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?
Crosstabulation Table:
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
The next question is about getting enough rest or sleep.
4.1
Data Results 4.1
During the past 30 days, for about how many days have you felt you did not get enough rest or sleep?
Crosstabulation Table:
Summary Index Table:
 
 
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:
Summary Index Table:
 
 
CDC Core
Section 6: Diabetes
6.1
Data Results 6.1
Have you EVER been told by a doctor that you have diabetes?

INTERVIEWER INSTRUCTION: 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: Hypertension Awareness
7.1
Data Results 7.1
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:
7.2
Data Results 7.2
Are you currently taking medicine for your high blood pressure?
 
 
CDC Core
Section 8: Cholesterol Awareness
8.1
Data Results 8.1
Blood cholesterol is a fatty substance found in the blood. Have you EVER had your blood cholesterol checked?
8.2
Data Results 8.2
About how long has it been since you last had your blood cholesterol checked?
8.3
Data Results 8.3
Have you EVER been told by a doctor, nurse, or other health professional that your blood cholesterol is high?
Crosstabulation Table:
 
 
CDC Core
Section 9: 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.
9.1
Data Results 9.1
Ever told you had a heart attack, also called a myocardial infarction?
Crosstabulation Table:
9.2
Data Results 9.2
(Ever told) you had angina or coronary heart disease?
9.3
Data Results 9.3
(Ever told) you had a stroke?
 
CDC Core
Section 10: Asthma
Crosstabulation Table:
Summary Index Table:
10.1
Data Results 10.1
Have you EVER been told by a doctor, nurse, or other health professional that you had asthma?
10.2
Data Results 10.2
Do you still have asthma?
 
 
CDC Core
Section 11: Tobacco Use
11.1
Data Results 11.1
Have you smoked at least 100 cigarettes in your entire life?
[Interviewer: 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:
CATI INTERVIEWER INSTRUCTION: If Q11.2 = 3 (Not at all); continue. Otherwise, go to Q11.5.
11.4
Data Results 11.4
How long has it been since you last smoked cigarettes regularly?
11.5
Data Results 11.5
Do you currently use chewing tobacco, snuff or snus every day, some days or not at all?

INTERVIEWER INSTRUCTION: Snus (Swedish for snuff) is a moist smokeless tobacco, usually sold in small pouches that are placed under the lip against the gum.
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 a National 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.

  • Yes, now on active duty
  • Yes, on active duty during the last 12 months, but not now
  • Yes, on active duty in the past, but not during the last 12 months
  • No, training for Reserves or National Guard only
  • No, never served in the military
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 from core, Question 12.8]. 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]
CATI INTERVIEWER INSTRUCTION: If Q12.11 = 7777 (Don't know/Not sure) or 9999 (Refused), skip Q12.13 and Q12.14.
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?

[If Female respondent & age < 46: If you were pregnant a year ago, how much did you weigh before your pregnancy?]
CATI INTERVIEWER INSTRUCTION: Subtract weight from Q12.13 from current weight Q12.11. If weight is the same, skip Q12.14.
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 telephone service because of weather or natural disasters.
Cell Phone Questions (12.19a-12.19d)
12.19a
Data Results 12.19a
Do you have a cell phone for personal use? Please include cell phones used for both business and personal use.
CATI INTERVIEWER INSTRUCTION: If Q12.19a = 1 (Yes), skip to Q12.19c.
12.19b
Data Results 12.19b
Do you share a cell phone for personal use (at least one-third of the time) with other adults?
CATI INTERVIEWER INSTRUCTION: If Q12.19b = 1 (Yes), skip to Q12.19d. Otherwise, skip to Q12.20.
12.19c
Data Results 12.19c
Do you usually share this cell phone (at least one-third of the time) with any other adults?
12.19d
Data Results 12.19d
Thinking about all the phone calls that you receive on your landline or cell phone, what percent, between 0 and 100, are received on your cell phone?
12.20
Data Results 12.20
Indicate sex of respondent. Ask Only if Necessary
CATI INTERVIEWER INSTRUCTION: If Q12.20 = 1 (Male) or Q12.20 = 2 (female) and is 45 years old or older, skip to next section.
12.21
Data Results 12.21
To your knowledge, are you now pregnant?
 
CDC Core
Section 13: Caregiver Status
People may provide regular care or assistance to a friend or family member who has a health problem, long-term illness or disability.
13.1
Data Results 13.1
During the past month, did you provide any such care or assistance to a friend or family member?
Crosstabulation Table:
 
CDC Core
Section 14: Disability
The following questions are about health problems or impairments you may have.
14.1
Data Results 14.1
Are you limited in any way in any activities because of physical, mental, or emotional problems?
Crosstabulation Table:
14.2
Data Results 14.2
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 15: Alcohol Consumption
15.1
Data Results 15.1
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?
CATI NOTE: If Q15.1 = 1 "Yes" continue, otherwise go to next section.
15.2
Data Results 15.2
During the past 30 days, how many days per week or per month did you have at least one drink of any alcoholic beverage?
CATI NOTE: If Q15.2 = 888 "No drinks in past 30 days" go to next section, otherwise continue.
15.3
Data Results 15.3
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:
15.4
Data Results 15.4
Considering all types of alcoholic beverages, how many times during the past 30 days did you have X [CATI INTERVIEWER INSTRUCTION: X = 5 for men, X = 4 for women] or more drinks on one occasion?
Crosstabulation Table:
15.5
Data Results 15.5
During the past 30 days, what is the largest number of drinks you had on any occasion?
 
CDC Core
CDC Module 31: Novel H1N1 Adult Immunization
INTERVIEWER INSTRUCTION: This module was included starting in October 2009 - December 2009.
There are currently vaccines available for two kinds of flu - the seasonal flu and the 2009 H1N1 flu. I will first ask you questions about vaccination for H1N1 flu, which is sometimes called swine flu or pandemic flu, and then ask you questions about vaccination for seasonal flu.
M31.1
Data Results M31.1
There are two ways to get the H1N1 flu vaccination. One is a shot in the arm and the other is a spray, mist or drop in the nose.
Since September, 2009, have you been vaccinated either way for the H1N1 flu?

[Interviewer INTERVIEWER INSTRUCTION: If asked why asking about H1N1 vaccinations when not available please say: "The distribution of the H1N1 Vaccines has already started. We are trying to find out if vaccinations are currently taking place in Kansas."
IF M31.1 = 1 "Yes" continue, else go to Section 16.
M31.2
Data Results M31.2
During what month did you receive your H1N1 flu vaccine?
M31.3
Data Results M31.3
Was this a shot or was it a vaccine sprayed in the nose?
 
 
CDC Core
Section 16: Immunization
NOTE: Changes in wording to the follow questions in this module was done in September of 2009 due to the H1N1 Pandemic Flu event. Changes of wording are in red.
16.1
Data Results 16.1
Now I will ask you questions about seasonal flu. A flu shot is an influenza vaccine injected in your arm. During the past 12 months, have you had a seasonal flu shot?
Crosstabulation Table:
CATI INTERVIEWER INSTRUCTION: If 16.1 = 1 "Yes"continue, otherwise got to question 16.3.
16.2
During what month and year did you receive your most recent seasonal flu shot?
16.3
Data Results 16.3
The seasonal flu vaccine sprayed in the nose is also called FluMist™. During the past 12 months, have you had a flu vaccine that was sprayed in your nose?
Crosstabulation Table:
CATI INTERVIEWER INSTRUCTION: If 16.3 = 1 "Yes" continue, otherwise got to question 16.5.
16.4
During what month and year did you receive your most recent seasonal flu vaccine that was sprayed in your nose?
16.5
Data Results 16.5
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 23: Pandemic Flu Pilot (Only asked in January & February of 2009)
23.1
Data Results 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
Data Results 23.2
What do you think is the most effective thing to do to prevent getting spreading 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.
"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 occurring.
23.3
Data Results 23.3
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? (INTERVIEWER INSTRUCTION: 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%)
23.4
Data Results 23.4
If there is a pandemic flu outbreak, how likely are you to get a pandemic flu vaccination if it was available to you?
  • Definitely get one
  • Probably get one
  • Probably not get one
  • Definitely not get a pandemic flu vaccination
23.5
Data Results 23.5
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...
  • Definitely go
  • Probably go
  • Probably not go
  • Definitely not go to a particular place to get vaccinated
23.6
Data Results 23.6
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
23.7
Data Results 23.7
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 preferred source?
  • Newspapers
  • Television
  • Radio
  • Internet Web sites
  • 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
23.8
Data Results 23.8
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 web site
  • 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 help with flu symptoms
  • Something else
23.9
Data Results 23.9
If public health officials recommended that everyone stay at home for a month because 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?
CATI INTERVIEWER INSTRUCTION: If Q12.9 (employment) = 1 "employed for wages" or 2 "self-employed" continue, otherwise skip to next section.
23.10
Data Results 23.10
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 Core
Section 17: Arthritis Burden
Next I will ask you about arthritis.
17.1
Data Results 17.1
Have you EVER been told by a doctor or other health professional that you have some form of arthritis, rheumatoid arthritis, gout, lupus, or fibromyalgia?

INTERVIEWER INTERVIEWER INSTRUCTION: Arthritis diagnoses includes:
  • rheumatism, polymyalgia rheumatica
  • osteoarthritis (not osteoporosis)
  • tendonitis, bursitis, bunion, tennis elbow
  • carpal tunnel syndrome, tarsal tunnel syndrome
  • joint infection, Reiter's syndrome
  • ankylosing spondylitis; spondylosis
  • rotator cuff syndrome
  • connective tissue disease, scleroderma, polymyositis,
    Raynaud's syndrome
  • vasculitis (giant cell arteritis, Henoch-Schonlein purpura,
    Wegener's granulomatosis, polyarteritis nodosa)
Crosstabulation Table:
Summary Index Table:
Arthritis can cause symptoms like pain, aching, or stiffness in or around the joint.
17.2
Data Results 17.2
Are you now limited in any way in any of your usual activities because of arthritis or joint symptoms?

INTERVIEWER INSTRUCTION: If a respondent question arises about medication, then the interviewer should reply: "Please answer the question based on how you are when you are taking any of the medications or treatments you might use."
Crosstabulation Table:
CATI INTERVIEWER INSTRUCTION: The following Q17.3 will be asked regardless of employment status.
17.3
Data Results 17.3
In this next question, we are referring to work for pay. Do arthritis or joint symptoms now affect whether you work, the type of work you do, or the amount of work you do?

INTERVIEWER INSTRUCTION: If respondent gives an answer to each issue (whether works, type work, or amount of work), then if any issue is "yes" mark the overall response as "yes." If a question arises about medications or treatment, then the interviewer should say: "Please answer the question based on your current experience, regardless of whether you are taking any medication or treatment."
17.4
Data Results 17.4
During the past 30 days, to what extent has your arthritis or joint symptoms interfered with your normal social activities, such as going shopping, to the movies, or to religious or social gatherings? Would you say…
  • A lot
  • A little
  • Not at all

INTERVIEWER INSTRUCTION: If a question arises about medications or treatments, then the interviewer should say: "Please answer the question based on your current experiences, regardless of whether you are taking any medication or treatment."
17.5
Data Results 17.5
Please think about the past 30 days, keeping in mind all of your joint pain or aching and whether or not you have taken medication. DURING THE PAST 30 DAYS, how bad was your joint pain ON AVERAGE? Please answer on a scale of 0 to 10 where 0 is no pain or aching and 10 is pain or aching as bad as it can be.
 
 
CDC Core
Section 18: Fruits and Vegetables
Crosstabulation Table:
Summary Index Table:
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.
18.1
Data Results 18.1
How often do you drink fruit juices such as orange, grapefruit, or tomato?
18.2
Data Results 18.2
Not counting juice, how often do you eat fruit?
18.3
Data Results 18.3
How often do you eat green salad?
18.4
Data Results 18.4
How often do you eat potatoes not including French fries, fried potatoes, or potatoes chips?
18.5
Data Results 18.5
How often do you eat carrots?
18.6
Data Results 18.6
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.]
 
CDC Core
Section 19: Physical Activity
Crosstabulation Table:
Summary Index Table:
CATI INTERVIEWER INSTRUCTION: If Q12.9 (employment status) = 1 "employed for wages" or 2 "self-employed" continue, otherwise go to Q19.2.
19.1
Data Results 19.1
When you are at work, which of the following best describes what you do? Would you say:
  • Mostly sitting or standing
  • Mostly walking
  • Mostly heavy labor or physically demanding work

[INTERVIEWER INSTRUCTION: If respondent has multiple jobs, include all jobs.]
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.
19.2
Data Results 19.2
Now, thinking about the moderate physical activities you do [fill in "when you are not working" if Q12.9 = 1 "employed for wages" or 2 "self-employed"] 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?
CATI NOTE: If Q19.2 = 1 "Yes" continue, otherwise go to Q19.5.
19.3
Data Results 19.3
How many days per week do you do these moderate activities for at least 10 minutes at a time?
CATI NOTE: If Q19.3 = 1-7 days per week continue, otherwise go to Q19.5.
19.4
Data Results 19.4
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:
19.5
Data Results 19.5
Now thinking about the vigorous physical activities you do [fill in "when you are not working" if "employed or "self-employed"] 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?
CATI NOTE: If Q19.5 = 1 "Yes" continue, otherwise go to next section.
19.6
Data Results 19.6
How many days per week do you do these vigorous activities for at least 10 minutes at a time?
CATI NOTE: If Q19.6 = 1-7 days per week continue, otherwise go to next section.
19.7
Data Results 19.7
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:
 
 
CDC Core
Section 20: HIV/AIDS
CATI NOTE: If respondent is 65 years old 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.
20.1
Data Results 20.1
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.
CATI NOTE: If Q20.1 = "Yes" continue, otherwise go to Q20.5.
20.2 Not including blood donations, in what month and year was your last HIV test?
INTERVIEWER INSTRUCTION: If response is before January 1985, code “Don’t know.”
20.3
Data Results 20.3
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?
CATI NOTE: Ask the following Q20.4 if Q20.2 response is within last 12 months, otherwise go to Q20.5.
20.4
Data Results 20.4
Was it a rapid test where you could get your results within a couple of hours?
20.5
Data Results 20.5
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 intravenous drugs in the past year.
  • You have been treated for a sexually transmitted or venereal 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?
Crosstabulation Table:
 
CDC Core
Section 21: Emotional Support and Life Satisfaction
The next two questions are about emotional support and your satisfaction with life.
21.1
Data Results 21.1
How often do you get the social and emotional support you need?

INTERVIEWER INTERVIEWER INSTRUCTION: If asked, say "please include support from any source".
  • Always
  • Usually
  • Sometimes
  • Rarely
  • Never
21.2
Data Results 21.2
In general, how satisfied are you with your life?
  • Very satisfied
  • Satisfied
  • Dissatisfied
  • Very dissatisfied
 
CDC Core
Section 22: Cancer Survivors
Now I am going to ask you about cancer.
22.1
Data Results 22.1
Have you EVER been told by a doctor, nurse, or other health professional that you had cancer?

READ ONLY IF NECESSARY: By "other health professional" we mean a nurse practitioner, a physician's assistant, social worker, or some other licensed professional.
Crosstabulation Table:
CATI NOTE: If Q22.1 = 1 "Yes" continue, otherwise go to next section.
22.2
Data Results 22.2
How many different types of cancer have you had?
CATI NOTE: If Q22.2 = 1 "Only one", 2 "Two" or 3 "Three or more" continue, otherwise go to next section.
22.3
Data Results 22.3
IF Q22.2 = 1 "Only one" Ask: At what age were you told you had cancer?

If Q22.2 is greater than 1 Ask: At what age was your first diagnosis of cancer?

INTERVIEWER NOTE: This question refers to the first time they were told about their first cancer.
22.4
Data Results 22.4
IF Q22.2 = 1 "Only one" Ask: What type of cancer was it?

If Q22.2 is greater than 1 Ask: With your most recent diagnoses of cancer, what type of cancer was it?

INTERVIEWER NOTE: Please read list only if respondent needs prompting for cancer type [1-28].

Breast
  • Breast Cancer
Female reproductive (Gynecologic)
  • Cervical cancer (cancer of the cervix)
  • Endometrial cancer (cancer of the uterus)
  • Ovarian cancer (cancer of the ovary)

  • Head/Neck
  • Head and neck cancer
  • Oral cancer
  • Pharyngeal (throat) cancer
  • Thyroid

  • Gastrointestinal
  • Colon (intestine) cancer
  • Esophageal (esophagus)
  • Liver cancer
  • Pancreatic (pancreas) cancer
  • Rectal (rectum) cancer
  • Stomach

  • Leukemia/Lymphoma (lymph nodes and bone marrow)
  • Hodgkin's Lymphoma (Hodgkin's disease)
  • Leukemia (blood) cancer
  • Non-Hodgkin's Lymphoma

  • Male reproductive
  • Prostate cancer
  • Testicular cancer

  • Skin
  • Melanoma
  • Other skin cancer

  • Thoracic
  • Heart
  • Lung

  • Urinary cancer
  • Bladder cancer
  • Renal (kidney) cancer

  • Others
  • Bone
  • Brain
  • Neuroblastoma
  • Other
 
CDC Section
Emergency Section 1: Adult ILI (Influenza Like Illness) [Asked September - December]
We would like to ask you some questions about recent respiratory illnesses.
ES1.1
Data Results ES1.1
During the past month, were you ill with a fever?
CATI NOTE: If ES1.1 = 1 "Yes" continue, otherwise go to ES1.8.
ES1.2
Data Results ES1.2
Did you also have a cough and/or sore throat?
CATI NOTE: If ES1.2 = 1 "Yes" continue, otherwise go to ES1.8.
ES1.3
Data Results ES1.3
When did you first become ill with fever, cough or sore throat?

INTERVIEWER NOTE: Choose the most specific answer.
  • Within the past week [past 1-7 days]
  • 2 weeks ago [past 8-14 days]
  • 3-4 weeks ago [past 15-30 days before today]
ES1.4
Data Results ES1.4
Did you visit a doctor, nurse, or other health professional for this illness?
CATI NOTE: If ES1.4 = 1 "Yes" continue, otherwise go to ES1.8.
ES1.5
Data Results ES1.5
What did the doctor, nurse, or other health professional tell you? Did they say...
  • You had regular influenza or the flu.
  • You had swine flu, also known as H1N1 or novel H1N1.
  • You had some other illness, but not the flu.
CATI NOTE:

If ES1.5 = 3 "Some other illness, not the flu", only 1 adult in the household and no children in the household then go to next section.

Otherwise if ES1.5 = 3 "Some other illness, but not the flu" go to ES1.8.
ES1.6
Data Results ES1.6
Did you have a flu test that was positive for this illness? Usually a swab from you nose or throat is tested. Would you say...
  • Yes, had flu test and it was positive.
  • No, had flu test but it was negative.
  • No, flu test was not done.
ES1.7
Data Results ES1.7
Did you receive Tamiflu® or oseltamivir [o sel TAM i veer] or an inhaled medicine called Relenza® or zanamivir [za NA mi veer] to treat this illness?
CATI NOTE:

If household has one adult, no children & adult has NOT been ill in the past month (ES1.1 or ES1.2 = 2 "No" ,7 "Don't know/Not sure" or 9 "Refused", then go to next section.

If household has one adult, no children and adult HAS been ill in the past month (ES1.1 or ES1.2 = 1 "Yes", then go to ES1.10.
ES1.8
Data Results ES1.8
Did any other members of your household have a fever with cough or sore throat during the past month?
CATI NOTE:

If ES1.8 = 2 "No", ES1.1 = 1 "Yes" and ES1.2 = 1 "Yes", then go to ES1.10.

Otherwise if ES1.8 = 2 "No" go to next section.
ES1.9
Data Results ES1.9
How many household members [CATI NOTE: If ES1.1 = 1 "Yes" and E1.2 = 1 "Yes" then insert ", including you,".] were ill during the past month?
CATI NOTE:

If (ES1.1 = 1 "Yes" and ES1.2 = 1 "Yes") or E1.8 = 1 "Yes" continue to E1.10.

Otherwise skip to next section.
ES1.10
Data Results ES1.10
How many people in your household, including you, were hospitalized for flu during the past month?

INTERVIEWER NOTE: If needed, "Hospitalized means admitted to a hospital to receive medical treatment."
 
 
CDC Module
Module 32: High Risk/Health Care Worker [Asked October - December]
The next few questions ask about health care work and chronic illness.
1
Data Results M32.1
Do you currently volunteer or work in a hospital, medical clinic, doctor's office, dentist's office, nursing home or some other health-care facility? This includes part-time or unpaid work in a health care facility as well as professional nursing care provided in the home.

INTERVIEWER NOTE: If necessary say: "This includes non-health professionals, such as administrative staff, who work in a health-care facility."
2
Data Results M32.2
Do you provide direct patient care as part of your routine work? By direct patient care we mean physical or hands-on contact with patients.

INTERVIEWER NOTE: If necessary say: If respondent answers 'don't know' or 'not sure' repeat question.
3
Data Results M32.3
Has a doctor, nurse, or other health professional ever said that you have…
  • Lung problems, other than asthma,
  • Kidney problems,
  • Anemia, including Sickle Cell or
  • A weakened immune system caused by a chronic illness or by medicines taken for a chronic illness?
CATI NOTE: If M32.3 = 1 "Yes" continue, otherwise go to next section.
4
Data Results M32.4
Do you still have (this/any of these) problem(s)?
 
CDC Module
Module 25: 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 "X"th child."

INTERVIEWER INSTRUCTION: If there are two children with the same birth date, randomly select one.
1
Data Results M25.1
What is the birth month and year of the “X"th child?
2
Data Results M25.2
Is the child a boy or a girl?
3
Data Results M25.3
Is the child Hispanic or Latino?
4
Data Results M25.4
Which one or more of the following would you say is the race of the child?
[Check all that apply]
5
Data Results M25.5
Which one of these groups would you say best represents the child's race?
6
Data Results M25.6
How are you related to the child?
 
CDC Module
Module 33: Novel H1N1 Childhood Immunization [Asked October - December]
CATI NOTE:
If response to Core Q12.7 = 88 (No children under age 18) or 99 (Refused), go to next module.

If selected child's age is greater then or equal to 6 months, continue. Otherwise, go to next module.
The next questions are about this child's immunization.

I will first ask you questions about vaccination for H1N1 flu, which is sometimes called swine flu or pandemic flu, and then ask you questions about vaccination for seasonal flu.

There are two ways to get the H1N1 flu vaccination. One is a shot in the arm and the other is a spray, mist or drop in the nose.
M33.1
Data Results M33.1
Since September, 2009, has [Fill: he/she] been vaccinated either way for the H1N1 flu?

INTERVIEWER NOTE: If asked why asking about H1N1 vaccinations when not available please say: "The distribution of the H1N1 Vaccines has already started. We are trying to find out if vaccinations are currently taking place in Kansas."
CATI NOTE:
If M33.1 = 1 "Yes" continue, otherwise go to M27.1.

If selected child's age is 10 years or older, go to M33.3. Otherwise, continue.
M33.2
Data Results M33.2
Since September, 2009, how many of these H1N1 vaccinations has [Fill: he/she] received?
CATI NOTE:
If M33.2 = 1 "One vaccination or dose" or 2 "Two or more vaccination or doses" continue, otherwise go to M27.1.
M33.3
Data Results M33.3
During what month did [Fill: he/she] receive [Fill: his/her]...

CATI Note:
If selected child's age is less than 10 years old, ask:
"...first H1N1 flu vaccine?"
Otherwise, ask:"...H1N1 flu vaccine?".
M33.4
Data Results M33.4
Was this a shot or was it a vaccine sprayed in the nose?
CATI NOTE:
If selected child's age is 10 years or older, go to next module.

If M33.2 = 2 "Two or more vaccination or doses" continue, otherwise go to next module.
M33.5
Data Results M33.5
During what month did [Fill: he/she] receive [Fill: his/her] second H1N1 flu vaccine?
M33.6
Data Results M33.6
Was this a shot or was it a vaccine sprayed in the nose?
 
 
CDC Module
Module 27: Childhood Immunization [Asked January-February & October-December]
NOTE: Changes in wording to the follow questions in this module was done in September of 2009 due to the H1N1 Pandemic Flu event. Changes of wording are in red.
CATI NOTE:
If response to Core Q12.7 = 88 (No children under age 18) or 99 (Refused), go to next module.

If selected child's age is greater than or equal 6 months, continue. Otherwise, go to next module.
M27.1
Data Results M27.1
Now I will ask you questions about seasonal flu. There are two types of seasonal flu vaccinations. One is a shot and the other is a spray in the nose. During the past 12 months, has [Fill: he/she] had a seasonal flu vaccination?
CATI NOTE: If M27.1 = 1 "Yes" continue, otherwise go to next module.
M27.2 The flu vaccination may have been either the flu shot or the flu spray. The flu spray is the flu vaccination that is sprayed in the nose. During what month and year did [Fill: he/she] receive [Fill: he/she] most recent seasonal flu vaccination?
 
 
CDC Emergency Section
Emergency Section 2: Childhood ILI - Influenza Like Illness [Asked September-December]
CATI NOTE: If Q12.7 = 88 "No children under age 18" or 99 "Refused", go to next module.
The next questions are about the "X"th child.
ES2.1
Data Results ES2.1
Has the child had a fever with cough and/or sore throat during the past month?
CATI NOTE: If ES2.1 = 1 "Yes" continue, otherwise go to next module.
ES2.2
Data Results ES2.2
Did the child visit a doctor, nurse, or other health professional for this illness?
 
 
CDC Module
Module 26: Childhood Asthma Prevalence
If response to Core Q12.7 = 88 "No children under age 18" or 99 "Refused", go to next module.
The next two questions are about the "X"th child.
M26.1
Data Results M26.1
Has a doctor, nurse, or other health professional EVER said that the child has asthma?
CATI NOTE: If M26.1 = 1 "Yes" continue, otherwise go to next module.
M26.2
Data Results M26.2
Does the child still have asthma?
Crosstabulation Table:
 
 
State-Added
Module 2: Asthma Call Back Survey Information
If Q10.1 = ‘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?
 
CDC Module
Module 14: Arthritis Management
NOTE: If Core Q17.1 = 1 (Yes), continue. Otherwise, go to next module.
1.
Data Results M14.1
Earlier you indicated that you had arthritis or joint symptoms. Thinking about your arthritis or joint symptoms, which of the following best describes you today?
  • I can do everything I would like to do
  • I can do most things I would like to do
  • I can do some things I would like to do
  • I can hardly do anything I would like to do
2.
Data Results M14.2
Has a doctor or other health professional EVER suggested losing weight to help your arthritis or joint symptoms?
3.
Data Results M14.3
Has a doctor or other health professional ever suggested physical activity or exercise to help your arthritis or joint symptoms?
Note: If the respondent is unclear about whether this means an increase or decrease in physical activity, this means increase.
4.
Data Results M14.4
Have you EVER taken an educational course or class to teach you how to manage problems related to your arthritis or joint symptoms?
 
 
State-Added
Module 3: Arthritis Call Back Survey Information
[Asked March, 2009 through September, 2009]
INTERVIEWER INSTRUCTION: If Core Q17.1 = 1 (Yes), continue. Otherwise, go to next module.
We would like to call you again within the next 2 weeks to talk in more detail about your experiences with arthritis. The information will be used to help develop programs and improve the quality of life of Kansans with arthritis. 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.
1. Would it be all right if we call back at a later time to ask additional questions about your arthritis?
2. Can I please have your first name, initials or nickname so we know who to refer to when we call back?
Some of the information that you shared with us today could be useful when combined with the information we will ask for during your arthritis interview. If the information from the two interviews is combined, identifying information such as your phone number and your name will not be included.
3. May we combine your answers from today with your answers from the interview about arthritis that will be done in the next two weeks?
 
 
State-Added
Module 4: Problem Gambling
Now I am going to ask you a few questions about gambling.
1.
Data Results SA4.1
In the last 12 months have you played the lottery, bingo, card games, slot machines, or any other betting games for money or something else of value? This activity could be at the casino, over the phone, on the computer, at the track, on the street, at home, or any other place.
Interviewer Note: If asked what we mean by "something else of value" this would include prizes, food, tickets, entertainment, or tokens for prizes.
Interviewer Note: If asked what the purpose of this question is respond: "Answers to this question will be used by health planners to help understand public gambling behavior and to develop problem gambling prevention programs."
Crosstabulation Table:
2.
Data Results M4.2for M4.2
Has the money you spent on gambling led to financial problems?
Interviewer Note: If asked what the purpose of this question is respond: "Answers to this question will be used by health planners to help understand public gambling behavior and to develop problem gambling prevention programs."
3.
Data Results M4.3for M4.3
Has the time you spent on gambling led to problems in your family, work, or personal life?
Interviewer Note: If asked what the purpose of this question is respond: "Answers to this question will be used by health planners to help understand public gambling behavior and to develop problem gambling prevention programs."
 
This year the State of Kansas BRFSS questionnaire is a split questionnaire. That is, the core questions above and the one state-added module is asked of every respondent. However, the additional CDC modules and state-added modules that follow are separated 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
CATI Interviewer instruction: Only asked of those not responding "Yes" (code = 1) to Core Q6.1 (if assigned qstpath=1).
1
Data Results M1.1
Have you had a test for high blood sugar or diabetes within the past three years?
CATI Interviewer instruction: 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?
Crosstabulation Table:
 
 
CDC Optional
Module 2: Diabetes
CATI Interviewer instruction: To be asked following Core Q6.1 (if assigned qstpath = 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 5: Diabetes Assessment
1
Data Results SA5.1

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.

  • Mother
  • Father
  • Brothers [Interviewer INTERVIEWER INSTRUCTION: include half brother]
  • Sisters [Interviewer INTERVIEWER INSTRUCTION: include half sister]
  • No one

If respondent is female, continue.
2
Data Results SA5.2
Have you had a baby weighing more then 9 pounds at birth?
 
 
CDC Module
Module 7: Actions to Control High Blood Pressure
CATI INTERVIEWER INSTRUCTION: If Core Q6.1 = 1 (Yes); continue. Otherwise, go to next module.
Are you now doing any of the following to help lower or control your high blood pressure?
1
Data Results M7.1
(Are you) changing your eating habits (to help lower or control your high blood pressure)?
2
Data Results M7.2
(Are you) cutting down on salt (to help lower or control your high blood pressure)?
3
Data Results M7.3
(Are you) reducing alcohol use (to help lower or control your high blood pressure)?
4
Data Results M7.4
(Are you) exercising (to help lower or control your high blood pressure)?
Has a doctor or other health professional ever advised you to do any of the following to help lower or control your high blood pressure?
5
Data Results M7.5
(Ever advised you to) change your eating habits (to help lower or control your high blood pressure)?
6
Data Results M7.6
(Ever advised you to) cut down on salt (to help lower or control your high blood pressure)?
7
Data Results M7.7
(Ever advised you to) reduce alcohol use (to help lower or control your high blood pressure)?
8
Data Results M7.8
(Ever advised you to) exercise (to help lower or control your high blood pressure)?
9
Data Results M7.9
(Ever advised you to) take medication (to help lower or control your high blood pressure)?
10
Data Results M7.10
Were you told on two or more different visits to a doctor or other health professional that you had high blood pressure?
If "Yes" and respondent is female, ask: "Was this only when you were pregnant?"
Crosstabulation Table:
 
 
State-Added
Module 6: Tobacco Indicators
1.
Data Results SA6.1for SA6.1
How much additional tax on a pack of cigarettes would you be willing to support if some or all of the money raised was used to support programs designed to reduce tobacco use?
  • More than two dollars a pack
  • Two dollars a pack
  • One dollar a pack
  • Fifty to ninety-nine cents a pack
  • Less than fifty cents a pack
  • No tax increase
2.
Data Results SA6.2for SA6.2
Would you support or oppose increasing the tax on smokeless tobacco? Smokeless tobacco products include chewing tobacco, snuff and snus (snus rhymes with goose).
Interviewer Note: Snus (Swedish for snuff) is moist smokeless tobacco, usually sold in small pouches, that is placed under the lip against the gum.
CATI INTERVIEWER INSTRUCTION: If Q11.2 = 3 (not at all) or Q11.3 = 1 (Yes); continue. Else got to next module.
3. When you quit smoking or the last time you tried to quit smoking, did you use nicotine replacement therapy - gum, patches, lozenges, nasal spray, inhaler, or the medications Zyban/Wellbutrin/buproprion (ZEYE ban/Well BYOU trin/byou PRO pee on) or Chantix/varenicline (SHAN tix/VAR en i cline) to assist you?

NOTE: Data for this question was collected for 1 month of the data collection period & missing for 11 months. Data collected are not complete for analysis of this question.
4. When you quit smoking or the last time you tried to quit smoking, did you use a telephone quitline to assist you?
Read if necessary: "A telephone quit line is a free telephone-based service that connects smokers with trained counselors who can help them quit smoking."

NOTE: Data for this question was collected for 1 month of the data collection period & missing for 11 months. Data collected are not complete for analysis of this question.
5. When you quit smoking or the last time you tried to quit smoking, did you use one-on-one counseling from a healthcare provider to assist you?

NOTE: Data for this question was collected for 1 month of the data collection period & missing for 11 months. Data collected are not complete for analysis of this question.
 
 
State-Added
Module 7: Oral Health
1
Data Results SA7.1
During the past 12 months, was there any time when you needed dental care but did not get it?
2
Data Results SA7.2
What was the main reason you did not receive the dental care you needed?
3
Data Results SA7.3
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:
 
CDC Optional
Module 4: Visual Impairment and Access to Eye Care
Crosstabulation Table:
Summary Index Table:
CATI Interviewer Instruction: 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)
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?
CATI INTERVIEWER INSTRUCTIONS: 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?
 
Part B
Summary Index Table:
 
CDC Module
Module 5: Inadequate Sleep
I would like to ask you a few questions about your sleep patterns.
1.
Data Results M5.1 for M5.1
On average, how many hours of sleep do you get in a 24-hour period? Think about the time you actually spend sleeping or napping, not just the amount of sleep you think you should get.
Interviewer Note: Enter hours of sleep in whole numbers, rounding 30 minutes (1/2 hour) or more up to the next whole hour and dropping 29 or fewer minutes.
2.
Data Results M5.2 for M5.2
Do you snore?
Interviewer Note: If the respondent indicates that their spouse or someone told him/her that they snore, then the answer to the question is "Yes", the respondent snores.
3.
Data Results M5.3 for M5.3
During the past 30 days, for about how many days did you find yourself unintentionally falling asleep during the day?
4.
Data Results M5.4 for M5.4
During the past 30 days, have you ever nodded off or fallen asleep, even just for a brief moment, while driving?
Crosstabulation Table:
 
 
CDC Module
Module 21: Mental Illness and Stigma
Crosstabulation Table:
Summary Index Table:
Now, I am going to ask you some questions about how you have been feeling during the past 30 days...
1
Data Results M21.1
About how often during the past 30 days did you feel nervous - would you say all of the time, most of the time, some of the time, a little of the time, or none of the time?
2
Data Results M21.2
During the past 30 days, about how often did you feel hopeless - would you say all of the time, most of the time, some of the time, a little of the time, or none of the time?
3
Data Results M21.3
During the past 30 days, about how often did you feel restless or fidgety?

[IF NECESSARY: all, most, some, a little, or none of the time?]
4
Data Results M21.4
During the past 30 days, about how often did you feel so depressed that nothing could cheer you up?

[IF NECESSARY: all, most, some, a little, or none of the time?]
5
Data Results M21.5
During the past 30 days, about how often did you feel that everything was an effort?

[IF NECESSARY: all, most, some, a little, or none of the time?]
6
Data Results M21.6
During the past 30 days, about how often did you feel worthless?

[IF NECESSARY: all, most, some, a little, or none of the time?]
[If all answers to Q1 through Q6 = "A little" or "None", skip next question]

The next question asks if any type of mental health condition or emotional problem has recently kept you from doing your work or other usual activities.
7
Data Results M21.7
During the past 30 days, for about how many days did a mental health condition or emotional problem keep you from doing your work or other usual activities?

[INTERVIEWER INSTRUCTION: If asked, "usual activities" includes housework, self-care, care giving, volunteer work, attending school, studies, or recreation]
8
Data Results M21.8
Are you now taking medicine or receiving treatment from a doctor or other health professional for any type of mental health condition or emotional problem?
Crosstabulation Table:
These next questions ask about peoples' attitudes toward mental illness and its treatment.
How much do you agree or disagree with these statements about people with mental illness…

[INTERVIEWER INTERVIEWER INSTRUCTION: If asked for the purpose of Q9 or Q10: Answers to these questions will be used by health planners to help understand public attitudes about mental illness and its treatment and to help guide health education programs].
9
Data Results M21.9
Treatment can help people with mental illness lead normal lives.
Do you - agree slightly or strongly, or disagree slightly or strongly?
10
Data Results M21.10
People are generally caring and sympathetic to people with mental illness.
Do you - agree slightly or strongly, or disagree slightly or strongly?
 
 
State-Added
Module 8: Disability
CATI INTERVIEWER INSTRUCTION: If response to Core Q14.1 or Q14.2 is "Yes" continue. Otherwise skip to next module.
1.
Data Results SA8.1
Are you restricted in any way to health care services such as physician visit, hospital inpatient care, dental visit, or mental health services?

Interviewer note: Mental health services include services that are provided by a Psychologist, psychiatrist, mental health counselor, social worker or other mental health professionals.
Crosstabulation Table:
2.
Data Results SA8.2
[Is this restriction due to…]

…physical access to buildings, offices or medical equipment needed (e.g., exam tables, scales, mammogram machines)?
3.
Data Results SA8.3
[Is this restriction due to…]

…lack of communication aids such as interpreters or alternate formats?
4.
Data Results SA8.4
[Is this restriction due to…]

…. another person such as a personal attendant or family member?
5.
Data Results SA8.5
What is the main reason for the restriction due to a personal attendant or family member? Is this due to the personal attendant or family member's…
  • Lack of training or knowledge
  • Crossing your personal boundaries
  • Refusing to provide requested services
  • Availability
  • Level of assistance
  • Willingness to do what you ask
  • Reliability
  • Trustworthiness
  • Way of treating you
6. Have you EVER been treated unfairly by a health-care provider or the provider's staff because of a disability?

NOTE: Data from respondents who responded 2, 7, and 9 to State-Added Module Q8.1 are missing. Data collected are not complete for analysis of this question.
 
 
CDC
Module 15: Tetanus Diphtheria (Adults)
Next, I will ask you about the tetanus diphtheria vaccination.
1.
Data Results M15.1
Have you received a tetanus shot in the past 10 years?
2.
Data Results M9.2
Was your most recent tetanus shot given in 2005 or later?
3.
Data Results M9.3
There are currently two types of tetanus shots available for adults. One contains the tetanus diphtheria vaccine. The other type contains tetanus diphtheria and pertussis or whooping cough vaccine. Did your doctor say your recent tetanus shot included the pertussis or whooping cough vaccine?
 
 
CDC
Module 16: Adult Human Papilloma Virus (HPV) Vaccination
CATI INTERVIEWER INSTRUCTION: To be asked of females between the ages of 18 and 49 years; otherwise, go to next module.
1.
Data Results M16.1
A vaccine to prevent the human papilloma virus or HPV infection is available and is called cervical cancer vaccine, HPV shot, or GARDASIL®. Have you EVER had the HPV vaccination?
Crosstabulation Table:
2.
Data Results M16.2
How many HPV shots did you receive?
 
 
CDC
Module 17: Shingles
CATI INTERVIEWER INSTRUCTION: If respondent is less than or equal to 49 years of age, go to next module.
The next question is about the Shingles vaccine.
1
Data Results CM17.1
Shingles is caused by the chicken pox virus. It is an outbreak of rash or blisters on the skin that may be associated with severe pain. A vaccine for shingles has been available since May 2006; it is called Zostavax®, the zoster vaccine, or the shingles vaccine. Have you had this vaccine?
Crosstabulation Table:
 
CDC
Module 29: Tetanus Diphtheria (Adolescents)
CATI Interviewer Instruction: If selected child is aged 10 to 17, continue. Otherwise, go to next module.
I would like to ask you about the tetanus diphtheria vaccine for your child.
1.
Data Results M29.1
Has he/she received a tetanus shot in the past 10 years?
2.
Data Results M29.2
Was his/her most recent tetanus shot given in 2005 or later?
3.
Data Results M29.3
There are currently two types of tetanus shots available today for older children and teenagers. One contains the tetanus diphtheria vaccine. The other type contains tetanus diphtheria and pertussis or whooping cough vaccine. Did the doctor say his/her most recent tetanus shot included the pertussis or whooping cough vaccine?
 
 
CDC
Module 28: Child Human Papilloma Virus (HPV)
CATI INTERVIEWER INSTRUCTION: If selected child is female between ages 9 and 17 years; continue. Otherwise, go to next module.
I have two additional questions about a vaccination the selected child may have had.
1.
Data Results M28.1
A vaccine to prevent the human papilloma virus or HPV infection is available and is called cervical cancer vaccine, HPV shot, or GARDASIL®. Has this child EVER had the HPV vaccination?
Crosstabulation Table:
2.
Data Results M28.2
How many HPV shots did she receive?
 
 
CDC
Module 23: Social Context
There are many different factors that can affect a person's health. I'm going to ask you about several factors that can affect a person's health.
1.
Data Results M23.1
Do you own or rent your home?

INTERVIEWER NOTE: "Other arrangement" may include group home or staying with friends or family without paying rent.
CATI Interviewer Instruction: If Q1 = 1 "Own" or 2 "Rent", continue. Otherwise go to Q3.
2.
Data Results M23.2
How often in the past 12 months would you say you were worried or stressed about having enough money to pay your rent/mortgage? Would you say you were worried or stressed---
  • Always
  • Usually
  • Sometimes
  • Rarely
  • Never
3.
Data Results M23.3
How often in the past 12 months would you say you were worried or stressed about having enough money to buy nutritious meals? Would you say you were worried or stressed---
  • Always
  • Usually
  • Sometimes
  • Rarely
  • Never
CATI Interviewer Instructions: If Core Q12.9 (employment status) equals...
  • 1 (Employed for wages) or 2 (Self-employed), go to Q4 and Q5
  • 3 (Out of work for more than 1 year), 4 (Out of work for less than 1 year), or 7 (Retired), go to Q6 and Q7
  • 5(A homemaker), 6 (A student), or 8 (Unable to work), go to Q7
4.
Data Results M23.4
At your main job or business, how are you generally paid for the work you do. Are you:
  • Paid by salary
  • Paid by the hour
  • Paid by the job/task (e.g. commission, piecework)
  • Paid some other way


INTERVIEWER NOTE: If paid in multiple ways at their main job, select option 4 (Paid some other way).
5.
Data Results M23.5
About how many hours do you work per week at all of your jobs and businesses combined?
CATI Interviewer Instruction: Go to Q8.
6.
Data Results M23.6
Thinking about the last time you worked, at your main job or business, how were you generally paid for the work you do? Were you:
  • Paid by salary
  • Paid by the hour
  • Paid by the job/task (e.g. commission, piecework)
  • Paid some other way


INTERVIEWER NOTE: If paid in multiple ways at their main job, select option 4 (Paid some other way).
7.
Data Results M23.7
Thinking about the last time you worked, about how many hours did you work per week at all of your jobs and businesses combined?
8.
Data Results M23.8
Did you vote in the last presidential election? The November 2008 election between Barack Obama and John McCain?