Behavioral Risk Factor
Indiana Statewide Survey Data,
01: Health Status
Would you say that in general your health is:
02: Healthy Days—Health-Related Quality of Life
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
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?
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
03: Health Care Access
Do you have any kind of health care coverage, including health insurance,
prepaid plans such as HMOs, or government plans such as
Do you have one person you think of as your personal doctor or health care
Was there a time in the past 12 months when you needed to see a doctor but could
not because of cost?
About how long has it been since you last visited a doctor for a routine
checkup? [A routine checkup is a general physical exam, not an exam for a
specific injury, illness, or condition.]
04: Physical Exercise
During the past month, other than your regular job, did you participate in any
physical activities or exercises such as running, calisthenics, golf, gardening,
or walking for exercise?
05: Chronic Health Conditions
Ever told you that you had a heart attack also called a myocardial
Ever told you had angina or coronary heart disease?
Ever told you had a stroke?
Ever told you had asthma?
Do you still have asthma?
Ever told you had skin cancer?
Ever told you had other types of cancer?
Ever told you have chronic obstructive pulmonary disease (COPD), emphysema or
Ever told you have some form of arthritis, rheumatoid arthritis, gout, lupus, or
Ever told you have a depressive order (including depression, major depression,
dysthymia, or minor depression)?
Ever told you have kidney disease? Do NOT include kidney stones, bladder
infection or incontinence.
Do you have any trouble seeing, even when wearing glasses or contact
Ever told you have diabetes?
Have you had a test for high blood sugar or diabetes within the past three
Have you ever been told by a doctor or other health professional that you have
pre-diabetes or borderline diabetes?
How old were you when you were told you have diabetes?
Are you now taking insulin?
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
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.
About how many times in the past 12 months have you seen a doctor, nurse, or
other health professional for your diabetes?
About how many times in the past 12 months has a health professional checked you
for 'A one C'?
About how many times in the past 12 months has a health professional checked
your feet for any sores or irritations?
When was the last time you had an eye exam in which the pupils were dilated?
This would have made you temporarily sensitive to bright
Has a doctor ever told you that diabetes has affected your eyes or that you had
Have you ever taken a course or class in how to manage your diabetes
Core 06: Oral Health
How long has it been since you last visited a dentist or a dental clinic for any
How many of your permanent teeth have been removed because of tooth decay or gum
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? Active
duty does not include training for the Reserves or National Guard, but DOES
include activation, for example, for the Persian Gulf War.
What county do you live in?
Do you own or rent your home?
Are you limited in any way in any activities because of physical, mental, or
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
Have you smoked at least 100 cigarettes in your entire
Do you now smoke cigarettes every day, some days, or not at
During the past 12 months, have you stopped smoking for one day or longer
because you were trying to quit smoking?
How long has it been since you last smoked a cigarette, even one or two
Do you currently use chewing tobacco, snuff, or snus every day, some days, or
not at all? (Snus (Swedish for snuff) is a moist smokeless
10: Alcohol Consumption
During the past 30 days, how many days per week or per month did you have at
least one drink of any alcoholic beverage?
One drink is equivalent to a 12-ounce beer, a 5-ounce glass of wine, or a drink
with one shot of liquor. During the past 30 days, on the days when you drank,
about how many drinks did you drink on the average?
Considering all types of alcoholic beverages, how many times during the past 30
days did you have 5 or more drinks for men or 4 or more drinks for women on an
During the past 30 days, what is the largest number of drinks you had on any
Core 11: Immunization
During the past 12 months, have you had either a seasonal flu shot or a seasonal
flu vaccine that was sprayed in your nose?
At what kind of place did you get your last flu
Have you ever had a pneumonia shot?
In the past 12 months, how many times have you fallen?
Did this fall cause an injury?
Core 13: Seatbelt
How often do you use seat belts when you drive or ride in a car?
Core 14: Drinking and
During the past 30 days, how many times have you driven when you've had perhaps
too much to drink?
Breast and Cervical Cancer Screening
A mammogram is an x-ray of each breast to look for breast cancer. Have you ever
had a mammogram?
How long has it been since you had your last
A clinical breast exam is when a doctor, nurse, or other health professional
feels the breasts for lumps. Have you ever had a clinical breast
How long has it been since your last breast exam?
A Pap test is a test for cancer of the cervix. Have you ever had a Pap
How long has it been since you had your last Pap test?
Have you had a hysterectomy?
Prostate Cancer Screening
A Prostate-Specific Antigen test, also called a PSA test, is a blood test used
to check men for prostate cancer. Has a doctor, nurse, or other health
professional EVER talked with you about the advantages of the PSA
Has a doctor, nurse, or other health professional EVER talked with you about the
disadvantages of the PSA test?
Has a doctor, nurse, or other health professional EVER recommended that you have
a PSA test?
Have you EVER HAD a PSA test?
How long has it been since you had your last PSA
What was the MAIN reason you had this PSA test – was it
Colorectal Cancer Screening
A blood stool test is a test that may use a special kit at home to determine
whether the stool contains blood. Have you ever had this test using a home
How long has it been since you had your last blood stool test using a home
Sigmoidoscopy and colonoscopy are exams in which a tube is inserted in the
rectum to view the colon for signs of cancer or other health problems. Have you
ever had either of these exams?
For a SIGMOIDOSCOPY, a flexible tube is inserted into the rectum to look for
problems. A COLONOSCOPY is similar, but uses a longer tube, and you are usually
given medication through a needle in your arm to make you sleepy and told to
have someone else drive you home after the test. Was your MOST RECENT exam a
sigmoidoscopy or a colonoscopy?
How long has it been since you had your last sigmoidoscopy or
Have you ever been tested for HIV? Do not count tests you may have had as part
of a blood donation. Include testing fluid from your
I am going to read you a list. When I am done, please tell me if any of the
situations apply to you. You do not need to tell me which one. [Risk factors for
Variables and Risk Factors:
Adults with good or better health
Respondents aged 18-64 that have any form of health care
that report doing physical activity or exercise during the past 30 days other
than their regular job
Adults who have ever been told they have asthma
Adults who have been told they currently have asthma
Computed asthma status
Respondents that have had a doctor diagnose them as having some form of
Adults aged 18+ that have had permanent teeth extracted
Adults aged 65+ who have had all their natural teeth
Adults that have visited a dentist, dental hygienist or dental clinic within the
Four-categories of Body Mass Index (BMI)
Adults who have a body mass index greater than 25.00 (Overweight or
Four-level smoker status: Everyday smoker, Someday smoker, Former smoker,
Adults who are current smokers
Adults that report having had at least one drink of alcohol in the past 30
Binge drinkers (males having five or more drinks on one occasion, females having
four or more drinks on one occasion)
Calculated total number of alcoholic beverages consumed per
Heavy drinkers (adult men having more than two drinks per day and adult women
having more than one drink per day)
Adult men that are heavy drinkers (having more than two drinks per
Adult women that are heavy drinkers (having more than one drinks per
Adults aged 65+ who have had a flu shot within the past
Adults aged 65+ who have ever had a pneumonia vaccination
Always or nearly always wear seat belts
Always wear seat belts
Women respondents aged 40+ that have had a mammogram in the past two
Women respondents aged 50+ that have had a mammogram in the past two
Women respondents aged 18+ that have had a pap test in the past three
Male respondents aged 40+ that have had a PSA test in the past two
Respondents aged 50+ that have had a blood stool test within the past two
Respondents aged 50 or older that have had a sigmoidoscopy or
Healthy People 2020 in Indiana
- 2011 Behavioral Risk Factor Surveillance Survey Questionnaire
to BRFSS Index