a legal entity, not an individual or group of people.
The family trust arrangement will be set out in a legal document, usually called a
trust deed. If your home is partly in a family trust and partly owned, select ‘Hold this
dwelling in a family trust’.
⚐Tool tip for ‘own or partly own’: What counts as owning or partly owning this
dwelling? The following situations count as owning:
• You or someone else here owns the dwelling, even if you don’t own the land.
1982
• You purchased the dwelling under unit title, stratum title or composite
leasehold (ie, there are multiple owners).
Act
• You purchased the dwelling under license to occupy. This may include self-
care villas, townhouses, apartments, or units in a retirement complex.
• The dwelling you own is a moveable dwelling such as a caravan, boat, tent or
motorhome, even if you bought it under hire purchase or some other financial
loan agreement.
If you have a ‘license to occupy’ select ‘Own or partly own this dwelling’.
Information
Select ‘Neither of these’ if you are occupying this dwelling under a rent-to-buy or
similar agreement.
Read response options.
Official
1
Hold this dwelling in a family trust [go to C4.19b]
2
Own or partly own this dwelling, with or without a mortgage [go to C4.19b]
3
Neither of these, for example renting
the
.K Don’t know
.R Refused
[Showcard]
under
C4.18a Who owns this house / flat?
1
Private person, trust or business
2
Local Authority or City Council
3
Kāinga Ora (formerly Housing New Zealand)
4
Other state-owned corporation or state-owned enterprise, or government
Released
department or ministry
5
Iwi, hapū or Māori land trust
6
Other community housing provider
.K Don’t know
.R Refused
NZHS Year 13 Child Questionnaire
52
Document 4
[Showcard]
C4.19b How many of each of the following rooms are there in this house or flat?
If this dwelling has no rooms of that type, enter ‘0’ (all fields must be fil ed).
Count any open-plan rooms as separate rooms. For example, a kitchen-dining
room is two separate rooms.
______ Bedrooms, including any sleepouts furnished as bedrooms [range 0–99]
______ Lounges, living rooms or family rooms [range 0–99]
______ Dining rooms [range 0–99]
______ Kitchens [range 0–99]
______ Conservatories you can sit in [range 0–99]
______ Studies, studios, hobby rooms [range 0–99]
.K Don’t know
.R Refused
1982
Interviewer observation – if both adult / child survey
Act
respondent
Complete following observation without asking the respondent:
CQ2 Is the adult who answered this child questionnaire, also selected as the NZHS adult
respondent?
Information
1
Yes [go to Exit]
2
No [go to introduction before C4.20]
Official
the
under
Released
NZHS Year 13 Child Questionnaire
53
Document 4
Extra questions if primary caregiver was not the NZHS
adult respondent
Now, a few questions about you.
[Showcard]
C4.20 What is your highest secondary school qualification?
[For VIP survey insert: You may need to scroll down to see all the answer options.]
1
None
2
NZ School Certificate in one or more subjects
or National Certificate level 1
or NCEA level 1
3
NZ Sixth Form Certificate in one or more subjects
1982
or National Certificate level 2
or NZ UE before 1986 in one or more subjects
or NCEA level 2
Act
4
NZ Higher School Certificate
or NZ University Bursary / Scholarship
or National Certificate level 3
or NCEA level 3
or NZ Scholarship level 4
5
Other secondary school qualification
gained in New Zealand [Specify]
_______________
Information
6
Other secondary school qualification
gained overseas
.K Don’t know
.R Refused
Official
the
under
Released
NZHS Year 13 Child Questionnaire
54
Document 4
[Showcard]
C4.21 What is your highest completed qualification?
[For VIP survey insert: You may need to scroll down to see all the answer options.]
0
None
1
National Certificate level 1
2
National Certificate level 2
3
National Certificate level 3
4
National Certificate level 4
5
Trade Certificate
6
Diploma or Certificate level 5
7
Advanced Trade Certificate
8
Diploma or Certificate level 6
9
Teachers Certificate / Diploma
1982
10 Nursing Diploma
11 Bachelor
12 Bachelor Hons
Act
13 Postgraduate Certificate / Diploma
14 Masters Degree
15 PhD
or other doctoral degree
77 Other [Specify] _________________
.K Don’t know
.R Refused
Information
If C4.20=2, 3, 4, 5, 6 (secondary school qualification completed) AND C4.21=0 (no
highest completed qualification), display message: Consistency check In question C4.20
you recorded that the respondent had completed a secondary school qualification, but in
C4.21 you recorded that they haven’t completed a qualification. Verify answers with
respondent.
Official
[Showcard]
C4.22 Which of these statements best describes your
current work situation:
the
1
Working in paid employment (includes self-employment)
2
Not in paid work, and looking for a job [go to Exit]
3
Not in paid work, and not looking for a job (for any reason, such as
under
being retired, a homemaker, caregiver, or full-time student) [go to Exit]
77 Other [Specify]
_________________ [go to Exit]
.K Don’t know [go to Exit]
.R Refused [go to Exit]
C4.23 How many hours a week do you
usually work?
Released
Round to nearest hour.
_____ hours (range 1–120)
.K Don’t know
.R Refused
NZHS Year 13 Child Questionnaire
55
Document 4
Exit
Thank you for talking with me about [Name’s] health. The Ministry of Health is very grateful
that you have given your time to provide this important information to them. Before we finish,
I would like to ask you a few more questions. Please note that any information you give me
from now on will
not be stored with your answers to the survey.
Recontact information for quality control
I would now like to collect some recontact information from you. This is so that my
Supervisor can call you in the next few weeks if there are any queries about the completion
of this survey or to check that you are happy with the way the interview was conducted.
C6.01 Is there a landline phone that my Supervisor can call you on?
1982
1
Yes [Specify] _________________ [only accept landline number format]
2
No
Act
C6.02 Do you have a cell phone number we could reach you on?
1
Yes [Specify] _________________ [only accept cell number format]
2
No
C6.03 Do you have an email address, in case we cannot contact you by telephone?
Information
1
Yes [Specify] _________________ [only accept email format]
2
No
Recontact information for follow-up research
Official
C6.04 I would now like to ask if you would be happy to be contacted within the next five
years about the possibility of [Name] being involved in follow-up health research of
the
importance to the Ministry of Health? Saying yes to this question won’t commit you or
[Name] to taking part in any further research, it just means we can contact you to ask.
1
Yes, you can contact me and ask if I want to help again
under
2
No, don’t contact me to help again [go to Data linkage introduction before C6.09]
If C6.01, C6.02 and C6.03 all=2 go to C6.06, otherwise go to C6.05.
C6.05 To recontact you for other health questions of importance to the Ministry of Health,
can we use the same phone number and email address you provided before?
Released
1
Yes [go to name and address C6.07]
2
No
C6.06 What phone number(s) and email address can we use to recontact you?
1
Landline number: ____________________ [only accept landline number format]
2
Cell phone number: ______________________ [only accept cell number format]
3
Email address: ______________________________ [only accept email format]
4
Do not record phone number(s) or email / Refused
NZHS Year 13 Child Questionnaire
56
Document 4
C6.07 Could I please also record your name and address? Remember that these details will
never be stored with your survey answers, to ensure that your survey results will
always be anonymous.
1
Yes, record my name and address
a. First name: ___________________________________ [mandatory field]
b. Surname: _________________________________________________
c. Street number and name: ________________________ [mandatory field]
d. Suburb: ______________________________________ [mandatory field]
e. City: _________________________________________ [mandatory field]
f.
Postcode: __________________________________________________
2
No, do
not record my name and address / Refused
C6.08 Could I also record [Name’s] full name and their address?
1982
Interviewer to update address if different to parent / guardian address.
1
Yes, record child’s name and address
Act
a. First name: ___________________________________ [mandatory field]
b. Middle name: _______________________________________________
c. Surname: _________________________________________________
d. Street number and name: ________________________ [mandatory field]
e. Suburb: ______________________________________ [mandatory field]
f.
City: _________________________________________ [mandatory field]
g. Postcode: _________________________________________________
Information
2
No, do not record child’s name and address / Refused
Consent for data linkage Official
The Ministry of Health would like to ask for your permission to combine the valuable
information you have provided about [Name] in this survey, with other information routinely
the
collected by government agencies. Combining the answers you have just given with other
information, such as education, income and housing, will help us to develop new ways to
improve the health and wellbeing of all New Zealanders.
under
To combine the information, the Ministry of Health needs your permission to use [Name’s]
name, address, gender and date of birth details. The Ministry is bound by the Privacy Act,
and these details will be kept secure and only used by approved staff for data linking.
[Name’s]
name, address and date of birth will be removed before the combined information
is made available to approved researchers. The combined information will only be used for
research purposes.
Released
C6.09 Are you willing for [Name’s] survey results to be linked with other information
routinely collected by government agencies?
1
Yes
2
No [go to Interviewer observations introduction before C6.15]
NZHS Year 13 Child Questionnaire
57
Document 4
C6.11 Can I please record [Name’s] name, address, date of birth and gender for data
linking? Please note:
• [Name’s] name, address, and date of birth will remain confidential and can only
be accessed by approved staff at the Ministry of Health or Statistics New
Zealand, for the purpose of linking data held by government agencies
• These details will be removed when the data has been linked (only the month
and year of birth will be retained)
• You have the right to change or access [Name’s] personal details (ie name,
address and date of birth).
To update a previously-recorded date, click on the date picker, select the month
and year from the drop-down lists, then
click on the correct day.
1
Yes
a. First name: ___________________________________ [mandatory field]
1982
b. Middle name: _______________________________________________
c. Surname: ____________________________________ [mandatory field]
Act
d. Street number and name: ________________________ [mandatory field]
e. Suburb: ______________________________________ [mandatory field]
f.
City: _________________________________________ [mandatory field]
g. Postcode: _________________________________________________
h. Date of birth: ____ (range [current in-field year minus 15]–[current in-field
year]) [mandatory field]
Information
i.
Gender: ______________________________________ [mandatory field]
2
No, don’t record any of these details
If first name, surname, address, date of birth, or gender not provided, display the following
Official
message: In order to help us link [Name’s] data, would you mind providing [Name’s] full
name, address, date of birth and gender?
the
If only one initial provided for either first or last name, display the following message: In
order to help us link [Name’s] data, would you mind providing [Name’s] full first and last
name, rather than initials?
If two or more names entered into first or last name field, display the following message:
under
Two or more names entered into a single field, please check and use the middle name field
if applicable.
If date of birth recorded at C6.11≠C4.01, display the following message: Data linkage
date of birth (dd/mm/yyyy) does not match date of birth recorded earlier in the survey
(dd/mm/yyyy). Please check with respondent.
Released
NZHS Year 13 Child Questionnaire
58
Document 4
Interviewer observations – setting
Complete following observations without asking the respondent:
C6.15 Record if other people were in the room during any part of the questionnaire.
[Select all that apply]
1
Spouse / partner
2
Parent(s)
3
Other adult(s)
4
Child who took part in survey
5
Other child(ren)
6
Completed alone in room
Respondent burden assessment self-complete section
1982
The next questions will ask you about your experience of the survey process. [For VIP:
These questions are for you to answer on your own.] [For F2F: I will turn the computer
Act
towards you, so you can answer the questions privately.]
START OF SELF-COMPLETE.
CR1.01 Please rate on a scale of 1–5, where 1 is Absolutely NOT Acceptable and 5 is
Highly Acceptable:
Information
1
2
3
4
5
Absolutely
Highly
NOT
Acceptable
Acceptable
Survey length
Official
The number of questions
Complexity of questions
the
Intrusiveness of questions
If VIP Survey and CQ1=2 (adult survey not yet completed) or CQ2=2 (adult survey
under
completed, but by different person to child survey), ask CR1.05 and CR1.06.
CR1.05 These next questions ask about your experience of taking part
online.
Please rate the following statements on a scale of 1–5, where 1 is Strongly
Disagree and 5 is Strongly Agree:
Released
1
2
3
4
5
Strongly
Strongly
Disagree
Agree
It was easy to book an appointment
The survey website was easy to
use
It was easy to communicate with
the interviewer
I felt comfortable to provide honest
answers
Overall, I enjoyed taking part online
NZHS Year 13 Child Questionnaire
59
Document 4
CR1.06 Did you encounter any problems with making an appointment, or taking part online?
1
Yes [Specify]
__________________
2
No
CR1.02 Would you take part in the New Zealand Health Survey again?
1
Yes [go to CR1.04]
2
No [go to CR1.03]
CR1.03 Please indicate why you would not take part again:
[Select all that apply]
1
Took too long
2
Too many questions
1982
3
Questions were too personal
4
Questions were not relevant
5
Survey was too repetitive
Act
6
Lost interest
7
Other [Specify]
_________________
CR1.04 Are there any other comments you would like to make about taking part in the
survey?
1
Yes [Specify] __________________ Information
2
No
Thank you for answering those questions; please click ‘Next’. [For F2F: Please hand the
computer back.]
Official
END OF SELF-COMPLETE SECTION.
New screen.
the
For VIP, go to Thank you.
Thank you again for completing this survey.
under
Survey end.
The rest of the questionnaire is collected in the Sample Manager tool.
Released
NZHS Year 13 Child Questionnaire
60
Document 4
Household composition
Ask next questions, C4.24 and C4.28, if there is more than 1 person in household
(Occupants in household screener>1).
Gender and age
C4.24 I would now like to enter some information about the
other people who live in this
household as this can affect [Name’s] health. Please confirm the initials, ages and
genders of all the people who usually live in this household.
The following questions cover the initials, age, gender and relationship of
every member of the household.
Update fields or add / delete occupants below as required.
Occupant grid pre-populated with information from household screener.
Provide three response options for gender: male, female, another gender.
1982
Occupant Name
ID
Age
Gender
Act
Relationships
The next questions are about relationships in your household.
The following questions cover the relationships between
every member of the household.
Information
Ask the relationships between every household member one-way. Eg if a father Matt is
asked the relationship to his son James, there’s no need to also ask James his relationship
to his father as it will be derived.
[Showcard]
Official
C4.28
If dealing with respondent’s relationships, insert:
What is [Name’s] relationship to you?
the
Include natural, step, adopted and foster relationships.
Otherwise insert:
What is [Name’s] relationship to [Name]?
under
Include natural, step, adopted and foster relationships.
1
Spouse or partner
2
Child (eg daughter)
3
Parent (eg mother)
4
Sibling (eg brother)
5
Grandchild
Released
6
Grandparent
7
Great-grandchild
8
Great-grandparent
9
Nephew or niece
10
Uncle or aunt
11
Other relative
12
Unrelated
.K
Don’t know
.R
Refused
Perform the following soft edit checks on all coded relationship pairs.
NZHS Year 13 Child Questionnaire
61
Document 4
Edit
Description
Error Message
Check
E1
A person is unlikely to have more than
[Name] is recorded as already having a spouse or
one spouse / partner in a household.
partner. Please verify that [Name] is another
spouse / partner of [Name].
E2
A person is unlikely to be living with more [Name] is recorded as already having two
than two parents at one time.
parents. Please verify that [Name] is another
parent of [Name].
E3
A person is unlikely to have a
This household spans at least 4 generations.
relationship of parent to one household
Please verify this with respondent and if this is not
member and a relationship of grandchild
correct, please select 'Go to' to review the
to another household member.
relationships in the household.
E4
It is unlikely that a person aged less than
[Name] is less than 15 years and is recorded as
15 years would be unrelated to all
being unrelated to any other household member.
household members.
Please verify this response.
1982
E5
It is unlikely that a person aged less than
[Name] is less than 15 years of age and is
15 years would be a spouse of another
recorded as the spouse/partner of [Name]. Please
Act
household member.
verify this response.
E6
It is unlikely that a person aged less than
[Name] is less than 15 years of age and is
15 years would be a parent of another
recorded as the parent of [Name]. Please verify
household member.
this response.
E7
A person aged less than 30 years is
[Name] is less than 30 years of age and recorded
unlikely to be the grandparent of another
as the grandparent of [Name]. Please verify this
household member.
response.
E8
A person aged less than 45 years is
[Name] is less than 45 years of age and recorded
Information
unlikely to be the great-grandparent of
as the great-grandparent of [Name]. Please verify
another household member.
this response.
E9
It is unlikely that a child is older than a
[Name] is younger than [Name] but is recorded as
parent.
their parent. Please verify this response.
Official
E10
It is unlikely that a child is older than their [Name] is younger than [Name] but is recorded as
grandparent.
their grandparent. Please verify this response.
the
E11
It is unlikely that a child is older than their [Name] is younger than [Name] but is recorded as
great-grandparent.
their great-grandparent. Please verify this
response.
E12
A person aged over 70 years is unlikely
[Name] is over 70 years of age and is recorded as
to have a relationship of niece or nephew the niece or nephew of [Name]. Please verify this
under
to another household member.
response.
E13
A person aged over 50 years is unlikely
[Name] is over 50 years of age and is recorded as
to be the grandchild of another
the grandchild of [Name]. Please verify this
household member.
response.
E14
A person aged over 30 years is unlikely
[Name] is over 30 years of age and is recorded as
to be the great-grandchild of another
the great-grandchild of [Name]. Please verify this
Released
household member.
response.
E15
A person aged over 70 years is unlikely
[Name] is over 70 years of age and is recorded as
to be the child / foster child / stepchild of
the child / foster child / stepchild of [Name].
another household member.
Please verify this response.
E16
A parent is likely to be at least 13 years
[Name] is recorded as the parent of [Name] but is
older than their child.
less than 13 years older than them. Please verify
this response.
E17
It is unlikely that the age gap between
[Name] is recorded as [Name's] brother / sister,
siblings would be greater than 40 years.
but is over 40 years older than them. Please
verify this response.
NZHS Year 13 Child Questionnaire
62
Document 4
Health measurements
If the measurements section is completed first (eg after the adult measurements and
before the child interview) ask:
Could you please tell me which of these age groups [Name] belongs to?
Age is asked as these questions depend on the child’s age.
1
Birth–11 months
2
12–23 months (1 year old)
3
2–4 years
4
5–9 years
5
10–14 years
.K Don’t know
.R Refused
1982
If the measurements section is completed at the end of the child questionnaire:
If child is aged 0–23 months old say: That’s the end of the questionnaire. [go to Thank
Act
you section].
If child aged 2–4 years old say: That’s the end of the questionnaire. I would now like to
measure [Name’s] height and weight.
Is this a good time for me to get measurements from [Name]?
1
Yes
2
No [MAKE A TIME TO VISIT WHEN CHILD IS HOME]
Information
If child aged 5+ years old say: That’s the end of the questionnaire. I would now like to
measure [Name’s] height, weight and waist circumference.
Official
Is this a good time for me to get measurements from [Name]?
1
Yes
the
2
No [MAKE A TIME TO VISIT WHEN CHILD IS HOME]
To child:
While I’m setting up the equipment, could you please remove your shoes and
any
heavy clothing so that we get the measurements right… Thank you.
under
For children aged 5–14, say: I am now going to take three measurements from you:
height, weight and waist, in that order.
For children aged 2–4, say: I am now going to take two measurements from you: height
and weight, in that order.
Released
I'm then going to take those measurements again, and if any of the second measures are
not close enough to the first ones, I'll measure you for a third time.
NZHS Year 13 Child Questionnaire
63
Document 4
Height
If aged 2 years and over.
Now I would like to measure your height.
Please stand with your back to the door / wall. Put your feet together and move them back
until your heels touch the door / wall. Stand up straight and look straight ahead.
If head is not in Frankfort Plane say…
Please raise / lower your chin. Take a deep breath and hold it.
Take measurement when breath is held and say it aloud.
That’s fine, you can breathe normally now and step away from the door / wall.
CM1.0 1st reading 0.000 (m)
1982
.R
Respondent refused to have height recorded
777
Respondent unable to have height recorded (eg chairbound, too unsteady
Act
on feet, in pain etc.)
Check any measurements that fall below the 1st percentile or above the 99th percentile.
Weight
If aged 2 years and over.
Wait until it turns zero. Please step onto the centre of the scale with your weight on both feet.
Information
Relax [take reading]. Thank you. You can step off now.
CM2.0 1st reading 000.0 (kg)
.R
Respondent refused to have weight recorded
Official
777
Respondent unable to have weight recorded (eg chairbound, too unsteady
on feet, in pain etc.)
the
Check any measurements that fall below the 1st percentile or above the 99th percentile.
Waist
under
If aged 5 years and over.
Please stand in a relaxed position. Take the end of the tape, pass it around your waist and
hand it back to me. Please help me to position the tape at the level of your waist. Good, now
just breathe normally [take measurement at end of breath out]. Thank you.
CM3.0 1st reading 000.0 (cm)
Released
.R
Respondent refused to have waist circumference recorded
777
Respondent unable to have waist circumference recorded
Check any measurements that fall below the 1st percentile or above the 99th percentile.
Computer repeats prompts as above and automatically does calculation if 3rd reading is
required – if more than 1% difference between first and second reading, a third reading is
required.
NZHS Year 13 Child Questionnaire
64
Document 4
Thank you
On behalf of the Ministry of Health, thank you once again for talking with me about [Name’s]
health.
[For F2F: Here is a small gift from the Ministry in recognition of your time.
Give Thank You card and koha.
Inside the card is a list of phone numbers you can call if you would like more information or
advice. If you’d prefer, I can arrange for this to be emailed to you along with the consent
form(s).]
[For VIP: We would like to email you a Thank you card (with a list of phone numbers you can
call if you would like more information or advice), along with the consent form(s).]
1982
If you’d rather not receive these items, that’s completely fine.
Act
1
Yes, please email to me
[Specify]
_______________ [only accept email format]
2
No, don’t email
End survey.
Information
Official
the
under
Released
NZHS Year 13 Child Questionnaire
65
Document Outline
