CDC Core
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
Crosstabulation Table:
1.2
Data Results 1.2
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?
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?
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 self-care, work, or recreation?
 
CDC Core
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:
2.2
Data Results 2.2
Medicare is a coverage plan for people 65 or over and for certain disabled people. Do you have Medicare?
2.3
Data Results 2.3
What type of health care coverage do you use to pay for most of your medical care?
2.3a
Data Results 2.3a
There are some types of coverage you may not have considered. Please tell me if you have any of the following:
2.4
Data Results 2.4
During the past 12 months, was there any time that you did not have any health insurance or coverage?
2.5
Data Results 2.5
About how long has it been since you had health care coverage?
2.6
Data Results 2.6
Was there a time during the last 12 months when you needed to see a doctor, but could not because of the cost?
Crosstabulation Table:
2.7
Data Results 2.7
About how long has it been since you last visited a doctor for a routine checkup?
 
CDC Core
Section 3: Hypertension Awareness
3.1
Data Results 3.1
About how long has it been since you last had your blood pressure taken by a doctor, nurse, or other health professional?
3.2
Data Results 3.2
Have you ever been told by a doctor, nurse, or other health professional that you have high blood pressure?
Crosstabulation Table:
3.3
Data Results 3.3
Have you been told on more than one occasion that your blood pressure was high, or have you been told this only once?
 
CDC Core
Section 4: Cholesterol Awareness
4.1
Data Results 4.1
Blood cholesterol is a fatty substance found in the blood. Have you ever had your blood cholesterol checked?
4.2
Data Results 4.2
About how long has it been since you last had your blood cholesterol checked?
4.3
Data Results 4.3
Have you ever been told by a doctor or other health professional that your blood cholesterol is high?
Crosstabulation Table:
 
CDC Core
Section 5: Diabetes
5.1
Data Results 5.1
Have you ever been told by a doctor that you have diabetes?
Crosstabulation Table:
CDC Core
Section 6: Oral Health
6.1
Data Results 6.1
How long has it been since you last visited a dentist or a dental clinic for any reason?
Crosstabulation Table:
6.2
Data Results 6.2
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.
Crosstabulation Table:
6.3
Data Results 6.3
How long has it been since you had your teeth "cleaned" by a dentist or dental hygienist?
CDC Core
Section 7: Skin Cancer
7.1
Data Results 7.1
The next question is about sunburns, including any time 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?
7.2
Data Results 7.2
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?
 
CDC Core
Section 8: Tobacco Use 
8.1
Data Results 8.1
Have you smoked at least 100 cigarettes in your entire life?
8.2
Data Results 8.2
Do you now smoke cigarettes everyday, some days, or not at all?
Crosstabulation Table:
8.3
Data Results 8.3
On the average, about how many cigarettes a day do you now smoke?
8.3a On the average, when you smoked during the past 30 days, about how many cigarettes did you smoke a day?
8.4
Data Results 8.4
During the past 12 months, have you quit smoking for 1 day or longer?
8.5
Data Results 8.5
About how long has it been since you last smoked cigarettes regularly, that is, daily?
 
CDC Core
Section 9: Alcohol Consumption 
9.1
Data Results 9.1
During the past month, have you had at least one drink of any alcoholic beverage such as beer, wine, wine coolers, or liquor?
9.2
Data Results 9.2
During the past month, how many days per week or per month did you drink any alcoholic beverages, on the average?
9.3
Data Results 9.3
A drink 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. On the days when you drank, about how many drinks did you drink on the average?
Crosstabulation Table:
9.4
Data Results 9.4
Considering all types of alcoholic beverages, how many times during the past month did you have 5 or more drinks on an occasion?
Crosstabulation Table:
9.5
Data Results 9.5
During the past month, how many times have you driven when you've had perhaps too much to drink?
Crosstabulation Table:
 
CDC Core
Section 10: Demographics
10.1
Data Results 10.1
What is your age?
10.2
Data Results 10.2
What is your race?
10.3
Data Results 10.3
Are you of Spanish or Hispanic origin?
10.4
Data Results 10.4
Are you:
 
  • Married
  • Divorced
  • Widowed
  • Separated
  • Never been married
  • A member of an unmarried couple
10.5
Data Results 10.5
How many children live in your household who are..

a. less than 5 years old?
b. 5 through 12 years old?
c. 13 through 17 years old?
10.6
Data Results 10.6
What is the highest grade or year of school you completed?
10.7
Data Results 10.7
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
10.8
Data Results 10.8
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
10.9 About how much do you weigh without shoes?
Crosstabulation Table:
 
10.10 About how tall are you without shoes?
10.11 What county do you live in?
10.12 Do you have more than one telephone number in your household?
10.13
Data Results 10.13
How many residential telephone numbers do you have?
10.14
Data Results 10.14
Indicate sex of respondent. Ask Only if Necessary
 
CDC Core
Section 11: Women's Health
11.1
Data Results 11.1
A mammogram is an x-ray of each breast to look for breast cancer. Have you ever had a mammogram?
11.2
Data Results 11.2
How long has it been since you had your last mammogram?
Crosstabulation Table:
11.3
Data Results 11.3
Was your 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?
11.4
Data Results 11.4
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?
11.5
Data Results 11.5
How long has it been since your last breast exam?
Crosstabulation Table:
11.6
Data Results 11.6
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?
11.7
Data Results 11.7
A Pap smear is a test for cancer of the cervix. Have you ever had a Pap smear?
11.8
Data Results 11.8
How long has it been since you had your last Pap smear?
Crosstabulation Table:
11.9
Data Results 11.9
Was your last Pap smear done as part of a routine exam, or to check a current or previous problem?
11.10
Data Results 11.10
Have you had a hysterectomy?
11.11
Data Results 11.11
To your knowledge, are you now pregnant?
 
CDC Core
Section 12: Immunizations
12.1
Data Results 12.1
During the past 12 months, have you had a flu shot?
Crosstabulation Table:
12.2
Data Results 12.2
At what kind of place did you get your last flu shot?
12.3
Data Results 12.3
Have you ever had a pneumonia vaccination?
Crosstabulation Table:
   
CDC Core
Section 13: Colorectal Cancer Screening
13.1
Data Results 13.1
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?
13.2
Data Results 13.2
When did you have your last blood stool test using a home kit?
Crosstabulation Table:
13.3
Data Results 13.3
A sigmoidoscopy or colonoscopy is when a tube is inserted in the rectum to view the bowel for signs of cancer and other health problems. Have you ever had this exam?
13.4
Data Results 13.4
When did you have your last sigmoidoscopy or colonoscopy?
Crosstabulation Table:
CDC Core
Section 14: Injury Control
14.1
Data Results 14.1
What is the age of the oldest child in your household under the age of 16?
14.2
Data Results 14.2
During the past year, how often has the [fill in age from Q14.1]-year-old child worn a bicycle helmet when riding a bicycle?
Crosstabulation Table:
14.3
Data Results 14.3
When was the last time you or someone else deliberately tested all of the smoke detectors in your home?
CDC Core
Section 15: HIV/AIDS
15.1
Data Results 15.1
If you had a child in school, at what grade do you think he or she should begin receiving education in school about HIV infection and AIDS?
15.2
Data Results 15.2
If you had a teenager who was sexually active, would you encourage him or her to use a condom?
15.3
Data Results 15.3
What are your chances of getting infected with HIV, the virus that causes AIDS?
Crosstabulation Table:
15.4
Data Results 15.4
Have you donated blood since March 1985?
15.5
Data Results 15.5
Have you donated blood in the past 12 months?
15.6
Data Results 15.6
Except for tests you may have had as part of blood donations, have you ever been tested for HIV?
15.6a Have you ever been tested for HIV?
15.7
Data Results 15.7
Not including your blood donations, have you been tested for HIV in the past 12 months?
15.7a Have you been tested for HIV in the past 12 months?
15.8
Data Results 15.8
What was the main reason you had your last test for HIV?
15.9
Data Results 15.9
Where did you have your last test for HIV?
15.10
Data Results 15.10
Did you receive the results of your last test?
15.11
Data Results 15.11
Did you receive counseling or talk with a health care professional about the results of your test?
State-Added
Module 1: Quality of Life/Disability
1
Data Results SA 1.1
How often do you get the social and emotional support you need?
2
Data Results SA 1.2
In general, how satisfied are you with your life?
3
Data Results SA 1.3
Are you limited in the kind or amount of work you can do because of any impairment or health problem?
4
Data Results SA 1.4
Because of any impairment or health problem, do you have any trouble learning, remembering, or concentrating?
5
Data Results SA 1.5
If you use special equipment or help from others to get around, what type do you use?
6
Data Results SA 1.6
Using special equipment or help, what is the farthest distance that you can go?
7
Data Results SA 1.7
What is farthest distance that you can walk by yourself, without any special equipment or help from others?
8
Data Results SA 1.8
Are you limited in any way in any activities because of any impairment or health problem?
Crosstabulation Table:
9
Data Results SA 1.9
What is the MAJOR impairment or health problem that limits your activities?
10
Data Results SA 1.10
Is this impairment or health problem the result of a work-related illness or injury?
11
Data Results SA 1.11
For HOW LONG have your activities been limited because of your major impairment or health problem?
12
Data Results SA 1.12
Because of any impairment or health problem, do you need the help of other persons with your PERSONAL CARE needs, such as eating, bathing, dressing, or getting around the house?
13
Data Results SA 1.13
Because of any impairment or health problem, do you need the help of other persons in handling your ROUTINE NEEDS, such as everyday household chores, doing necessary business, shopping, or getting around for other purposes?
14
Data Results SA 1.14
During the past 30 days, for about how many days did PAIN make it hard for you to do your usual activities, such as self-care, work, or recreation?
Crosstabulation Table:
15
Data Results SA 1.15
During the past 30 days, for about how many days have you felt SAD, BLUE, or DEPRESSED?
Crosstabulation Table:
16
Data Results SA 1.16
During the past 30 days, for about how many days have you felt WORRIED, TENSE, or ANXIOUS?
Crosstabulation Table:
17
Data Results SA 1.17
During the past 30 days, for about how many days have you felt that you did not get ENOUGH REST or SLEEP?
Crosstabulation Table:
18
Data Results SA 1.18
During the past 30 days, for about how many days have you felt VERY HEALTHY and FULL OF ENERGY?
Crosstabulation Table:
19
Data Results SA 1.19
Is there anyone [insert "else" if "yes" to Q3, Q4, or Q8 or b-m to Q5a]
in your household who is LIMITED in any way in any activities because of any impairment or health problem?
20 How old are these people?
 
State-Added
Module 2: Diabetes
1
Data Results SA 2.1
Is paying for your diabetes supplies a problem?
2
Data Results SA 2.2
Have you talked to a dietician (diet specialist), or nutritionist about your diabetes during the past 5 years?
3
Data Results SA 2.3
When you go to your doctor for your diabetes, are you usually told to remove your socks and shoes before you see the doctor?
4
Data Results SA 2.4
When you last visited your doctor for your diabetes did he or she examine your feet?
5
Data Results SA 2.5
Who decides when you need your next diabetes check-up?
6
Data Results SA 2.6
Do you take insulin injections, diabetes pills, or both?
7
Data Results SA 2.7
How old were you when you were told you had diabetes?
8
Data Results SA 2.8
Have you ever heard of glycosylated hemoglobin (gli-KOS-ilated he-mo-glo-bin) or hemoglobin "A one C"?
9
Data Results SA 2.9
Please answer yes or no to the following questions. Has your diabetes caused you any of the following health problems?

a. Permanent loss of vision
b. Loss of kidney function
c. Skin sores or ulcers
d. Amputation
e. Heart disease
f. Numbness, tingling, or pain in feet or legs
g. Lose protein in urine
10
Data Results SA 2.10
Were you hospitalized during the past two years?
11
Data Results SA 2.11
What was the reason for your most recent hospitalization?
 
State-Added
Module 3: Physical Activity
This was a pilot physical activity module. Due to the way the questions were asked the data did not seem to accurately represent vigorous and moderate physical activity levels. Therefore, prevalence rates and frequencies from this module were not included in the 1999 BRFSS Report.
1
Data Results SA 3.1
How many hours per week do you work at a job or business?
2 What kind of work do you do now?
3 What kind of business or industry Is this? (What was made, sold, or service provided)
4
Data Results SA 3.4
When you are at work, which of the following best describes what you do?
5
Data Results SA 3.5
During the past seven days, how many days did you do vigorous activities for at least ten minutes, such as running, aerobics, heavy yard work, or anything else that caused large increases in breathing or heart rate? (...physical activity that you do when you are not at work)
6 On days when you did vigorous activities, how much total time did you spend doing these activities?
7 During the past seven days, how many days did you do moderate activities for at least ten minutes, such as brisk walking, bicycling, gardening, or anything else that caused some increase in breathing or heart rate? (...physical activity that you do when you are not at work)
8 On days when you did moderate activities, how much total time did you spend doing these activities?
9 During the past seven days, how many days did you walk continuously for at least ten minutes for recreation, exercise, or to get to and from places? (...activities both at work and not at work, that you might have already included in your previous answers.)
10
Data Results SA 3.10
On days when you walked, how much total time did you spend walking?
11
Data Results SA 3.11
During the past seven days, how many days did you do any activities that increase muscle strength or tone, such as lifting weights, pull-ups, push-ups, or sit-ups?
12
Data Results SA 3.12
During the past seven days, how many hours did you spend watching television while sitting or lying down?
13
Data Results SA 3.13
During the past seven days, how many hours did you spend using a computer during your leisure-time?
14
Data Results SA 3.14
Which of the following best describes your future plans regarding physical activity?
15
Data Results SA 3.15
Has a doctor or other health professional ever talked to you about physical activity or exercise?
16
Data Results SA 3.16
How much has your weight changed over the past five years?
17 About how much do you think you weighed when you were 21 years old?
 
State-Added
Module 4: Parenting Issues
1
Data Results SA 4.1
What is the age of the oldest child in your household under the age of 18?
2
Data Results SA 4.2
Are you a parent or a guardian of this child?
3
Data Results SA 4.3
Would you say you are the parent or guardian who spends the most time caring for the [age from Q. 1] year old child?
4
Data Results SA 4.4
Is the [age from Q. 1]year old child’s time divided between parents or guardians who live in separate households?
5
Data Results SA 4.5
About how many hours did the [age from Q. 1] year old child watch television yesterday?
Crosstabulation Table:
6
Data Results SA 4.6
To the following questions please answer how many days out of the past seven days you did the following activities with the [age from Q. 1] year old child?
7
Data Results SA 4.7
Please answer yes or no to the following questions. Are there family rules about:

a. What time the [age from Q. 1] year old child goes to bed on a school night?
b. The amount of time the [age from Q. 1] year old child is allowed to watch television?
c. Which television programs and movies the [age from Q. 1] year old child is allowed to watch?
d. Which computer or video games the [age from Q. 1] year old child is allowed to play?
Crosstabulation Table:
8
Data Results SA 4.8
Where does the [age from Q. 1] year old child go most often when school lets out?
9
Data Results SA 4.9
On how many days out of the past seven days was the [age from Q. 1] year old child supervised by an adult after school?
10
Data Results SA 4.10
To the following questions please answer how many days during the past seven days you have done the following activities with the [age from Q. 1] year old child.

A. Played a sport, physical game, or exercised with the [age from Q. 1] year old child?
B. Played a non-physical game with the [age from Q. 1] year old child?
C. Watched television with the [age from Q. 1] year old child?
D. Read to the [age from Q. 1] year old child?
11
Data Results SA 4.11
About how many hours per week does the [age from Q. 1] year old child spend in a day care center, day care home, or pre-school?
 
State-Added
Module 5: STDs and AIDS
1
Data Results SA 5.1
Have you personally ever known anyone with AIDS or the HIV virus?
2
Data Results SA 5.2
Have you been pregnant during the past two years?
3
Data Results SA 5.3
Did your doctor offer you an HIV test during your last pregnancy?
4
Data Results SA 5.4
Has a doctor or other health professional ever talked with you about your sexual practices, including family planning, sexually transmitted diseases, AIDS, or the use of condoms?
5
Data Results SA 5.5
The following questions ask about the acceptability of certain programs designed to reduce the spread of sexually transmitted diseases and AIDS within communities. Please answer whether the following programs would be very acceptable, somewhat acceptable, somewhat unacceptable, or very unacceptable to you to have in your community.

a. Contacting and treating the sexual partners of persons with sexually transmitted diseases?
b. Needle exchange programs for injectable drug users?
c. Condom distribution to teenagers?
6
Data Results SA 5.6
How many new sex partners did you have during the past 12 months?
Crosstabulation Table:
7
Data Results SA 5.7
Did you discuss your concerns about AIDS or sexually transmitted diseases before having sex for the first time with your most recent sexual partner?
8
Data Results SA 5.8
Did you use a condom the first time you had sex with your most recent sex partner?
Crosstabulation Table:
9
Data Results SA 5.9
Were you drunk or high the first time you had sex with your most recent sex partner?
 
State-Added
Module 6: Dental Sealants
1
Data Results SA 6.1
How many of the children in your household are aged 7 to 17?
2
Data Results SA 6.2
Dental sealants are special plastic coatings that are painted on the tops of the back teeth to prevent tooth decay. They are put on by a dentist or dental hygienist. They are different from fillings, caps, crowns, and fluoride treatments. How many of the children aged 7 to 17 living in your household, ever had dental sealants placed on their teeth?
Crosstabulation Table:
 
State-Added
Module 7: Folic Acid
1
Data Results SA 7.1
Some health experts recommend that women take 400 micrograms of the 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
Crosstabulation Table:
2
Data Results SA 7.2
When is it most important that a woman take the vitamin folic acid?
3
Data Results SA 7.3
Are you currently taking 400 mg of the vitamin folic acid each day?
 
State-Added
Module 8: Injury Control
1
Data Results SA 8.1
How often do you use seatbelts when you drive or ride in a car?
Crosstabulation Table:
2
Data Results SA 8.2
How often does the [fill in age from Q.1 Module 14 ]-year-old child in your household use a...

car safety seat [for child under 5]
seatbelt [for child 5 or older]

...when they ride in a car?
Crosstabulation Table:
3
Data Results SA 8.3
Which of the following best describes whether you have a smoke detector in your home?
Crosstabulation Table: