12engp~

PHARMACOEPIDEMIOLOGY (PH)
*PH1. The next questions are about your use of medicines. First, how many different kinds of prescription medicines have you (IF NEC: A “prescription medicine” is one that you can only obtain from a doctor or by giving a doctor’s written approval PROBE INITIAL ZERO/ DK: Please include any prescription medicines, even if you took them only once. *PH2. How many different kinds of non-prescription medicines have you taken during the past seven days? Please include vitamins, supplements, and any other type of medicine you obtained without a prescription. PROBE INITIAL ZERO/ DK: Please include any non-prescription medicines, even if you took them only once.
*PH2a. INTERVIEWER CHECKPOINT: (SEE *PH2)
*PH2 EQUALS ‘0’, ‘998’ OR ‘999’ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 GO TO *PH2.1
ALL OTHERS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2 *PH2b. Were any of the non-prescription medicines to help with mood, nerves and/or emotional problems? GO TO *PH2.1
GO TO *PH2.1
GO TO *PH2.1
*PH2c. Were you taking the non-prescription medicines for mood, nerves and/or emotional problems on your own or under the *PH2.1. (RB, PG 27) Please turn to Page 27 in the booklet. In the past 12 months, did you take any of the following types of prescription medications under the supervision of a doctor, for your emotions or nerves or your use of alcohol or drugs? INTERVIEWER: READ EXAMPLES IN PARENTHESES ONLY IF R CANNOT READ INTERVIEWER: (IF VOL) USE FOR PHYSICAL PROBLEM CODE 7 *PH2.1a. Sleeping pills or other sedatives, (such as Ambien or *PH2.1b. Anti-depressant medications, (such as Prozac or Zoloft)? *PH2.1c. Tranquilizers, (such as Xanax or Ativan)? *PH2.1d. Amphetamines or other stimulants, (such as Ritalin or *PH2.1e. Anti-psychotic medications, (such as Haldol or Risperdal)? *PH2.2. INTERVIEWER CHECKPOINT: (SEE *PH2.1a – *PH2.1e)
AT LEAST ONE RESPONSE CODED ‘1’ OR ‘8’ .1 GO TO *PH4 INTRO 1
*PH2.3. Did you take any type of prescription medicine in the past 12 months for problems with your emotions, nerves, substance use, energy, concentration, sleep, or ability to cope with stress? Include medicines even if you took them only once. YES . 1 GO TO *PH4 INTRO 2
NO. 5 GO TO * PH4 INTRO 3
DON’T KNOW . 8 GO TO * PH4 INTRO 3
REFUSED . 9 GO TO * PH4 INTRO 3
*PH4 INTRO 1. (RB, PG 28-29) Which of
*PH4 INTRO 2. (RB, PG 28-29) Which *PH4 INTRO 3. (RB, PG 28-29) Which
INTERVIEWER: IF NEC, ASK R TO CONSULT MEDICATION BOTTLES FOR NAMES. RECORD UP TO 20 MENTIONS. RECORD ID NUMBERS IF THE MEDICATIONS ARE LISTED ON THE NEXT PAGE. IF NOT LISTED, RECORD “998” AS THE ID NUMBER. TAKE CARE TO SPELL MED NAME CORRECTLY AND TO WRITE DISTINCTLY MEDICATION NAME
ID NUMBER
ID# MEDICINE
ID# MEDICINE
ID# MEDICINE
MEDICINE
ID# MEDICINE
ID# MEDICINE
*PH2.3a. INTERVIEWER CHECKPOINT: (SEE *PH2.3)
*PH2.3 EQUALS ‘5’, ‘8’ , ‘9’ .1 GO TO *PH5.5

PROGRAMMER: REPEAT *PH5.1 - *PH5.6 SERIES AS A SET FOR EACH MED UP TO 20. THEN GO TO *PH6
*PH5.1. About how many days out of the past 30 did you take (MED)? *PH5.2. About how many days out of 365 in the past 12 months did you take (MED)? *PH5.3. In the past 365 days, what's your best estimate of the month and day you took (MED) for the first time? PROBE DON'T KNOWS FOR BEST ESTIMATE OF MONTH AND DAY *PH5.4. What's your best estimate of the month and day you took (MED) most recently? PROBE DON'T KNOWS FOR BEST ESTIMATE OF MONTH AND DAY *PH5.5. How much (MED) did you usually take daily when you took it? (PROBE: Was that a pill, injection, teaspoon, tablespoon, drops or doses by syringe?) INTERVIEWER: CODE FRACTIONS AS DECIMALS:
DON’T KNOW . 998
*PH5.6. How many milligrams of medicine were in each (pill/ injection/ teaspoon/tablespoon/drop/dose by syringe)? INTERVIEWER: IF NEC, ASK R TO CONSULT MEDICINE BOTTLE.
*PH5.7. INTERVIEWER CHECKPOINT: (SEE *PH2.3)
*PH2.3 EQUALS ‘5’, ‘8’ , ‘9’ .1 GO TO *DM1, NEXT SECTION

*PH6. INTERVIEWER CHECKPOINT: (SEE *PH4)
ONE TO THREE MEDICINES TAKEN.1 ASK *PH14.1 - *PH20b SERIES FOR EACH
FOUR OR MORE MEDICINES TAKEN.2 RANDOMLY SAMPLE THREE MEDICINES AND
ASK *PH14.1 - *PH20b SERIES FOR EACH
*PH14.1. (RB, PG 30) (Look at page 30 in your booklet.) You mentioned taking (MED). What problem(s) did you (IF NEC: How did you think it would help you?) PROBE UNTIL NO MORE MENTIONS: Any other problem II. PHYSICAL SYMPTOMS *PH14.2. Overall, how effective was (MED) in doing the things VERY EFFECTIVE………………….1 GO TO *PH14.4
you expected it to do – very, somewhat, not very, or not IF VOL “EFFECTIVE IN SOME WAYS AND NOT DON’T KNOW……………………….8 GO TO *PH14.4
OTHERS,” PROBE: Taking everything into REFUSED…………………………….9 GO TO *PH14.4
consideration, how would you rate its overall effectiveness? (Was it very, somewhat, not very, or not *PH14.3. Why was (MED) not as effective in doing what DON’T FEEL BETTER (FEEL THE SAME)………….1 MADE PROBLEM WORSE………………………….2 OTHER…………………………………………………3 DON’T KNOW…………………………………………8 REFUSED………………………………………………9 *PH14.4. Since you started taking (MED), have you had any NO……………………………. 5 GO TO *PH15
DON’T KNOW………………. 8 GO TO *PH15
REFUSED……………………. 9 GO TO *PH15
*PH14.5. Were the problems so bad that you had to stop taking (MED)? YES…………………………… *PH15. (Did you take/ Are you taking) (MED) under the supervision of a health professional? Or, (did you take/ are ON OWN/WITHOUT SUPERVISION. 2 GO TO *PH17
you taking) it on your own without the supervision of a DON’T KNOW. 8 GO TO *PH17
REFUSED. 9 GO TO *PH17
*PH15.1. Who prescribed the (medication/ MED) – a psychiatrist, a general or family doctor, some other medical doctor or specialist, or some other health professional? *PH16. People do not always take their medicine as they are supposed to. Think of a typical month when you took (MED) in the past 12 months. How many days out of 30 did you either forget to take it or take less of it than YES…………1 GO TO *PH14.1 FOR NEXT MED OR *DM1, NEXT
DK………….8 GO TO *PH14.1 FOR NEXT MED OR *DM1, NEXT
REFUSED….9 GO TO *PH14.1 FOR NEXT MED OR *DM1, NEXT
*PH18. INTERVIEWER CHECKPOINT: (SEE *PH15)
*PH15 EQUALS ‘1’. 1
ALL OTHERS. 2 GO TO *PH20
*PH19. Did the health professional who supervised your use of YES. 1 GO TO *PH14.1 FOR NEXT
medication tell you to stop taking (MED)? MED OR *DM1, NEXT
PROFESSIONAL AGREED . 7 GO TO *PH20
*PH19a. Did the professional agree with your decision to stop? *PH20. Did you stop taking (MED) because you felt so much FELT BETTER. 1 GO TO *PH14.1 FOR NEXT
better that you no longer needed it, or did you stop for MED OR *DM1, NEXT
*PH20a. (RB, PG 31) (Looking at page 31 in your booklet,) which of these are reasons why you stopped taking INTERVIEWER: CIRCLE ALL THAT APPLY. READ LIST TO CONTINUE TAKING THE MEDICINE . 4 CONVENIENT…………………………………9 MEDICINE…………………………………….10 CONDITION (EX. DIABETES).…………….11 *PH20.1. When you stopped taking (MED), did you take NO………………………5 GO TO *PH20a.1
DON’T KNOW…….….8 GO TO *PH20a.1
REFUSED………….….9 GO TO *PH20a.1
*PH20.2. Did the new medicine work better than the YES, BETTER…………………………1 SAME………………………………….2 NO, WORSE………………………….3 DON’T KNOW……………………….8 REFUSED…………………………….9 *PH20a.1. INTERVIEWER CHECKPOINT: (SEE *PH20a)
*PH20a EQUALS ‘6’ .1
ALL OTHERS.2 GO TO *PH14.1
FOR NEXT MED OR
*DM1, NEXT
*PH20b. What were the side effects that made you stop taking PROBE: Any other side effects that made you stop GO TO *PH14.1 FOR NEXT MED OR *DM1, NEXT SECTION

Source: http://www.multiculturalmentalhealth.org/downloads/nlaasenglish/12.%20Eng%20Pharm%20Epi%20(PH)%20-%20with%20extensions.pdf