Behavioral Risk Factor Surveillance System

Indiana Statewide Survey Data, 2003

 

Table of Contents

 

Preface

 

Introduction:

 

 

Tables:

Section 1: Health Status

Q1. Would you say that, in general, your health is:
Q2. Now thinking about your physical health, which includes physical illness and injury, for how many days during the past 30 days was your physical health not good?
Q3. Now thinking about your mental health, which includes stress, depression, and problems with emotions, for how many days during the past 30 days was your mental health not good?
Q4. During the past 30 days, for about how many days did poor physical or mental health keep you from doing your usual activities, such as self-care, work, or recreation?

Section 2: Health Care Access

Q5. Do you have any kind of health care coverage, including health insurance, prepaid plans such as HMOs, or government plans such as Medicare?
Q6. Do you have one person you think of as your personal doctor or health care provider?
Q7. Was there a time in the past 12 months when you needed to see a doctor but could not because of the cost?

Section 3: Exercise

Q8. During the past month, other than your regular job, did you participate in any physical activities or exercise such as running, calisthenics, golf, gardening, or walking for exercise?

Section 4: Diabetes

Q9. Have you ever been told by a doctor that you have diabetes?

Section 5: Hypertension Awareness

Q10. Have you ever been told by a doctor, nurse, or other health professional that you have high blood pressure?
Q11. Are you currently taking medicine for your high blood pressure?

Section 6: Cholesterol Awareness

Q12. Have you ever had your blood cholesterol checked?
Q13. About how long has it been since you last had your blood cholesterol checked?
Q14. Have you ever been told by a doctor, nurse, or other health professional that your blood cholesterol is high?

Section 7: Fruits and Vegetables

[Q95. Summary index for fruits and vegetables.]

Section 8: Weight Control

Q15. Are you now trying to lose weight?
Q16. Are you now trying to maintain you current weight, that is, to keep from gaining weight?
Q17. Are you eating either fewer calories or less fat to lose weight or keep from gaining weight?
Q18. Are you using physical activity or exercise to lose weight or keep from gaining weight?
Q19. In the past 12 months, has a doctor, nurse, or other health professional given you advice about your weight?

Section 9: Asthma

Q20. Have you ever been told by a doctor, nurse, or other health professional that you had asthma?
Q21. Do you still have asthma?

Section 10: Immunization

Q22. During the past 12 months, have you had a flu shot?
Q23. Have you ever had a pneumonia shot? This shot is usually given only once or twice in a personís lifetime and is different from the flu shot - it is called the pneumococcal vaccine.

Section 11: Tobacco Use

Q24. Have you smoked at least 100 cigarettes in your entire life?
Q25. Do you now smoke cigarettes every day, some days, or not at all?
Q26. During the past 12 months, have you stopped smoking for one day or longer because you were trying to quit smoking?

Section 12: Alcohol Consumption

Q27. Considering all types of alcoholic beverages, how many times during the past 30 days did you have 5 or more drinks on an occasion?

Section 13: Excess Sun Exposure

Q28. Have you had a sunburn within the past 12 months?
Q29. Including times when even a small part of your skin was red for more than 12 hours, how many sunburns have you had within the past 12 months?

Section 14: Demographics

Q30. Number and percent of respondents from each county.
Q31. To your knowledge, are you now pregnant?

Section 15: Arthritis

Q32. During the past 30 days, have you had any symptoms of pain, aching, or stiffness in or around a joint? Please do not include the back or neck.†
Q33. Did your joint symptoms first begin more than 3 months ago?
Q34. Have you ever seen a doctor or other health professional for these joint symptoms?
Q35. Have you ever been told by a doctor or other health professional that you have some form of arthritis, rheumatoid arthritis, gout, lupus, or fibromyalgia?
Q36. Are you now limited in any way of your usual activities because of arthritis or joint symptoms?
Q37. Does arthritis or joint symptoms now affect whether you work, the type of work you do, or the amount of work you do?† We are referring to work for pay.

Section 16: Falls

Q38. In the past three months, have you had a fall?
Q39. Were you injured? By injured, we mean the fall caused you to limit your regular activities for at least a day or to go see a doctor.

Section 17: Disability

Q40. Are you limited in any way in any activities because of physical, mental, or emotional problems?
Q41. Do you now have any health problem that requires you to use special equipment, such as a cane, a wheelchair, a special bed, or a special telephone?

Section 18: Physical Activity

Q42. When you are at work, which of the following best describes what you do?
Q43. In a usual week outside of work, do you do moderate activities for at least 10 minutes at a time, such as brisk walking, bicycling, vacuuming, gardening, or anything else?
Q44. In a usual week outside of work, do you do vigorous activities for at least 10 minutes at a time, such as running, aerobics, heavy yard work, or anything else?

Section 19: Veterans Status

Q45. Have you ever served on active duty in the United States Armed Forces, either in the regular military or in a National Guard or military reserve unit?
Q46. Which of the following best describes your service in the United States military?
Q47. In the last 12 months, have you received some or all of your health care from VA facilities?

Section 20: AIDS

Q48. True or false: A pregnant woman with HIV can get treatment to help reduce the chances that she will pass the virus on to her baby.
Q49. True or false: There are medical treatments available that are intended to help a person who is infected with HIV to live longer.
Q50. How important do you think it is for people to know their HIV status by getting tested?
Q51. Have you ever been tested for HIV? Do not count tests you may have had as part of a blood donation.
Q52. Not including blood donations, which of these would you say was the main reason for your last HIV test?
Q53. Where did you have your last HIV test: at a private doctor or HMO office, at a counseling and testing site, at a hospital, at a clinic, in a jail or prison, at home, or somewhere else?
Q54. Please tell me if any of the situations apply to you.† You don't need to tell me which one.
Q55. In the past 12 months, has a doctor, nurse, or other health professional talked to you about preventing sexually transmitted diseases through condom use?

Module 1: Diabetes

Q56. How old were you when you were told you have diabetes?
Q57. Are you now taking insulin?
Q58. Are you taking diabetes pills?
Q59. About how often do you check your blood for glucose or sugar? Include times when checked by a family member or friend but do not include times when checked by a health professional.
Q60. About how often do you check your feet for any sores or irritations? Include times when checked by a family member or friend but do not include times when checked by a health professional.
Q61. Have you ever had any sores or irritations on your feet that took more than four weeks to heal?
Q62. About how many times in the past 12 months have you seen a doctor, nurse, or other health professional for your diabetes?
Q63. About how many times in the past 12 months has a doctor, nurse, or other health professional checked you for hemoglobin "A one C"?
Q64. About how many times in the past 12 months has a health professional checked your feet for any sores or irritations?
Q65. When was the last time you had an eye exam in which the pupils were dilated?
Q66. Has a doctor ever told you that diabetes has affected your eyes or that you had retinopathy?
Q67. Have you ever taken a course or class in how to manage your diabetes yourself?

Module 6: Adult Asthma History

Q68. How old were you when you were first told by a doctor, nurse, or other health professional that you had asthma?
Q69. During the past 12 months, have you had an episode of asthma or an asthma attack?
Q70. During the past 12 months, how many times did you visit an emergency room or urgent care center because of your asthma?
Q71. During the past 12 months, how many times did you see a doctor, nurse, or other health professional for urgent treatment of worsening asthma symptoms?
Q72. During the past 12 months, how many times did you see a doctor, nurse, or other health professional for a routine checkup for your asthma?
Q73. During the past 12 months, how many days were you unable to work or carry out your usual activities because of your asthma?
Q74. During the past 30 days, how often did you have any symptoms of asthma?
Q75. During the past 30 days, how many days did symptoms of asthma make it difficult for you to stay asleep?
Q76. During the past 30 days, how often did you take asthma medication that was prescribed or given to you by a doctor? This includes using an inhaler.

Module 7: Childhood Asthma

Q77. How many of the children in your household have ever been diagnosed with asthma?
Q78. Does this child/these children still have asthma?

Module 12: Other Tobacco Products

Q79. Have you ever used or tried any smokeless tobacco products such as chewing tobacco or snuff?
Q80. Do you currently use chewing tobacco or snuff every day, some days, or not at all?
Q81. Have you ever smoked a cigar, even one or two puffs?
Q82. Do you now smoke cigars every day, some days, or not at all?
Q83. Have you ever smoked tobacco in a pipe, even one or two puffs?
Q84. Do you now smoke a pipe every day, some days, or not at all?
Q85. A bidi is a flavored cigarette from India. Have you ever smoked a bidi, even one or two puffs?
Q86. Do you now smoke bidis every day, some days, or not at all?

Module 13: Arthritis

Q87. Concerning your arthritis or joint symptoms, which of the following best describes you today?
Q88. Has a doctor or other health professional ever suggested losing weight to help your arthritis or joint symptoms?
Q89. Has a doctor or other health professional ever suggested physical activity or exercise to help your arthritis or joint symptoms?
Q90. Have you ever taken an educational course or class to teach you how to manage problems related to your arthritis or joint symptoms?

Calculated Variables and Risk Factors

Q91. Leisure time physical activity.
Q92. Respondents told that they have high blood pressure risk factor.
Q93. Respondents who had their cholesterol checked within the past five years.
Q94. Respondents who had their cholesterol checked and were told it was high risk factor.
Q95. Summary index for fruits and vegetables.
Q96. Risk factor for lifetime asthma prevalence.
Q97. Risk factor for current asthma prevalence.
Q98. Risk factor for respondents aged 65+ who had a flu shot in the past 12 months.
Q99. Risk factor for respondents aged 65+ who have ever had a pneumonia shot.
Q100. At risk for smoking (all current smokers).
Q101. Drink any alcoholic beverages in past 30 days.
Q102. At risk for binge drinking (greater than or equal to five or more drinks on one or more occasion).
Q103. Number of drinks of alcoholic beverages per day.
Q104. At risk for heavy alcohol consumption (greater than two drinks per day for men and greater than one drink per day for women).
Q105. At risk for heavy alcohol consumption in men (greater than two drinks per day).
Q106. At risk for heavy alcohol consumption in women (greater than one drink per day).
Q107. Body Mass Index (_BMI2) categorized.
Q108. Risk factor for being overweight or obese.
Q109. Moderate physical activity categories.
Q110. Vigorous physical activity categories.
Q111. Physical activity categories.
Q112. Risk factor for meeting Healthy People - 2010 Objective #22-2 for Moderate Physical Activity.
Q113. Risk factor for meeting Healthy People - 2010 Objective #22-3 for Vigorous Physical Activity.
Q114. Meet recommendations for physical activity.
Q115. Respondents who do no physical activity or exercise.
Q116. Ever been tested for HIV risk factor.
Q117. Ever participated in high-risk behavior risk factor.
Q118. Risk factor for having been counseled by a health professional within the past 12 months on prevention of sexually transmitted diseases through condom use.
Q119. Risk factor for fair or poor health.
Q120. Consume five or more servings of fruits or vegetables per day.

 

Appendices:

 

Appendix A - Healthy People 2010 in Indiana

Background

Progress


            Appendix B - 2003 Behavioral Risk Factor Surveillance Survey Questionnaire