Behavioral Risk Factor
Surveillance System
Indiana Statewide
Survey Data, 2017
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: Cholesterol Awareness
C05.01 About how long has it been since you last had your
blood cholesterol checked?
C05.02 Have you ever been told by a doctor, nurse
or other health professional that your blood cholesterol is high?
C05.03 Are you currently taking medicine prescribed by
a doctor or other health professional for your blood cholesterol?
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: Arthritis Burden
C07.01 Are you now limited in any way in any of your usual activities
because of arthritis or joint symptoms?
C07.02 Do
arthritis or joint symptoms now affect whether you work, the type of work you do or the amount
of work you do?
C07.03 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?
C07.04 During
the past 30 days, how bad was your joint pain on average? Please answer on a scale of 0 to 10 where 0
is no pain and 10 is pain or aching as bad as it can be.
Core 08: Demographics
C08.08 Do you own or rent
your home?
C08.09 What
county do you live in?
C08.14 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?
C08.22 Are you
deaf or have serious difficulty hearing?
C08.23 Are you
blind or do you have serious difficulty seeing, even when wearing glasses?
C08.24 Because
of a physical, mental, or emotional condition, do you have serious difficulty
concentrating, remembering or making decisions?
C08.25 Do you
have serious difficulty walking or climbing stairs?
C08.26 Do you
have difficulty dressing or bathing?
C08.27 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 09: 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: E-Cigarettes
C10.01 Have
you ever used an e-cigarette or other electronic vaping product, even just one
time, in your entire life?
C10.02 Do you
now use e-cigarettes or other electronic vaping products every day, some days,
or not at all?
Core 11: Alcohol Consumption
C011.01 During
the past 30 days, how many days did you have at least one drink of any
alcoholic beverage?
C11.02 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?
C11.03
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?
C11.04 During the past 30
days, what is the largest number of drinks you had on any occasion?
Core 13: Exercise
C13.01 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?
C13.02 What type of physical
activity or exercise did you spend the most time doing during the past month?
C13.03 How many times per week or per month did
you take part in this activity during the month?
C13.04 And when you took part in this activity,
for how many minutes or hours did you usually keep at it?
C13.05 What other type of physical activity gave
you the next most exercise during the past month?
C13.06 How many times per week or per month did you
take part in this activity during the month?
C13.07 And when you took part in this activity, for
how many minutes or hours did you usually keep at it?
C13.08 During the past month, how many times per week
or per month did you do physical activities or exercises to strengthen your muscles?
Core 14: Seat Belts
C14.01 How often do you use seat
belts when you drive or ride in a car?
Core 15: Immunization
C15.01 During the past 12
months, have you had either a flu shot or a flu vaccine that was sprayed in
your nose?
C15.02 A pneumonia shot or
pneumococcal vaccine is usually given only once or twice in a person´s lifetime
nd is different from the flu shot. Have you ever had a pneumonia shot?
C15.03 Have you ever had the shingles
or zoster vaccine?
Core 16: HIV
C16.01 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.
C16.02 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.
Calculated Variables and Risk
Factors:
CLV01.01
Adults with good or better health
CLV02.01
Three-level not good physical health status: 0 days, 1-13 days, 14-30 days
CLV02.02
Three-level not good mental health status: 0 days, 1-13 days, 14-30 days
CLV03.01
Respondents aged 18-64 that have any form of health care coverage
CLV04.01 Adults who have been told
they have high blood pressure by a doctor, nurse, or other health professional
CLV05.01 Cholesterol check within past five 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 Respondents who
have ever reported having coronary heart disease or myocardial infarction
CLV06.02 Adults who have
ever been told they have asthma
CLV06.03 Adults who have
been told they currently have asthma
CLV06.04
Computed asthma status
CLV06.05 Respondents
that have had a doctor diagnose them as having some form of arthritis
CLV08.12 Four-level
categories of Body Mass Index (BMI)
CLV08.14 Adults who are overweight or obese
CLV09.01 Four-level
smoker status: every day smoker, someday smoker, former smoker, never smoked
CLV09.02 Adults who are
current smokers
CLV10.01 Four-level
e-cigarette smoker status
CLV10.02 Adults who
are current e-cigarette users
CLV11.01 Adults who
reported having had at least one drink of alcohol in the past 30 days
CLV11.03 Binge drinkers
(males having five or more drinks on one occasion, females having four or more
drinks on one occasion)
CLV11.05 Heavy drinkers
(adult men having more than two drinks per day and adult women having more than
one drink per day)
CLV13.01 Adults who report
doing physical activity or exercise during the past 30 days other than their regular job
CLV14.01 Always or nearly always wear seat belts
CLV14.02 Always wear seat belts
CLV15.01 Adults aged 65+
years who have had a flu shot within the past year
CLV15.02 Adults aged 65+
years who have ever had a pneumonia vaccination
CLV16.01 Adults who have
ever been tested for HIV
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 Are you now taking insulin?
M02.02 About how often do you check your blood sugar?
M02.03 About how often do you check your feet for any sores or irritations?
Include times checked by a family member or friend.
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 have you seen a doctor,
nurse, or other health professional checked you for A1C?
M02.06 About how many times in the past 12 months have you seen a doctor,
nurse, or other 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?
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
diabetes yourself?
Module 13: Cancer
M13.01 How many different types of cancer have you had?
M13.02 At what age were you told that you had cancer?
M13.03 What type of cancer was it?
M13.04 Are you currently receiving treatment for cancer? By
treatment we mean surgery, radiation therapy, chemotherapy, or chemotherapy
pills.
M13.05 What type of doctor provides
the majority of your health care?
M13.06 Did any doctor, nurse, or
other health professional ever give you a written summary of all the cancer
treatments you received?
M13.07 Have you ever received instruction form a doctor,
nurse, or other health professional about where you should return or who you
should see for routine cancer check-ups after completing treatment for cancer?
M13.08 Were these instructions written down or printed on
paper for you?
M13.09 With your most recent diagnosis of cancer, did you
have health insurance that paid for all or part of your cancer treatment?
M13.10 Were you ever denied health insurance or life
insurance coverage because of your cancer?
M13.11 Did you participate in a
clinical trial as part of your cancer treatment?
M13.12 Do you currently have physical pain caused by your
cancer or cancer treatment?
M13.13 Is your pain currently under
control?
Module 17: Pre-Conception
M17.01 Did you or your husband/partner
do anything the last time you had sex to keep you from getting pregnant?
M17.02
What did you or your husband/partner do the last time you had sex to keep you from
getting pregnant?
M17.03
What was your main reason for not doing anything the last time you had sex to keep you
from getting pregnant?
Module 27: Sexual Orientation and
Gender Identity
M27.01 Do you consider
yourself to be (sexual orientation)?
M27.02
Do you consider yourself to be transgender?
Module 30: Asthma
M30.01 Has
a doctor, nurse or other health professional ever said that the child has
asthma?
M30.02 Does the child
still have asthma?
Appendices:
Appendix A - Healthy
People 2020 in Indiana
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