Behavioral Risk Factor Surveillance System

Indiana Statewide Survey Data, 2004

 

Table of Contents

 

Preface

 

Introduction:

 

 

Tables:

Section 1: Health Status

Q1. Would you say that, in general, your health is:

Section 2: Healthy Days - Health-Related Quality of Life

Q2. 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?
Q3. 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?
Q4. 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?

Section 3: Health Care Access

Q5. Do you have any kind of health care coverage, including health insurance, prepaid plans such as HMOs, or government plans such as Medicare?
Q6. Do you have one person you think of as your personal doctor or health care provider?
Q7. Was there a time in the past 12 months when you needed to see a doctor but could not because of the cost?

Section 4: Exercise

Q8. During the past month, other than your regular job, did you participate in any physical activities or exercise such as running, calisthenics, golf, gardening, or walking for exercise?

Section 5: Environmental Factors

Q9. In the past 12 months, have you had an illness or symptom that you think was caused by something in the air inside a home, office, or other building?
Q10. In the past 12 months, have you had an illness or symptom that you think was caused by pollution in the air outdoors?

Section 6: Excess Sun Exposure

Q11. Have you had a sunburn within the past 12 months?
 Q12. Including times when even a small part of your skin was red for more than 12 hours, how many sunburns have you had within the past 12 months?

Section 7: Tobacco Use

Q13. Have you smoked at least 100 cigarettes in your entire life?
Q14. Do you now smoke cigarettes every day, some days, or not at all?
 Q15. During the past 12 months, have you stopped smoking for one day or longer because you were trying to quit smoking?

Section 8: Alcohol Consumption

Q16. Considering all types of alcoholic beverages, how many times during the past 30 days did you have 5 or more drinks on an occasion?
Q17. During the past 30 days, how many times have you driven when you've had perhaps too much to drink?

Section 9: Asthma

Q18. Have you ever been told by a doctor, nurse, or other health professional that you had asthma?
Q19. Do you still have asthma?

Section 10: Diabetes

Q20. Have you ever been told by a doctor that you have diabetes?

Section 11: Oral Health

Q21. How long has it been since you last visited a dentist or dental clinic for any reason?
Q22. How many of your permanent teeth have been removed because of tooth decay or gum disease?  Do not include teeth lost for other reasons, such as injury or orthodontics.
Q23. How long has it been since you had your teeth cleaned by a dentist or dental hygienist?

Section 12: Immunization

Q24. During the past 12 months, have you had a flu shot?
Q25. During the past 12 months, have you had a flu vaccine that was sprayed in your nose?
Q26. Have you ever had a pneumonia shot? This shot is usually given only once or twice in a person's lifetime.

Section 13: Demographics

Q27. Number and percentage of respondents in each county.
Q28. To your knowledge, are you now pregnant?

Section 14: Veteran's Status

Q29. 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?
Q30. Which of the following best describes your service in the United States military?
Q31. In the last 12 months, have you received some or all of your health care from VA facilities?

Section 15: Women's Health

Q32. Have you ever had a mammogram?
Q33. How long has it been since you had your last mammogram?
Q34. 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?
Q35. How long has it been since your last breast exam?
Q36. A Pap test is a test for cancer of the cervix.  Have you ever had a Pap test?
Q37. How long has it been since you had your last Pap test?
Q38. Have you had a hysterectomy?

Section 16: Prostate Cancer Screening

Q39. A Prostate-Specific Antigen test, also called a PSA test, is a blood test used to check men for prostate cancer.  Have you ever had a PSA test?
Q40. How long has it been since you had your last PSA test?
Q41. Have you ever had a digital rectal exam?
Q42. How long has it been since your last digital rectal exam?
Q43. Have you ever been told by a doctor, nurse, or other health professional that you had prostate cancer?

Section 17: Colorectal Cancer Screening

Q44. Have you ever had a blood stool test using a home kit?
Q45. How long has it been since you had your last blood stool test using a home kit?
Q46. Have you ever had a sigmoidoscopy or colonoscopy?
Q47. How long has it been since you had your last sigmoidoscopy or colonoscopy?

Section 18: Family Planning

Q48. Are you or your spouse/partner doing anything now to keep from getting pregnant?
Q49. What method are you/your spouse using to keep from getting pregnant?
Q50. What is the main reason for not doing anything to keep from getting pregnant?
Q51. How do you feel about having a child sometime in the future?
Q52. How soon would you want to have a child?

Core 19: Disability

Q53. Are you limited in any way in any activities because of physical, mental, or emotional problems?
Q54. 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?

Section 20: AIDS

Q55. True or false: A pregnant woman with HIV can get treatment to help reduce the chances that she will pass the virus on to her baby.
Q56. True or false: There are medical treatments available that are intended to help a person who is infected with HIV to live longer.
Q57. Have you ever been tested for HIV?  Do not count tests you may have had as part of a blood donation.
Q58. In the past 12 months, how many times have you been tested for HIV, including times you did not get your results?
Q59. Not including blood donations, which of these would you say was the main reason for your last HIV test?
Q60. Where did you have your last HIV test?
Q61. What type of clinic did you go to for your last HIV test?
Q62. Was this test done by a nurse or other health worker, or with a home testing kit?
Q63. Please tell me if any of these situations apply to you.  You don't need to tell me which one.
Q64. In the past 12 months, has a doctor, nurse, or other health professional talked to you about preventing sexually transmitted diseases through condom use?

Section 21: Firearms

Q65. Are any firearms kept in or around your home?
Q66. Are any of these firearms now loaded?
Q67. Are any of these loaded firearms also unlocked? (You do not need a key or a combination to get the gun or to fire it.  Safety is not counted as a lock.)

Module 1: Diabetes

Q68. How old were you when you were told you have diabetes?
Q69. Are you now taking insulin?
Q70. Are you now taking diabetes pills?
Q71. 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.
Q72. 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.
Q73. Have you ever had any sores or irritations on your feet that took more than four weeks to heal?
Q74. About how many times in the past 12 months have you seen a doctor, nurse, or other health professional for your diabetes?
Q75. About how many times in the past 12 months has a doctor, nurse, or other health professional checked you for hemoglobin "A one C"?
Q76. About how many times in the past 12 months has a health professional checked your feet for any sores or irritations?
Q77. When was the last time you had an eye exam in which the pupils were dilated?
Q78. Has a doctor ever told you that diabetes has affected your eyes or that you had retinopathy?
Q79. Have you ever taken a course or class in how to manage your diabetes yourself?

Module 16: Secondhand Smoke Policy

Q80. Which statement best describes the rules about smoking inside your home?
Q81. While working at your job, are you indoors most of the time?
Q82. Which of the following best describes your place of work's official smoking policy for indoor public or common areas such as lobbies, rest rooms, and lunch rooms?
Q83. Which of the following best describes your place of work's official smoking policy for work areas?

Module 17: Arthritis Burden

Q84. During the past 30 days, have you had any symptoms of pain, aching, or stiffness in or around a joint? Please do not include the back or neck. 
Q85. Did your joint symptoms first begin more than 3 months ago?
Q86. Have you ever seen a doctor or other health professional for these joint symptoms?
Q87. 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?
Q88. Are you now limited in any way in any of your usual activities because of arthritis or joint symptoms?
Q89. We are referring to work for pay.  Do arthritis or joint symptoms now affect whether you work, the type of work you do, or the amount of work you do?

Module 18: Arthritis Management

Q90. Concerning your arthritis or joint symptoms, which of the following best describes you today?
Q91. Has a doctor or other health professional ever suggested losing weight to help your arthritis or joint symptoms?
Q92. Has a doctor or other health professional ever suggested physical activity or exercise to help your arthritis or joint symptoms?
Q93. Have you ever taken an educational course or class to teach you how to manage problems related to your arthritis or joint symptoms?

Calculated Variables and Risk Factors

Q94. Risk factor for fair and poor health.
Q95. Leisure time physical activity.
Q96. Four level smoker status.
Q97. At risk for smoking (all current smokers).
Q98. Drink any alcoholic beverages in past 30 days.
Q99. At risk for binge drinking (greater than or equal to five or more drinks on one or more occasion).
Q100. Number of drinks of alcoholic beverages per day.
Q101. At risk for heavy alcohol consumption (greater than two drinks per day for men and greater than one drink per day for women).
Q102. At risk for heavy alcohol consumption in men (greater than two drinks per day).
Q103. At risk for heavy alcohol consumption in women (greater than one drink per day).
Q104. Risk factor for lifetime asthma prevalence.
Q105. Risk factor for current asthma prevalence.
Q106. Computed asthma status.
Q107. Risk factor for having had permanent teeth extracted.
Q108. Risk factor for having had all permanent teeth extracted.
Q109. Risk factor for having visited a dentist, dental hygienist, or dental clinic within the past year.
Q110. Risk factor for respondents aged 65+ years who have had a flu shot in the past 12 months.
Q111. Risk factor for respondents aged 65+ who have ever had a pneumonia shot.
Q112. Three categories of Body Mass Index (BMI).
Q113. Risk factor for being overweight or obese.
Q114. Female respondents aged 40+ who have not had a mammogram in the past two years.
Q115. Female respondents aged 18+ who have not had a Pap test in the past three years.
Q116. Male respondents aged 40+ who have not had a PSA test in the past two years.
Q117. Respondents aged 50+ who have not had a blood stool test within the past two years.
Q118. Respondents aged 50+ who have never had a sigmoidoscopy or colonoscopy.
Q119. Ever been tested for HIV risk factor.
Q120. Ever participated in high-risk behavior risk factor.
Q121. Risk factor for having been counseled by a doctor, nurse, or other health professional on prevention of sexually transmitted diseases through condom use.
Q122. Risk factor for respondents living in a home with a loaded firearm.
Q123. Risk factor for respondents living in a home with a loaded and unlocked firearm.

 

Appendices:

 

Appendix A - Healthy People 2010 in Indiana

Background

Progress


            Appendix B - 2004 Behavioral Risk Factor Surveillance Survey Questionnaire