Behavioral Risk Factor
Surveillance System
Indiana Statewide
Survey Data, 2015
Table of
Contents
Preface
Introduction:
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, or Indian Health
Service?
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: Hypertension Awareness
C04.01 Have
you ever been told by a doctor, nurse, or other health professional that you
have high blood pressure?
C04.02 Are you
currently taking medicine for your high blood pressure?
Core 05: Blood Cholesterol
C05.01 Have you
ever had your blood cholesterol checked?
C05.02 About how
long has it been since you last had your blood cholesterol checked?
C05.03 Have you
ever been told by a doctor, nurse, or other health professional that your blood
cholesterol is high?
Core 06: Chronic Health
Conditions
C06.01 Ever
told you that you had a heart attack also called a myocardial infarction?
C06.02 Ever told you had
angina or coronary heart disease?
C06.03 Ever told you had a
stroke?
C06.04 Ever told you had
asthma?
C06.05 Do you still have
asthma?
C06.06 Ever told you had
skin cancer?
C06.07 Ever told you had
any other types of cancer?
C06.08 Ever told you have
(COPD) chronic obstructive pulmonary disease, emphysema or chronic bronchitis?
C06.09 Ever told you have
some form of arthritis, rheumatoid arthritis, gout, lupus, or fibromyalgia?
C06.10 Ever told you have
a depressive disorder including depression, major depression, dysthymia, or
minor depression?
C06.11 Ever told you have
kidney disease? Do NOT include kidney stones, bladder infection or incontinence.
C06.12 Ever told you have
diabetes?
C06.13 How old were you
when you were told you have diabetes?
Core 07: Demographics
C07.08 Do you own or rent
your home?
C07.09 What county do you
live in?
C07.14 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?
C07.22 Are you
limited in any way in any activities because of physical, mental, or emotional
problems?
C07.23 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?
C07.24 Are you
blind or do you have serious difficulty seeing, even when wearing glasses?
C07.25 Because
of a physical, mental, or emotional condition, do you have serious difficulty
concentrating, remembering or making decisions?
C07.26 Do you
have serious difficulty walking or climbing stairs?
C07.27 Do you
have difficulty dressing or bathing?
C07.28 Because
of a physical, mental, or emotional condition, do you have difficulty doing
errands alone such as visiting a doctor's office or shopping?
Core 08: Tobacco Use
C08.01 Have
you smoked at least 100 cigarettes in your entire life?
C08.02 Do you
now smoke cigarettes every day, some days, or not at all?
C08.03 During
the past 12 months, have you stopped smoking for one day or longer because you
were trying to quit smoking?
C08.04 How
long has it been since you last smoked a cigarette, even one or two puffs?
C08.05 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 9: Alcohol Consumption
C09.01 During
the past 30 days, how many days did you have at least one drink of any
alcoholic beverage?
C09.02 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?
C09.03
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?
C09.04 During the past 30
days, what is the largest number of drinks you had on any occasion?
Core 12: Arthritis
C12.01 Are you now limited
in any way in any of your usual activities because of arthritis or joint
symptoms?
C12.02 Do arthritis or
joint symptoms now affect whether you work, the type of work you do or the
amount of work you do?
C12.03 During the past 30
days, to what extent has your arthritis or joint symptoms interfered with your
normal social activities, such as going shopping, to the movies, or to
religious or social gatherings?
C12.04 During the past 30
days how bad was your joint pain on average?
Core 13: Seatbelt Use
C13.01 How often do you use seat belts when you drive or ride
in a car?
Core 14: Immunization
C14.01 During the past 12
months, have you had either a flu shot or a flu vaccine that was sprayed in
your nose?
C14.04 A pneumonia shot or
pneumococcal vaccine is usually given only once or twice in a person’s lifetime
and is different from the flu shot. Have you ever had a pneumonia shot?
Core 15: HIV
C15.01 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.
C15.03 Where did you have
your last HIV test - at a private doctor or HMO office, at a counseling and
testing site, in the emergency room, as an inpatient in a hospital, in a
clinic, in a jail or prison, at a drug treatment facility, at home, or
somewhere else?
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 who have
been told that they have high blood pressure by a doctor, nurse, or other
health professional
CLV05.01 Cholesterol
check within past 5 years
CLV05.02 Adults who have
had their cholesterol checked and have been told by a doctor, nurse or other
health professional that it was high
CLV06.01 Adults who have
ever been told they have asthma
CLV06.02 Adults who have
been told they currently have asthma
CLV06.03
Computed asthma status
CLV06.05 Respondents
that have had a doctor diagnose them as having some form of arthritis
CLV07.19 Four-level
categories of Body Mass Index (BMI)
CLV07.20 Adults who have
a body mass index greater than 25.00 (overweight or obese)
CLV08.01 Four-level
smoker status: every day smoker, someday smoker, former smoker, never smoked
CLV08.02 Adults who are
current smokers
CLV09.02 Adults who
reported having had at least one drink of alcohol in the past 30 days
CLV09.03 Binge drinkers
(males having five or more drinks on one occasion, females having four or more
drinks on one occasion)
CLV09.05 Heavy drinkers
(adult men having more than two drinks per day and adult women having more than
one drink per day)
CLV10.11 Total fruits
consumed per day
CLV10.12 Total vegetables
consumed per day
CLV10.19 Consume fruit
one or more times per day
CLV10.20 Consume
vegetables one or more times per day
CLV11.01
Adults who report doing physical activity or exercise during the past 30 days
other than their regular job
CLV11.23
Physical Activity Index
CLV11.24
Adults that participated in 150 minutes (or vigorous equivalent minutes) of
physical activity per week
CLV11.25
Adults that participated in 300 minutes (or vigorous equivalent minutes) of
physical activity per week
CLV11.27
Muscle strengthening recommendation
CLV11.28
Aerobic and Strengthening Recommendation
CLV13.01 Always or
nearly always wear seat belts
CLV13.02 Always wear
seat belts
CLV14.01 Adults aged 65+
years who have had a flu shot within the past year
CLV14.02 Adults aged 65+
years who have ever had a pneumonia vaccination
Module 02: Diabetes
M02.01 Are you
now taking insulin?
M02.02 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.
M02.03 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.
M02.04 About
how many times in the past 12 months have you seen a doctor, nurse, or other
health professional for your diabetes?
M02.05 About
how many times in the past 12 months has a health professional checked you for
'A one C'?
M02.06 About
how many times in the past 12 months has a health professional checked your
feet for any sores or irritations?
M02.07 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.
M02.08 Has a
doctor ever told you that diabetes has affected your eyes or that you had
retinopathy?
M02.09 Have
you ever taken a course or class in how to manage your diabetes yourself?
Module 04: Care Giver
M04.01 During the past 30
days, did you provide regular care or assistance to a friend or family member
who has a health problem or disability?
M04.02 What is his/her relationship
to you? For example is he/she your (mother/daughter or father/son)?
M04.03 For how long have
you provided care for that person?
M04.04 In an average week,
how many hours do you provide care or assistance?
M04.05 What is the main
health problem, long-term illness, or disability that the person you care for
has?
M04.06 In the past 30
days, did you provide care for this person by managing personal care such as
giving medications, feeding, dressing, or bathing?
M04.07 In the past 30
days, did you provide care for this person by managing household tasks such as
cleaning, managing money, or preparing meals?
M04.08 Of the following
services, which one do you most need that you are not currently getting?
M04.09 In the next two
years, do you expect to provide care or assistance to a friend or family member
who has a health problem or disability?
Module 21: Sexual Orientation and
Gender Identity
M21.01 Do you consider
yourself to be (sexual orientation)?
M21.02
Do you consider yourself to be transgender?
Module 23: Asthma
M23.01 Has a doctor, nurse
or other health professional ever said that the child has asthma?
M23.02 Does the child
still have asthma?
Appendices:
Appendix A - Healthy
People 2020 in Indiana
Appendix
B - 2015 Behavioral Risk Factor Surveillance
Survey Questionnaire
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