Salt Intake (CVH)
c = CDC Core Question, o = CDC Optional Question, s = State-Added Question
Now I would like to ask you some questions about salt intake. A small amount of the salt we eat occurs naturally in foods. Most of the salt we eat is added to foods, such as salt found in canned foods and breads. Salt also can be added in cooking or at the table.

Within the past 30 days, did you buy food from a store or a restaurant labeled "low salt" or "low sodium"?
Are you currently watching or reducing your salt intake?
How many days, weeks, months, or years have you been watching or reducing your salt intake?
Has a doctor or other health professional ever advised you to reduce salt intake?
These next questions are about some of the food you eat. Please think about all meals, snacks, and food consumed at home and away from home.

I will be asking how often you ate each one: for example, once a day, twice a week, three times a month, five times a year and so forth.

Processed meats are meats (beef, pork, chicken and turkey) preserved by smoking, curing, salting or by the addition of preservatives. A few examples of processed meats are deli meats or cold cuts, sausages, franks or hot dogs, bacon, and ham. Thinking of all forms of processed meats, over the past 12 months, how many times per day, week, month or year did you eat processed meats?
Over the past 12 months, how often did you eat salty snacks? (for example, potato or tortilla chips, popcorn, pretzels, crackers, salted nuts).
Over the past 12 months, how often did you eat pizza?
 
Seatbelts
c = CDC Core Question, o = CDC Optional Question, s = State-Added Question
During the past 30 days, how often did the [randomly selected child] ride in the back seat?
 
During the past 30 days, how often did the [randomly selected child] use a child safety seat, booster seat, or seat belt when riding in a car, van, sports utility vehicle, or truck?
 
During that time, did the [randomly selected child] use: a child safety seat?
 
(During that time, did the [randomly selected child] use): a booster seat?
 
(During that time, did the [randomly selected child] use): a seat belt only?
 
(Has a doctor or other health professional ever talked with you) about drug abuse?
 
How often do you use seat belts when you drive or ride in a car?
 
How often does the [fill in age]-year-old child in your household use a... car safety seat [for child under 5] or seatbelt [for child 5 or older] ...when they ride in a car?
 
How often does the oldest child (of children under age 15) in your household use a... car safety seat [for child under 5] or seatbelt [for child 5 or older] ...when they ride in a car?
1993c, 1994o
 
Sexual Behavior
c = CDC Core Question, o = CDC Optional Question, s = State-Added Question
Are you or your [fill in (husband/partner)] using any kind of birth control now? Birth control means having your tubes tied, vasectomy, the pill, condoms, diaphragm, foam, rhythm, Norplant, shots (Depo-provera) or any other way to keep from getting pregnant.
1998o
 
Are you or your [fill in (wife/partner)] using any kind of birth control now? Birth control means having your tubes tied, vasectomy, the pill, condoms, diaphragm, foam, rhythm, Norplant, shots (Depo-provera) or any other way to keep from getting pregnant.
1998s
 
Are you or your [husband/wife/partner] doing anything now to keep [you/her] from getting pregnant? Some things people do to keep from getting pregnant include not having sex at certain times, using birth control methods such as the pill, Norplant, shots or Depo-provera, condoms, diaphragm, foam, IUD, having their tubes tied, or having a vasectomy.
 
During the past 12 months, with how many different people have you had sexual intercourse?
1997s
 
[Females] What is your main reason for not doing anything to keep from getting pregnant?
[Males]What is your main reason for not doing anything to keep your partner from getting pregnant? 
 
(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?
 
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 the situations apply to you. You don't need to tell me which one.
  • You have used injectable drugs in the past year.
  • You tested positive for having HIV, the virus that causes AIDS.
  • You had anal sex without a condom in the past year.
Do any of these situations apply to you?
1997s
 
In the past five years, have you been treated for a sexually transmitted or venereal disease?
1997s
 
Some things people do to keep from getting pregnant include not having sex at certain times, using birth control methods such as the pill, Norplant, shots or Depo-provera, condoms, diaphragm, foam, IUD, having their tubes tied, or having a vasectomy. Are you or your [husband/wife/partner] doing anything now to keep [you/her] from getting pregnant?
 
The last time you had sexual intercourse, was the condom used ..
  • To prevent pregnancy
  • To prevent diseases like syphilis, gonorrhea, and AIDS
  • For both of these reasons
  • For some other reason
1997s
 
Was a condom used the last time you had sexual intercourse?
1997s
 
Were you treated at a local health department?
1997s
 
What are you or your [if female husband/partner; if male, insert wife/partner] doing now to keep [if female, insert "you"; insert "her" if male] from getting pregnant?
 
What are your reasons for not using any birth control now?
1998o
 
What kinds of birth control are you or your [fill in (husband/partner)] using now?
1998o
 
What kinds of birth control are you or your [fill in (wife/partner)] using now?
1998s
 
What is the main reason for not doing anything to keep [if female husband/partner; if male, insert wife/partner] from getting pregnant?
 
What other method are you also using to prevent pregnancy?
 
Sexual Violence
c = CDC Core Question, o = CDC Optional Question, s = State-Added Question
These next questions may be hard for you to answer but the information is very important. These questions are about different types of physical and/or sexual violence or other unwanted sexual experiences that might or might not have happened to you since you were 18 years old. We recognize this is a sensitive topic. Some people may feel uncomfortable with these questions. The information you provide us will be kept strictly confidential. At the end of this section, I will give you a phone number for organizations that can provide information and referral for these issues. Please keep in mind that if you are not in a safe place you can ask me to skip any question you do not want to answer.

Are you in a safe place to answer these questions?
 
Now, I am going to ask you questions about unwanted sex.

CATI NOTE: If respondent is female read:
Unwanted sex includes things like putting anything into your vagina, anus, or mouth or making you do these things to them after you said or showed that you didn't want to.

CATI NOTE: If respondent is male read:
Unwanted sex includes things like putting anything into your anus, or mouth or making you do these things to them after you said or showed that you didn't want to.

It includes times when you were unable to consent, for example, you were drunk or asleep, or you thought you would be hurt or punished if you refused.

Has anyone EVER had sex with you after you said or showed that you didn't want them to or without your consent?
 
Has this happened in the past 12 months?
 
Think about the time of the most recent incident involving a person who had sex with you, or attempted to have sex with you, after you said or showed that you didn't want to or without your consent.

What was that person's relationship to you?
 
Shingles
c = CDC Core Question, o = CDC Optional Question, s = State-Added Question
Shingles is caused by the chicken pox virus. It is an outbreak of rash or blisters on the skin that may be associated with severe pain. A vaccine for shingles has been available since May 2006; it is called Zostavax®, the zoster vaccine, or the shingles vaccine. Have you had this vaccine?
 
Skin Cancer
c = CDC Core Question, o = CDC Optional Question, s = State-Added Question
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.”
(Ever told) you had skin cancer?
 
Have you ever been told by a doctor that you have skin cancer?
1997s
 
Have you had any of the following skin cancers?
  • Melanoma
  • Basal cell
  • Squamous cell
  • Some other type of skin cancer (specify: _____)
1997s
 
How long ago was your melanoma skin cancer diagnosed?
1997s
 
Including times when even a small part of your skin was red for more than 12 hours, how many sunburns have you had within the past 12 months?
 
The next question is about sunburns, including any time that even a small part of your skin was red for more than 12 hours. Have you had a sunburn within the past 12 months?
 
Have you ever had all of your skin from head to toe checked for cancer either by a dermatologist or some other kind of doctor?
[Interviewer note: If asked, 'A dermatologist is a doctor who specializes in skin diseases'.]
If 'Yes' probe for how long ago
 
When you go outside on a very sunny day, for more than one hour, how often do you stay in the shade?
 
When you go outside on a very sunny day, for more than one hour, how often do you wear a hat that shades your face, ears, and neck?
[READ IF NECESSARY] Do not include visors, baseball caps, or hats that do not shade the ears and neck.
 
When you go outside on a very sunny day, for more than one hour, how often do you wear a long sleeved shirt?
 
When you go outside on a very sunny day, for more than one hour, how often do you use sunscreen?
 
Have you used a sun lamp or tanning bed in the past 12 months?
 
Has a doctor, nurse, or other health professional ever advised or discussed with you about taking protective measures against skin cancer. Protective measures include use of sunscreen, protective clothing and avoiding exposure to sunlamps or tanning beds.
If 'Yes', probe for how long ago
 
Sleep
c = CDC Core Question, o = CDC Optional Question, s = State-Added Question
The next question is about getting enough rest or sleep

During the past 30 days, for about how many days have you felt you did not get enought rest or sleep?
 
I would like to ask you a few questions about your sleep patterns.

During the past 30 days, for about how many days have you felt you did not get enough rest or sleep?
 
Sleep, Inadequate
c = CDC Core Question, o = CDC Optional Question, s = State-Added Question
On average, how many hours of sleep do you get in a 24-hour period? Think about the time you actually spend sleeping or napping, not just the amount of sleep you think you should get.
Interviewer Note: Enter hours of sleep in whole numbers, rounding 30 minutes (1/2 hour) or more up to the next whole hour and dropping 29 or fewer minutes.
 
I would like to ask you a few questions about your sleep patterns.

During the past 30 days, for about how many days have you felt you did not get enough rest or sleep?
 
Do you snore?
Interviewer Note: If the respondent indicates that their spouse or someone told him/her that they snore, then the answer to the question is "Yes", the respondent snores.
 
During the past 30 days, for about how many days did you find yourself unintentionally falling asleep during the day?
 
During the past 30 days, have you ever nodded off or fallen asleep, even just for a brief moment, while driving?
 
Smoke Detectors
c = CDC Core Question, o = CDC Optional Question, s = State-Added Question
Do you have a functioning smoke detector on every level of your home and outside each sleeping area?
 
Do you have a specific plan for how you would escape from your house or apartment in case of fire?
1993c
 
Does your family have an escape plan in case of fire in the home?
 
(Has a doctor or other health professional ever talked with you) about injury prevention, such as safety belt use, helmet use, or smoke detectors?
 
Has your family practiced an escape plan in case of fire in the home?
 
Has your family practiced or discussed an escape plan in case of a fire at home?
1994o
 
Is there a working smoke detector in your household?
1994s
 
When was the last time you or someone else deliberately tested all of the smoke detectors in your home?
 
When was the last time you or someone else deliberately tested all of the smoke detectors in your home, either by pressing the test buttons or holding a source of smoke near them?
1995c, 1997c
 
Which of the following best describes whether you have a smoke detector in your home? Is it:
  • I don't have a smoke detector.
  • I have an installed and working smoke detector.
  • I have a smoke detector, but it is not installed.
  • I have a smoke detector, but it is broken or the battery is missing.
  • I have a smoke detector, but don't know if it works.
 
Social Context
c = CDC Core Question, o = CDC Optional Question, s = State-Added Question
About how many hours do you work per week at all of your jobs and businesses combined?
 
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).
 
Do you rent or own your home?
1996s, 1997o
 
Did you vote in the last presidential election? The November 2008 election between Barack Obama and John McCain?
 
Do you rent or own your home?
INTERVIEWER NOTE: "Other arrangement" may include group home or staying with friends or family without paying rent.
 
How long have you lived at your current address?
1996s, 1997o
 
How many close friends or relatives would help you with your emotional problems or feelings if you needed it?
1997o
 
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
 
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
 
How safe from crime do you consider your neighborhood to be?
1997o
 
In the past 30 days, have you been concerned about having enough food for you or your family?
1997o
 
Thinking about the last time you worked, about how many hours did you work per week at all of your jobs and businesses combined?
 
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).
 
What is the source of water you usually drink at home? Is it:
  • City/town water supple
  • Private well
  • Bottled water
  • Other
1996s
 
Suicide
c = CDC Core Question, o = CDC Optional Question, s = State-Added Question
The following questions deal with suicide. Many people feel that this subject is personal, but we would appreciate you trying to answer these questions. Remember that you don't have to answer any questions that you don't want to.

Has there been a time in the past 12 months when you thought of taking your own life?
 
If CDC Module Q24.6 = 1 (Yes, but did not require treatment), 2 (Yes, was treated at a VA facility) or 3 (Yes, was treated at a non-VA facility), read:
During the past 12 months, before you attempted suicide, did you make a plan about how you would attempt suicide?

Else, read:
During the past 12 months, did you make a plan about how you would attempt suicide?
 
Other Sugar Sweetened Beverage Consumption Among Adults
c = CDC Core Question, o = CDC Optional Question, s = State-Added Question
Previously, we asked about your consumption of regular soda or pop and sweetened fruit drinks. The following question will be asking how often you drank other sugar sweetened drinks: for example, once a day, twice a week, three times a month, and so forth.

During the past 30 days, how many times per day, week or month did you drink other sugar sweetened drinks such as sports drinks, energy drinks, coffee drinks or sweet tea? Do not include regular soda or pop, diet soda or diet pop, sweetened fruit drinks, or 100% fruit juice.
 
Sugar Sweetened Beverage Consumption Among Children
c = CDC Core Question, o = CDC Optional Question, s = State-Added Question
These next questions are about the milk, soda and other sugar sweetened beverages the "Xth" [Fill in correct number] child drank during the past 30 days.

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

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 he/she] drink flavored milk?
During the past 30 days, how often did [Fill: he/she] drink regular soda or pop that contains sugar? Do not include diet soda or diet pop.
During the past 30 days, how often did [Fill: 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.

Interviewer note: Fruit flavored drinks are sweetened beverages that often contain some fruit juice or flavoring.
 
Sugar Sweetened Beverages and Menu Labeling
c = CDC Core Question, o = CDC Optional Question, s = State-Added Question
Now I would like to ask you some questions about sugary beverages.

Interviewer note: Please remind respondents to include regular soda that they mixed with alcohol.

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.
 

During the past 30 days, how often did you drink sweetened fruit drinks, such as Kool-Aid, cranberry juice cocktail, and lemonade? Include fruit drinks you made at home and added sugar to.

Interviewer note: Fruit drinks are sweetened beverages that often contain some fruit juice or flavoring. Do not include 100% fruit juice, sweet tea, coffee drinks, sports drinks, or energy drinks.

 
The next question is about eating out at fast food and chain restaurants. When calorie information is available in the restaurant, how often does this information help you decide what to order?
 
Excess Sun Exposure
c = CDC Core Question, o = CDC Optional Question, s = State-Added Question
The next question is about sunburns, including any time that even a small part of your skin was red for more than 12 hours. Have you had a sunburn within the past 12 months?
1999cfor The next question is about sunburns, including any time that even a small part of your skin was red for more than 12 hours. Have you had a sunburn within the past 12 months?, 2003cfor The next question is about sunburns, including any time that even a small part of your skin was red for more than 12 hours. Have you had a sunburn within the past 12 months?, 2003cfor The next question is about sunburns, including any time that even a small part of your skin was red for more than 12 hours. Have you had a sunburn within the past 12 months?, 2004cfor The next question is about sunburns, including any time that even a small part of your skin was red for more than 12 hours. Have you had a sunburn within the past 12 months?, 2008sfor The next question is about sunburns, including any time that even a small part of your skin was red for more than 12 hours. Have you had a sunburn within the past 12 months?
 
Including times when even a small part of your skin was red for more than 12 hours, how many sunburns have you had within the past 12 months?