Behavioral Risk Factor
Surveillance System
Indiana Statewide Survey Data,
2012
Table
of Contents
Preface
Introduction:
Tables:
Core
01: Health Status
C01.01
Would you say that in general your health is:
Core
02: Healthy Days—Health-Related Quality of Life
C02.01
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?
C02.02
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?
C02.03
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?
Core
03: Health Care Access
C03.01
Do you have any kind of health care coverage, including health insurance,
prepaid plans such as HMOs, or government plans such as
Medicare?
C03.02
Do you have one person you think of as your personal doctor or health care
provider?
C03.03
Was there a time in the past 12 months when you needed to see a doctor but could
not because of cost?
C03.04
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.]
Core
04: Physical Exercise
C04.01
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?
Core
05: Chronic Health Conditions
C05.01
Ever told you that you had a heart attack also called a myocardial
infarction?
C05.02
Ever told you had angina or coronary heart disease?
C05.03
Ever told you had a stroke?
C05.04
Ever told you had asthma?
C05.05
Do you still have asthma?
C05.06
Ever told you had skin cancer?
C05.07
Ever told you had other types of cancer?
C05.08
Ever told you have chronic obstructive pulmonary disease (COPD), emphysema or
chronic bronchitis?
C05.09
Ever told you have some form of arthritis, rheumatoid arthritis, gout, lupus, or
fibromyalgia?
C05.10
Ever told you have a depressive order (including depression, major depression,
dysthymia, or minor depression)?
C05.11
Ever told you have kidney disease? Do NOT include kidney stones, bladder
infection or incontinence.
C05.12
Do you have any trouble seeing, even when wearing glasses or contact
lenses?
C05.13
Ever told you have diabetes?
Module 01:
Pre-Diabetes
M01.01
Have you had a test for high blood sugar or diabetes within the past three
years?
M01.02
Have you ever been told by a doctor or other health professional that you have
pre-diabetes or borderline diabetes?
Module
02: Diabetes
M02.01
How old were you when you were told you have diabetes?
M02.02
Are you now taking insulin?
M02.03
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.
M02.04
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.
M02.05
About how many times in the past 12 months have you seen a doctor, nurse, or
other health professional for your diabetes?
M02.06
About how many times in the past 12 months has a health professional checked you
for 'A one C'?
M02.07
About how many times in the past 12 months has a health professional checked
your feet for any sores or irritations?
M02.08
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
light.
M02.09
Has a doctor ever told you that diabetes has affected your eyes or that you had
retinopathy?
M02.10
Have you ever taken a course or class in how to manage your diabetes
yourself?
Core 06: Oral Health
C06.01
How long has it been since you last visited a dentist or a dental clinic for any
reason?
C06.02
How many of your permanent teeth have been removed because of tooth decay or gum
disease?
Core 7:
Demographics
C07.05
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.
C07.13
What county do you live in?
C07.19
Do you own or rent your home?
Core 8:
Disability
C8.01
Are you limited in any way in any activities because of physical, mental, or
emotional problems?
C8.02
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?
Core 9:
Tobacco Use
C09.01
Have you smoked at least 100 cigarettes in your entire
life?
C09.02
Do you now smoke cigarettes every day, some days, or not at
all?
C09.03
During the past 12 months, have you stopped smoking for one day or longer
because you were trying to quit smoking?
C09.04
How long has it been since you last smoked a cigarette, even one or two
puffs?
C09.05
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
tobacco)
Core
10: Alcohol Consumption
C10.01
During the past 30 days, how many days per week or per month did you have at
least one drink of any alcoholic beverage?
C10.02
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?
C10.03
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
occasion?
C10.04
During the past 30 days, what is the largest number of drinks you had on any
occasion?
Core 11: Immunization
C11.01
During the past 12 months, have you had either a seasonal flu shot or a seasonal
flu vaccine that was sprayed in your nose?
C11.03
At what kind of place did you get your last flu
shot/vaccine?
C11.04
Have you ever had a pneumonia shot?
Core 12:
Falls
C12.01
In the past 12 months, how many times have you fallen?
C12.02
Did this fall cause an injury?
Core 13: Seatbelt
Use
C13.01
How often do you use seat belts when you drive or ride in a car?
Core 14: Drinking and
Driving
C14.01
During the past 30 days, how many times have you driven when you've had perhaps
too much to drink?
Core 15:
Breast and Cervical Cancer Screening
C15.01
A mammogram is an x-ray of each breast to look for breast cancer. Have you ever
had a mammogram?
C15.02
How long has it been since you had your last
mammogram?
C15.03
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
exam?
C15.04
How long has it been since your last breast exam?
C15.05
A Pap test is a test for cancer of the cervix. Have you ever had a Pap
test?
C15.06
How long has it been since you had your last Pap test?
C15.07
Have you had a hysterectomy?
Core 16:
Prostate Cancer Screening
C16.01
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
test?
C16.02
Has a doctor, nurse, or other health professional EVER talked with you about the
disadvantages of the PSA test?
C16.03
Has a doctor, nurse, or other health professional EVER recommended that you have
a PSA test?
C16.04
Have you EVER HAD a PSA test?
C16.05
How long has it been since you had your last PSA
test?
C16.06
What was the MAIN reason you had this PSA test – was it
…?
Core 17:
Colorectal Cancer Screening
C17.01
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
kit?
C17.02
How long has it been since you had your last blood stool test using a home
kit?
C17.03
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?
C17.04
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?
C17.05
How long has it been since you had your last sigmoidoscopy or
colonoscopy?
Core
18: HIV/AIDS
C18.01
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
mouth.
C18.03
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
HIV.]
Calculated
Variables and Risk Factors:
CLV01.01
Adults with good or better health
CLV03.01
Respondents aged 18-64 that have any form of health care
coverage
CLV04.01
Adults
that report doing physical activity or exercise during the past 30 days other
than their regular job
CLV05.01
Adults who have ever been told they have asthma
CLV05.02
Adults who have been told they currently have asthma
CLV05.03
Computed asthma status
CLV05.04
Respondents that have had a doctor diagnose them as having some form of
arthritis
CLV06.01
Adults aged 18+ that have had permanent teeth extracted
CLV06.02
Adults aged 65+ who have had all their natural teeth
extracted
CLV06.03
Adults that have visited a dentist, dental hygienist or dental clinic within the
past year
CLV07.18
Four-categories of Body Mass Index (BMI)
CLV07.19
Adults who have a body mass index greater than 25.00 (Overweight or
Obese)
CLV09.01
Four-level smoker status: Everyday smoker, Someday smoker, Former smoker,
Non-smoker
CLV09.02
Adults who are current smokers
CLV10.01
Adults that report having had at least one drink of alcohol in the past 30
days
CLV10.03
Binge drinkers (males having five or more drinks on one occasion, females having
four or more drinks on one occasion)
CLV10.04
Calculated total number of alcoholic beverages consumed per
day
CLV10.06
Heavy drinkers (adult men having more than two drinks per day and adult women
having more than one drink per day)
CLV10.07
Adult men that are heavy drinkers (having more than two drinks per
day)
CLV10.08
Adult women that are heavy drinkers (having more than one drinks per
day)
CLV11.01
Adults aged 65+ who have had a flu shot within the past
year
CLV11.02
Adults aged 65+ who have ever had a pneumonia vaccination
CLV13.01
Always or nearly always wear seat belts
CLV13.02
Always wear seat belts
CLV15.01
Women respondents aged 40+ that have had a mammogram in the past two
years
CLV15.02
Women respondents aged 50+ that have had a mammogram in the past two
years
CLV15.03
Women respondents aged 18+ that have had a pap test in the past three
years
CLV16.01
Male respondents aged 40+ that have had a PSA test in the past two
years
CLV17.01
Respondents aged 50+ that have had a blood stool test within the past two
years
CLV17.02
Respondents aged 50 or older that have had a sigmoidoscopy or
colonoscopy
Appendices:
Appendix
A -
Healthy People 2020 in Indiana
Appendix B
- 2011 Behavioral Risk Factor Surveillance Survey Questionnaire ![]()
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