Understanding Disparities in Persons with Multiple Chronic Conditions: Research Approaches and Datasets. Appendix A – HHS Standards for Race, Ethnicity, Sex, Primary Language, and Disability Status (2011)

09/30/2013

I and II. Race and Ethnicity

Ethnicity Data Standard  Categories
Are you Hispanic, Latino/a, or Spanish origin (One or more categories may be selected)
a. ____No, not of Hispanic, Latino/a, or Spanish origin
b. ____Yes, Mexican, Mexican American, Chicano/a
c. ____Yes, Puerto Rican
d. ____Yes, Cuban
e. ____Yes, another Hispanic, Latino, or Spanish origin
These categories roll-up to the Hispanic or Latino category of the OMB standard

 

Race Data Standard Categories
What is your race?
(One or more categories may be selected)
a.   ____White
b.   ____Black or African American
c.   ____American Indian or Alaska Native
These categories are part of the current OMB standard
d.   ____Asian Indian
e.   ____Chinese
f.   ____Filipino
g.   ____Japanese
h.   ____Korean
i.   ____Vietnamese
j.   ____Other Asian
These categories roll-up to the Asian category of the OMB standard
k.  ____Native Hawaiian
l.   ____Guamanian or Chamorro
m. ____Samoan
n.  ____Other Pacific Islander
 
These categories roll-up to the Native Hawaiian or Other Pacific Islander category of the OMB standard

III. Sex

Sex Data Standard
What is your sex?
a. ____Male
b. ____Female

IV. Primary language

Data Standard for Primary Language
How well do you speak English? (5 years old or older)
a. ____Very well
b. ____Well
c. ____Not well
d. ____Not at all

 

Data Collection for Language Spoken (Optional)

1. Do you speak a language other than English at home? (5 years old or older)
a. ____Yes
b. ____No

For persons speaking a language other than English (answering yes to the question above):

2.What is this language? (5 years old or older)
a. ____Spanish
b. ____Other Language (Identify)

V. Disability Status

Data Standard for Disability Status

1. Are you deaf or do you have serious difficulty hearing?
a. ____Yes
b. ____No

2. Are you blind or do you have serious difficulty seeing, even when wearing glasses?
a. ____Spanish
b. ____Other Language (Identify)

3. Because of a physical, mental, or emotional condition, do you have serious difficulty
concentrating, remembering, or making decisions? (5 years old or older)
a. ____Yes
b. ____No

4. Do you have serious difficulty walking or climbing stairs? (5 years old or older)
a. ____Yes
b. ____No

5. Do you have difficulty dressing or bathing? (5 years old or older)
a. ____Yes
b. ____No

6. Because of a physical, mental, or emotional condition, do you have difficulty doing errands alone
such as visiting a doctor's office or shopping? (15 years old or older)
a. ____Yes
b. ____No

 

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