BEHAVIORAL
RISK FACTOR SURVEILLANCE SYSTEM
INDIANA
STATEWIDE SURVEY DATA, 2002
Table of Contents
Introduction:
Tables:
Section 1: Health Status
q1.1 How would you say your general health is?
q2.1 Do you have any kind of health care coverage?
q2.2 Do you have one person you think of as your personal doctor or health care provider?
q2.3 When you are sick or need advice about your health, to which one of the following places do you usually go?
q2.4 Was there a time in the past 12 months when you needed medical care, but could not get it?
q2.5 What is the main reason you did not get medical care?
q3.1 During the past month, other than your regular job, did you participate in any physical activity or exercise?
Section 4: Fruits and Vegetables
q4.1 How often do you drink fruit juices such as orange, grapefruit, or tomato?
q4.2 Not counting juice, how often do you eat fruit?
q4.3 How often do you eat green salad?
q4.4 How often do you eat potatoes not including french fries, fried potatoes or potato chips?
q4.5 How often do you eat carrots?
q4.6 Not counting carrots, potatoes, or salad, how many servings of vegetables do you usually eat?
q5.1 Have you ever been told by a doctor, nurse or other health professional that you had asthma?
q5.2 Do you still have asthma?
q6.1 Have you ever been told by a doctor that you have diabetes?
q7.1 How long has it been since you last visited a dentist or a dental clinic for any reason?
q7.2 How many of your permanent teeth have been removed because of tooth decay or gum disease?
q7.3 How long has it been since you had your teeth cleaned by a dentist or hygienist?
q8.1 During the past 12 months, have you had a flu shot?
q8.2 At what kind of place did you get your last flu shot?
q8.3 Have you ever had a pneumonia shot?
Section 9: Tobacco Use
q9.1 Have you smoked at least 100 cigarettes in your entire life?
q9.2 Do you now smoke cigarettes every day, some days, or not at all?
q9.3 During the past 12 months, have you stopped smoking for one day or longer because you were trying to quit smoking?
Section 10: Alcohol Consumption
q10.1 During the past 30 days, how many days per week or per month did you have at least one drink of any alcoholic beverage?
q10.2 On the days when you drank, about how many drinks did you drink on the average?
q10.3 How many times during the past 30 days did you have 5 or more drinks on an occasion?
q10.4 During the past 30 days, how many times have you driven when you have had perhaps too much to drink?
Section 11: Use of Seat Belts
q11.1 How often do you use seatbelts when you drive or ride in a car?
Section 12: Demographics
q12.12 What county do you live in?
q12.16 To your knowledge, are you now pregnant?
Section 13: Family Planning
q13.1 Are you or your spouse/partner doing anything now to keep from getting pregnant?
q13.2 What are you or your spouse/partner doing now to keep from getting pregnant?
q13.3 What other method are you also using to prevent pregnancy?
q13.4 What is the main reason you are not trying to prevent pregnancy?
Section 14: Women's Health
q14.1 Have you ever had a mammogram?
q14.2 How long has it been since you had your last mammogram?
q14.3 Have you ever had a clinical breast exam?
q14.4 How long has it been since your last breast exam?
q14.5 Have you ever had a pap smear?
q14.6 How long has it been since you had your last pap smear?
q14.7 Have you had a hysterectomy?
Section 15: Prostate Cancer Screening
q15.1 Have you ever had a PSA test?
q15.2 How long has it been since your last PSA test?
q15.3 Have you ever had a digital rectal exam?
q15.4 How long has it been since your last digital rectal exam?
q15.5 Have you ever been told by a doctor, nurse or other health professional that you had prostate cancer?
Section 16: Colorectal Cancer Screening
q16.1 Have you ever had a blood stool test using a home kit?
q16.2 How long has it been since you had your last blood stool test?
q16.3 Have you ever had a sigmoidoscopy or colonoscopy?
q16.4 How long has it been since you had your last sigmoidoscopy or colonoscopy?
Section 17: HIV/AIDS
q17.1 Can a pregnant woman with HIV get treatment to reduce the chances that she will pass the virus on to her baby?
q17.2 Are there medical treatments available that are intended to help a person who is infected with HIV to live longer?
q17.3 How important do you think it is for people to know their HIV status by getting tested?
q17.4 Have you ever been tested for HIV? Do not count tests you may have had as part of a blood donation.
q17.6 What was the main reason you had your last HIV test?
q17.7 Where did you have your last HIV test?
q17.8 Have you had any high risk situations that could give you HIV?
q17.9 In the past 12 months, has a doctor, nurse or other health professional talked to you about preventing STDs through condom use?
Section 18: Firearms
q18.1 Are any firearms kept in or around your home?
q18.2 Are any of these firearms now loaded?
q18.3 Are any of these loaded firearms also unlocked?
Module 1: Diabetes
m1.1 How old were you when you were told you have diabetes?
m1.2 Are you now taking insulin?
m1.3 Are you now taking diabetes pills?
m1.4 About how often do you check your blood for sugar or glucose?
m1.5 About how often do you check your feet for any sores or irritations?
m1.6 Have you ever had any sores or irritations on your feet that took more than four weeks to heal?
m1.7 About how many times in the past 12 months have you seen a doctor, nurse or other health professional for your diabetes?
m1.8 About how many times in the past 12 months has a doctor, nurse or other health professional checked you for hemoglobin 'A one C'?
m1.9 About how many times in the past 12 months has a health professional checked your feet for any sores or irritations?
m1.10 When was the list time you had an eye exam in which the pupils were dilated?
m1.11 Has a doctor ever told you that diabetes has affected your eyes or that you had retinopathy?
m1.12 Have you ever taken a course or class in how to manage your diabetes yourself?
Module 6: Quality of Life
m6.1 Are you limited in any way in any activities because of physical, mental or emotional problems?
m6.2 Do you now have any health problem that requires you to use special equipment?
m6.3 What is your major impairment or health problem?
m6.4 For how long have your activities been limited because of your major impairment or health problem?
m6.5 Because of any impairment or health problem, do you need the help of other persons with your personal care needs?
m6.6 Because of any impairment or health problem, do you need the help of other persons in handling your routine needs?
m6.7 During the past 30 days, for about how many days did pain make it hard for you to do your usual activities?
m6.8 During the past 30 days, for about how many days have you felt sad, blue or depressed?
m6.9 During the past 30 days, for about how many days have you felt worried, tense or anxious?
m6.10 During the past 30 days, for about how many days have you felt you did not get enough rest or sleep?
m6.11 During the past 30 days, for about how many days have you felt very healthy and full of energy?
Module 9: Childhood Asthma
m9.1 How many of the children in your household have ever been diagnosed with asthma?
m9.2 Number of children in household that still have asthma.
Module 11: Cardiovascular Disease
m11.1 To lower your risk of developing heart disease or stroke, are you eating fewer high fat or high cholesterol foods?
m11.2 To lower your risk of developing heart disease or stroke, are you eating more fruits and vegetables?
m11.3 To lower your risk of developing heart disease or stroke, are you more physically active?
m11.4 Within the past 12 months, has a doctor, nurse or other health professional told you to eat fewer high fat/cholesterol foods?
m11.5 Within the past 12 months, has a doctor, nurse or other health professional told you to eat more fruits and vegetables?
m11.6 Within the past 12 months, has a doctor, nurse or other health professional told you to be more physically active?
m11.7 Has a doctor, nurse or other health professional ever told you that you had a heart attack or myocardial infarction?
m11.8 Has a doctor, nurse or other health professional ever told you that you had angina or coronary heart disease?
m11.9 Has a doctor, nurse or other health professional ever told you that you had a stroke?
m11.10 At what age did you have your first heart attack?
m11.11 At what age did you have your first stroke?
m11.12 After you left the hospital after your heart attack/stroke, did you go to any kind of outpatient rehabilitation?
m11.13 Do you take aspirin daily or every other day?
m11.14 Do you have a health problem that makes taking aspirin unsafe for you?
m11.15 Do you take aspirin to relieve pain?
m11.16 Do you take aspirin to reduce the chance of a heart attack?
m11.17 Do you take aspirin to reduce the chance of a stroke?
Module 13: Folic Acid
m13.1 Do you currently take any vitamin pills or supplements?
m13.2 Are any of these a multivitamin?
m13.3 Do any of the vitamin pills or supplements contain folic acid?
m13.4 How often do you take this vitamin pill or supplement?
m13.5 Some health experts recommend that women take 400 micrograms of the B vitamin folic acid, for which one of the following reasons?
Module 14: Tobacco Indicators
m14.1 How old were you the first time you smoked a cigarette, even one or two puffs?
m14.2 How old were you when you first started smoking cigarettes regularly?
m14.3 About how long has it been since you last smoked cigarettes regularly?
m14.4 In the past 12 months, have you seen a doctor, nurse, or other health professional to get any kind of care for yourself?
m14.5 In the past 12 months, has a doctor, nurse or other health professional advised you to quit smoking?
m14.6 Which statement best describes the rules about smoking inside your home?
m14.7 While working at your job, are you indoors most of the time?
m14.8 Which of the following best describes your place of work's official smoking policy for indoor public or common areas?
m14.9 Which of the following best describes your place of work's official smoking policy for work areas?
Module 16: Arthritis
m16.1 During the past 30 days, have you had any symptoms of pain, aching, or stiffness in or around a joint?
m16.2 Did your joint symptoms first begin more than 3 months ago?
m16.3 Have you ever seen a doctor or other health professional for these joint symptoms?
m16.4 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?
m16.5 Are you now limited in any way of your usual activities because of arthritis or joint symptoms?
m16.6 Do arthritis or joint symptoms now affect whether you work for pay, the type of work you do or the amount of work you do?
Calculated Risk Factors:
rf3.1 No leisure time physical activity or exercise during past 30 days other than regular job.
rf4.8 Fruit and vegetable servings index.
rf5.1 Lifetime asthma prevalence.
rf5.2 Current asthma prevalence.
rf5.3 Computed asthma status.
rf7.1 Risk factor for having had permanent teeth extracted.
rf7.2 Risk factor for having had all permanent teeth extracted - respondents aged 65+.
rf7.3 Risk factor for having visited a dentist, dental hygienist or dental clinic within past year.
rf8.1 Respondents age 65 years and older having had a flu shot in past 12 months.
rf8.2 Respondents age 65 years and older ever having a pneumonia shot.
rf9.1 Computed smoking status.
rf9.2 At risk for smoking (current smokers).
rf10.2 Drink any alcoholic beverages in past 30 days.
rf10.3 At risk for binge drinking.
rf10.6 At risk for heavy alcohol consumption.
rf10.7 At risk for heavy alcohol consumption - males.
rf10.8 At risk for heavy alcohol consumption - females.
rf10.9 At risk for drinking and driving.
rf11.1 Risk factor for ‘always’ or ‘nearly always’ seatbelt use.
rf11.2 Risk factor for ‘always’ seatbelt use.
rf12.16 Body mass index - three categories.
rf12.17 Risk factor for being overweight or obese.
rf14.1 Women aged 40 and older that have not had a mammogram within past two years.
rf14.2 Women aged 18 years and older that have not had a pap smear within past three years.
rf15.1 Men aged 40 and older that have not had a PSA test within past two years.
rf16.1 Respondents age 50 and older that have not had a blood stool test within past two years.
rf16.2 Respondents age 50 and older that have never had a sigmoidoscopy or colonoscopy.
rf17.1 Ever been tested for HIV?
rf17.2 Ever participated in HIV high-risk behavior?
rf18.1 Risk factor for living in home with loaded firearm.
rf18.2 Risk factor for living in home with loaded and unlocked firearm.
Appendices:
Appendix A - Healthy People 2010 in Indiana
Appendix B - Definitions of BRFSS Risk Factors
Appendix C - 2002
Behavioral Risk Factor Surveillance Survey Questionnaire