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?
Crosstabulation Table:
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?
Crosstabulation Table:
 
 
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, government plans such as Medicare, or Indian Health Service?
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.
Crosstabulation Table:
 
CDC Core
Section 4: Inadequate Sleep
I would like to ask you about your sleep pattern.
4.1
Data Results 4.1
On average, how many hours of sleep do you get in a 24-hour period?

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.
Crosstablulation Table:
 
CDC Core
Section 5: Hypertension Awareness
5.1
Data Results 5.1
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:
5.2
Data Results 5.2
Are you currently taking medicine for your high blood pressure?
 
 
CDC Core
Section 6: Cholesterol Awareness
6.1
Data Results 6.1
Blood cholesterol is a fatty substance found in the blood. Have you EVER had your blood cholesterol checked?
6.2
Data Results 6.2
About how long has it been since you last had your blood cholesterol checked?
Crosstabulation Table:
6.3
Data Results 6.3
Have you EVER been told by a doctor, nurse, or other health professional that your blood cholesterol is high?
Crosstabulation Table:
 
 
CDC Core
Section 7: Chronic Health Conditions
Now I would like to ask you some questions about general health conditions.
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.
7.1
Data Results 7.1
(Ever told) you had a heart attack, also called a myocardial infarction?
Crosstabulation Table:
7.2
Data Results 7.2
(Ever told) you had angina or coronary heart disease?
Crosstabulation Table:
7.3
Data Results 7.3
(Ever told) you had a stroke?
Crosstabulation Table:
7.4
Data Results 7.4
(Ever told) you had asthma?
7.5
Data Results 7.5
Do you still have asthma?
Crosstabulation Table:
Summary Index:
7.6
Data Results 7.6
(Ever told) you had skin cancer?
Crosstabulation Table:
7.7
Data Results 7.7
(Ever told) you had any other types of cancer?
Crosstabulation Table:
7.8
Data Results 7.8
(Ever told) you have Chronic Obstructive Pulmonary Disease or COPD, emphysema or chronic bronchitis?
Crosstabulation Table:
7.9
Data Results 7.9
(Ever told) you have some form of arthritis, rheumatoid arthritis, gout, lupus, or fibromyalgia?

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:
7.10
Data Results 7.10
(Ever told) you have a depressive disorder, including depression, major depression, dysthymia, or minor depression?
Crosstabulation Table:
7.11
Data Results 7.11
(Ever told) you have kidney disease? DO NOT include kidney stones, bladder infection or incontinence.
Crosstabulation Table:
7.12
Data Results 7.12
(Ever told) 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 8: Demographics
8.1
Data Results 8.1
What is your age?
8.2
Data Results 8.2
Are you Hispanic, Latino/a, or Spanish origin?
8.3
Data Results 8.3
Which one or more of the following would you say is your race? (Mark all that Apply)
If more than one response to Q8.3, continue. Otherwise, go to Q8.5.
8.4
Data Results 8.4
Which one of these groups would you say BEST represents your race?
8.5
Data Results 8.5

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.

Crosstabulation Table:
8.6
Data Results 8.6
Are you:
  • Married
  • Divorced
  • Widowed
  • Separated
  • Never been married
  • A member of an unmarried couple
8.7
Data Results 8.7
How many children less than 18 years of age live in your household ?
8.8
Data Results 8.8
What is the highest grade or year of school you completed?
8.9
Data Results 8.9
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
8.10
Data Results 8.10
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
State-Added 1: Average Hours Worked
If Core Q8.9 = 1 (Employed for Wages), 2 (Self-Employed), 5 (A Homemaker), 6 (A Student) or 7 (Retired); skip out of the Demographics Core Section to ask the State-Added Average Hours Worked Module.
1.
Data Results SA1.1
Previously, you indicated you were (a) [insert response from core reported employment status]. On the average, how many hours per week, if any, do you work at a job or business?
Skip back into Demographics Core Section at Q8.11, and continue with the survey.
 
8.11 About how much do you weigh without shoes?
[Round fractions up]
 
8.12 About how tall are you without shoes?
[Round fractions down]
Crosstabulation Table:
Summary Index Table:
8.13 What county do you live in?
8.14
What is your ZIP Code where you live?
Data Results Table:
If Landline Survey; continue.

If Cell Phone Survey; skip to Q8.19.
8.15
Data Results 8.15
Do you have more than one telephone number in your household?
Do not include cell phones or numbers that are only used by a computer or fax machine.
8.16
Data Results 8.16
How many of these phone numbers are residential numbers?
8.17
Data Results 8.17
Do you have a cell phone for personal use? Please include cell phones used for both business and personal use.
If Q8.17 = 2 (No), skip to Q8.19
8.18
Data Results 8.18
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?
8.19
Data Results 8.19
Have you used the internet in the past 30 days?
8.20
Data Results 8.20
Do you own or rent your home?

INTERVIEWER NOTE: "Other arrangement" may include group homes, staying with friends or family without paying rent.

INTERVIEWER NOTE: Home is defined as the place where you live most of the time/the majority of the year.
8.21
Data Results 8.21
Indicate sex of respondent. (Asked Only if Necessary)
If Q8.21 = 1 (Male) or Q8.21 = 2 (female) and is 45 years old or older, skip to next section.
8.22
Data Results 8.22
To your knowledge, are you now pregnant?
 
The following questions are about health problems or impairments you may have.
Crosstabulation Table:
Summary Index:
8.23
Data Results 8.23
Are you limited in any way in any activities because of physical, mental, or emotional problems?
Crosstabulation Table:
8.24
Data Results 8.24
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?

INTERVIEWER NOTE: Include occasional use or use in certain circumstances.

8.25
Data Results 8.25
Are you blind or do you have serious difficulty seeing, even when wearing glasses?
8.26
Data Results 8.26
Because of a physical, mental, or emotional condition, do you have serious difficulty concentrating, remembering, or making decisions?
8.27
Data Results 8.27
Do you have serious difficulty walking or climbing stairs?
8.28
Data Results 8.28
Do you have difficulty dressing or bathing?
8.29
Data Results 8.29
Because of a physical, mental, or emotional condition, do you have difficulty doing errands alone such as visiting a doctor's office or shopping?
 
 
CDC Core
Section 9: Tobacco Use
9.1
Data Results 9.1
Have you smoked at least 100 cigarettes in your entire life?
[NOTE: 5 packs = 100 cigarettes]
If Q9.1 = 1 (Yes); continue. Otherwise, go to Q9.5.
9.2
Data Results 9.2
Do you now smoke cigarettes every day, some days, or not at all?
Crosstabulation Table:
Summary Index Table:
If Q9.2 = 1 (Every day) or 2 (Some days); continue. Otherwise, if Q9.2 = 3 (Not at all); go to Q9.4. Else, go to Q9.5.
9.3
Data Results 9.3
During the past 12 months, have you stopped smoking for one day or longer because you were trying to quit smoking?
Crosstabulation Table:
Go to Q9.5.
9.4
Data Results 9.4
How long has it been since you last smoked a cigarette, even one or two puffs?
9.5
Data Results 9.5
Do you currently use chewing tobacco, snuff or snus every day, some days or not at all? (Snus rhymes with 'goose')

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 10: Alcohol Consumption
10.1
Data Results 10.1
During the past 30 days, how many days per week or per month did you have at least one drink of any alcoholic beverage such as beer, wine, a malt beverage or liquor?
If Q10.1 = 888 "No drinks in past 30 days", 777 "Don't know/Not sure" or 999 "Refused"; go to next section.
10.2
Data Results 10.2
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?

INTERVIEWER NOTE: A 40 ounce beer would count as 3 drinks, or a cocktail drink with 2 shots would count as 2 drinks.
Crosstabulation Table:
Summary Index:
10.3
Data Results 10.3
Considering all types of alcoholic beverages, how many times during the past 30 days did you have X [X = 5 for men, X = 4 for women] or more drinks on one occasion?
Crosstabulation Table:
Summary Index:
10.4
Data Results 10.4
During the past 30 days, what is the largest number of drinks you had on any occasion?
 
CDC Core
Section 11: Fruits and Vegetables
Crosstabulation Table:
Summary Index::
These next questions are about the fruits and vegetables you ate or drank during the past 30 days. Please think about all forms of fruits and vegetables including cooked or raw, fresh, frozen or canned. Please think about all meals, snacks, and food consumed at home and away from home.
I will be asking how often you ate or drank each one: for example, once a day, twice a week, three times a month, and so forth.
INTERVIEWER NOTE:
If respondent responds less than once per month, put "0" times per month.
If respondent gives a number without a time frame, ask: "
Was that per day, week, or month?"
11.1
Data Results 11.1
During the past month, how many times per day, week or month did you drink 100% PURE fruit juices? Do not include fruit-flavored drinks with added sugar or fruit juice you made at home and added sugar to. Only include 100% juice.

INTERVIEWER NOTE:

DO NOT INCLUDE fruit drinks with added sugar or other added sweeteners like Kool-aid, Hi-C, lemonade, cranberry cocktail, Tampico, Sunny Delight, Snapple, Fruitopia, Gatorade, Power-Ade, or yogurt drinks. Do not include fruit juice drinks that provide 100% daily vitamin C but include added sugar.

DO NOT INCLUDE vegetable juices such as tomato and V8 if respondent provides but include in "other vegetables" Q11.6.

INCLUDE 100% pure juices including orange, mango, papaya, pineapple, apple, grape (white or red), or grapefruit. Only count cranberry juice if the R perception is that it is 100% juice with no sugar or artificial sweetener added. 100% juice blends such as orange-pineapple, orange-tangerine, cranberry-grape are also acceptable as are fruit-vegetable 100% blends. 100% pure juice from concentrate (i.e., reconstituted) is counted.

11.2
Data Results 11.2
During the past month, not counting juice, how many times per day, week, or month did you eat fruit? Count fresh, frozen, or canned fruit.

Read only if necessary: "Your best guess is fine. Include apples, bananas, applesauce, oranges, grape fruit, fruit salad, watermelon, cantaloupe or musk melon, papaya, lychees, star fruit, pomegranates, mangos, grapes, and berries such as blueberries and strawberries."

INTERVIEWER NOTE:

DO NOT INCLUDE fruit jam, jelly, or fruit preserves.

DO NOT INCLUDE dried fruit in ready-to-eat cereals.

INCLUDE dried raisins, cran-raisins if respondent tells you (but due to their small serving size they are not included In the prompt).

INCLUDE cut up fresh, frozen, or canned fruit added to yogurt, cereal, jello, and other meal items.

INCLUDE culturally and geographically appropriate fruits that are not mentioned (e.g. genip, soursop, sugar apple, figs, tamarind, bread fruit, sea grapes, carambola, longans, lychees, akee, rambutan, etc.).

11.3
Data Results 11.3
During the past month, how many times per day, week, or month did you eat cooked or canned beans, such as refried, baked, black, garbanzo beans, beans in soup, soybeans, edamame, tofu or lentils. DO NOT INCLUDE long green beans.

Read only if necessary: "Include round or oval beans or peas such as navy, pinto, split peas, cow peas, hummus, lentils, soy beans and tofu. Do NOT include long green beans such as string beans, broad or winged beans, or pole beans. "

INTERVIEWER NOTE:

INCLUDE soybeans also called edamame, TOFU (BEAN CURD MADE FROM SOYBEANS), kidney, pinto, hummus, lentils, black, black-eyed peas, cow peas, lima beans and white beans. Include bean burgers including garden burgers and veggie burgers.

INCLUDE falafel and tempeh.

11.4
Data Results 11.4
During the past month, how many times per day, week, or month did you eat dark green vegetables for example broccoli or dark leafy greens including romaine, chard, collard greens or spinach?

INTERVIEWER NOTE:

Each time a vegetable is eaten it counts as one time.

DO NOT INCLUDE iceberg (head) lettuce if specifically told type of lettuce.

INCLUDE all raw leafy green salads including spinach, mesclun, romaine lettuce, bok choy, dark green leafy lettuce, dandelions, komatsuna, watercress, and arugula.

INCLUDE all cooked greens including kale, collard greens, choys, turnip greens, mustard greens.

11.5
Data Results 11.5
During the past month, how many times per day, week, or month did you eat orange-colored vegetables such as sweet potatoes, pumpkin, winter squash, or carrots?

Read only if needed: "Winter squash have hard, thick skins and deep yellow to orange flesh. They include acorn, buttercup, and spaghetti squash."

INTERVIEWER NOTE:

INCLUDE all forms of carrots including long or baby-cut.

INCLUDE carrot-slaw (e.g. shredded carrots with or without other vegetables or fruit).

INCLUDE all forms of sweet potatoes including baked, mashed, casserole, pie, or sweet potatoes fries.

INCLUDE all hard-winter squash varieties including acorn, autumn cup, banana, butternut, buttercup, delicate, hubbard, kabocha (Also known as an Ebisu, Delica, Hoka, Hokkaido, or Japanese Pumpkin; blue kuri), and spaghetti squash. Include all forms including soup.

INCLUDE Include pumpkin, including pumpkin soup and pie. Do not include pumpkin bars, cake, bread or other grain-based desert-type food containing pumpkin (i.e. similar to banana bars, zucchini bars we do not include).

11.6
Data Results 11.6
Not counting what you just told me about, during the past month, about how many times per day, week, or month did you eat OTHER vegetables? Examples of other vegetables include tomatoes, tomato juice or V-8 juice, corn, eggplant, peas, lettuce, cabbage, and white potatoes that are not fried such as baked or mashed potatoes.

Read only if needed: "Do not count vegetables you have already counted and do not include fried potatoes."

INTERVIEWER NOTE:

DO NOT INCLUDE products consumed usually as condiments including ketchup, catsup, salsa, chutney, relish.

DO NOT INCLUDE rice or other grains.

INCLUDE corn, peas, tomatoes, okra, beets, cauliflower, bean sprouts, avocado, cucumber, onions, peppers (red, green, yellow, orange); all cabbage including American-style cole-slaw; mushrooms, snow peas, snap peas, broad beans, string, wax-, or pole-beans.

INCLUDE any form of the vegetable (raw, cooked, canned, or frozen).

INCLUDE tomato juice if respondent did not count in fruit juice.

INCLUDE culturally and geographically appropriate vegetables that are not mentioned (e.g. daikon, jicama, oriental cucumber, etc.).

 
CDC Core
Section 12: Exercise (Physical Activity)
Crosstabulation Table:
Summary Index::
The next few questions are about exercise, recreation, or physical activities other than your regular job duties.
INTERVIEWER INSTRUCTION:
If respondent does not have a "regular job duty" or is retired, they may count the physical activity or exercise they spend the most time doing in a regular month.
12.1
Data Results 12.1
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:
CATI NOTE: If Q12.1 = 1 "Yes"; continue, otherwise go to Q12.8.
12.2
What type of physical activity or exercise did you spend the most time doing during the past month? (First Activity)
See Physical Activity Coding List (Please refer to the .pdf of the Questionnaire for the 2013 survey.)

INTERVIEWER INSTRUCTION: If the respondent's activity is not included in the Physical Activity Coding List, choose the option listed as "Other".

INTERVIEWER NOTE:

Housework may be included as a physical activity or exercise spent and can be coded as "Other".

CATI NOTE: If Q12.2 = 77 "Don't know/Not sure" or 99 "Refused", go to Q12.8.
12.3
Data Results 12.3
How many times per week or per month did you take part in this activity during the past month? (First Activity)
12.4
Data Results 12.4
And when you took part in this activity, for how many minutes or hours did you usually keep at it? (First Activity)
12.5
What other type of physical activity gave you the next most exercise during the past month? (Second Activity)
See Physical Activity Coding List (Please refer to the .pdf of the Questionnaire for the 2013 survey.)

INTERVIEWER INSTRUCTION: If the respondent's activity is not included in the Physical Activity Coding List, choose the option listed as "Other ".

CATI NOTE: If Q12.5 = 88 "No other activity", 77 "Don't know/Not sure" or 99 "Refused", go to Q12.8.
12.6
Data Results 12.6
How many times per week or per month did you take part in this activity during the past month?(Second Activity)
12.7
Data Results 12.7
And when you took part in this activity, for how many minutes or hours did you usually keep at it? (Second Activity)
12.8
Data Results 12.8
During the past month, how many times per week or per month did you do physical activities or exercises to STRENGTHEN your muscles? Do NOT count aerobic activities like walking, running, or bicycling. Count activities using your own body weight like yoga, sit-ups or push-ups and those using weight machines, free weights, or elastic bands.
 
CDC Core
Section 13: Arthritis Burden
CATI NOTE: If Q7.9 = 1 "Yes" then continue, else go to next section.
Next, I will ask you about your arthritis
Arthritis can cause symptoms like pain, aching, or stiffness in or around a joint.
13.1
Data Results 13.1
Are you now limited in any way in any of your usual activities because of arthritis or joint symptoms?

INTERVIEWER INSTRUCTION: 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."

Crosstabulation Table:
CATI Note: Next question, Q13.2, should be asked of all respondents regardless of employment status.
13.2
Data Results Q13.2
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 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."
13.3
Data Results Q13.3
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."
13.4
Data Results Q13.4
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 14: Seatbelt Use
14.1
Data Results 14.1
How often do you use seat belts when you drive or ride in a car? Would you say...
  • Always
  • Nearly Always
  • Sometimes
  • Seldom
  • Never
Crosstabulation Table:
 
CDC Core
Section 15: Immunization
15.1
Data Results 15.1

Now I will ask you questions about the flu vaccine. There are two ways to get the flu vaccine, one is a shot in the arm and the other is a spray, mist, or drop in the nose called FluMist?

During the past 12 months, have you had either a flu shot or a flu vaccine that was sprayed in your nose?

READ IF NECESSARY:
"A new flu shot came out in 2011 that injects vaccine into the skin with a very small needle. It is called Fluzone Intradermal vaccine. This is also considered a flu shot."

Crosstabulation Table:
If Q15.1 = 1 (Yes); continue. Else, go to Q15.4.
15.2 During what month and year did you receive your most recent flu shot injected into your arm or flu vaccine that was sprayed in your nose?
15.3
Data Results 15.3
Since 2005, have you had a tetanus shot?

If "yes", ask:

"Was this Tdap, the tetanus shot that also has pertussis or whooping cough vaccine?

15.4
Data Results 15.4
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 16: HIV/AIDS
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 don't want to. Although we will ask you about testing, we will not ask you about the results of any test you may have had.
16.1
Data Results 16.1
Have you ever been tested for HIV? Do not count tests you may have had as part of a blood donation. Include testing fluid from your mouth.
Crosstabulation Table:
Summary Index Table:
If Q16.1 = 1 (Yes); continue. Otherwise, go to NEXT MODULE.
16.2 Not including blood donations, in what month and year was your last HIV test?

INTERVIEWER NOTE:

If response is before January 1985, code "Don't know."

If the respondent remembers the year but cannot remember the month, code the first two digits 77 and the last four digits for the year.

16.3
Data Results 16.3
Where did you have your last HIV test - at a private doctor or HMO office, at a counseling and testing site, at an emergency room, as an inpatient in a hospital, at a clinic, in a jail or prison, at a drug treatment facility, at home, or somewhere else?
  • Private doctor or HMO office
  • Counseling and testing site
  • Emergency room
  • Hospital inpatient
  • Clinic
  • Jail or prison (or other correctional facility)
  • Drug treatment facility
  • At home
  • Somewhere else
 
CDC Optional
Module 20: Random Child Selection

CATI NOTE: If Core Question 8.7 = 88, or 99 (no children under age 18 in the household or refused); go to NEXT MODULE.

INTERVIEWER INSTRUCTION:

If Core Section Q8.7 = 1 Child, interviewer please read:
"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 Section Q8.7 > 1 Child, interviewer please read:
"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."

I have some additional questions about one specific child. The child I will be referring to is the "Xth" child in your household. All following questions about children will be about the "Xth" child.
M20.1
Data Results M20.1
What is the birth month and year of the "Xth" child?
M20.2
Data Results M20.2
Is the child a boy or a girl?
M20.3
Data Results M20.3
Is the child Hispanic, Latino/a, or Spanish origin?
M20.4
Data Results M20.4
Which one or more of the following would you say is the race of the child?
[Check all that apply]
If more than one response to M20.4, continue. Otherwise, go to M20.6.
M20.5
Data Results M20.5
Which one of these groups would you say best represents the child's race?
M20.6
Data Results M20.6
How are you related to the child?
 
CDC Optional
Module 21: Childhood Asthma Prevalence
CATI NOTE: If response to Core Q8.7 = 88 "No children under age 18" or 99 "Refused", go to NEXT MODULE.
The next two questions are about the "Xth" child.
M21.1
Data Results M21.1
Has a doctor, nurse, or other health professional EVER said that the child has asthma?
If M21.1 = 1 "Yes"; continue. Otherwise, go to NEXT MODULE.
M21.2
Data Results M21.2
Does the child still have asthma?
Crosstabulation Table:
 
State-Added
Module 2: Childhood Diabetes
CATI NOTE: If Core Q8.7 = 88, or 99 (No children under age 18 in the household, or Refused); go to NEXT MODULE.
Now, I would like to ask you about the "Xth" child.
SA2.1
Data Results SA2.1
Has a doctor, nurse or other health professional EVER said the child has diabetes?
 
 
State-Added
Module 3: Sugar Sweetened Beverage Consumption Among Children
CATI NOTE: If Core Q8.7 = 88, or 99 (No children under age 18 in the household, or Refused); go to NEXT MODULE.
Crosstabulation Table:
Summary Index:

These next questions are about the milk, soda and other sugar sweetened beverages the "Xth" child drank during the past 30 days.

I will be asking how often the "Xth" child drank each one: for example, once a day, twice a week, three times a month, and so forth.

INTERVIEWER NOTE:

If respondent responds less than once per month, put "0" times per month.

If respondent gives a number without a time frame, ask: "Was that per day, week, or month?"

SA3.1
Data Results SA3.1
Flavored milk is plain milk which has had a flavoring such as chocolate or strawberry added to it. During the past 30 days, how often did [Fill in: he/she] drink flavored milk?
SA3.2
Data Results SA3.2
During the past 30 days, how often did [Fill in: he/she] drink regular soda or pop that contains sugar? Do not include diet soda or diet pop.
Crosstabulation Table:
SA3.3
Data Results SA3.3
During the past 30 days, how often did [Fill in: he/she] drink sugar sweetened beverages such as punch, Kool-Aid, sports drinks, other fruit flavored drinks or sweet tea? Do not include 100% fruit juice, milk, soda or non-calorie beverages.

NOTE: Fruit flavored drinks are sweetened beverages that often contain some fruit juice or flavoring.
 
 
State-Added
Module 4: Asthma Call Back Survey Information (Asked of Landline Respondents Only)
If Adult Asthma Q7.4 = 1 (Yes) or Childhood Asthma Prevalence CDC Module Q21.1 = 1 (Yes) and Random Child Selection CDC Module Q20.6 = 1 (Parent) or 3 (Foster parent or guardian) then continue. Otherwise, go to NEXT MODULE.
SA4.1
We would like to call you again within the next 2 weeks to talk in more detail about your experiences with asthma. The information will be used to help develop programs 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 all right if we call back at a later time to ask additional questions about your asthma?
 
 
State-Added
Module 5: Cognitive Impairment
SA5.1
Data Results SA5.1
The next few questions ask about difficulties in thinking or remembering that can make a big difference in everyday activities. This does not refer to occasionally forgetting your keys or the name of someone you recently met. This refers to things like confusion or memory loss that are happening more often or getting worse. We want to know how these difficulties impact you.

During the past 12 months, have you experienced confusion or memory loss that is happening more often or is getting worse?
Crosstabulation Table:
CATI NOTE: If Q1 = 1 (Yes) then continue. Otherwise, go to NEXT MODULE.
SA5.2
Data Results SA5.2
During the past 12 months, how often "have you”; given up household activities or chores"you” used to do, because of confusion or memory loss that is happening more often or is getting worse? Would you say...
  • Always
  • Usually
  • Sometimes
  • Rarely
  • Never
Crosstabulation Table:
SA5.3
Data Results SA5.3
As a result of "your” confusion or memory loss, in which of the following four areas "do you” need the MOST assistance? Would you say...
  • Safety [Read only if necessary: such as forgetting to turn off the stove or falling]
  • Transportation [Read only if necessary: such as getting to doctor's appointments]
  • Household activities [Read only if necessary: such as managing money or housekeeping]
  • Personal care [Read only if necessary: such as eating or bathing]
SA5.4
Data Results SA5.4
During the past 12 months, how often has confusion or memory loss interfered with "your” ability to work, volunteer, or engage in social activities? Would you say...
  • Always
  • Usually
  • Sometimes
  • Rarely
  • Never
Crosstabulation Table:
SA5.5
Data Results SA5.5
During the past 30 days, how often has a family member or friend provided any care or assistance for "you” because of confusion or memory loss? Would you say...
  • Always
  • Usually
  • Sometimes
  • Rarely
  • Never
Crosstabulation Table:
SA5.6
Data Results SA5.6
Has anyone discussed with a health care professional, increases in "your” confusion or memory loss?
CATI NOTE: If Q6 = 1 (Yes) then continue. Otherwise, go to NEXT MODULE.
SA5.7
Data Results SA5.7
Have "you” received treatment such as therapy or medications for confusion or memory loss?
SA5.8
Data Results SA5.8
Has a health care professional ever said "you have” Alzheimer's disease or some other form of dementia?
Crosstabulation Table:
Summary Index:
 
State-Added
Module 6: Oral Health (CDC Rotating Core Section)
SA6.1
Data Results SA6.1
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.
SA6.2
Data Results SA6.2
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.

INTERVIEWER 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:
 
 
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 Optional 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 NOTE:
If Core Section 7 Q7.12 > 1, continue. Otherwise, go to Core Section 8.

Only asked of those not responding "Yes” (code = 1) to Core Section Q7.12 (Diabetes awareness question).
M1.1
Data Results M1.1
Have you had a test for high blood sugar or diabetes within the past three years?
If Core Q5.13 = 4 (No, pre-diabetes or borderline diabetes); answer Q2 "Yes" (code = 1).
M1.2
Data Results M1.2

Have you ever been told by a doctor or other health professional that you have pre-diabetes or borderline diabetes?

If "Yes" and respondent is female, ask: "Was this only when you were pregnant?"

Crosstabulation Table:
CATI NOTE: Go Back to Core Section 8.
 
 
CDC Optional
Module 2: Diabetes
CATI NOTE:
If Core Section 7 Q7.12 = 1 (Yes), continue. Otherwise, go to Core Section 8.
M2.1
Data Results M2.1
How old were you when you were told you have diabetes?
M2.2
Data Results M2.2
Are you now taking insulin?
M2.3
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.
M2.4
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.
M2.5
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?
M2.6
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" ?
CATI NOTE: If Q4 = 555 (No feet), go to Q8.
M2.7
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?
M2.8
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.
M2.9
Data Results M2.9
Has a doctor EVER told you that diabetes has affected your eyes or that you had retinopathy?
M2.10
Data Results M2.10
Have you EVER taken a course or class in how to manage your diabetes yourself?
CATI NOTE: Go Back to Core Section 8.
 
 
State-Added
Module 7: Diabetes Risk Assessment
SA7.1
Data Results SA7.1

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 INSTRUCTION: include half brother]
  • Sisters [INTERVIEWER INSTRUCTION: include half sister]
  • No one
CATI NOTE: If respondent is female, continue. Otherwise, go to NEXT MODULE.
SA7.2
Data Results SA7.2
Have you had a baby weighing more then 9 pounds at birth?
 
 
CDC Optional
Module 5: Sugar Drinks
Now I would like to ask you some questions about sugary beverages.
Crosstabulation Table:
Summary Index:
M5.1
Data Results M5.1

During the past 30 days, how often did you drink regular soda or pop that contains sugar? Do not include diet soda or diet pop.

Please read: You can answer times per day, week, or month: for example, twice a day, once a week, and so forth.

Crosstabulation Table:
M5.2
Data Results M5.2

During the past 30 days, how often did you drink sugar-sweetened fruit drinks (such as Kool-aid and lemonade), sweet tea, and sports or energy drinks (such as Gatorade and Red Bull)? Do not include 100% fruit juice, diet drinks, or artificially sweetened drinks.

Please read: You can answer times per day, week, or month: for example, twice a day, once a week, and so forth.

Crosstabulation Table:
 
 
CDC
Module 6: Sodium or Salt Related Behavior
Now I would like to ask you some questions about sodium or salt intake.

Most of the sodium or salt we eat comes from processed foods and foods prepared in restaurants. Salt also can be added in cooking or at the table.
M6.1
Data Results for M6.1
Are you currently watching or reducing your sodium or salt intake?
CATI NOTE: If Core M6.1 = 1 (Yes); continue. Otherwise, go to M6.3.
M6.2
Data Results for M6.2
How many days, weeks, months, or years have you been watching or reducing your sodium or salt intake?
M6.3
Data Results for M6.3
Has a doctor or other health professional ever advised you to reduce sodium or salt intake?
 
 
State-Added
Module 8: Salt Intake
SA8.1
Data Results SA8.1

Within the past 30 days, did you buy food from a store or a restaurant labeled "low salt” or "low sodium.” Would you say...

  • Yes
  • No
  • Did not buy food in the past 30 days
Crosstabulation Table:
 
 
State-Added
Module 9: Actions to Control High Blood Pressure
CATI NOTE: If Core Q5.1 = 1 (Yes); continue. Otherwise, go to NEXT MODULE.

Earlier you stated that you had been diagnosed with high blood pressure.

Are you now doing any of the following to help lower or control your high blood pressure?

SA9.1
Data Results SA9.1
(Are you) changing your eating habits (to help lower or control your high blood pressure)?
SA9.2
Data Results SA9.2

IF CDC Module 6 Q1 = 1 (Yes); please read:
You had indicated previously that you are currently watching or reducing your sodium or salt intake.

(Are you) cutting down on salt (to help lower or control your high blood pressure)?

SA9.3
Data Results SA9.3
(Are you) reducing alcohol use (to help lower or control your high blood pressure)?
SA9.4
Data Results SA9.4
(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?
SA9.5
Data Results SA9.5
(Ever advised you to) change your eating habits (to help lower or control your high blood pressure)?
SA9.6
Data Results SA9.6

IF CDC Module 6 Q1 = 1 (Yes); please read:
You had indicated previously that a doctor or other health professional advised you to reduce sodium or salt intake.

(Ever advised you to) cut down on salt (to help lower or control your high blood pressure)?

SA9.7
Data Results SA9.7
(Ever advised you to) reduce alcohol use (to help lower or control your high blood pressure)?
SA9.8
Data Results SA9.8
(Ever advised you to) exercise (to help lower or control your high blood pressure)?
SA9.9
Data Results SA9.9
(Ever advised you to) take medication (to help lower or control your high blood pressure)?
SA9.10
Data Results SA9.10

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?"
 
 
State-Added
Module 10: Tobacco Indicators
The next questions refer to tobacco issues.
SA10.1
Data Results for SA10.1
The Kansas State Legislature passed a statewide smoking ban in 2010 that prohibits smoking in indoor public places. Do you support or oppose this law?

INTERVIEWER NOTE: The Kansas Indoor Clean Air Act bans smoking in restaurants, bars, work places and other indoor public places, but does not ban smoking in casinos, 20% of hotel rooms and some private clubs.
Crosstabulation Table:
SA10.2
Data Results for SA10.2
A telephone quitline is a free telephone-based service that connects people who use tobacco with someone who can help them quit. Are you aware of any telephone quitline services that are available to help "you” [or "people”] quit using tobacco?
SA10.3
Data Results for SA10.3
Have you ever tried smoking cigars, cigarillos, or very small cigars that look like cigarettes in your entire life, even one or two puffs?

IF RESPONDENT IS UNSURE WHAT CIGARILLOS ARE, SAY: "Cigarillos are small, regular cigars. They are usually sold individually or in packs of 5 or 8. Some common brands are Black and Mild's, Swisher Sweets Cigarillos, and Phillies Blunts, but there are others.”

IF RESPONDENT IS UNSURE WHAT VERY SMALL CIGARS THAT LOOK LIKE CIGARETTES ARE, SAY:"Very small cigars that look like cigarettes are usually brown in color and have a spongy filter like a cigarette. They are about the same size as cigarettes and are often sold in packs of 20. Some common brands are Prime Time little filter cigars and Winchester little filter cigars, but there are others.”
Crosstabulation Table:
CATI NOTE: If State-Added Q10.3 = 1 (Yes); continue. Otherwise, go to Q5.
SA10.4
Data Results for SA10.4
During the past 30 days, that is, since [fill in with appropriate DATE], on how many days did you smoke cigars, cigarillos, or very small cigars that look like cigarettes?

IF RESPONDENT IS UNSURE WHAT CIGARILLOS ARE, SAY: "Cigarillos are small, regular cigars. They are usually sold individually or in packs of 5 or 8. Some common brands are Black and Mild's, Swisher Sweets Cigarillos, and Phillies Blunts, but there are others.”

IF RESPONDENT IS UNSURE WHAT VERY SMALL CIGARS THAT LOOK LIKE CIGARETTES ARE, SAY:"Very small cigars that look like cigarettes are usually brown in color and have a spongy filter like a cigarette. They are about the same size as cigarettes and are often sold in packs of 20. Some common brands are Prime Time little filter cigars and Winchester little filter cigars, but there are others.”
Crosstabulation Table:
SA10.5
Data Results for SA10.5
Have you ever used or tried any dissolvable tobacco products such as Ariva, Stonewall, orbs, sticks, or strips?

INTERVIEWER NOTE: Dissolvable tobacco is finely milled tobacco which dissolves in the mouth.
Crosstabulation Table:
SA10.6
Data Results for SA10.6
Have you ever used or tried Electronic Cigarettes or E-cigarettes, such as Ruyan or NJOY?
Crosstabulation Table:
 
 
State-Added
Module 11: Family History of Cancer, Genetic Counseling/Testing
SA11.1
Data Results for SA11.1
Do you have a family history of [Fill with: if female "breast, ovarian, or colorectal” or if male "breast or colorectal”] cancer? Include only blood relatives. Do not include adoptive or those related only by marriage.
Crosstabulation Table:
SA11.2
Data Results for SA11.2
Have you ever received genetic counseling for cancer? This would include a conversation with an expert, a suitably trained health care provider, about your hereditary risk of cancer.
Crosstabulation Table:
SA11.3
Data Results for SA11.3
Have you ever had a blood or saliva test to determine your hereditary risk for cancer? A doctor or other health professional would have ordered this test and you would have received the results.
 
 
Part B
Summary Index Table:
 
CDC Optional
Module 9: Arthritis Management
CATI NOTE: If Core Q7.9 = 1 (Yes), continue. Otherwise, go to NEXT MODULE.
M9.1
Data Results M9.1
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
M9.2
Data Results M9.2
Has a doctor or other health professional EVER suggested losing weight to help your arthritis or joint symptoms?
M9.3
Data Results M9.3
Has a doctor or other health professional ever suggested physical activity or exercise to help your arthritis or joint symptoms?

INTERVIEWER NOTE:

If the respondent is unclear about whether this means an increase or decrease in physical activity, this means increase.

M9.4
Data Results M9.4
Have you EVER taken an educational course or class to teach you how to manage problems related to your arthritis or joint symptoms?
 
 
CDC Module
Module 17: Mental Illness and Stigma
Crosstabulation Table:
Summary Index Table:
Now, I am going to ask you some questions about how you have been feeling lately.
M17.1
Data Results M17.1
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?
M17.2
Data Results M17.2
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?
M17.3
Data Results M17.3
During the past 30 days, about how often did you feel restless or fidgety?

[IF NECESSARY, READ: Would you say: all, most, some, a little, or none of the time?]

M17.4
Data Results M17.4
During the past 30 days, about how often did you feel so depressed that nothing could cheer you up?

[IF NECESSARY, READ: Would you say: all, most, some, a little, or none of the time?]

M17.5
Data Results M17.5
During the past 30 days, about how often did you feel that everything was an effort?

INTERVEIWER NOTE:
If respondent asks:
What does "everything was an effort" mean?; say,"Whatever it means to you."

[IF NECESSARY, READ: Would you say: all, most, some, a little, or none of the time?]

M17.6
Data Results M17.6
During the past 30 days, about how often did you feel worthless?

[IF NECESSARY, READ: Would you say: all, most, some, a little, or none of the time?]

M17.7
Data Results M17.7
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 NOTE:
If asked what "usual activities" are, this includes:
housework, self-care, care giving, volunteer work, attending school, studies, or recreation.
M17.8
Data Results M17.8
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.
M17.9
Data Results M17.9

Treatment can help people with mental illness lead normal lives.
Do you - agree slightly or strongly, or disagree slightly or strongly?

INTERVIEWER NOTE:
If asked for the purpose of Q9; say:

"The 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”.

M17.10
Data Results M17.10
People are generally caring and sympathetic to people with mental illness.
Do you - agree slightly or strongly, or disagree slightly or strongly?

INTERVIEWER NOTE:
If asked for the purpose of Q10; say:

"The 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”.

 
 
CDC
Module 11: Adult Human Papilloma Virus (HPV) Vaccination
CATI NOTE: To be asked of respondents between the ages of 18 and 49 years. Otherwise, go to NEXT MODULE.
M11.1
Data Results M11.1
A vaccine to prevent the human papilloma virus or HPV infection is available and is called cervical cancer vaccine, HPV shot, [CATI Fill: If female “GARDASIL
or CERVARIX”; if male “GARDASIL”]
. Have you EVER had the HPV vaccination?
Crosstabulation Table:
M11.2
Data Results M11.2
How many HPV shots did you receive?
 
 
State-Added
Module 12: Parental Attitudes About Vaccines
CATI NOTE: If Core Section Q8.7 = 88 or 99 (No children under age 18 in the household, or Refused), go to Next Module.
SA12.1
Data Results SA12.1
In general, how confident are you in the safety of routine childhood vaccines? Would you say...
  • Not at all confident
  • A little confident
  • Moderately confident
  • Very confident
Crosstabulation Table:
SA12.2
Data Results SA12.2
What is your greatest concern about childhood vaccines, if any? Would you say...

Interviewer Probe: If they give more than one answer, please say: "Which ONE is your greatest concern?"
  • Too many vaccines are given
  • Vaccines are not safe
  • Vaccines cause diseases such as autism
  • Vaccines are not necessary
  • Vaccines cause short term side effects, such as fever and pain
  • I have no concerns about childhood vaccines
SA12.3
Data Results SA12.3
What is the most important source of information that has helped you make decisions about vaccinating your child? Would you say...
  • Healthcare provider
  • Media such as magazines, television, or radio
  • Internet
  • Friends or family
SA12.4
Data Results SA12.4
The next question is about the "Xth" [Fill in correct number] child.

Have you obtained ALL age appropriate immunizations or shots for [Fill him/her] as recommended by your child?s healthcare provider? Would you say...
  • Yes, all age appropriate
  • Yes, some age appropriate
  • No
  • Healthcare provider has not recommended any immunizations
  • Healthcare provider has specifically stated not to obtain any immunizations
 
 
State-Added
Module 13: Childhood Immunization
CATI NOTE: If response to Core Q8.7 = 88 (No children under age 18) or 99 (Refused), go to NEXT MODULE.
CATI NOTE: If selected child's age is greater than or equal 6 months, continue. Otherwise, go to NEXT MODULE.
SA13.1
Data Results SA13.1
During the past 12 months, has [CATI: Fill he/she] had a seasonal flu vaccination? There are two types of flu vaccinations. One is a shot and the other is a spray in the nose.
If SA13.1 = 1 "Yes" continue, otherwise go to NEXT MODULE.
SA13.2
During what month and year did [CATI: Fill he/she] receive [CATI: Fill his/her] most recent seasonal flu vaccination? The seasonal flu vaccination may have been either the flu shot or the flu spray. The flu spray is the flu vaccination that is sprayed the nose?
 
 
State-Added
Module 14: Child Human Papilloma Virus (HPV)
CATI INTERVIEWER INSTRUCTION: If selected child between the 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.
SA14.1
Data Results SA14.1
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:
SA14.2
Data Results SA14.2
How many HPV shots did [CATI: Fill he/she] receive?
 
 
State-Added
Module 15: Radon Awareness
SA15.1
Data Results SA15.1
Now we will be asking about Radon.

Have you ever heard of radon?

INTERVIEWER NOTE: Radon is a radioactive gas that occurs in nature.
SA15.2
Data Results SA15.2
The next set of questions is about the home where you currently live.

To your knowledge, has the air in your home been tested for the presence of radon gas?
If Q2 = 1; continue. Else, go to Q5.
SA15.3
Data Results SA15.3
To your knowledge, have the radon levels in your home ever been found at 4.0 picocuries per liter (pCi/L) or higher?

INTERVIEWER NOTE: Picocurie is a unit of measure for levels of radon gas. It is a very small unit of measure. The United States Environmental Protection Agency (EPA) recommends that mitigation action be taken whenever the level of radon gas in a home is at or above 4.0 picocuries per liter.
If Q3 = 1; continue. Else, go to Q5.
SA15.4
Data Results SA15.4
What action(s) did you take because the radon levels in your home were at 4.0 picocuries per liter (pCi/L) or higher?

SELECT ALL THAT APPLY

  • No action was taken [Go to NEXT MODULE]
  • Retested the home for radon
  • Had a radon mitigations system installed in the home
  • Stopped using the basement or lowest level of the home as a living area
  • Other (specify)
  • Sump Pump Repaired, Covered or Sealed
  • Installed Exhaust Fan
  • Sealed Basement Cracks
Go to NEXT MODULE
SA15.5
Data Results SA15.5
Do you have a radon mitigations system installed in your home?

  • Yes, a radon mitigation systems is installed in the home
  • No
  • No, I live in a new home that was built with radon resistant techniques
 
State-Added
Module 16: Large Scale Agricultural Burning in Kansas
(Asked May - December 2013)
SA16.1
Data Results SA16.1
Each April in Kansas land owner's burn thousands of acres of grassland as part of pasture management. Smoke from burning grassland can cause poor outdoor air quality. Thinking back to April of 2013, did you have an illness or symptom that you think was caused by poor outdoor air quality from burning?
SA16.2
Data Results SA16.2
Thinking back to April of 2013, how many times did you reduce or change your outdoor activity level because you thought the air quality was bad or was affecting how well you felt? Please do not include times when you made changes because of high pollen or other allergens.
 
State-Added
Module 17: Oral Health
SA17.1
Data Results SA17.1
During the past 12 months, was there any time when you needed dental care but did not get it?
Crosstabulation Table:
If Q1 = 1 (Yes); continue. Else, go to Q3.
SA17.2
Data Results SA17.2
What was the main reason you did not receive the dental care you needed?
SA17.3
Data Results SA17.3
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
Module 19: Social Context
Now, I am going to ask you about several factors that can affect a person's health.
If Core Section Q8.20 = 1 (own) or 2 (rent); continue. Else, go to Q2.
M19.1
Data Results M19.1
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
Crosstabulation Table:
M19.2
Data Results M19.2
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
Crosstabulation Table:
If Core Section Q8.9 = 1 (Employed for wages) or 2 (Self-employed); continue to Q3 and Q4.
If Core Section Q8.9 = 3 (Out of work for 1 year or more), 4 (Out of work for less than 1 year), or 7 (Retired); go to Q5 and Q6.
If Core Section Q8.9 = 5 (A homemaker), 6 (A student), or 8 (Unable to work);, go to Q7.
M19.3
Data Results M19.3
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).
M19.4
Data Results M19.4
About how many hours do you work per week at all of your jobs and businesses combined?
CATI Interviewer Instruction: Go to Q7.
M19.5
Data Results M19.5
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).
M19.6
Data Results M19.6
Thinking about the last time you worked, about how many hours did you work per week at all of your jobs and businesses combined?
M19.7
Data Results M19.7
Did you vote in the last presidential election? The November 2012 election between Barack Obama and Mitt Romney.
Crosstabulation Table: