2003-2004 Kansas Women's Health Survey

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KANSAS
WOMEN'S HEALTH SURVEY
2003-2004

Section 1: Health Status
1.1 Data Results 1.1	Would you say that in general your health is: Excellent Very good Good Fair Poor 7. Don't know/Not sure 9. Refused
Crosstabulation Table:		Percentage of Females with Fair or Poor Self-Perceived Health Status
1.2 Data Results 1.2	Now thinking about your physical health, which includes physical illness and injury, for how may days during the past 30 days was your physical health not good?
1.3 Data Results 1.3	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?
Crosstabulation Table:		Percentage of Females Who Reported Their Mental Health Was Not Good on 14 or More Days in the Past 30 Days
1.4 Data Results 1.4	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 a self care, work, or recreation?

Section 2: Health Care Access
2.1 Data Results 2.1	Do you have any kind of health care coverage, including health insurance, prepaid plans such as HMOs, or government plans such as Medicare?
Crosstabulation Table:		Percentage of Females Who Lack Health Care Coverage
2.2 Data Results 2.2	What type of health care coverage do you use to pay for most of your medical care?
2.3 Data Results 2.3	Is there a book, a certain number you are supposed to call, or a website you are supposed to access with a list of doctors associated with your [fill in type (Medicare/Medicaid/health coverage) from Q2.2] plan?
2.4 Data Results 2.4	Does your [fill in type (Medicare/Medicaid/health coverage) from Q2.2] plan require you to select a certain doctor or clinic for all your routine care?
2.5 Data Results 2.5	Do you have one person you think of as your personal doctor or health care provider? [If "No", ask: "Is there more than one or is there no person who you think of?"]
Crosstabulation Table:		Percentage of Females with No Personal Doctor or Health Care Provider
2.6 Data Results 2.6	Was there a time during the past 12 months when you needed to see a doctor but could not because of the cost?
2.7 Data Results 2.7	About how long has it been since you last visited a doctor for a routine checkup? (Interviewer: A routine checkup is a general physical exam, not an exam for a specific injury, illness, or condition.)

Section 3: Cardiovascular Disease Awareness
3.1 Data Results 3.1	What do you think is the one greatest health problem facing women today?
3.2 Data Results 3.2	As far as you know, what is the leading cause of death for all women?
3.3 Data Results 3.3	Based on what you know, what are the major causes of heart disease? [MARK ALL THAT APPLY]
3.4	Now I would like to discuss ways to prevent heart disease. Which of the following activities do you believe can prevent or reduce the risk of getting heart disease?
a. Data Results 3.4a	...Quitting smoking?
b. Data Results 3.4b	...Getting physical exercise?
c. Data Results 3.4c	...Taking special vitamins like E, C or A?
d. Data Results 3.4d	...Losing weight?
e. Data Results 3.4e	...Reducing dietary cholesterol intake?
f. Data Results 3.4f	...Reducing stress?
g. Data Results 3.4g	...Taking multivitamins with folic acid?
h. Data Results 3.4h	...Taking pills containing estrogen only or estrogen plus progestin, also known as hormone replacement therapy?
i. Data Results 3.4i	...Reducing sodium or salt in the diet?
j. Data Results 3.4j	...Reducing animal products in your diet (such as meat, whole milk, butter and cream)?
k. Data Results 3.4k	...Aroma therapy?
3.5 Data Results 3.5	What is your primary source for health related information?

Section 4: Exercise
4.1 Data Results 4.1	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?
Crosstabulation Table:		Percentage of Females Not Participating in Any Physical Activity

Section 5: Diabetes
5.1 Data Results 5.1	Have you ever been told by a doctor that you have diabetes? [If "Yes" and respondent is female, ask: "Was this only when you were pregnant?"]
Crosstabulation Table:		Percentage of Females with Diagnosed Diabetes

Section 6: History of Cancer/Family History of Cancer
6.1 Data Results 6.1	Have you ever been told by a doctor that you had cancer?
6.2 Data Results 6.2	What type of cancer was it? (Mark all that apply) [Interviewer: If respondent indicates cancer type is Lymphoma be sure to clarify between Non-Hodgkin's and Hodgkin's. Code Hodgkin's. as "Other" and specify.]
6.3 Data Results 6.3	Considering the most recent cancer, what type was it? [Interviewer: If respondent indicates cancer type is Lymphoma be sure to clarify between Non-Hodgkin's and Hodgkin's. Code Hodgkin's. as "Other" and specify.]
6.4 Data Results 6.4	How long ago were you diagnosed with [if 6.2 > 1 then insert "the most recent cancer", else insert "cancer"]?
6.5 Data Results 6.5	These next questions are about family history of cancer. We are specifically interested in the cancer history of your first degree biological relatives, which includes only your mother, father, sister or half-sister, brother or half-brother, son, or daughter. Has anyone in your first-degree family ever been diagnosed with cancer? [Interviewer: Include half-siblings]
6.6 Data Results 6.6	How is this person, or these people, related to you? (Mark all that apply)
6.7a Data Results 6.7a	What type of cancer did or does your biological mother have? (Mark all that apply) [Interviewer: If respondent indicates cancer type is Lymphoma be sure to clarify between Non-Hodgkin's and Hodgkin's. Code Hodgkin's. as "Other" and specify.]
6.7b Data Results 6.7b	What type of cancer did or does your biological sister or half-sister have? (Mark all that apply) [Interviewer: If respondent indicates cancer type is Lymphoma be sure to clarify between Non-Hodgkin's and Hodgkin's. Code Hodgkin's. as "Other" and specify.] IF RESPONSE INCLUDES MORE THAN ONE SISTER, INCLUDE CODE 10.
6.7c Data Results 6.7c	What type of cancer did or does your biological daughter have? (Mark all that apply) [Interviewer: If respondent indicates cancer type is Lymphoma be sure to clarify between Non-Hodgkin's and Hodgkin's. Code Hodgkin's. as "Other" and specify.] IF RESPONSE INCLUDES MORE THAN ONE DAUGHTER, INCLUDE CODE 10.
6.7d Data Results 6.7d	What type of cancer did or does your biological father have? (Mark all that apply) [Interviewer: If respondent indicates cancer type is Lymphoma be sure to clarify between Non-Hodgkin's and Hodgkin's. Code Hodgkin's. as "Other" and specify.]
6.7e Data Results 6.7e	What type of cancer did or does your biological brother or half-brother have? (Mark all that apply) [Interviewer: If respondent indicates cancer type is Lymphoma be sure to clarify between Non-Hodgkin's and Hodgkin's. Code Hodgkin's. as "Other" and specify.] IF RESPONSE INCLUDES MORE THAN ONE BROTHER, INCLUDE CODE 10.
6.7f Data Results 6.7f	What type of cancer did or does your biological son have? (Mark all that apply) [Interviewer: If respondent indicates cancer type is Lymphoma be sure to clarify between Non-Hodgkin's and Hodgkin's. Code Hodgkin's. as "Other" and specify.] IF RESPONSE INCLUDES MORE THAN ONE SON, INCLUDE CODE 10.

Section 7: Services to Uninsured Women
7.1 Data Results 7.1	To your knowledge, are there programs in your community that provide breast and cervical cancer screening services to women who do not have insurance?

Section 8: Osteoporosis
8.1 Data Results 8.1	Osteoporosis, sometimes called thin or brittle bones, is a disease in which bones become fragile and more likely to break. Has a doctor, nurse, or other health professional discussed your personal risk of osteoporosis with you?
8.2 Data Results 8.2	A bone density test measures how much bone density you have in your hip, spine, arm, wrist, or heel. Have you ever had a bone density test? [IF NEEDED: A ROUTINE X-RAY DOES NOT MEASURE BONE DENSITY. INCLUDE TESTS (HEEL) THAT MAY ONLY TAKE A SHORT TIME.]
8.3 Data Results 8.3	Have you ever been told by a doctor that you have osteoporosis?
8.4 Data Results 8.4	Are you currently taking any medications prescribed by your doctor for treatment of your osteoporosis?
8.5 Data Results 8.5	During the past month, did you take any products to supplement your calcium intake, such as Tums, Oscal, calcium fortified orange juice, or some other calcium supplement?

Section 9: Hormone Replacement Therapy
9.1 Data Results 9.1	Estrogens such as Pre marin and progestins such as Pro vera are female hormones that may be prescribed around the time of menopause, after menopause, or after a hysterectomy. These hormones are sometimes referred to as hormone replacement therapy. Has your doctor discussed the benefits and risks of hormone replacement therapy with you?
9.2 Data Results 9.2	Other than birth control pills, has your doctor ever prescribed hormone replacement therapy for you?
9.3 Data Results 9.3	Are you currently on hormone replacement therapy?
9.4 Data Results 9.4	How long were you or have you been on hormone replacement therapy?
9.5 Data Results 9.5	What type of hormone replacement therapy[if 9.3 = 2 insert "were you on", else insert "are you on"]? Was it or is it estrogen only or a combination of estrogen and progestin? [Interviewer: IF respondent says they don't know what type probe for brand name and specify the brand name in 'other'.]
9.6 Data Results 9.6	For what reasons [if 9.3 = 2 insert "were you on", else insert "are you on"] hormone replacement therapy? [MARK ALL THAT APPLY]
9.7 Data Results 9.7	What was the main reason why you quit taking hormone replacement therapy? [Interviewer: If respondent answers "news reports" or "media", please probe to see what was the topic that was being reported.]

Section 10: Tobacco Use
10.1 Data Results 10.1	Have you smoked at least 100 cigarettes in your entire life? [Note: 5 packs = 100 cigarettes.]
10.2 Data Results 10.2	Do you now smoke cigarettes every day, some days, or not at all?
Crosstabulation Table:		Percentage of Females Who Currently Smoke Cigarettes

Section 11: Tobacco Smoke Exposure
11.1 Data Results 11.1	Not including yourself, how many of the adults who live in your household smoke cigarettes, cigars or pipes?
11.2 Data Results 11.2	During the past 7 days, that is since [DATEFILL], how many days did anyone smoke cigarettes, cigars, or pipes anywhere inside your home?
11.3 Data Results 11.3	Which statement best describes the rules about smoking inside you home? Do not include decks, garages, or porches?

Section 12: Alcohol Consumption
12.1 Data Results 12.1	A drink of alcohol is 1 can or bottle of beer, 1 glass of wine, 1 can or bottle of wine cooler, 1 cocktail, or 1 shot of liquor. During the past 30 days, how many days per week or per month did you have at least one drink of any alcoholic beverage?
12.2 Data Results 12.2	On the days when you drank, about how many drinks did you drink on the average?
Crosstabulation Table:		Percentage of Females Who Reported Heavy Alcohol Consumption in the Past 30 Days
12.3 Data Results 12.3	Considering all types of alcoholic beverages, how many times during the past 30 days did you have 5 or more drinks on an occasion?
Crosstabulation Table:		Percentage of Females Who Reported Consuming Five or More Alcohol Drinks on an Occasion in the Past 30 Days
		Percentage of Females Ages 18 to 44 Who Reported Consuming Five or More Alcoholic Drinks on an Occasion in the Past 30 Days

Section 13: Excess Sun Exposure
13.1 Data Results 13.1	The next two questions are about intentional sun exposure or the use of tanning services at a salon for the purpose of obtaining a tan. During the past 12 months, how many times did you visit a tanning salon?
13.2 Data Results 13.2	During the past 12 months, how many times did you lay out in the sun or engage in other outdoor activities with the intent of obtaining a tan?
13.3 Data Results 13.3	The next questions are about what you do to protect your skin when you go outside. When you go outside on a sunny summer day for more than on hour, how often do you use sunscreen or sun block? [Interviewer: Summer means June, July, and August. Sunny is what the respondent considers sunny.]
13.4 Data Results 13.4	What is the Sun Protection Factor or SPF of the sunscreen you use most often?
13.5 Data Results 13.5	The next question is about sunburns including anytime that even a small part of your skin was red for more than 12 hours. Have you had a sunburn within the past 12 months?
Crosstabulation Table:		Percentage of Females Who Had a Sunburn Within the Past 12 Months
13.6 Data Results 13.6	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 14: Demographics
14.1 Data Results 14.1	What is your age?
14.2 Data Results 14.2	Are you of Hispanic or Latino?
14.3 Data Results 14.3	Which one or more of the following would you say is your race?
14.4 Data Results 14.4	Which one of these groups would you say best represents your race?
14.5 Data Results 14.5	Are you: Married Divorced Widowed Separated Never been married A member of an unmarried couple
14.6 Data Results 14.6	How many children less than 18 years of age live in your household ?
14.7 Data Results 14.7	What is the highest grade or year of school you completed?
14.8 Data Results 14.8	Are you currently: Employed for wages Self-employed Out of work for more than 1 year Out of work for less than 1 year Homemaker Student Retired Unable to work
14.9 Data Results 14.9	You indicated you were (a) [insert response from core, Q14.8]. On the average, how many hours per week, if any, do you work at a job or business?
14.10 Data Results 14.10	Is your annual household income from all sources: Less than $25,000 ($20,000 to less than $25,000) Less than $20,000 ($15,000 to less than $20,000) Less than $15,000 ($10,000 to less than $15,000) Less than $10,000 or Less than $35,000 ($25,000 to less than $35,000) Less than $50,000 ($35,000 to less than $50,000) Less than $75,000 ($50,000 to less than $75,000) $75,000 or more
14.11	About how much do you weigh without shoes?
14.12	How much would you like to weigh?
14.13	About how tall are you without shoes?
Crosstabulation Table:		Percentage of Females who are Overweight or Obese (BMI >= 25)
		Percentage of Females who are Obese (BMI >= 30)
14.14	What county do you live in?
14.15 Data Results 14.15	Do you have more than one telephone number in your household? Do not include cell phones or numbers that are only used by a computer or fax machine.
14.16 Data Results 14.16	How many of these phone numbers are residential numbers?
14.17 Data Results 14.17	During the past 12 months, has your household been without telephone service for 1 week or more? Do not include when service is interrupted by weather or natural disasters.
14.18 Data Results 14.18	To your knowledge, are you now pregnant?

Section 15: Breast and Cervical Cancer Screening
15.1 Data Results 15.1	A mammogram is an x-ray of each breast to look for breast cancer. Have you ever had a mammogram?
15.2 Data Results 15.2	At what age did you have your first mammogram?
15.3 Data Results 15.3	How long has it been since you had your last mammogram?
Crosstabulation Table:		Percentage of Females Ages 40 Years and Older Who Reported They Had Not Had a Mammogram within the Preceding Two Years
		Percentage of Females Ages 50 Years and Older Who Reported They Had Not Had a Mammogram within the Preceding Two Years
15.4 Data Results 15.4	What is the main reason why you have never had a mammogram?
15.5 Data Results 15.5	What is the main reason why you did not have a mammogram during the past two years?
15.6 Data Results 15.6	Was you last mammogram done as part of a routine checkup, because of a breast problem other than cancer, or because you've already had breast cancer?
15.7 Data Results 15.7	How were the results of your last mammogram communicated to you?
15.8 Data Results 15.8	A clinical breast exam is when a doctor, nurse or other health professional feels the breast for lumps. Have you ever had a clinical breast exam?
15.9 Data Results 15.9	How long has it been since your last breast exam?
15.10 Data Results 15.10	Was your last breast exam done as part of a routine checkup, because of a breast problem other than cancer, or because you've already had breast cancer?
15.11 Data Results 15.11	Have you ever done a breast self exam?
15.12 Data Results 15.12	How long has it been since you last did a breast self examination?
15.13 Data Results 15.13	How did you learn to do a breast self examination?
15.14 Data Results 15.14	What is the main reason why you have never done a breast self examination?
15.15 Data Results 15.15	A Pap smear is a test for cancer of the cervix. Have you ever had a Pap smear?
15.16 Data Results 15.16	At what age did you have your first Pap smear?
15.17 Data Results 15.17	How long has it been since you had your last Pap smear?
Crosstabulation Table:		Percentage of Females Who Reported They Had Not Had a Pap Smear within the Preceding Three Years
15.18 Data Results 15.18	Was your last Pap smear done as part of a routine exam, or to check a current or previous problem?
15.19 Data Results 15.19	What is the main reason why you have never had a Pap smear test?
15.20 Data Results 15.20	What is the main reason why you did not have a Pap smear test during the past three years?
15.21 Data Results 15.21	How were the results of your last Pap smear test communicated to you?
15.22 Data Results 15.22	Have you had a hysterectomy?

Section 16: Pregnancy
16.1 Data Results 16.1	Have you been pregnant in the last 5 years?
16.2 Data Results 16.2	Thinking back to your last pregnancy, just before you got pregnant, how did you feel about becoming pregnant?
16.3 Data Results 16.3	Thinking back to just before you got pregnant with your current pregnancy, how did you feel about becoming pregnant?

Section 17: Breastfeeding
17.1 Data Results 17.1	Have you given birth to a child in the past 5 years?
17.2 Data Results 17.2	What is the age of your youngest child? (or children if multiple births)
17.3 Data Results 17.3	Did you breast feed your youngest child? (or children if multiple births)
17.4 Data Results 17.4	[Among women who did not breast feed youngest child(ren)] What factors led to your decision to not breast feed your youngest child(ren)? (Mark all that apply)
17.5 Data Results 17.5	Are you currently breastfeeding your youngest child? (or children if multiple births)
17.6 Data Results 17.6	How old was your youngest child when you stopped breastfeeding him or her? (or children if multiple births)
17.7 Data Results 17.7	[Among women who breast fed youngest child(ren)] What factors motivated you to breast feed your youngest child(ren)? (Mark all that apply)
17.8 Data Results 17.8	[Among current breast feeders] Do you currently work outside the home?
17.9 Data Results 17.9	Do you have a place at your work site where you can breast pump?
17.10 Data Results 17.10	What kind of place is it?
17.11 Data Results 17.11	[Among women who breast fed their youngest child(ren) and are not currently breastfeeding] Did you breast feed your youngest child(ren) as long as you wanted to?
17.12 Data Results 17.12	What was the main reason you stopped breastfeeding your youngest child(ren) before you wanted to?
17.13 Data Results 17.13	[If pregnant] Previously you indicated that you are pregnant. Do you plan to breast feed the child you are currently carrying?
17.14 Data Results 17.14	[Among all women ages 18-44 who have been pregnant in the past 5 years.] Has your doctor discussed the benefits of breastfeeding with you?

Section 18: Physical Activity
18.1 Data Results 18.1	When you are at work, which of the following best describes what you do? [NOTE: If respondent has multiple jobs, include all jobs.] Would you say: Mostly sitting or standing Mostly walking Mostly heavy labor or physically demanding work
We are interested in two types of physical activity - vigorous and moderate. Vigorous activities cause large increases in breathing or heart rate while moderate activities cause small increases in breathing or heart rate.
18.2 Data Results 18.2	Now, thinking about the moderate physical activities you do [fill in (when you are not working,) if "employed" or "self-employed", or "student" or "retired" with hours worked reported] in a usual week, do you do moderate activities for at least 10 minutes at a time, such as brisk walking, bicycling, vacuuming, gardening, or anything else that causes small increases in breathing or heart rate?
18.3 Data Results 18.3	How many days per week do you do these moderate activities for at least 10 minutes at a time?
18.4 Data Results 18.4	On days when you do moderate activities for at least 10 minutes at a time, how much total time per day do you spend doing these activities?
18.5 Data Results 18.5	Now thinking about the vigorous physical activities you do [fill in (when you are not working,) if "employed" or "self-employed", or "student" or "retired" with hours worked reported] in a usual week, do you do vigorous activities for at least 10 minutes at a time, such as running, aerobics, heavy yard work, or anything else that causes large increases in breathing or heart rate?
18.6 Data Results 18.6	How many days per week do you do these vigorous activities for at least 10 minutes at a time?
18.7 Data Results 18.7	On days when you do vigorous activities for at least 10 minutes at a time, how much total time per day do you spend doing these activities?
Crosstabulation Table:		Percentage of Females Not Participating in Recommended Level of Vigorous Physical Activity

Section 19: Disability
The following question is about health problems or impairments you may have.
19.1 Data Results 19.1	Are you limited in any way in any activities because of physical, mental, or emotional problems?
Crosstabulation Table:		Percentage of Females Who Reported Activity Limitations Due to Physical, Mental, or Emotional Problems

Section 20: Colorectal Cancer Screening
20.1 Data Results 20.1	Has a doctor or nurse ever talked to you about being tested for colorectal cancer?
20.2 Data Results 20.2	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?
20.3 Data Results 20.3	What is the main reason that you have not had a blood stool test?
20.4 Data Results 20.4	How long has it been since you had your last blood stool test using a home kit?
Crosstabulation Table:		Percentage of Females Ages 50 Years and Older Who Reported They Had Not Received a Fecal Occult Blood Test for Colorectal Cancer within the Preceding Two Years
20.5 Data Results 20.5	What was the main reason you had your last blood stool test?
20.6 Data Results 20.6	Sigmoidoscopy and colonoscopy are exams in which a tube is inserted in the rectum to view the bowel for signs of cancer or other health problems. Have you ever had either of these exams?
Crosstabulation Table:		Percentage of Females Ages 50 Years and Older Who Reported They Had Never Had A Sigmoidoscopy Or A Colonoscopy Exam
20.7 Data Results 20.7	What is the main reason that you have not had a sigmoidoscopy or colonoscopy?
20.8 Data Results 20.8	How long has it been since you had your last sigmoidoscopy or colonoscopy?
20.9 Data Results 20.9	What was the main reason you had your last sigmoidoscopy or colonoscopy?

Section 21: Folic Acid
21.1 Data Results 21.1	Some health experts recommend that women take 400 micrograms of the B vitamin folic acid, for which of the following reasons.. To make strong bones To prevent birth defects To prevent high blood pressure Some other reason
21.2 Data Results 21.2	When is it most important that a women take the vitamin folic acid? Would you say: Before pregnancy During pregnancy After pregnancy
21.3 Data Results 21.3	Are you currently taking 400 micrograms of the vitamin folic acid each day?
21.4 Data Results 21.4	Has a doctor ever talked with you about taking the vitamin folic acid?