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:
 
CDC Core
Section 2: Healthy Days - Health Related Quality of Life
2.1
Data Results 2.1
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?
2.2
Data Results 2.2
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:
2.3
Data Results 2.3
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 3: Health Care Access
3.1
Data Results 3.1
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:
3.2
Data Results 3.2
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 as your personal doctor or health care provider?")
Crosstabulation Table:
3.3
Data Results 3.3
Was there a time in the past 12 months when you needed to see a doctor but could not because of cost?
3.4
Data Results 3.4
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.
 
CDC Core
Section 4: Sleep
4.1
Data Results 4.1
The next question is about getting enough rest or sleep.

During the past 30 days, for about how many days have you felt you did not get enough rest or sleep?
 
CDC Core
Section 5: Exercise
5.1
Data Results 5.1
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:
 
 
CDC Core
Section 6: Diabetes
6.1
Data Results 6.1
Have you EVER been told by a doctor that you have diabetes?

Note: If respondent says 'pre-diabetes or borderline diabetes', use response Code 4.

(If "Yes" and respondent is female, ask: "Was this only when you were pregnant?")
Crosstabulation Table:
 
 
CDC Core
Section 7: Oral Health
7.1
Data Results 7.1
How long has it been since you last visited a dentist or a dental clinic for any reason? Include visits to dental specialists, such as orthodontists.
7.2
Data Results 7.2
How many of your permanent teeth have been removed because of tooth decay or gum disease? Include teeth lost to infection, but do not include teeth lost for other reasons, such as injury or orthodontics.

NOTE: If wisdom teeth are removed because of tooth decay or gum disease, they should be included in the count for lost teeth.
Crosstabulation Table:
7.3
Data Results 7.3
How long has it been since you had your teeth cleaned by a dentist or dental hygienist?
 
 
CDC Core
Section 8: Cardiovascular Disease Prevalence
Now I would like to ask you some questions about cardiovascular disease.
Has a doctor, nurse, or other health professional EVER told you that you had any of the following? For each, tell me "Yes", "No", or you're "Not sure.
8.1
Data Results 8.1
Ever told you had a heart attack, also called a myocardial infarction?
Crosstabulation Table:
8.2
Data Results 8.2
(Ever told) you had angina or coronary heart disease?
8.3
Data Results 8.3
(Ever told) you had a stroke?
 
 
CDC Core
Section 9: Asthma
Summary Index Table:
9.1
Data Results 9.1
Have you EVER been told by a doctor, nurse, or other health professional that you had asthma?
9.2
Data Results 9.2
Do you still have asthma?
Crosstabulation Table:
 
 
CDC Core
Section 10: Disability
The following questions are about health problems or impairments you may have.
10.1
Data Results 10.1
Are you limited in any way in any activities because of physical, mental, or emotional problems?
Crosstabulation Table:
10.2
Data Results 10.2
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? (Include occasional use or use in certain circumstances.)
Crosstabulation Table:
 
 
CDC Core
Section 11: Tobacco Use
11.1
Data Results 11.1
Have you smoked at least 100 cigarettes in your entire life? [NOTE: 5 packs = 100 cigarettes]
11.2
Data Results 11.2
Do you now smoke cigarettes every day, some days, or not at all?
Crosstabulation Table:
Summary Index Table:
11.3
Data Results 11.3
During the past 12 months, have you stopped smoking for one day or longer because you were trying to quit smoking?
Crosstabulation Table:
 
 
CDC Core
Section 12: Demographics
12.1
Data Results 12.1
What is your age?
12.2
Data Results 12.2
Are you of Hispanic or Latino?
12.3
Data Results 12.3
Which one or more of the following would you say is your race?
12.4
Data Results 12.4
Which one of these groups would you say BEST represents your race?
12.5
Data Results 12.5

Have you ever served on active duty in the United States Armed Forces, either in the regular military or in the Nationsl Guard or military reserve unit? Active duty does not include training for the Reserves or National Guard, but DOES include activation, for example, for the Persian Gulf War.

Crosstabulation Table:
12.6
Data Results 12.6
Are you:
  • Married
  • Divorced
  • Widowed
  • Separated
  • Never been married
  • A member of an unmarried couple
12.7
Data Results 12.7
How many children less than 18 years of age live in your household ?
12.8
Data Results 12.8
What is the highest grade or year of school you completed?
12.9
Data Results 12.9
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
12.10
Data Results 12.10
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
State-Added Module 1: Hours Worked
(Skipped out of the core to ask the following question.)
1.
Data Results SA1.1
Previously, you indicated you were (a) [insert response 'employed', 'self-employed', 'a homemaker', 'a student', or 'retired' from Question 12.9]. On the average, how many hours per week, if any, do you work at a job or business?
(Skip back into core, and continue with the survey.)
12.11 About how much do you weigh without shoes?
[Round fractions up]
12.12 About how tall are you without shoes?
[Round fractions down]
Crosstabulation Table:
Summary Index Table:
12.13 How much did you weigh a year ago?
[NOTE: If female respondent and age less than 46, ask: 'If you were pregnant a year ago, how much did you weigh before your pregnancy?']
12.14
Data Results 12.14
Was the change between your current weight and your weight a year ago intentional?
12.15 What county do you live in?
12.16 What is your ZIP Code where you live?
12.17
Data Results 12.17
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.
12.18
Data Results 12.18
How many of these phone numbers are residential numbers?
12.19
Data Results 12.19
During the past 12 months, has your household been without telephone service for 1 week or more? Do not include interruptions of phone service due to weather or natural disasters.
12.20
Data Results 12.20
Indicate sex of respondent. Ask Only if Necessary
12.21
Data Results 12.21
To your knowledge, are you now pregnant?
 
CDC Core
Section 13: Alcohol Consumption
13.1
Data Results 13.1
During the past 30 days, have you had at least one drink of any alcoholic beverage such as beer, wine, a malt beverage or liquor?
13.2
Data Results 13.2
During the past 30 days, how many days per week or per month did you have at least one drink of any alcoholic beverage?
Crosstabulation Table:
13.3
Data Results 13.3
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?
Crosstabulation Table:
13.4
Data Results 13.4
Considering all types of alcoholic beverages, how many times during the past 30 days did you have ['5' for men, '4' for women] or more drinks on an occasion?
13.5
Data Results 13.5
During the past 30 days, what is the largest number of drinks you had on any occasion?
 
 
CDC Core
Section 14: Immunization
14.1
Data Results 14.1
A flu shot is an influenza vaccine injected in your arm. During the past 12 months, have you had a flu shot?
Crosstabulation Table:
14.2 During what month and year did you receive your most recent flu shot?
14.3
Data Results 14.3
During the past 12 months, have you had a flu vaccine that was sprayed in your nose? The flu vaccine that is sprayed in the nose is also called FluMist™.
Crosstabulation Table:
14.4 During what month and year did you receive your most recent flu vaccine that was sprayed in your nose?
14.5
Data Results 14.5
A pneumonia shot or pneumococcal vaccine is usually given only once or twice in a person's lifetime and is different from the flu shot. Have you EVER had a pneumonia shot?
Crosstabulation Table:
 
CDC Core
Section 15: Falls
If respondent is 45 years or older continue, otherwise go to next section.
The next questions ask about recent falls. By a fall, we mean when a person unintentionally comes to rest on the ground or another lower level.
15.1
Data Results 15.1
In the past 3 months, how many times have you fallen?
15.2
Data Results 15.2
If ONE fall reported ask: "Did this fall cause an injury?".
If MULTIPLY falls reported ask: "How many of these falls caused an injury?".

By an injury, we mean the fall caused you to limit your regular activities for at least a day or to go see a doctor.
 
CDC Core
Section 16: Seatbelt Use
16.1
Data Results 16.1
How often do you use seat belts when you drive or ride in a car? Would you say: Always, Nearly always, Sometimes, Seldom and Never.
Crosstabulation Table:
 
CDC Core
Section 17: Drinking and Driving
If Q13.1 = 2 (No); go to next section.
The next question is about drinking and driving.
17.1
Data Results 17.1
During the past 30 days, how many times have you driven when you've had perhaps too much to drink?
Crosstabulation Table:
 
 
CDC Core
Section 18: Women's Health
If respondent is male, go to the next section.
The next questions are about breast and cervical cancer.
18.1
Data Results 18.1
A mammogram is an x-ray of each breast to look for breast cancer. Have you ever had a mammogram?
18.2
Data Results 18.2
How long has it been since you had your last mammogram?
Crosstabulation Table:
18.3
Data Results 18.3
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?
18.4
Data Results 18.4
How long has it been since your last breast exam?
18.5
Data Results 18.5
A Pap test is a test for cancer of the cervix. Have you ever had a Pap test?
18.6
Data Results 18.6
How long has it been since you had your last Pap test?
Crosstabulation Table:
18.7
Data Results 18.7
Have you had a hysterectomy?
Read only if necessary: A hysterectomy is an operation to remove the uterus (womb).
 
CDC Core
Section 19: Prostate Cancer Screening
If respondent is less than 40 years of age, or is female, go to next section.
Now, I will ask you some questions about prostate cancer screening.
19.1
Data Results 19.1
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?
19.2
Data Results 19.2
How long has it been since you had your last PSA test?
Crosstabulation Table:
19.3
Data Results 19.3
A digital rectal exam is an exam in which a doctor, nurse, or other health professional places a gloved finger into the rectum to feel the size, shape, and hardness of the prostate gland. Have you ever had a digital rectal exam?
19.4
Data Results 19.4
How long has it been since your last digital rectal exam?
19.5
Data Results 19.5
Have you ever been told by a doctor, nurse, or other health professional that you had prostate cancer?
 
CDC Core
Section 20: Colorectal Cancer Screening
If respondent is < 50 years of age, go to next section.
20.1
Data Results 20.1
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?
20.2
Data Results 20.2
How long has it been since you had your last blood stool test using a home kit?
Crosstabulation Table:
20.3
Data Results 20.3
Sigmoidoscopy and colonoscopy are exams in which a tube is inserted in the rectum to view the colon for signs of cancer or other health problems. Have you ever had either of these exams?
Crosstabulation Table:
20.4
Data Results 20.4
For a SIGMOIDOSCOPY, a flexible tube is inserted into the retum to look for problems. A COLONOSCOPY is similar, but uses a longer tube, and you are usually given medication through a needle in your arm to make you sleepy and told to have someone else drive you home after the test. Was your MOST RECENT exam a sigmoidoscopy or a colonoscopy?
20.5
Data Results 20.5
How long has it been since you had your last sigmoidoscopy or colonoscopy?
 
CDC Core
Section 21: HIV/AIDS
If respondent is 65 years of age or older, go to next section.
The next few questions are about the national health problem of HIV, the virus that causes AIDS. Please remember that your answers are strictly confidential and that you do not have to answer every question if you do not want to. Although we will ask you about testing, we will not ask you about the results of any test you may have had.
21.1
Data Results 21.1
Have you EVER been tested for HIV? Do not count tests you may have had as part of a blood donation.
Include test using fluid from your mouth.
21.2 Not including blood donations, in what month and year was your last HIV test?
Note: If response is before January 1985, code “Don’t know.”
21.3
Data Results 21.3
Where did you have your last HIV test, at a private doctor or HMO office, at a counseling and testing site, at a hospital, at a clinic, in a jail or prison, at home, drug treatment facility or somewhere else?
If Q2 = within last 12 months; continue. Otherwise, go to Q5.
21.4
Data Results 21.4
Was it a rapid test where you could get your results within a couple of hours?
21.5
Data Results 21.5
I'm going to read you a list. When I'm done, please tell me if any of the situations apply to you. You do not need to tell me which one.
  • You have used inravenous drugs in the past year.
  • You have been treated for a sexually transmitted or veneral disease in the past year.
  • You have given or received money or drugs in exchange for sex in the past year.
  • You had anal sex without a condom in the past year.
Do any of these situations apply to you?
 
CDC Core
Section 22: Emotional Support and Life Satisfaction
The next two questions are about emotional support and your satisfaction with life.
22.1
Data Results 22.1
How often do you get the social and emotional support you need? NOTE: If asked, say: "Please include support from any source."
22.2
Data Results 22.2
In general, how satisfied are you with your life?
 
CDC Core
Section 23: Pandemic Flu Pilot (Only asked in December of 2008)
23.1 What do you think is the most effective ONE thing you can do to prevent getting sick from the flu?
  • Avoiding touching your eyes, nose or mouth as much as possible during the flu season.
  • Avoiding close contact with others who may have the flu.
  • Getting the flu vaccination.
  • Taking anti-viral medication, like Tamiflu, on the first or second day that you have symptoms of the flu.
23.2 What do you think is the most effective thing to do to prevent getting spearding the flu to people when you are sick?
  • Frequent hand washing.
  • Covering your mouth and nose when coughing or sneezing.
  • Staying home when you are sick with the flu.
  • Getting the flu vaccination.
  • Something else.
23.3 How many flu vaccinations, including FluMist, have you had in the past 5 years, that is, since January 2003?
23.4 Since September 2008, have you seen a doctor or other health professional about your own health?
23.5 Since September 2008, has a doctor or other health professional told you to get a flu vaccination?
NOTE: Flu vaccination includes the flu shot and flu mist which is sprayed into the nose.
23.6 Do you think the flu vaccination is very effective, somewhat effective, not at all effective in preventing the flu?
23.7 If you do not get the flu vaccination this fall or winter, what do you think are your chances of getting the flu?
Ask the following question of respodents who reported NOT receiving a flu vaccination this flu season.
23.8 There are many reasons why people don't get flu vaccinations. What is the ONE main reason you did not get a flu vaccination last flu season? (NOTE: If more than one reason is given, ask "What is the one MAIN reason you did not get the flu vaccination last flu season?")
Ask the following question of respodents who reported NOT receiving a flu vaccination in the past 5 years, since January 2003.
23.9 If you were to get the flu baccination, how worried would you be about getting sick from it?
23.10 Do you know what the term "pandemic flu" means?
23.11 "Pandemic Influenza" or "Pan Flu" is a global outbreak of a new type of serious influenza that almost everyone is susceptible to and it spreads quickly from person to person. Currently, there is not a pandemic flu outbreak occuring.

Are you very concerned, somewhat concerned or not at all concerned about a pandemic flu outbreak?
23.12 If there is a pandemic flu outbreak and you do not get the pandemic flu vaccination, what do you think your chances are of getting sick with the pandemic flu? (NOTE: Please read both the subjective label and the percentage range.)
  • Very High (90%-100%)
  • High (70%-89%)
  • Average (50%-69%)
  • Low (20%-49%)
  • Very Low (less than or equal to 19%)
23.13 If there is a pandemic flu outbreak, how likely are you to get a pandemic flu vaccination if it was available to you?
  • Definetely get one
  • Probably get one
  • Probably not get one
  • Definitely not get a pandemic flu vaccination
23.14 If public health officials recommended that everyone go to a particular public place such as a local school, fire station, or sports stadium to get vaccinated to prevent the spread of pandemic flu, would you...
  • Definetely go
  • Probably go
  • Probably not go
  • Definitely not go to a particular place to get vaccinated
23.15 Imagine an outbreak of pandemic flu in the U.S. in the next year. What would be the most important ONE thing you would want to know?
  • How to prevent getting the flu
  • How to prevent spreading the flu
  • Symptoms of the flu
  • How to treat the flu
  • Cities where cases of the flu have been identified
  • Information about the flu vaccine
  • Something else
23.16 During a pandemic flu outbreak in the U.S., what would be your ONE most preferred source for getting information about the pandemic flu? Please tell me you one most perferred source?
  • Newspapers
  • Television
  • Radio
  • Internet Websites
  • Your doctor
  • The CDC (Centers for Disease Control and Prevention)
  • State or local public health departments
  • Other government agencies
  • Family or friends
  • Religious leaders
  • Some other source
23.17 Excluding vaccination, what is the ONE most likely thing you would do if a pandemic flu outbreak were reported IN YOUR STATE? Please choose one from the following list.
  • Consult a website
  • Avoid crowds and public events
  • Consult your doctor
  • Try to get a prescription for an anti-viral drug such as Tamiflu
  • Reduce or avoid travel
  • Wash hands frequently
  • Wear a face mask
  • Keep household members at home while the outbreak lasts
  • Stock up on medicines and food to hlep with flu symptoms
  • Something else
23.18 If public health officials recommended that everyone stay at home for a month becuase of a serious outbreak of pandemic flu in your community, are you very likely, somewhat likely, somewhat unlikely, or very unlikely to stay home for a month?
23.19 During a severe outbreak of pandemic flu in your community, would you participate in a telephone interview like this one about pandemic flu? Would you definitely participate, probably participate, probably not participate, or definitely not participate in an interview?
23.20 I'm going to read you a list of job types. Please tell me if you currently work in any of these fields.
  • a. Emergency medical services, law enforcement, fire services, or in the manufacture of pandemic vaccines or anti-virals
  • b. Public health, healthcare provider, home health, or in a nursing home.
  • c. Homeland or national security as one who would be deployed during a flu pandemic.
 
CDC Optional
Module 15: Random Child Selection

If Core Question 12.7 = 88, or 99 (no children under age 18 in the household, or refused), go to next module.

If Core Question 12.7 = 1; INTERVIEWER: "Previously, you indicated there was one child age 17 or younger in your household. I would like to ask you some questions about that child." [Go to Q1]

If Core 12.7 is >1 and Core Question 12.7 does not equal to 88 or 99; INTERVIEWER: "Previously, you indicated there were [number] children age 17 or younger in your household. Think about those [number] children in order of their birth, from oldest to youngest. The oldest child is the first child and the youngest child is the last child." Please include children with the same birth date, including twins, in the order of their birth.

INTERVIEWER: "I have some additional questions about one specific child. The child I will be referring to is the "X"th child in your household. All following questions about children will be about the "Xth" child."

Note: If there are two children with the same birth date, randomly select one.
1
Data Results M15.1
What is the birth month and year of the “Xth” child?
2
Data Results M15.2
Is the child a boy or a girl?
3
Data Results M15.3
Is the child Hispanic or Latino?
4
Data Results M15.4
Which one or more of the following would you say is the race of the child?
[Check all that apply]
5
Data Results M15.5
Which one of these groups would you say best represents the child's race?
6
Data Results M15.6
How are you related to the child?
 
CDC Optional
Module 16: Childhood Asthma Prevalence
If response to Core Q12.7 = 88 (None) or 99 (Refused), go to next module.
The next two questions are about the "Xth" child.
1
Data Results M16.1
Has a doctor, nurse, or other health professional EVER said that the child has asthma?
2
Data Results M16.2
Does the child still have asthma?
Crosstabulation Table:
 
 
State-Added
Module 2: Asthma Call Back Survey Information
If Q8.1 = ‘yes” or Childhood Asthma Prevalence Module Q1 = ‘Yes’ and Random Child Selection Module Q6 = “Parent” (1) or “Foster parent or guardian” (3) then continue. Otherwise, go to next module.
1
We would like to call you again within the next 2 weeks to talk in more detail about [your/your child's] experiences with asthma. The information will be used to help develop and improve the quality of life of Kansans with asthma. The information you gave us today and any you give us in the future will be kept confidential. If you agree to this, we will keep your first name or initials and phone number on file, separate from the answers collected today. Even if you agree now, you may refuse to participate in the future.

Would it be okay if we called you back to ask additional asthma-related questions at a later time?
 
This year the State of Kansas BRFSS questionnaire is a split questionnaire. That is, the core questions above, two CDC optional modules and two state-added modules are asked of every respondent. However, the additional CDC optional modules and state-added modules that follow are seperated into two parts: Part A and Part B. Each record was pre-determined to be asked either Part A or Part B.
 
Part A
Summary Index Table:
CDC Optional
Module 1: Pre-Diabetes
Note: Only asked of those not responding "Yes" (code = 1) to Core Q6.1 (Diabetes awareness question).
1
Data Results M1.1
Have you had a test for high blood sugar or diabetes within the past three years?
Note: If Core Q6.1 = 4 (No, pre-diabetes or borderline diabetes); answer Q2 "Yes" (code = 1).
2
Data Results M1.2
Have you ever been told by a doctor or other health professional that you have pre-diabetes or borderline diabetes?
 
 
CDC Optional
Module 2: Diabetes
Note: To be asked following Core Q6.1; if response is "Yes" (code = 1)
1
Data Results M2.1
How old were you when you were told you have diabetes?
2
Data Results M2.2
Are you now taking insulin?
3
Data Results M2.3
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.
4
Data Results M2.4
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.
5
Data Results M2.5
About how many times in the past 12 months have you seen a doctor, nurse, or other health professional for your diabetes?
6
Data Results M2.6
A test for "A one C" measures the average level of blood sugar over the past three months. About how many times in the past 12 months has a doctor, nurse, or other health professional checked you for "A one C" ?
7
Data Results M2.7
About how many times in the past 12 months has a health professional checked your feet for any sores or irritations?
8
Data Results M2.8
When was the last time you had an eye exam in which the pupils were dilated? This would have made you temporarily sensitive to bright light.
9
Data Results M2.9
Has a doctor ever told you that diabetes has affected your eyes or that you had retinopathy?
10
Data Results M2.10
Have you ever taken a course or class in how to manage your diabetes yourself?
 
 
State-Added
Module 3: Diabetes Assessment
1
Data Results SA3.1

Which of the following family members, if any, have been told by a doctor that they have diabetes? Include only blood relatives. Do not include adoptive or those related only by marriage.

[Mark all that apply:]

  • Mother
  • Father
  • Brothers [Interviewer note: include half brother]
  • Sisters [Interviewer note: include half sister]
  • No one
Note: If respondent is female, continue; otherwise, go to next module.
2
Data Results SA3.2
Have you had a baby weighing more then 9 pounds at birth?
 
 
State-Added
Module 4: Hypertension Awareness
SA4.1
Data Results SA4.1
Have you EVER been told by a doctor, nurse, or other health professional that you have high blood pressure?
(If "Yes" and respondent is female, ask: "Was this only when you were pregnant?")
Crosstabulation Table:
SA4.2
Data Results SA4.2
Are you currently taking medicine for your high blood pressure?
 
 
State-Added
Module 5: Cholesterol Awareness
SA5.1
Data Results SA5.1
Blood cholesterol is a fatty substance found in the blood. Have you EVER had your blood cholesterol checked?
SA5.2
Data Results SA5.2
About how long has it been since you last had your blood cholesterol checked?
SA5.3
Data Results SA5.3
Have you EVER been told by a doctor, nurse, or other health professional that your blood cholesterol is high?
Crosstabulation Table:
 
 
CDC Optional
Module 4: Visual Impairment and Access to Eye Care
Note: If respondent is less than 40 years of age, go to next module.
Now I would like to ask you questions about your vision. These questions are for all respondents regardless of whether or not you wear glasses or contact lenses. If you wear glasses or contact lenses, answer questions as if you are wearing them.
M4.1
Data Results M4.1
How much difficulty, if any, do you have in recognizing a friend across the street? Would you say:
  • No difficulty
  • A little difficulty
  • Moderate difficulty
  • Extreme difficulty
  • Unable to do because of eyesight
  • Unable to do for other reasons
  • Not applicable (Blind)
M4.2
Data Results M4.2
How much difficulty, if any, do you have reading print in newspapers, magazines, recipes, menus, or numbers on the telephone? Would you say:
  • No difficulty
  • A little difficulty
  • Moderate difficulty
  • Extreme difficulty
  • Unable to do because of eyesight
  • Unable to do for other reasons
  • Not applicable (Blind)
Crosstabulation Table:
M4.3
Data Results M4.3
When was the last time you had your eyes examined by any doctor or eye care provider?
M4.4
Data Results M4.4
What is the main reason you have not visited an eye care professional in the past 12 months?
Note: Skip Q5, if any response to CDC Optional Module 2 (Diabetes) Q8, go to Q6.
M4.5
Data Results M4.5
When was the last time you had an eye exam in which the pupils were dilated? This would have made you temporarily sensitive to bright light.
M4.6
Data Results M4.6
Do you have any kind of health insurance coverage for eye care?
M4.7
Data Results M4.7
Have you been told by an eye doctor or other health care professional that you NOW have cataracts?
M4.8
Data Results M4.8
Have you EVER been told by an eye doctor or other health care professional that you had glaucoma?
M4.9
Data Results M4.9
Age-related Macular Degeneration (AMD) is a disease that affects the macula, the part of the eye that allows you to see fine detail.

Have you EVER been told by an eye doctor or other health care professional that you had age-related macular degeneration?
 
State-Added
Module 6: Excess Sun Exposure
The next questions are about sunburns, including any time that even a small part of your skin was red for more than 12 hours.
SA6.1
Data Results SA6.1
Have you had a sunburn within the past 12 months?
Crosstabulation Table:
SA6.2
Data Results SA6.2
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?
 
State-Added
Module 7: Fruits and Vegetables
Summary Index Tables:
Crosstabulation Tables:
These next questions are about the foods you usually eat or drink. Please tell me how often you eat or drink each one, for example, twice a week, three times a month, and so forth. Remember, I am only interested in the foods you eat. Include all foods you eat, both at home and away from home.
SA7.1
Data Results SA7.1
How often do you drink fruit juices such as orange, grapefruit, or tomato?
SA7.2
Data Results SA7.2
Not counting juice, how often do you eat fruit?
SA7.3
Data Results SA7.3
How often do you eat green salad?
SA7.4
Data Results SA7.4
How often do you eat potatoes not including French fries, fried potatoes, or potatoes chips?
SA7.5
Data Results SA7.5
How often do you eat carrots?
SA7.6
Data Results SA7.6
Not counting carrots, potatoes, or salad, how many servings of vegetables do you usually eat? [Example: A serving of vegetables at both lunch and dinner would be two servings.]
 
State-Added
Module 8: Physical Activity
Summary Index Table:
Crosstabulation Table:
If Core Q12.9 = 1 (employed for wages) or 2 (self-employed) then continue. Otherwise, go to Q2.
SA8.1
Data Results SA8.1
When you are at work, which of the following best describes what you do? Would you say:
[NOTE: If respondent has multiple jobs, include all jobs.]
  • 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.
SA8.2
Data Results SA8.2
Now, thinking about the moderate physical activities you do [fill in "when you are not working" if 1, employed, or 2, self-employed, in Question 13.8] 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?
SA8.3
Data Results SA8.3
How many days per week do you do these moderate activities for at least 10 minutes at a time?
SA8.4
Data Results SA8.4
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?
Crosstabulation Table:
SA8.5
Data Results SA8.5
Now thinking about the vigorous physical activities you do [fill in "when you are not working" if 1, employed, or 2, self-employed, in Question 13.8] 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?
SA8.6
Data Results SA8.6
How many days per week do you do these vigorous activities for at least 10 minutes at a time?
SA8.7
Data Results SA8.7
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:
 
 
Part B
Summary Index Table:
CDC Opitional
Module 7: Other Tobacco Products
Now, I would like to ask you questions about your use of tobacco products other than cigarettes.
M7.1
Data Results M7.1
Have you ever used or tried any smokeless tobacco products such as chewing tobacco, snuff or snus? (Snus rhymes with goose.)
[NOTE: Snus (Swedish for snuff) is a moist smokeless tobacco, usually sold in small pouches,
that is placed under the lip against the gum.]
M7.2
Data Results M7.2
Do you currently use chewing tobacco, snuff or snus every day, some days, or not at all?
Crosstabulation Table:
M7.3
Data Results M7.3
Do you currently use cigars, pipes, bidis, kreteks, or tobacco products? Do not include cigarettes, snus, snuff, or chewing tobacco.
[Note: Bidis are small, brown, hand-rolled cigarettes from India and other southeast Asian countries.
Kreteks are clove cigarettes made in Indonesia that contain clove extract and tobacco.]
 
 
CDC Optional
Module 8: Secondhand Smoke I
These next questions are about exposure to secondhand smoke.
If Core Q12.9 = 1 (Employed) or Core Q12.9 = 2 (Self-Employed); continue. Otherwise, go to Q2.
M8.1
Data Results M8.1
On how many of the past 7 days, did someone smoke in your indoor workplace while you were there?
M8.2
Data Results M8.2
On how many of the past 7 days, did anyone smoke in your home while you were there?
M8.3
Data Results M8.3
Which statement best describes the rules about smoking inside your home? Do not include decks, garages, or porches.
M8.4
Data Results M8.4
In bars, do you THINK smoking should be allowed in all areas, some areas or not allowed at all?
M8.5
Data Results M8.5
In restaurants, do you THINK smoking should be allowed in all areas, some areas or not allowed at all?
M8.6
Data Results M8.6
Inside indoor workplaces, do you THINK smoking should be allowed in all areas, some areas or not allowed at all?
 
 
State-Added
Module 9: COPD
SA9.1
Data Results SA9.1
Have you ever been told by a doctor or health professional that you have chronic obstructive pulmonary disease (COPD), emphysema or chronic bronchitis?
 
State-Added
Module 10: Underage Drinking
SA10.1
Data Results SA10.1
Over the past 12 months, did you ever buy or give alcohol to someone under the age of 21? This includes beer, wine, wine coolers and liquor such as rum, gin, vodka, or whiskey. Do not include giving a few sips of wine for religious purposes.
SA10.2
Data Results SA10.2
Previously you indicated that over the past 12 months you bought or gave alcohol to someone under the age 21. Are you the parent or legal guardians of all individuals you supplied alcohol to?
[NOTE: If respondent asks why we are asking this question, please respond with: "In Kansas it is illegal to purchase alcohol to anyone under the age of 21. The exception to this rule, according to Kansas law, is that a parent or legal guardian may provide alcoholic beverages to their child or ward when supervised by the parent or legal guardian. Despite enforcement of such laws, research shows that many youth acquire alcohol from individuals older than themselves."
SA10.3
Data Results SA10.3
Over the past 12 months, did you ever allow alcohol to be consumed on your property by persons under the age of 21?
SA10.4
Data Results SA10.4
During the past 12 months, did you hear, read, or watch an advertisement about prevention of underage drinking?
If Q4 = 1 (Yes); continue. Otherwise, go to next module.
SA10.5a
Data Results SA10.5a
Through which of the following media did you hear or see advertisements about the prevention of underage drinking?

a. Television

SA10.5b
Data Results SA10.5b
Through which of the following media did you hear or see advertisements about the prevention of underage drinking?

b. Radio

SA10.5c
Data Results SA10.5c
Through which of the following media did you hear or see advertisements about the prevention of underage drinking?

c. Billboard

SA10.5d
Data Results SA10.5d
Through which of the following media did you hear or see advertisements about the prevention of underage drinking?

d. Newspaper Article

SA10.5e
Data Results SA10.5e
Through which of the following media did you hear or see advertisements about the prevention of underage drinking?

e. Brochure/Fact sheet

SA10.5f
Data Results SA10.5f
Through which of the following media did you hear or see advertisements about the prevention of underage drinking?

f. Other

 
 
State-Added
Module 11: Oral Health
SA11.1
Data Results SA11.1
During the past 12 months, was there any time when you needed dental care but did not get it?
SA11.2
Data Results SA11.2
What was the main reason you did not receive the dental care you needed?
SA11.3
Data Results SA11.3
Do you have any kind of insurance coverage that pays for some or all of your routine dental care, including dental insurance, prepaid plans such as HMOs, or government plans such as Medicaid?
Crosstabulation Table:
 
 
State-Added
Module 13: Natural Disasters and 2008 Greensburg Kansas Tornado
The next question asks about how prepared you are for a large-scale disaster or emergency. By large-scale disaster or emergency we mean any event that leaves you isolated in your home or displaces you from your home for at least 3 days. This might include natural disasters such as hurricanes, tornadoes, floods and ice storms.
SA13.1
Data Results SA13.1
How well prepared doyou feel your household is to handle a large-scale natural disaster or emergency, such as tornados, floods and ice storms? Would you say...
  • Well prepared
  • Somewhat prepared
  • Not prepared at all
SA13.2
Data Results SA13.2
Where is the location of the storm shelter nearest to your home?
[NOTE: If repsondent asks,"What do you mean by shelter on home premises?" This is a basement, cellar, specific room in thier home or a special storm shelter on thier property.]
SA13.3
Data Results SA13.3
In the even of an approaching tornado, how would you get to the nearest storm shelter?
  • Walk
  • Drive < 1 mile
  • Drive 1 to 5 miles
  • Drive 6 to 10 miles
  • Drive > 10 miles
  • No shelter near home
SA13.4
Data Results SA13.4
Where you or anyone your know affected by the 2008 Greensburg Kansas tornado? Include family members, friends, co-workers or acquaintances.
 
State-Added
Module 14: Disability
SA14.1
Data Results SA14.1
Because of an impairment or health problem do you have problems with any of the following:

…..thinking, remembering or controlling emotions?
SA14.2
Data Results SA14.2
[Because of an impairment or health problem do you have problems]:

….. seeing, hearing or communicating?
SA14.3
Data Results SA14.3
[Because of an impairment or health problem do you have problems]:

…. nerves, muscles or joints?
SA14.4
Data Results SA14.4
Does your impairment or health problem affect your ability with any of the following…

…. go to school or work?
SA14.5
Data Results SA14.5
[Does your impairment or health problem affect your ability to]

… perform personal care activities including bathing, dressing, grooming, using the toilet or getting in and out of bed?
SA14.6
Data Results SA14.6
[Does your impairment or health problem affect your ability to]

… perform household activities including paying bills, shopping, cooking, or cleaning the house?
SA14.7
Data Results SA14.7
[Does your impairment or health problem affect your ability to]

… move around including walking, using stairs, lifting or carrying objects?
SA14.8
Data Results SA14.8
Is your ability to move around due to any of the following:

… paralysis?
NOTE: If asked, "Paralysis is defined as loss of function or feeling that affects the ability to move your arms or legs but does not include amputation or missing limbs."
SA14.9
Data Results SA14.9
[Is your ability to move around asffected due to:]

…a chronic disease such as diabetes or arthritis?
 
 
CDC Optional
Module 11: Veterans' Health Status
If Core Q12.5 = 1 (Yes); continue. Otherwise, go to next module.
These next questions relate to military service.
M11.1
Data Results M11.1
Which of the following best describes your service in the United States military?
M11.2
Data Results M11.2
In the last 12 months, have you received some or all of your health care from VA hospital or clinic?
NOTE: If "Yes", probe for "All" or "Some" of the health care.
M11.3
Data Results M11.3
Since September 11, 2001, have you been deployed to the regions of Afghanistan or Iraq in support of U.S. military operations?
NOTE: This includes countries in the Middle East region such as Iraq, Saudi Arabia, Kuwait, the Persian Gulf, and other forward deployed operating areas such as the countries bordering Afghanistan.
 
CDC Optional
Module 13: Anxiety and Depression
Now, I am going to ask you some questions about your mood. When answering these questions, please think about how many days each of the following has occured in the past 2 weeks.
M13.1
Data Results M13.1
Over the last 2 weeks, how many days have you had little interest or pleasure in doing things?
M13.2
Data Results M13.2
Over the last 2 weeks, how many days have you felt down, depressed or hopless?
M13.3
Data Results M13.3
Over the last 2 weeks, how many days have you had trouble falling asleep or staying asleep or sleeping too much?
M13.4
Data Results M13.4
Over the last 2 weeks, how many days have you felt tired or had little energy?
M13.5
Data Results M13.5
Over the last 2 weeks, how many days have you had a poor appetite or eaten too much?
M13.6
Data Results M13.6
Over the last 2 weeks, how many days have you felt bad about yourself or that you were a failure or had let yourself or your family down?
M13.7
Data Results M13.7
Over the last 2 weeks, how many days have you had trouble concentrating on things, such as reading the newspaper or watching the TV?
M13.8
Data Results M13.8
Over the last 2 weeks, how many days have you moved or spoken so slowly that other people could have noticed? Or the opposite-being so fidgety or restless that you were moving around a lot more than usual?
M13.9
Data Results M13.9
Has a doctor or other healthcare provider EVER told you that you had an anxiety disorder (including acute stress disorder, anxiety, generalized anxiety disorder, obessive-compulsive disorder, panic disorder, phobia, posttraumatic stress disorder, or social anxiety disorder)?
M13.10
Data Results M13.10
Has a doctor or other healthcare provider EVER told you that you have a depressive disorder (including depression, major depression, dysthymia, or minor depression)?
Crosstabulation Table:
 
 
State-Added
Module 15: Depression Treatment
If CDC Module 13 Q10 = 1 (Yes) for ever diagnosed with a depressive disorder; continue. Otherwise, go to Q2.
SA15.1
Data Results SA15.1
About how long has it been since you were diagnosed with depression?
Now, I am going to ask a few questions about your feelings of being sad, discouraged or uninterested in the past 12 months and the treatment received for these feelings.
SA15.2
Data Results SA15.2
During the past 12 months, have you had a period of two weeks or longer when you felt sad, discouraged or uninterested?
SA15.3
Data Results SA15.3
Did you receive any treatment for your sadness, discouragement or lack of interest at any time in the past 12 months by a medical doctor or other health professionals? (By health professional we mean psychologists, counseolors, spiritual advisors, herbalists, acupuncturists, and other healing professionals.)
SA15.4
Data Results SA15.4
During the past 12 months, did you get a precscription medicine for your sadness, discouragement or lack of interest?
Crosstabulation Table:
SA15.5
Data Results SA15.5
During the past 12 months, did you receive counseling or therapy from a medical doctor or other health professional for your sadness, discouragement or lack of interest? (By health professional we mean psychologists, counseolors, spiritual advisors, herbalists, acupuncturists, and other healing professionals.)
If Q3 = 2 (No); continue. Otherwise, go to Q7.
SA15.6
Data Results SA15.6
What was the main reason you did not receive treatment that you needed for your sadness, discouragement or lack of interest in the past 12 months?
SA15.7
Data Results SA15.7
During the past 12 months, how many different times have you stayed overnight or longer in a hospital to receive treatment for your sadness, discouragement or lack of interest?
 
 
State-Added
Module 12: Food Security and Insecurity
These next questions are about the food eaten in your family. People do different things when they are running out of money for food to make their food or money go further.
SA16.1
Data Results SA16.1
In the last 12 months, did you or other adults in your household ever cut the size of your meals or skip meals because there wasn't enough money for food?
If Q1 = 1 (Yes); continue. Otherwise, go to Q3.
SA16.2
Data Results SA16.2
How often did this happen?
SA16.3
Data Results SA16.3
In the last 12 months, did you ever eat less than you felt you should because there wasn't enough money to buy food?
SA16.4
Data Results SA16.4
In the last 12 months, were you ever hungry but didn't eat because you couldn't afford enough food?
Now I'm going to read you 2 statements that people have made about their food situation. For these statements, please tell me whether the statement was often, sometimes, or never true for you or other members of your household in the last 12 months.
SA16.5
Data Results SA16.5
The first statement is, "The food that I or we bought just didn't last, and I or we didn't have money to get more."
Was that often, sometimes or never true for you in the last 12 months?
SA16.6
Data Results SA16.6
"I or we couldn't afford to eat balanced meals."
Was that often, sometimes or never true for you in the last 12 months?