H1N1 Influenza, Adult
c = CDC Core Question, o = CDC Optional Question, s = State-Added Question
During what month did you receive your H1N1 flu vaccine?
 
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."
 
Was this a shot or was it a vaccine sprayed in the nose?
 
H1N1 Influenza, Child
c = CDC Core Question, o = CDC Optional Question, s = State-Added Question
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.
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."

[Asked October - December]
 
Since September, 2009, how many of these H1N1 vaccinations has [Fill: he/she] received?

[Asked October - December]
 
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?".

[Asked October - December]
 
Was this a shot or was it a vaccine sprayed in the nose?

[Asked October - December]
 
During what month did [Fill: he/she] receive [Fill: his/her] second H1N1 flu vaccine?

[Asked October - December]
 
Was this a shot or was it a vaccine sprayed in the nose?

[Asked October - December]
 
Hand Washing
c = CDC Core Question, o = CDC Optional Question, s = State-Added Question
After the oldest child in your household, between the ages of 5 and 17, uses the toilet, how often do they wash their hands with soap and water?
1998s
 
After using the toilet, how often do you wash your hands with soap and water?
1998s
 
Besides meals prepared for yourself and your family, do you prepare or handle food to be eaten by other persons on a regular basis?
1998s
 
During the past three months, have you had diarrhea with at least three loose stools in a single day?
1998s
 
To the following questions please answer very important, somewhat important, or not important. How important is it that a person wash their hands:

a. After using the toilet?
b. After handling raw meat?
c. After working outdoors?
d. Before eating?
e. After reading the newspaper?
f. Before preparing food?
1998s
 
Health Care Access, Adult
c = CDC Core Question, o = CDC Optional Question, s = State-Added Question
About how long has it been since you had health care coverage?
 
About how long has it been since you last visited a doctor for a routine checkup?
 
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.
 
About how long have you had [fill in type (Medicare/Medicaid/this particular health coverage)]?
1996c, 1997c
 
Do you have any kind of health care coverage, including health insurance, prepaid plans such as HMOs, or government plans such as Medicare?
1993c, 1994c, 1995c, 1996c, 1997c, 1998c, 1999cfor Do you have any kind of health care coverage, including health insurance, prepaid plans such as HMOs, or government plans such as Medicare?, 2000cfor Do you have any kind of health care coverage, including health insurance, prepaid plans such as HMOs, or government plans such as Medicare?, 2001cfor Do you have any kind of health care coverage, including health insurance, prepaid plans such as HMOs, or government plans such as Medicare?, 2002cfor Do you have any kind of health care coverage, including health insurance, prepaid plans such as HMOs, or government plans such as Medicare?, 2003cfor Do you have any kind of health care coverage, including health insurance, prepaid plans such as HMOs, or government plans such as Medicare?, 2004cfor Do you have any kind of health care coverage, including health insurance, prepaid plans such as HMOs, or government plans such as Medicare?, 2005cfor Do you have any kind of health care coverage, including health insurance, prepaid plans such as HMOs, or government plans such as Medicare?, 2006cfor Do you have any kind of health care coverage, including health insurance, prepaid plans such as HMOs, or government plans such as Medicare?, 2007cfor Do you have any kind of health care coverage, including health insurance, prepaid plans such as HMOs, or government plans such as Medicare?, 2008cfor Do you have any kind of health care coverage, including health insurance, prepaid plans such as HMOs, or government plans such as Medicare?, 2009cfor Do you have any kind of health care coverage, including health insurance, prepaid plans such as HMOs, or government plans such as Medicare?, 2010cfor Do you have any kind of health care coverage, including health insurance, prepaid plans such as HMOs, or government plans such as Medicare?
 
Do you have any kind of health care coverage, including health insurance, prepaid plans such as HMOs, or government plans such as Medicare or Indian Health Services?
 
Do you have one person you think of as your personal doctor or health care provider?
2000ofor Do you have one person you think of as your personal doctor or health care provider?, 2001cfor Do you have one person you think of as your personal doctor or health care provider?, 2002cfor Do you have one person you think of as your personal doctor or health care provider?, 2003cfor Do you have one person you think of as your personal doctor or health care provider?, 2004cfor Do you have one person you think of as your personal doctor or health care provider?, 2005cfor Do you have one person you think of as your personal doctor or health care provider?, 2006cfor Do you have one person you think of as your personal doctor or health care provider?, 2007cfor Do you have one person you think of as your personal doctor or health care provider?, 2008cfor Do you have one person you think of as your personal doctor or health care provider?, 2009cfor Do you have one person you think of as your personal doctor or health care provider?, 2010cfor Do you have one person you think of as your personal doctor or health care provider?, 2011cfor Do you have one person you think of as your personal doctor or health care provider?, 2012cfor Do you have one person you think of as your personal doctor or health care provider?
 
Does your [fill in type (Medicare/Medicaid/health coverage)] plan require you to select a certain doctor or clinic for all of your routine care?
1996c, 1997c
 
During the past 12 months, was there a time that you did not have any health insurance or coverage?
 
Is there a book or list of doctors associated with your [fill in type (Medicare/Medicaid/health coverage)] plan?
1996c, 1997c
 
Is there one particular clinic, health center, doctor's office, or other place that you usually go to if you are sick or need advice about your health?
1993c
 
Medicare is a coverage plan for people 65 or over and for certain disabled people. Do you have Medicare?
 
There are some types of coverage you may not have considered. Please tell me if you have any of the following:
  • Employer
  • Someone else's employer
  • Self-purchased plan
  • Medicare
  • Medicaid or Medical Assistance
  • Military, CHAMPUS, Tricare, or VA
  • Other
  • None
 
Was there a time during the last 12 months when you needed to see a doctor, but could not because of the cost?
 
Was there a time in the past 12 months when you needed to see a doctor, but could not because of the cost?
2005cfor Was there a time in the past 12 months when you needed to see a doctor, but could not because of the cost?, 2006cfor Was there a time in the past 12 months when you needed to see a doctor, but could not because of the cost?, 2007cfor Was there a time in the past 12 months when you needed to see a doctor, but could not because of the cost?, 2008cfor Was there a time in the past 12 months when you needed to see a doctor, but could not because of the cost?, 2009cfor Was there a time in the past 12 months when you needed to see a doctor, but could not because of the cost?, 2010cfor Was there a time in the past 12 months when you needed to see a doctor, but could not because of the cost?, 2011cfor Was there a time in the past 12 months when you needed to see a doctor, but could not because of the cost?, 2012cfor Was there a time in the past 12 months when you needed to see a doctor, but could not because of the cost?
 
Was there a time in the past 12 months when you needed medical care, but could not get it?
 
What is the main reason you did not get medical care?
 
What type of health care coverage do you use to pay for most of your medical care?
 
When you are sick or need advice about your health, to which one of the following places do you usually go?

2002cfor When you are sick or need advice about your health, to which one of the following places do you usually go?

 
Health Care Access, Child
c = CDC Core Question, o = CDC Optional Question, s = State-Added Question
About how long has it been since the youngest child last visited a doctor for a routine checkup?
1997s
 
Does the [randomly selected child] have any kind of insurance coverage that pays for some or all of [his/her] routine dental care, including dental insurance, prepaid plans such as HMOs, or government plans such as Medicaid?
 
Does the youngest child have any kind of health care coverage, including health insurance, prepaid plans such as HMOs, or government plans such as Medicare?
1997s
 
During the past 12 months, was there any time when the [randomly selected child] needed dental care but did not get it?
 
How long has it been since the [randomly selected child] last visited a dentist or dental clinic for any reason?
 
Is there one particular clinic, health center, doctor's office, or other place that you usually go to if the youngest child is sick or you need advice about the youngest child's health?
1997s
 
There are some types of coverage you may not have considered. Please tell me if the youngest child may have any of the following:
  • Your employer
  • Someone else's employer
  • A plan that you or someone else buys on your own
  • Medicare
  • Medicaid or Medical Assistance [or substitute state program name]
  • The military, CHAMPUS, or the VA [or CHAMP-VA]
  • The Indian Health Service [or the Alaska Native Health Service]
  • Some other source
1997s
 
What type of health care coverage do you use to pay for most of the youngest child's medical care?
1997s
 
What was the main reason the [randomly selected child] did not receive the dental care [he/she] needed?
 
Was there a time during the last 12 months when the youngest child needed to see a doctor, but could not because of the cost?
1997s
 
Health Care Coverage
c = CDC Core Question, o = CDC Optional Question, s = State-Added Question
During the past 12 months, was there any time that you did not have any health insurance or coverage?
1997o
 
Other than [fill in type (Medicare/Medicaid/the health coverage that pays for most of your health care)], do you have any other type of health care coverage?
1997o
 
What type of health care coverage do you use to pay for most of your medical care? Is it coverage through:
  • Your employer
  • Someone else's employer
  • A plan that you or someone else buys on your own
  • Medicare
  • Medicaid or Medical Assistance
  • The military, CHAMPUS, TriCare, or the VA
  • The Indian Health Service (or the Alaska Native Health Service)
  • Some other source
 
What was the main reason you were without health care coverage for the past 12 months?
1998s
 
Health Care Coverage, Lack of
c = CDC Core Question, o = CDC Optional Question, s = State-Added Question
What was the main reason you were without health care coverage?
1997o, 1998s
 
What was the main reason you were without health care coverage for the past 12 months?
1998s
 
Health Care Satisfaction
c = CDC Core Question, o = CDC Optional Question, s = State-Added Question
Do you have one person you think of as your personal doctor or health care provider?
2000ofor Do you have one person you think of as your personal doctor or health care provider?, 2001cfor Do you have one person you think of as your personal doctor or health care provider?, 2002cfor Do you have one person you think of as your personal doctor or health care provider?, 2003cfor Do you have one person you think of as your personal doctor or health care provider?, 2004cfor Do you have one person you think of as your personal doctor or health care provider?, 2005cfor Do you have one person you think of as your personal doctor or health care provider?, 2006cfor Do you have one person you think of as your personal doctor or health care provider?, 2007cfor Do you have one person you think of as your personal doctor or health care provider?, 2008cfor Do you have one person you think of as your personal doctor or health care provider?, 2009cfor Do you have one person you think of as your personal doctor or health care provider?, 2010cfor Do you have one person you think of as your personal doctor or health care provider?, 2011cfor Do you have one person you think of as your personal doctor or health care provider?
 
In the last 12 months, how many times did you go to an emergency room to get care for yourself?
 
In the last 12 months, [fill in "not counting times you went to an emergency room" as needed], how many times did you go to a doctor’s office or clinic to get care for yourself?
 
In the last 12 months, how often did doctors or other health providers listen carefully to you?
 
In the last 12 months, how often did doctors or other health providers explain things in a way you could understand?
 
In the last 12 months, how often did doctors or other health providers show respect for what you had to say?
 
In the last 12 months, how often did doctors or other health providers spend enough time with you?
 
We want to know your rating of all your health care in the last 12 months from all doctors and other health providers. Use any number from 1 to 5 where 1 is the worst health care possible, and 5 the best health care possible. How would you rate all your health care?
 
Health Care Utilization
c = CDC Core Question, o = CDC Optional Question, s = State-Added Question
How far do you have to travel to see the doctor or health care provider of your choice?
1996s
 
How far do you have to travel to use the hospital of your choice?
1996s
 
Is there one of these places that you go to most often when you are sick or need advice about your health?
1995o, 1996o
 
Is there one particular clinic, health center, doctor's office, or other place that you usually go to if you are sick or need advice about your health?
1995o, 1996o
 
What is the main reason you do not have a usual source of medical care?
1995o, 1996o
 
What kind of place is it -- a clinic, a health center, a hospital, a doctor's office, or some other place?
1995o, 1996o
 
Health Literacy
c = CDC Core Question, o = CDC Optional Question, s = State-Added Question
Now I would like to ask you some questions about medical forms or medical information.

How confident are you in filling out medical forms by yourself? For example insurance forms, questionnaires, and doctor’s office forms.
 
How often do you have problems learning about your health condition because of difficulty in understanding written information?

Interviewer Probe: If respondent states they do not have a health condition, say: "This would include any routine visit to a doctor’s office for a physical exam, women’s health exam or men’s health exam."
 
How often do you have someone help you read medical materials? For example: family member, friend, caregiver, doctor, nurse or other health professional.
 
Health of Children
c = CDC Core Question, o = CDC Optional Question, s = State-Added Question
About how long has it been since the youngest child last visited a doctor for a routine checkup?
1997s
 
Did anyone in this household get food stamps at any time during the last 12 months?
1997s
 
Does the youngest child have any kind of health care coverage, including health insurance, prepaid plans such as HMOs, or government plans such as Medicare?
1997s
 
Does the youngest child's father live in this household?
1997s
 
Does the youngest child's mother live in this household?
1997s
 
How is the youngest child in your household related to you?
1997s
 
Is the youngest child limited in any way in any activities because of any impairment or health problem?
 
Is there one particular clinic, health center, doctor's office, or other place that you usually go to if the youngest child is sick or you need advice about the youngest child's health?
1997s
 
There are some types of coverage you may not have considered. Please tell me if the youngest child may have any of the following:
  • Your employer
  • Someone else's employer
  • A plan that you or someone else buys on your own
  • Medicare
  • Medicaid or Medical Assistance [or substitute state program name]
  • The military, CHAMPUS, or the VA [or CHAMP-VA]
  • The Indian Health Service [or the Alaska Native Health Service]
  • Some other source
1997s
 
Was there a time during the last 12 months when the youngest child needed to see a doctor, but could not because of the cost?
1997s
 
What is the age of the youngest child in your household?
1997s
 
What is the age of the youngest child under age 18 in your household?
 
What type of health care coverage do you use to pay for most of the youngest child's medical care?
1997s
 
Would you say that in general the youngest child’s health is:
  • Excellent
  • Very Good
  • Good
  • Fair
  • Poor
 
Health Status
c = CDC Core Question, o = CDC Optional Question, s = State-Added Question
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?
1993c, 1994c, 1995c, 1996c, 1997c, 1998c, 1999cfor 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?, 2000cfor 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?, 2001cfor 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?, 2002ofor 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?, 2003cfor 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?, 2004cfor 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?, 2005cfor 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?, 2006cfor 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?, 2007cfor 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?, 2008cfor 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?, 2009cfor 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?, 2010cfor 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?, 2011cfor 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?
 
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?
1993c, 1994c, 1995c, 1996c, 1997c, 1998c, 1999cfor 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?, 2000cfor 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?, 2001cfor 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?, 2002ofor 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?, 2003cfor 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?, 2004cfor 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?, 2005cfor 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?, 2006cfor 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?, 2007cfor 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?, 2008cfor 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?, 2010cfor 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?, 2011cfor 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?
 
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?
1993c, 1994c, 1995c, 1996c, 1997c, 1998c, 1999cfor 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?, 2000cfor 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?, 2001cfor 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?, 2002ofor 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?, 2003cfor 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?, 2004cfor 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?, 2005cfor 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?, 2006cfor 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?, 2007cfor 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?, 2008c for 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? , 2009c for 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? , 2010c for 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? , 2011c for 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?
 
Would you say that in general your health is:
  • Excellent
  • Very Good
  • Good
  • Fair
  • Poor
1993c, 1994c, 1995c, 1996c, 1997c, 1998c, 1999cfor Would you say that in general your health is:, 2000cfor Would you say that in general your health is:, 2001cfor Would you say that in general your health is:, 2002cfor Would you say that in general your health is:, 2003cfor Would you say that in general your health is:, 2004cfor Would you say that in general your health is:, 2005cfor Would you say that in general your health is:, 2006cfor Would you say that in general your health is:, 2007cfor Would you say that in general your health is:, 2008cfor Would you say that in general your health is:, 2009cfor Would you say that in general your health is:, 2010cfor Would you say that in general your health is:, 2011cfor Would you say that in general your health is:, 2012cfor Would you say that in general your health is: Excellen, Very Good, Good, Fair or Poor
 
Healthy Days - Health Related Quality of Life
c = CDC Core Question, o = CDC Optional Question, s = State-Added Question
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?
1993c, 1994c, 1995c, 1996c, 1997c, 1998c, 1999cfor 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?, 2000cfor 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?, 2001cfor 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?, 2002ofor 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?, 2003cfor 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?, 2004cfor 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?, 2005cfor 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?, 2006cfor 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?, 2007cfor 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?, 2008cfor 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?, 2009cfor 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?, 2010cfor 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?, 2011cfor 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?, 2012c for 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?
 
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?
1993c, 1994c, 1995c, 1996c, 1997c, 1998c, 1999cfor 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?, 2000cfor 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?, 2001cfor 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?, 2002ofor 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?, 2003cfor 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?, 2004cfor 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?, 2005cfor 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?, 2006cfor 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?, 2007cfor 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?, 2008cfor 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?, 2009cfor 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?, 2010cfor 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?, 2011cfor 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?, 2012c for 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?
 
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?
1993c, 1994c, 1995c, 1996c, 1997c, 1998c, 1999cfor 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? , 2000cfor 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? , 2001cfor 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? , 2002ofor 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? , 2003cfor 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? , 2004cfor 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? , 2005c for 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? , 2006c for 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? , 2007c for 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? , 2008c for 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? , 2009c for 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? , 2010c for 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? , 2011c for 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? , 2012c for 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?
 
Heart Attack and Stroke
c = CDC Core Question, o = CDC Optional Question, s = State-Added Question
If you thought someone was having a heart attack or stroke, what is the first thing you would do?
 
Which of the following do you think is a symptom of a heart attack? For each, tell me yes, no, or you're not sure.
a. Do you think pain or discomfort in the jaw, neck, or back are symptoms of a heart attack?
2004o for Which of the following do you think is a symptom of a heart attack? For each, tell me yes, no, or you're not sure. a. Do you think pain or discomfort in the jaw, neck, or back are symptoms of a heart attack?, 2005o for Which of the following do you think is a symptom of a heart attack? For each, tell me yes, no, or you're not sure. a. Do you think pain or discomfort in the jaw, neck, or back are symptoms of a heart attack?, 2007o for Which of the following do you think is a symptom of a heart attack? For each, tell me yes, no, or you're not sure. a. Do you think pain or discomfort in the jaw, neck, or back are symptoms of a heart attack? , 2010o for Which of the following do you think is a symptom of a heart attack? For each, tell me yes, no, or you're not sure. a. Do you think pain or discomfort in the jaw, neck, or back are symptoms of a heart attack?, 2011o for Which of the following do you think is a symptom of a heart attack? For each, tell me yes, no, or you're not sure. a. Do you think pain or discomfort in the jaw, neck, or back are symptoms of a heart attack?
 
Which of the following do you think is a symptom of a heart attack? For each, tell me yes, no, or you're not sure.
b. (Do you think) feeling weak, lightheaded, or faint (are symptoms of a heart attack?)
2004o for Which of the following do you think is a symptom of a heart attack? For each, tell me yes, no, or you're not sure. b. (Do you think) feeling weak, lightheaded, or faint (are symptoms of a heart attack?), 2005o for Which of the following do you think is a symptom of a heart attack? For each, tell me yes, no, or you're not sure. b. (Do you think) feeling weak, lightheaded, or faint (are symptoms of a heart attack?), 2007o for Which of the following do you think is a symptom of a heart attack? For each, tell me yes, no, or you're not sure. b. (Do you think) feeling weak, lightheaded, or faint (are symptoms of a heart attack?) , 2010o for Which of the following do you think is a symptom of a heart attack? For each, tell me yes, no, or you're not sure. b. (Do you think) feeling weak, lightheaded, or faint (are symptoms of a heart attack?), 2011o for Which of the following do you think is a symptom of a heart attack? For each, tell me yes, no, or you're not sure. b. (Do you think) feeling weak, lightheaded, or faint (are symptoms of a heart attack?)
 
Which of the following do you think is a symptom of a heart attack? For each, tell me yes, no, or you're not sure.
c. (Do you think) chest pain or discomfort (are symptoms of a heart attack?)
2004ofor Which of the following do you think is a symptom of a heart attack? For each, tell me yes, no, or you're not sure. c. (Do you think) chest pain or discomfort (are symptoms of a heart attack?) , 2005ofor Which of the following do you think is a symptom of a heart attack? For each, tell me yes, no, or you're not sure. c. (Do you think) chest pain or discomfort (are symptoms of a heart attack?) , 2007ofor Which of the following do you think is a symptom of a heart attack? For each, tell me yes, no, or you're not sure. c. (Do you think) chest pain or discomfort (are symptoms of a heart attack?) , 2010ofor Which of the following do you think is a symptom of a heart attack? For each, tell me yes, no, or you're not sure. c. (Do you think) chest pain or discomfort (are symptoms of a heart attack?) , 2011ofor Which of the following do you think is a symptom of a heart attack? For each, tell me yes, no, or you're not sure. c. (Do you think) chest pain or discomfort (are symptoms of a heart attack?)
 
Which of the following do you think is a symptom of a heart attack? For each, tell me yes, no, or you're not sure.
d. (Do you think) sudden trouble seeing in one or both eyes (is a symptom of a heart attack?)
2004o for Which of the following do you think is a symptom of a heart attack? For each, tell me yes, no, or you're not sure. d. (Do you think) sudden trouble seeing in one or both eyes (is a symptom of a heart attack?), 2005o for Which of the following do you think is a symptom of a heart attack? For each, tell me yes, no, or you're not sure. d. (Do you think) sudden trouble seeing in one or both eyes (is a symptom of a heart attack?), 2007o for Which of the following do you think is a symptom of a heart attack? For each, tell me yes, no, or you're not sure. d. (Do you think) sudden trouble seeing in one or both eyes (is a symptom of a heart attack?) , 2010o for Which of the following do you think is a symptom of a heart attack? For each, tell me yes, no, or you're not sure. d. (Do you think) sudden trouble seeing in one or both eyes (is a symptom of a heart attack?), 2011o for Which of the following do you think is a symptom of a heart attack? For each, tell me yes, no, or you're not sure. d. (Do you think) sudden trouble seeing in one or both eyes (is a symptom of a heart attack?)
 
Which of the following do you think is a symptom of a heart attack? For each, tell me yes, no, or you're not sure.
e. (Do you think) pain or discomfort in the arms or shoulder (are symptoms of a heart attack?)
2004o for Which of the following do you think is a symptom of a heart attack? For each, tell me yes, no, or you're not sure. e. (Do you think) pain or discomfort in the arms or shoulder (are symptoms of a heart attack?), 2005o for Which of the following do you think is a symptom of a heart attack? For each, tell me yes, no, or you're not sure. e. (Do you think) pain or discomfort in the arms or shoulder (are symptoms of a heart attack?), 2007o for Which of the following do you think is a symptom of a heart attack? For each, tell me yes, no, or you're not sure. e. (Do you think) pain or discomfort in the arms or shoulder (are symptoms of a heart attack?) , 2010o for Which of the following do you think is a symptom of a heart attack? For each, tell me yes, no, or you're not sure. e. (Do you think) pain or discomfort in the arms or shoulder (are symptoms of a heart attack?), 2011o for Which of the following do you think is a symptom of a heart attack? For each, tell me yes, no, or you're not sure. e. (Do you think) pain or discomfort in the arms or shoulder (are symptoms of a heart attack?)
 
Which of the following do you think is a symptom of a heart attack? For each, tell me yes, no, or you're not sure.
f. (Do you think) shortness of breath (is a symptom of a heart attack?)
2004ofor Which of the following do you think is a symptom of a heart attack? For each, tell me yes, no, or you're not sure. f. (Do you think) shortness of breath (is a symptom of a heart attack?) , 2005ofor Which of the following do you think is a symptom of a heart attack? For each, tell me yes, no, or you're not sure. f. (Do you think) shortness of breath (is a symptom of a heart attack?) , 2007ofor Which of the following do you think is a symptom of a heart attack? For each, tell me yes, no, or you're not sure. f. (Do you think) shortness of breath (is a symptom of a heart attack?) , 2010ofor Which of the following do you think is a symptom of a heart attack? For each, tell me yes, no, or you're not sure. f. (Do you think) shortness of breath (is a symptom of a heart attack?) , 2011ofor Which of the following do you think is a symptom of a heart attack? For each, tell me yes, no, or you're not sure. f. (Do you think) shortness of breath (is a symptom of a heart attack?)
 
Which of the following do you think is a symptom of a stroke? For each, tell me yes, no, or you're not sure.
a. Do you think sudden confusion or trouble speaking are symptoms of a stroke?
2004ofor Which of the following do you think is a symptom of a stroke? For each, tell me yes, no, or you're not sure. a. Do you think sudden confusion or trouble speaking are symptoms of a stroke?, 2005ofor Which of the following do you think is a symptom of a stroke? For each, tell me yes, no, or you're not sure. a. Do you think sudden confusion or trouble speaking are symptoms of a stroke?, 2007ofor Which of the following do you think is a symptom of a stroke? For each, tell me yes, no, or you're not sure. a. Do you think sudden confusion or trouble speaking are symptoms of a stroke? , 2010ofor Which of the following do you think is a symptom of a stroke? For each, tell me yes, no, or you're not sure. a. Do you think sudden confusion or trouble speaking are symptoms of a stroke?, 2011ofor Which of the following do you think is a symptom of a stroke? For each, tell me yes, no, or you're not sure. a. Do you think sudden confusion or trouble speaking are symptoms of a stroke?
 
Which of the following do you think is a symptom of a stroke? For each, tell me yes, no, or you're not sure.
b. Do you think sudden numbness or weakness of face, arm, leg, especially on one side, are symptoms of a stroke?
2004o for Which of the following do you think is a symptom of a stroke? For each, tell me yes, no, or you're not sure. b. Do you think sudden numbness or weakness of face, arm, leg, especially on one side, are symptoms of a stroke?, 2005o for Which of the following do you think is a symptom of a stroke? For each, tell me yes, no, or you're not sure. b. Do you think sudden numbness or weakness of face, arm, leg, especially on one side, are symptoms of a stroke?, 2007o for Which of the following do you think is a symptom of a stroke? For each, tell me yes, no, or you're not sure. b. Do you think sudden numbness or weakness of face, arm, leg, especially on one side, are symptoms of a stroke? , 2010o for Which of the following do you think is a symptom of a stroke? For each, tell me yes, no, or you're not sure. b. Do you think sudden numbness or weakness of face, arm, leg, especially on one side, are symptoms of a stroke?, 2011o for Which of the following do you think is a symptom of a stroke? For each, tell me yes, no, or you're not sure. b. Do you think sudden numbness or weakness of face, arm, leg, especially on one side, are symptoms of a stroke?
 
Which of the following do you think is a symptom of a stroke? For each, tell me yes, no, or you're not sure.
c. (Do you think) sudden trouble seeing in one or both eyes (is a symptom of a stroke?)
2004o for Which of the following do you think is a symptom of a stroke? For each, tell me yes, no, or you're not sure. c. (Do you think) sudden trouble seeing in one or both eyes (is a symptom of a stroke?), 2005o for Which of the following do you think is a symptom of a stroke? For each, tell me yes, no, or you're not sure. c. (Do you think) sudden trouble seeing in one or both eyes (is a symptom of a stroke?), 2007o for Which of the following do you think is a symptom of a stroke? For each, tell me yes, no, or you're not sure. c. (Do you think) sudden trouble seeing in one or both eyes (is a symptom of a stroke?) , 2010o for Which of the following do you think is a symptom of a stroke? For each, tell me yes, no, or you're not sure. c. (Do you think) sudden trouble seeing in one or both eyes (is a symptom of a stroke?), 2011o for Which of the following do you think is a symptom of a stroke? For each, tell me yes, no, or you're not sure. c. (Do you think) sudden trouble seeing in one or both eyes (is a symptom of a stroke?)
 
Which of the following do you think is a symptom of a stroke? For each, tell me yes, no, or you're not sure.
d. (Do you think) sudden chest pain or discomfort (are symptoms of stroke?)
2004ofor Which of the following do you think is a symptom of a stroke? For each, tell me yes, no, or you're not sure. d. (Do you think) sudden chest pain or discomfort (are symptoms of stroke?), 2005ofor Which of the following do you think is a symptom of a stroke? For each, tell me yes, no, or you're not sure. d. (Do you think) sudden chest pain or discomfort (are symptoms of stroke?), 2007ofor Which of the following do you think is a symptom of a stroke? For each, tell me yes, no, or you're not sure. d. (Do you think) sudden chest pain or discomfort (are symptoms of stroke?) , 2010ofor Which of the following do you think is a symptom of a stroke? For each, tell me yes, no, or you're not sure. d. (Do you think) sudden chest pain or discomfort (are symptoms of stroke?), 2011ofor Which of the following do you think is a symptom of a stroke? For each, tell me yes, no, or you're not sure. d. (Do you think) sudden chest pain or discomfort (are symptoms of stroke?)
 
Which of the following do you think is a symptom of a stroke? For each, tell me yes, no, or you're not sure.
e. (Do you think) sudden trouble walking, dizziness, or loss of balance (are symptoms of a stroke?)
2004o for Which of the following do you think is a symptom of a stroke? For each, tell me yes, no, or you're not sure. e. (Do you think) sudden trouble walking, dizziness, or loss of balance (are symptoms of a stroke?), 2005o for Which of the following do you think is a symptom of a stroke? For each, tell me yes, no, or you're not sure. e. (Do you think) sudden trouble walking, dizziness, or loss of balance (are symptoms of a stroke?),2007o, 2010o for Which of the following do you think is a symptom of a stroke? For each, tell me yes, no, or you're not sure. e. (Do you think) sudden trouble walking, dizziness, or loss of balance (are symptoms of a stroke?), 2011o for Which of the following do you think is a symptom of a stroke? For each, tell me yes, no, or you're not sure. e. (Do you think) sudden trouble walking, dizziness, or loss of balance (are symptoms of a stroke?)
 
Which of the following do you think is a symptom of a stroke? For each, tell me yes, no, or you're not sure.
f. (Do you think) severe headache with no known cause (is a symptom of a stroke?)
2004ofor Which of the following do you think is a symptom of a stroke? For each, tell me yes, no, or you're not sure. f. (Do you think) severe headache with no known cause (is a symptom of a stroke?), 2005ofor Which of the following do you think is a symptom of a stroke? For each, tell me yes, no, or you're not sure. f. (Do you think) severe headache with no known cause (is a symptom of a stroke?), 2007ofor Which of the following do you think is a symptom of a stroke? For each, tell me yes, no, or you're not sure. f. (Do you think) severe headache with no known cause (is a symptom of a stroke?), 2010ofor Which of the following do you think is a symptom of a stroke? For each, tell me yes, no, or you're not sure. f. (Do you think) severe headache with no known cause (is a symptom of a stroke?), 2011ofor Which of the following do you think is a symptom of a stroke? For each, tell me yes, no, or you're not sure. f. (Do you think) severe headache with no known cause (is a symptom of a stroke?)
 
High Blood Pressure, Actions to Control
c = CDC Core Question, o = CDC Optional Question, s = State-Added Question
Are you now doing any of the following to help lower or control your high blood pressure:
(Are you) changing your eating habits (to help lower or control your high blood pressure)?
 
Are you now doing any of the following to help lower or control your high blood pressure:
(Are you) cutting down on salt (to help lower or control your high blood pressure)?
 
Are you now doing any of the following to help lower or control your high blood pressure:
(Are you) reducing alcohol use (to help lower or control your high blood pressure)?
 
Are you now doing any of the following to help lower or control your high blood pressure:
(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:
(Ever advised you to) change your eating habits (to help lower or control your high blood pressure)?
2005ofor 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:
(Ever advised you to) change your eating habits (to help lower or control your high blood pressure)?
, 2007ofor 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:
(Ever advised you to) change your eating habits (to help lower or control your high blood pressure)?
, 2009ofor 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:
(Ever advised you to) change your eating habits (to help lower or control your high blood pressure)?
, 2011ofor 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:
(Ever advised you to) change your eating habits (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:
(Ever advised you to) cut down on salt (to help lower or control your high blood pressure)?
2005ofor 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:
(Ever advised you to) cut down on salt (to help lower or control your high blood pressure)?
, 2007ofor 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:
(Ever advised you to) cut down on salt (to help lower or control your high blood pressure)?
, 2009ofor 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:
(Ever advised you to) cut down on salt (to help lower or control your high blood pressure)?
, 2011ofor 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:
(Ever advised you to) cut down on salt (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:
(Ever advised you to) reduce alcohol use (to help lower or control your high blood pressure)?
2005ofor 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:
(Ever advised you to) reduce alcohol use (to help lower or control your high blood pressure)?
, 2007ofor 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:
(Ever advised you to) reduce alcohol use (to help lower or control your high blood pressure)?
, 2009ofor 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:
(Ever advised you to) reduce alcohol use (to help lower or control your high blood pressure)?
, 2011ofor 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:
(Ever advised you to) reduce alcohol use (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:
(Ever advised you to) exercise (to help lower or control your high blood pressure)?
2005ofor 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:
(Ever advised you to) exercise (to help lower or control your high blood pressure)?
, 2007ofor 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:
(Ever advised you to) exercise (to help lower or control your high blood pressure)?
, 2009ofor 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:
(Ever advised you to) exercise (to help lower or control your high blood pressure)?
, 2011ofor 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:
(Ever advised you to) exercise (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:
(Ever advised you to) take medication (to help lower or control your high blood pressure)?
2005ofor 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:
(Ever advised you to) take medication (to help lower or control your high blood pressure)?
, 2007ofor 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:
(Ever advised you to) take medication (to help lower or control your high blood pressure)?
, 2009ofor 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:
(Ever advised you to) take medication (to help lower or control your high blood pressure)?
, 2011ofor 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:
(Ever advised you to) take medication (to help lower or control your high blood pressure)?
 
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?”
 
High Risk/Health Care Worker
c = CDC Core Question, o = CDC Optional Question, s = State-Added Question
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 inlculdes non-health professionals, such as administrative staff, who work in a health-care facility."
 
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.
 
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?
 
Do you still have (this/any of these) problem(s)?
 
HIV/AIDS/STDs
c = CDC Core Question, o = CDC Optional Question, s = State-Added Question
A pregnant woman with HIV can get treatment to help reduce the chances that she will pass the virus on to her baby. (True, False or Don't know/Not sure)
 
Can you tell by looking at a person if he or she has the AIDS virus?
1993c
 
Did you discuss your concerns about AIDS or sexually transmitted diseases before having sex for the first time with your most recent sexual partner?
 
Did you receive counseling or talk with a health care professional about the results of your test?
 
Did you make any of the following changes in the last 12 months?
  • a. Did you decrease the number of your sexual partners or become abstinent?
  • b. Do you now have sexual intercourse with only the same partner?
  • c. Do you now always use condoms for protection?
1997c
 
Did you receive the results of your last test?
 
Did you use a condom the first time you had sex with your most recent sex partner?
 
Did your doctor offer you an HIV test during your last pregnancy?
 
Due to what you know about HIV, have you changed your sexual behavior in the last 12 months?
1995c, 1996c, 1997c
 
Except for tests you may have had as part of blood donations, have you ever been tested for HIV?
 
Has a doctor or other health professional ever talked with you about your sexual practices, including family planning, sexually transmitted diseases, AIDS, or the use of condoms?
 
Have you:
  • a. Had sexual intercourse with only one partner?
  • b. Used condoms for protection?
  • c. Been more careful in selecting sexual partners?
1995c, 1996c
 
Have you been pregnant during the past two years?
 
Have you donated blood in the past 12 months?
 
Have you donated blood since March 1985?
 
Have you ever been tested for HIV? Do not count tests that you may have had as part of a blood donation. Include test using fluid from your mouth.
2005cfor Have you ever been tested for HIV? Do not count tests that you may have had as part of a blood donation. Include test using fluid from your mouth., 2003cfor Have you ever been tested for HIV? Do not count tests that you may have had as part of a blood donation., 2004cfor Have you ever been tested for HIV? Do not count tests that you may have had as part of a blood donation., 2006cfor Have you ever been tested for HIV? Do not count tests that you may have had as part of a blood donation., 2007cfor Have you ever been tested for HIV? Do not count tests that you may have had as part of a blood donation., 2008cfor Have you ever been tested for HIV? Do not count tests that you may have had as part of a blood donation., 2009cfor Have you ever been tested for HIV? Do not count tests that you may have had as part of a blood donation., 2010cfor Have you ever been tested for HIV? Do not count tests that you may have had as part of a blood donation., 2011cfor Have you ever been tested for HIV? Do not count tests that you may have had as part of a blood donation., 2012cfor Have you ever been tested for HIV? Do not count tests that you may have had as part of a blood donation.
 
Have you ever been tested for HIV? Do not count tests that you may have had as part of a blood donation.
 
Have you ever had your blood tested for HIV?
1995c, 1996c, 1997c
 
Have you ever had your blood tested for the AIDS virus infection?
1994c
 
Have you personally ever known anyone with AIDS or the HIV virus?
 
Have you personnally ever known anyone with AIDS or the AIDS virus?
1994c
 
How effective do you think these treatments are helping persons with HIV to live longer?
 
How important do you think it is for people to know their HIV status by getting tested?
 
How many new sex partners did you have during the past 12 months?
 
I'm going to read you a list. When I'm done, please tell me if any of these situations apply to you. You don't 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?
2002cfor I'm going to read you a list. When I'm done, please tell me if any of these situations apply to you. You don't need to tell me which one., 2003cfor I'm going to read you a list. When I'm done, please tell me if any of these situations apply to you. You don't need to tell me which one., 2004cfor I'm going to read you a list. When I'm done, please tell me if any of these situations apply to you. You don't need to tell me which one., 2005cfor I'm going to read you a list. When I'm done, please tell me if any of these situations apply to you. You don't need to tell me which one., 2008cfor I'm going to read you a list. When I'm done, please tell me if any of these situations apply to you. You don't need to tell me which one., 2009cfor I'm going to read you a list. When I'm done, please tell me if any of these situations apply to you. You don't need to tell me which one., 2010cfor I'm going to read you a list. When I'm done, please tell me if any of these situations apply to you. You don't need to tell me which one., 2011cfor I'm going to read you a list. When I'm done, please tell me if any of these situations apply to you. You don't need to tell me which one., 2012cfor I'm going to read you a list. When I'm done, please tell me if any of these situations apply to you. You don't need to tell me which one.
 
I am going to read you a list of reasons why some people have been tested for HIV. Not including blood donations, which of these would you say was the MAIN reason for your last HIV test?
 
If you had a child in school, at what grade do you think he or she should begin AIDS education in school?
1994c
 
If you had a child in school, at what grade do you think he or she should begin receiving education in school about HIV infection and AIDS?
 
If you had a child in school, would you allow him or her to be in the same classroom with another child who is infected with the AIDS virus?
1993c, 1994c
 
If you had a teenager who was sexually active, would you encourage him or her to use a condom?
 
If you received the results of your last test, did you receive counseling or talk with a health care professional about how to lower your chances of becoming infected with the AIDS virus or how to avoid passing it on to another person?
1993c
 
In the past 12 months, how many times have you been tested for HIV, including times you did not get your results?
2004c
 
In the past 12 months has a doctor, nurse, or other health professional talked to you about preventing sexually transmitted diseases through condom use?
 
In the past five years (that is, since 1988), have your chances of getting the AIDS virus increased, decreased, or stayed the same?
1993c
 
In the past year, have your chances of getting the AIDS virus increased, decreased, or stayed the same?
1993c, 1994c
 
Not including your blood donations, have you been tested for HIV in the past 12 months?
 
Not including blood donations, in what month and year was your last HIV test?
2001c, 2002c, 2003c, 2004c, 2005c, 2006c, 2008c, 2009c, 2010c, 2011c
 
Some people use condoms to keep from getting infected with HIV through sexual activity. How effective do you think a properly used condom is for this purpose?
1993c, 1994c, 1995c, 1996c
 
The following questions ask about the acceptability of certain programs designed to reduce the spread of sexually transmitted diseases and AIDS within communities. Please answer whether the following programs would be very acceptable, somewhat acceptable, somewhat unacceptable, or very unacceptable to you to have in your community.
  • a. Contacting and treating the sexual partners of persons with sexually transmitted diseases?
  • b. Needle exchange programs for injectable drug users?
  • c. Condom distribution to teenagers?
 
There are medical treatments available that are intended to help a person who is infected with HIV to live longer. (True, False or Don't know/Not sure)
 
To your knowledge is there medical treatment available that may help a person who is infected with the AIDS virus live longer?
1993c
 
Was it a rapid test where you could get your results within a couple of hours?
 
Was this test done by a nurse or other health worker, or with a home testing kit?
 
Were you drunk or high the first time you had sex with your most recent sex partner?
 
What are your chances of getting infected with HIV, the virus that causes AIDS?
 
What are your changes of getting the AIDS virus?
1993c, 1994c
 
What type of clinic did you go to for your last HIV test?
 
What was the main reason you had your last AIDS blood test?
1994c
 
What was the main reason you had your last test for HIV?
 
When did you last donate blood?
1994c, 1995c, 1996c, 1997c
 
When was your last AIDS blood test?
1994c
 
When was your last blood test for HIV?
1995c, 1996c, 1997c
 
When was your last test?
1993c
 
Where did you have your last blood test for the AIDS virus?
1993c, 1994c
 
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, or somewhere else?
 
Where did you have the 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?
2005cfor Where did you have the 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?, 2006cfor Where did you have the 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?, 2007cfor Where did you have the 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?, 2008cfor Where did you have the 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?, 2009cfor Where did you have the 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?, 2010cfor Where did you have the 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?
 
Where did you have your last test for HIV?
 
Would you be willing to work next to or near a person who you know is infected with the AIDS virus?
1993c, 1994c
 
HIV Testing in Pregnancy
c = CDC Core Question, o = CDC Optional Question, s = State-Added Question
Did your doctor offer you an HIV test during your last pregnancy?
 
Have you been pregnant during the past two years?
 
Human Papilloma Virus, Adult
c = CDC Core Question, o = CDC Optional Question, s = State-Added Question
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?
 
How many HPV shots did you receive?
 
Human Papilloma Virus, Child
c = CDC Core Question, o = CDC Optional Question, s = State-Added Question
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?
 
How many HPV shots did she receive?
 
Hypertension Awareness
c = CDC Core Question, o = CDC Optional Question, s = State-Added Question
About how long has it been since you last had your blood pressure taken by a doctor, nurse, or other health professional?
 
Are you currently taking medicine for your high blood pressure?
 
Have you been told on more than one occasion that your blood pressure was high, or have you been told this only once?
1993c, 1995c, 1997c, 1999cfor
 
Have you ever been told by a doctor, nurse, or other health professional that you have high blood pressure?
1993c, 1995c, 1997c, 1999cfor Have you ever been told by a doctor, nurse, or other health professional that you have high blood pressure?, 2001cfor Have you ever been told by a doctor, nurse, or other health professional that you have high blood pressure?, 2003cfor Have you ever been told by a doctor, nurse, or other health professional that you have high blood pressure?, 2004ofor Have you ever been told by a doctor, nurse, or other health professional that you have high blood pressure?, 2005cfor Have you ever been told by a doctor, nurse, or other health professional that you have high blood pressure?, 2007cfor Have you ever been told by a doctor, nurse, or other health professional that you have high blood pressure?, 2008sfor Have you ever been told by a doctor, nurse, or other health professional that you have high blood pressure?, 2009cfor Have you ever been told by a doctor, nurse, or other health professional that you have high blood pressure?, 2011cfor Have you ever been told by a doctor, nurse, or other health professional that you have high blood pressure?, 2012sfor Have you ever been told by a doctor, nurse, or other health professional that you have high blood pressure?