Form 1 Survey

TABLE OF CONTENTS

HEALTH COMMUNICATION ......................................................................

1

HEALTH INFORMATION SEEKING .............................................................
CANCER INFORMATION SEEKING ............................................................
HEALTH INFORMATION EXPOSURE .........................................................
INTERNET USE ...........................................................................................

1
5
7
7

HEALTH SERVICES ...................................................................................

10

HEALTH CARE USE ....................................................................................
HEALTH CARE EXPERIENCE.....................................................................
AVOIDANCE OF DOCTORS........................................................................
HEALTH RECORDS.....................................................................................
CONSENT....................................................................................................
GENETIC TESTS.........................................................................................
CLINICAL TRIALS........................................................................................
INFORMATION SOURCES ..........................................................................

10
11
13
14
15
15
16
16

BEHAVIOR AND RISK FACTORS .............................................................

17

ENERGY BALANCE.....................................................................................
SUN EXPOSURE.........................................................................................
TOBACCO ...................................................................................................
LUNG CANCER ...........................................................................................
CERVICAL CANCER....................................................................................
COLON CANCER.........................................................................................

17
22
23
27
28
32

CANCER ....................................................................................................

37

NUMERACY.................................................................................................
CANCER COGNITION .................................................................................
CANCER HISTORY .....................................................................................

37
38
40

HEALTH STATUS AND DEMOGRAPHICS................................................

43

HEALTH STATUS ........................................................................................
DEMOGRAPHICS ........................................................................................

43
45

DEBRIEFING QUESTIONS.........................................................................

49

MAIL QUESTIONNAIRE...............................................................................
CATI FROM MAIL SAMPLE .........................................................................

49
49

HINTS 2007, Final CATI Study Instrument (06-15--07), National Cancer Institute (NCI)

Page i

HEALTH COMMUNICATION

HEALTH INFORMATION SEEKING
HCQ1005.
HC01SeekHealthInfo

Have you ever looked for health information from any source?
YES...........................................................
NO.............................................................

HCQ1010.
HC02WhereSeekHealthInfo

1
2 (HCQ1055)

The most recent time you looked for health information, where did you go first?
[IF SP HAS MADE MORE THAN ONE SEARCH, PROBE FOR THE MOST
RECENT SEARCH.]
BOOKS......................................................
BROCHURES, PAMPHLETS, ETC.............
CANCER ORGANIZATION ........................
FAMILY .....................................................
FRIEND/CO-WORKER...............................
HEALTH CARE PROVIDER .......................
INTERNET.................................................
LIBRARY ...................................................
MAGAZINES..............................................
NEWSPAPERS..........................................
TELEPHONE INFORMATION NUMBER
(1-800 NUMBER)....................................
COMPLEMENTARY OR ALTERNATIVE
PRACTITIONER.....................................
OTHER (SPECIFY) ....................................

HCQ1015.
HC02LookElsewhere

1
2
3
4
5
6
7
8
9
10
11
12
91

Did you look or go anywhere else [for health information]?
YES...........................................................
NO.............................................................

1
2 (HC1030)

HINTS 2007, Final CATI Study Instrument (06-15--07), National Cancer Institute (NCI)

Page 1

HCQ1020.
HC03WhereSeekHealthInfo2

Where else did you look or go?
[CODE ALL THAT APPLY.]
[PROBE: Anywhere else?]
DID NOT LOOK OR GO ANYWHERE
ELSE .........................................................
BOOKS......................................................
BROCHURES, PAMPHLETS, ETC.............
CANCER ORGANIZATION ........................
FAMILY .....................................................
FRIEND/CO-WORKER...............................
HEALTH CARE PROVIDER .......................
INTERNET.................................................
LIBRARY ...................................................
MAGAZINES..............................................
NEWSPAPERS..........................................
TELEPHONE INFORMATION NUMBER
(1-800 NUMBER)....................................
COMPLEMENTARY OR ALTERNATIVE
PRACTITIONER.....................................
OTHER (SPECIFY) ....................................

HCQ1030.
HC04WhoLookingFor

22
23
91

The most recent time you looked for information was it for…
yourself,.....................................................
for someone else, or...................................
both? .........................................................

HCQ1035.
HC05aLotOfEffort

11
12
13
14
15
16
17
18
19
20
21

1
2
3

Based on the results of your most recent search for health information, how
much do you agree or disagree with the following statements?
It took a lot of effort to get the information you needed. Would you say you…
[IF SP HAS MADE MORE THAN ONE SEARCH, PROBE FOR THE MOST
RECENT SEARCH.]
strongly agree, ...........................................
somewhat agree,........................................
somewhat disagree, or ...............................
strongly disagree?......................................

HCQ1040.
HC05bFrustrated

1
2
3
4

[Based on the results of your most recent search for health information, how
much do you agree or disagree with the following statements?]
You felt frustrated during your search for the information.
[IF NEEDED: Would you say you strongly agree, somewhat agree, somewhat
disagree, or strongly disagree?]
STRONGLY AGREE ..................................
SOMEWHAT AGREE.................................
SOMEWHAT DISAGREE ...........................
STRONGLY DISAGREE ............................

1
2
3
4

HINTS 2007, Final CATI Study Instrument (06-15--07), National Cancer Institute (NCI)

Page 2

HCQ1045.
HC05cConcernedQuality

[Based on the results of your most recent search for health information, how
much do you agree or disagree with the following statements?]
You were concerned about the quality of the information.
[IF NEEDED: Would you say you strongly agree, somewhat agree, somewhat
disagree, or strongly disagree?]
STRONGLY AGREE ..................................
SOMEWHAT AGREE.................................
SOMEWHAT DISAGREE ...........................
STRONGLY DISAGREE ............................

HCQ1050.
HC05dTooHardUnderstand

1
2
3
4

[Based on the results of your most recent search for health information, how
much do you agree or disagree with the following statements?]
The information you found was hard to understand.
[IF NEEDED: Would you say you strongly agree, somewhat agree, somewhat
disagree, or strongly disagree?]
STRONGLY AGREE ..................................
SOMEWHAT AGREE.................................
SOMEWHAT DISAGREE ...........................
STRONGLY DISAGREE ............................

HCQ1055.
HC06ConfidentGetHealthInf

1
2
3
4

Overall, how confident are you that you could get health-related advice or
information if you needed it? Would you say. . .
completely confident,..................................
very confident,............................................
somewhat confident, ..................................
a little confident, or .....................................
not confident at all? ....................................

1
2
3
4
5

[HCQ1060 THROUGH HCQ1100 WILL BE ASKED IN A RANDOM ORDER]
HCQ1060.
HC07aTrustDoctor

In general, how much would you trust information about health or medical topics
from a doctor or other health care professional? Would you say a lot, some, a
little, or not at all?
A LOT........................................................
SOME........................................................
A LITTLE ...................................................
NOT AT ALL ..............................................

1
2
3
4

HINTS 2007, Final CATI Study Instrument (06-15--07), National Cancer Institute (NCI)

Page 3

HCQ1065.
HC07bTrustFamily

[In general, how much would you trust information about health or medical
topics?]
How about from family or friends?
[IF NEEDED: Would you say a lot, some, a little or not at all?]
A LOT........................................................
SOME........................................................
A LITTLE ...................................................
NOT AT ALL ..............................................

HCQ1070.
HC07cTrustNewspaperMag

1
2
3
4

[In general, how much would you trust information about health or medical
topics?]
How about in newspapers or magazines?
[IF NEEDED: Would you say a lot, some, a little or not at all?]
A LOT........................................................
SOME........................................................
A LITTLE ...................................................
NOT AT ALL ..............................................

HCQ1075.
HC07dTrustRadio

1
2
3
4

[In general, how much would you trust information about health or medical
topics?]
How about on the radio?
[IF NEEDED: Would you say a lot, some, a little or not at all?]
A LOT........................................................
SOME........................................................
A LITTLE ...................................................
NOT AT ALL ..............................................

HCQ1080.
HC07eTrustInternet

1
2
3
4

[In general, how much would you trust information about health or medical
topics?]
How about on the Internet?
[IF NEEDED: Would you say a lot, some, a little or not at all?]
A LOT........................................................
SOME........................................................
A LITTLE ...................................................
NOT AT ALL ..............................................

1
2
3
4

HINTS 2007, Final CATI Study Instrument (06-15--07), National Cancer Institute (NCI)

Page 4

HCQ1085.
HC07fTrustTV

[In general, how much would you trust information about health or medical
topics?]
How about on television?
[IF NEEDED: Would you say a lot, some, a little or not at all?]
A LOT........................................................
SOME........................................................
A LITTLE ...................................................
NOT AT ALL ..............................................

HCQ1090.
HC07gTrustGov

1
2
3
4

[In general, how much would you trust information about health or medical
topics…]
How about from government health agencies?
[IF NEEDED: Government health agencies include the National Institutes of
Health, the Centers for Disease Control and Prevention, and state and local
health departments.]
[IF NEEDED: Would you say a lot, some, a little, or not at all?]
A LOT........................................................
SOME........................................................
A LITTLE ...................................................
NOT AT ALL ..............................................

HCQ1095.
HC07hTrustCharities

1
2
3
4

[In general, how much would you trust information about health or medical
topics…]
How about from charitable organizations?
[IF NEEDED: Would you say a lot, some, a little, or not at all?]
A LOT........................................................
SOME........................................................
A LITTLE ...................................................
NOT AT ALL ..............................................

HCQ1100.
HC07iTrustReligiousOrgs

1
2
3
4

[In general, how much would you trust information about health or medical
topics…]
How about from religious organizations and leaders?
[IF NEEDED: Would you say a lot, some, a little, or not at all?]
A LOT........................................................
SOME........................................................
A LITTLE ...................................................
NOT AT ALL ..............................................

1
2
3
4

HINTS 2007, Final CATI Study Instrument (06-15--07), National Cancer Institute (NCI)

Page 5

CANCER INFORMATION SEEKING
HCQ1105.
HC08SeekCancerInfo

Have you ever looked for information about cancer from any source?
YES...........................................................
NO.............................................................

1
2 (HCQ1145)

HCQ1110.
HC09WhenSeekCancerInfo_UNIT Think about the most recent time you looked for cancer-related information
from any source.
About how long ago was that?
[ENTER UNIT.]
DAYS AGO................................................
WEEKS AGO.............................................
MONTHS AGO ..........................................
YEARS AGO..............................................
HCQ1115.
HC09WhenSeekCancerInfo

1
2
3
4

[ENTER NUMBER.]
|__|__|

HCQ1120.
HC10WhatCancerInfoLookF

What type of information were you looking for in your most recent search?
[CODE ALL THAT APPLY.]
[PROBE: Anything else?]
SPECIFIC CANCER...................................
CANCER ORGANIZATIONS ......................
CAUSES OF CANCER/RISK FACTORS
FOR CANCER........................................
COPING WITH CANCER/ DEALING
WITH CANCER..........................................
DIAGNOSIS OF CANCER..........................
INFORMATION ON CANCER IN GENERAL
PAYING FOR MEDICAL CARE/
INSURANCE ..........................................
PREVENTION OF CANCER.......................
PROGNOSIS/ RECOVERY FROM
CANCER................................................
SCREENING/ TESTING/ EARLY
DETECTION..............................................
SYMPTOMS OF CANCER .........................
TREATMENT/ CURES FOR CANCER........
WHERE TO GET MEDICAL CARE.............
INFORMATION ON COMPLEMENTARY
ALTERNATIVE, OR UNCONVENTIONAL
TREATMENTS .......................................
OTHER (SPECIFY) ....................................

11
12
13
14
15
16
17
18
19
20
21
22
23
24
91

HINTS 2007, Final CATI Study Instrument (06-15--07), National Cancer Institute (NCI)

Page 6

HCQ1130.
HC11WhereSeekCancerInfo

The most recent time you looked for cancer information, where did you go first?
[IF SP HAS MADE MORE THAN ONE SEARCH, PROBE FOR THE MOST
RECENT SEARCH.]
BOOKS......................................................
BROCHURES, PAMPHLETS, ETC.............
CANCER ORGANIZATION ........................
FAMILY .....................................................
FRIEND/CO-WORKER...............................
HEALTH CARE PROVIDER .......................
INTERNET.................................................
LIBRARY ...................................................
MAGAZINES..............................................
NEWSPAPERS..........................................
TELEPHONE INFORMATION NUMBER
(1-800 NUMBER)....................................
COMPLEMENTARY OR ALTERNATIVE
PRACTITIONER.....................................
OTHER (SPECIFY) ....................................

1
2
3
4
5
6
7
8
9
10
11
12
91

HEALTH INFORMATION EXPOSURE

HCQ1145.
HC12ReadHealthSection

The next few questions are about various ways you might get health information.
Some newspapers or general magazines publish a special section that focuses
on health. In the past 12 months, have you read health sections of the
newspaper or of a general magazine?
YES...........................................................
NO.............................................................

HCQ1150.
HC13HealthOnNews

Some local television and radio news programs include special segments of their
newscasts that focus on health issues. In the past 12 months, have you watched
or listened to health segments on the local news?
YES...........................................................
NO.............................................................

HCQ1155.
HC14NoticeInfo

1
2

1
2

Some people notice information about health on the Internet, even when they are
not trying to find out about a health concern they have or someone in the family
has. Have you read such health information on the Internet in the past 12
months?
YES...........................................................
NO.............................................................

1
2

HINTS 2007, Final CATI Study Instrument (06-15--07), National Cancer Institute (NCI)

Page 7

INTERNET USE
HCQ1160.
HC15UseInternet

Do you ever go on-line to access the Internet or World Wide Web, or to send and
receive e-mail?
YES...........................................................
NO.............................................................

HCQ1165.
HC16WhereUseInternet

1
2 (NEXT SECTION)

Where do you go on-line to use the Internet?
[CODE ALL THAT APPLY.]
[PROBE: Anywhere else?]
HOME........................................................
WORK .......................................................
SCHOOL ...................................................
A PUBLIC LIBRARY...................................
A COMMUNITY CENTER...........................
SOMEONE ELSE'S HOUSE.......................
SOME OTHER PLACE...............................

11
12
13
14
15
16
91

BOX HCQ-1
IF RESPONDENT ACCESSES THE INTERNET AT HOME
(HCQ1165=11), ASK HCQ1175.
OTHERWISE, GO TO HCQ1185.
HCQ1175.
HC17AccessInternetHome

When you use the Internet at home, do you mainly access it through…
a telephone modem,...................................
a cable or satellite modem, .........................
a DSL modem, ...........................................
a wireless device such as a PDA, or ...........
some other way (specify)?..........................

HCQ1185.
HC18aBuyMedicine

1
2
3
4
91

Here are some ways people use the Internet. Some people have done these
things, but other people have not. In the past 12 months, have you done the
following things while using the Internet?
Bought medicine or vitamins on-line?
YES...........................................................
NO.............................................................

1
2

HINTS 2007, Final CATI Study Instrument (06-15--07), National Cancer Institute (NCI)

Page 8

HCQ1190.
HC18bSupportGroup

[In the past 12 months, have you done the following things while using the
Internet?]
Participated in an on-line support group for people with a similar health or
medical issue?
YES...........................................................
NO.............................................................

HCQ1195.
HC18cTalkDoctor

1
2

[In the past 12 months, have you done the following things while using the
Internet?]
Used e-mail or the Internet to communicate with a doctor or a doctor’s office?
YES...........................................................
NO.............................................................

HCQ1200.
HC18dDiet

1
2

[In the past 12 months, have you done the following things while using the
Internet?]
Used a website to help you with your diet, weight, or physical activity?
YES...........................................................
NO.............................................................

HCQ1205.
HC18eProvider

1
2

[In the past 12 months, have you done the following things while using the
Internet?]
Looked for a healthcare provider?
YES...........................................................
NO.............................................................

HCQ1210.
HC18fPDA

1
2

[In the past 12 months, have you done the following things while using the
Internet?]
Downloaded to a portable device, such as an iPod, cell phone, or PDA?
YES...........................................................
NO.............................................................

HCQ1215.
HC18gMySpace

1
2

[In the past 12 months, have you done the following things while using the
Internet?]
Visited a “social networking” site, such as “My Space” or “Second Life”?
YES...........................................................
NO.............................................................

1
2

HINTS 2007, Final CATI Study Instrument (06-15--07), National Cancer Institute (NCI)

Page 9

HCQ1220.
HC18hBlog

[In the past 12 months, have you done the following things while using the
Internet?]
Wrote in an online diary or “blog” (i.e., Web log)?
YES...........................................................
NO.............................................................

HCQ1225.
HC18iPersonalHealthInfo

1
2

[In the past 12 months, have you done the following things while using the
Internet?]
Kept track of personal health information, such as care received, test results, or
upcoming medical appointments?
YES...........................................................
NO.............................................................

1
2

HINTS 2007, Final CATI Study Instrument (06-15--07), National Cancer Institute (NCI)

Page 10

HEALTH SERVICES

HEALTH CARE USE
The next few questions are about your use of health care services.
HSQ1005.
HS01RegularProvider

Not including psychiatrists and other mental health professionals, is there a
particular doctor, nurse, or other health professional that you see most often?
YES...........................................................
NO.............................................................

HSQ1010
HS02WhatTypeProvider

What kind of health professional do you see most often- a doctor, nurse, or some
other health professional?
DOCTOR...................................................
NURSE......................................................
OTHER (SPECIFY) ....................................

HSQ1020.
HS03FreqGoProvider

1
2
3
4
5
6
95

Do you have any kind of health care coverage, including health insurance,
prepaid plans such as HMOs, or government plans such as Medicare?
YES...........................................................
NO.............................................................

HSQ1030.
HS05CAMUse

1
2
91

During the past 12 months, not counting times you went to an emergency room,
how many times did you go to a doctor, nurse, or other health professional to get
care for yourself?
1 TIME.......................................................
2 TIMES ....................................................
3 TIMES ....................................................
4 TIMES ....................................................
5-9 TIMES .................................................
10 OR MORE TIMES .................................
NONE........................................................

HSQ1025.
HS04Insurance

1
2

1
2

During the past 12 months, did you use any complementary, alternative, or
unconventional therapies such as herbal supplements, acupuncture, chiropractic,
homeopathy, meditation, yoga, or Tai Chi?
YES...........................................................
NO.............................................................

1
2

BOX HSQ-1
IF DID NOT SEE HEALTH PROFESSIONAL (HSQ1020=95), GO TO
HSQ1085.
OTHERWISE, CONTINUE.

HINTS 2007, Final CATI Study Instrument (06-15--07), National Cancer Institute (NCI)

Page 11

BOX HSQ-2
IF DID NOT USE CAM THERAPIES (HSQ1030=2), GO TO
HSQ1040.
OTHERWISE, CONTINUE.

HSQ1035.
HS06DiscussCAM

Did you discuss your use of unconventional therapies with any of your doctors?
YES...........................................................
NO.............................................................

1
2

HEALTH CARE EXPERIENCE
HSQ1040.
HS07aAskQuestions

The following questions are about your communication with all doctors, nurses,
or other health professionals you saw during the past 12 months.
During the past 12 months, how often did doctors, nurses, or other health
professionals give you the chance to ask all the health-related questions you
had? Would you say…
always, ......................................................
usually, ......................................................
sometimes, or ............................................
never? .......................................................

HSQ1045.
HS07bFeelingsAddressed

1
2
3
4

How often did doctors, nurses or other health professionals give the attention you
needed to your feelings and emotions?
[IF NEEDED: Would you say always, usually, sometimes, or never?]
ALWAYS....................................................
USUALLY ..................................................
SOMETIMES .............................................
NEVER ......................................................

HSQ1050.
HS07cInvolvedInDecisions

1
2
3
4

How often did they involve you in decisions about your health care as much as
you wanted?
[IF NEEDED: Would you say always, usually, sometimes, or never?]
ALWAYS....................................................
USUALLY ..................................................
SOMETIMES .............................................
NEVER ......................................................

1
2
3
4

HINTS 2007, Final CATI Study Instrument (06-15--07), National Cancer Institute (NCI)

Page 12

HSQ1055.
HS07dUnderstoodNextSteps

How often did they make sure you understood the things you needed to do to
take care of your health?
[IF NEEDED: Would you say always, usually, sometimes, or never?]
ALWAYS....................................................
USUALLY ..................................................
SOMETIMES .............................................
NEVER ......................................................

HSQ1060.
HS07eHelpUncertainty

1
2
3
4

How often did they help you deal with feelings of uncertainty about your health or
health care?
[IF NEEDED: Would you say always, usually, sometimes, or never?]
ALWAYS....................................................
USUALLY ..................................................
SOMETIMES .............................................
NEVER ......................................................

HSQ1065.
HS07fDrTakeCareNeeds

1
2
3
4

In the past 12 months, how often did you feel you could rely on your doctors,
nurses or other health professionals to take care of your health care needs?
[IF NEEDED: Would you say always, usually, sometimes, or never?]
ALWAYS....................................................
USUALLY ..................................................
SOMETIMES .............................................
NEVER ......................................................

HSQ1070.
HS08QualityCare

1
2
3
4

Overall, how would you rate the quality of health care you received in the past 12
months? Would you say…
excellent, ...................................................
very good,..................................................
good, .........................................................
fair, or ........................................................
poor?.........................................................

1
2
3
4
5

BOX HSQ-3
IF DOES NOT USE INTERNET (HCQ1160=2), GO TO HSQ1085.
OTHERWISE, CONTINUE.

HINTS 2007, Final CATI Study Instrument (06-15--07), National Cancer Institute (NCI)

Page 13

HSQ1075.
HS09TalkedDoctor

In the past 12 months, have you talked to a doctor, nurse, or other health
professional about any kind of health information you have gotten from the
Internet?
YES...........................................................
NO.............................................................

HSQ1080.
HS10DoctorInterested

In the past 12 months when you talked with a health care professional, how
interested were they in hearing about the information you found on-line?
Were they…
very interested, ..........................................
somewhat interested, .................................
a little interested, or ....................................
not at all interested? ...................................

HSQ1085.
HS11TakeCareHealth

1
2 (HSQ1085)

1
2
3
4

Overall, how confident are you about your ability to take good care of your
health? Would you say…
completely confident,..................................
very confident,............................................
somewhat confident, ..................................
a little confident, or .....................................
not confident at all? ....................................

1
2
3
4
5

AVOIDANCE OF DOCTORS
HSQ1090.
HS12DontAvoidDoc

HSQ1095.
HS13BodyExam

Some people avoid visiting their doctor even when they suspect they should.
Would you say this is true for you, or not true for you?
TRUE ........................................................ 1
NOT TRUE ................................................ 2 (HSQ1120)

Here are some reasons people give for not wanting to see their health care
provider [or doctor] . Which of the following do you agree with...
I avoid seeing my doctor because I feel uncomfortable when my body is being
examined. Would you say you…
strongly agree, ...........................................
somewhat agree,........................................
somewhat disagree, or ...............................
strongly disagree?......................................

1
2
3
4

HINTS 2007, Final CATI Study Instrument (06-15--07), National Cancer Institute (NCI)

Page 14

HSQ1100.
HS14FearIllness

I avoid seeing my doctor because I fear I may have a serious illness.
[IF NEEDED: Would you say you strongly agree, somewhat agree, somewhat
disagree, or strongly disagree.]
STRONGLY AGREE ..................................
SOMEWHAT AGREE.................................
SOMEWHAT DISAGREE ...........................
STRONGLY DISAGREE ............................

HSQ1105.
HS15Dying

1
2
3
4

I avoid seeing my doctor because it makes me think about dying.
[IF NEEDED: Would you say you strongly agree, somewhat agree, somewhat
disagree, or strongly disagree.]
STRONGLY AGREE ..................................
SOMEWHAT AGREE.................................
SOMEWHAT DISAGREE ...........................
STRONGLY DISAGREE ............................

HSQ1110.
HS16WhyAvoidDr

Are there any other reasons why you avoid seeing your doctor?
YES...........................................................
NO.............................................................

HSQ1115.
HS16WhyAvoidDr_OS

1
2
3
4

1
2 (HSQ1120)

[Are there any other reasons you avoid seeing your doctor?]
[SPECIFY:]
_______________________

HEALTH RECORDS
HSQ1120.
HS17ProviderMaintainEMR

As far as you know, do your healthcare providers maintain your medical
information in a portable, electronic format?
YES...........................................................
NO.............................................................

HSQ1125.
HS18EMR

1
2

How important is it to you that your healthcare providers are able to share your
medical information with each other electronically? Would you say…
very important, ...........................................
somewhat important, or ..............................
not at all important?....................................

1
2
3

HINTS 2007, Final CATI Study Instrument (06-15--07), National Cancer Institute (NCI)

Page 15

HSQ1130.
HS19PHR

How important would it be for you to get your own medical information
electronically? Would you say…
very important, ...........................................
somewhat important, or ..............................
not at all important?....................................

1
2
3

CONSENT
HSQ1135.
HS20InfoSafe

In general, I think that the information I give doctors is safely guarded. Would
you say you…
Strongly agree,...........................................
Somewhat agree, .......................................
Somewhat disagree, or...............................
Strongly disagree? .....................................

HSQ1140.
HS21NonlinkedInfoUsed

2
2
3
4

Scientists doing research should be able to review my medical information if the
information cannot be linked to me personally. Would you say you…
[IF NEEDED: Would you say you strongly agree, somewhat agree, somewhat
disagree, or strongly disagree?]
STRONGLY AGREE ..................................
SOMEWHAT AGREE.................................
SOMEWHAT DISAGREE ...........................
STRONGLY DISAGREE ............................

HSQ1145.
HS22UseBlood

1
2
3
4

If I give permission for my blood or tissue to be used in a research study, other
approved studies may also use it without further permission from me.
[IF NEEDED: Would you say you strongly agree, somewhat agree, somewhat
disagree, or strongly disagree?]
STRONGLY AGREE ..................................
SOMEWHAT AGREE.................................
SOMEWHAT DISAGREE ...........................
STRONGLY DISAGREE ............................

1
2
3
4

GENETIC TESTS
HSQ1150.
HS23HadGeneticTest

Have you ever had a genetic test?
YES...........................................................
NO.............................................................

1
2 (HSQ1155)

HINTS 2007, Final CATI Study Instrument (06-15--07), National Cancer Institute (NCI)

Page 16

HSQ1155.
HS24GeneticTestUseful

How useful was the genetic test information to you or your physician? Would you
say…
Very useful,................................................
Somewhat useful, or...................................
Not at all useful? ........................................

1
2
3

CLINICAL TRIALS
HSQ1160.
HS25ParticipateClinicalTrial

Clinical trials are research studies that involve people. They are designed to test
the safety and effectiveness of new treatments and to compare new treatments
with the standard care that people currently get.
Have you ever participated in a clinical trial?
YES...........................................................
NO.............................................................

HSQ1165.
HS26FundCancerResearch

1
2

How important do you think it is for the government to fund cancer research?
Would you say…
very important, ...........................................
important,...................................................
somewhat important, or ..............................
not at all important?....................................

1
2
3
4

INFORMATION SOURCES
HSQ1170.
HS27NCI

Before being contacted for this study had you ever heard of the National Cancer
Institute?
YES...........................................................
NO.............................................................

HSQ1175.
HS28CDC

[Before being contacted for this study had you ever heard of…] CDC or the
Centers for Disease Control and Prevention?
YES...........................................................
NO.............................................................

HSQ1180.
HS29ACS

1
2

1
2

[Before being contacted for this study had you ever heard of…] the American
Cancer Society?
YES...........................................................
NO.............................................................

1
2

HINTS 2007, Final CATI Study Instrument (06-15--07), National Cancer Institute (NCI)

Page 17

BEHAVIOR AND RISK FACTORS

ENERGY BALANCE
BRQ1005.
BR01Fruits

The next few questions are about your fruit and vegetable consumption.
How many servings of fruits do you usually eat or drink each day? Think of a
serving as being about 1 medium piece, or 1/2 cup of fruit, or 3/4 cup of fruit
juice.
|__|__|

BRQ1010.
BR02Vegetables

How many servings of vegetables do you usually eat or drink each day? Think of
a serving as being about 1 cup of raw leafy vegetables, 1/2 cup of other cooked
or raw vegetables, or 3/4 cup of vegetable juice.
|__|__|

BRQ1015.
BR03NumberServings

How many servings of fruits and vegetables do you think a person should eat
each day for good health?
[IF R GIVES RANGE, PROBE FOR AN EXACT NUMBER.
IF DON’T KNOW, DO NOT PROBE.]
|__|__|

BRQ1025.
BR04AnyExercisePastMonth

The next few questions are about your exercise, recreation, and physical activity
patterns.
During the past month, did you participate in any physical activities or exercises
such as running, calisthenics, golf, gardening, or walking for exercise?
YES...........................................................
NO.............................................................

BRQ1030.
BR05TimesModerateExercise

1
2 (BRQ1045)

In a typical week, how many days do you do any physical activity or exercise of
at least moderate intensity, such as brisk walking, bicycling at a regular pace,
swimming at a regular pace, and heavy gardening?
[IF NEEDED: moderate-intensity activities make you breathe somewhat harder
than normal.]
|__|__|

HINTS 2007, Final CATI Study Instrument (06-15--07), National Cancer Institute (NCI)

Page 18

BOX BRQ-1
IF DOES NOT EXERCISE IN A TYPICAL WEEK (BRQ1030=0), GO
TO BRQ1045.
OTHERWISE, CONTINUE.
BRQ1035.
BR06HowLongModerate
Exercise_UNIT

On the days that you do any physical activity or exercise of at least
moderate intensity, how long are you typically doing these activities?
[ENTER UNIT.]
MINUTES ..................................................
HOURS .....................................................

BRQ1040.
BR06HowLongModerate
Exercise

1
2

[ENTER NUMBER.]
|__|__|__|__|

BRQ1045.
BR07RecommendDays
Exercise

How many days a week of physical activity or exercise of at least moderate
intensity are recommended for the average adult to stay healthy?

|__|__|
BRQ1050.
BR08RecommendTimeExercise
_UNIT

On those days, how long should the average adult be physically active to stay
healthy?
[ENTER UNIT.]
MINUTES ..................................................
HOURS .....................................................

BRQ1055.
BR08RecommendTimeExercise

1
2

[ENTER NUMBER.]
|__|__|__|__|

BRQ1060.
BR09ExerciseLowerRiskCancer

As far as you know, does physical activity or exercise increase the chances of
getting some types of cancer, decrease the chances of getting some types of
cancer, or does it not make much difference?
INCREASES CHANCES OF CANCER .......
DECREASES CHANCES OF CANCER ......
MAKES NO DIFFERENCE .........................

1
2
3

HINTS 2007, Final CATI Study Instrument (06-15--07), National Cancer Institute (NCI)

Page 19

BRQ1065.
BR10Height_FEET

About how tall are you without shoes?
[ROUND FRACTIONS OF INCHES DOWN TO WHOLE INCH.]
[ENTER FEET.]
|__|__|

BRQ1070.
BR10Height_INCHES

[ENTER INCHES.]
|__|__|

BRQ1075.
BR11Weight

About how much do you weigh without shoes?
[ROUND FRACTIONS UP TO WHOLE NUMBER.]
|__|__|__|

BRQ1080.
BR12WeightPerception

Right now do you feel you are…
overweight, ................................................
slightly overweight,.....................................
slightly underweight, ..................................
underweight, or ..........................................
just about the right weight for you?..............

BRQ1085.
BR13TryLoseWeight

Have you tried to lose any weight in the past 12 months?
YES...........................................................
NO.............................................................

BRQ1090.
BR14LowCarbDiet

1
2

Do you think that a low carbohydrate, high protein diet is a healthy way to lose
weight?
YES...........................................................
NO.............................................................

BRQ1100.
BR16SunlightVitD

1
2

Have you tried a low carbohydrate, high protein diet in the past 12 months?
YES...........................................................
NO.............................................................

BRQ1095.
BR15LowCarbDietHealthy

1
2
3
4
5

1
2

Do you agree or disagree with the following statement?
Sunlight helps the body produce Vitamin D naturally. Would you say you…
Agree, or....................................................
Disagree? ..................................................

1
2

HINTS 2007, Final CATI Study Instrument (06-15--07), National Cancer Institute (NCI)

Page 20

BOX BRQ-2
IF DOES NOT HAVE REGULAR DOCTOR (HSQ1005=2), GO TO
BRQ1130.
OTHERWISE, CONTINUE.

BRQ1105.
BR17TakeDrDietExerAdvice

How much do you agree or disagree with the following statements?
I take the advice my primary care provider or doctor gives about diet and
exercise. Would you say you…
strongly agree, ...........................................
somewhat agree,........................................
neither agree nor disagree,.........................
somewhat disagree, or ...............................
strongly disagree?......................................
HAVE NOT RECEIVED ADVICE ................
DOES NOT HAVE A DOCTOR...................

BRQ1110.
BR18DrHasEffectiveStrategies

1
2
3
4
5
6
7 (BRQ1130)

My primary care provider or doctor has effective strategies and/or tools to help
me maintain a healthy weight or lose weight. Would you say you…
[IF NEEDED: Would you say you strongly agree, somewhat agree, neither agree
nor disagree, somewhat disagree, or strongly disagree?]
STRONGLY AGREE ..................................
SOMEWHAT AGREE.................................
NEITHER AGREE NOR DISAGREE...........
SOMEWHAT DISAGREE ...........................
STRONGLY DISAGREE ............................

BRQ1115.
BR19TimeToDiscussWeight

1
2
3
4
5

My primary care provider or doctor has enough time to talk with me about weight
control.
[IF NEEDED: Would you say you strongly agree, somewhat agree, neither agree
nor disagree, somewhat disagree, or strongly disagree?]
STRONGLY AGREE ..................................
SOMEWHAT AGREE.................................
NEITHER AGREE NOR DISAGREE...........
SOMEWHAT DISAGREE ...........................
STRONGLY DISAGREE ............................

1
2
3
4
5

HINTS 2007, Final CATI Study Instrument (06-15--07), National Cancer Institute (NCI)

Page 21

BRQ1120.
BR20DrsNeedTraining

My primary care provider or doctor needs more training in diet, weight, and
physical activity counseling.
[IF NEEDED: Would you say you strongly agree, somewhat agree, neither agree
nor disagree, somewhat disagree, or strongly disagree?]
STRONGLY AGREE ..................................
SOMEHWAT AGREE.................................
NEITHER AGREE NOR DISAGREE...........
SOMEWHAT DISAGREE ...........................
STRONGLY DISAGREE ............................

BRQ1125.
BR21DrsInfluence

1
2
3
4
5

I am more likely to adopt a healthier lifestyle if my primary care provider or doctor
recommends that I do so.
[IF NEEDED: Would you say you strongly agree, somewhat agree, neither agree
nor disagree, somewhat disagree, or strongly disagree?]
STRONGLY AGREE ..................................
SOMEWHAT AGREE.................................
NEITHER AGREE NOR DISAGREE...........
SOMEWHAT DISAGREE ...........................
STRONGLY DISAGREE ............................

BRQ1130.
BR22GenesDetermineWeight

To what extent do you believe that genes can determine body weight and body
composition (fat, muscle)? Would you say…
A lot, ..........................................................
Some,........................................................
A little, or....................................................
Not at all? ..................................................

BRQ1135.
BR23GeneCaloriesBurned

1
2
3
4
5

1
2
3
4

To what extent do you believe that genes can determine how you respond to
exercise and how many calories you burn while exercising?
[IF NEEDED: Would you say a lot, some, a little, or not at all?]
A LOT........................................................
SOME........................................................
A LITTLE ...................................................
NOT AT ALL ..............................................

BRQ1140.
BR24ObesityNotInherited

1
2
3
4

To what extent do you believe that obesity is not inherited, but is caused by
overeating and not exercising.
[IF NEEDED: Would you say a lot, some, a little, or not at all?]
A LOT........................................................
SOME........................................................
A LITTLE ...................................................
NOT AT ALL ..............................................

1
2
3
4

HINTS 2007, Final CATI Study Instrument (06-15--07), National Cancer Institute (NCI)

Page 22

SUN EXPOSURE
BRQ1150.
BR25aSunscreen

For the following questions, think about what you do when you are outside during
the summer on a warm sunny day.
How often do you wear sunscreen? Would you say…
[IF R DOES NOT GO OUTSIDE ON A SUNNY DAY, CODE 95.]
always, ......................................................
often, .........................................................
sometimes, ................................................
rarely, or ....................................................
never? .......................................................
DOES NOT GO OUT ON SUNNY DAY.......

BRQ1155.
BR25bShoulderSleeveShirt

1
2
3
4
5
95 (BRQ1170)

[How often do you…] wear a shirt with sleeves that cover your shoulders?
[IF NEEDED: Would you say always, often, sometimes, rarely, or never?]
ALWAYS....................................................
OFTEN ......................................................
SOMETIMES .............................................
RARELY ....................................................
NEVER ......................................................

BRQ1160.
BR25cHat

1
2
3
4
5

[How often do you…] wear a hat?
[IF NEEDED: Would you say always, often, sometimes, rarely, or never?]
ALWAYS....................................................
OFTEN ......................................................
SOMETIMES .............................................
RARELY ....................................................
NEVER ......................................................

BRQ1165.
BR25dShade

1
2
3
4
5

[How often do you…] stay in the shade or under an umbrella?
[IF NEEDED: Would you say always, often, sometimes, rarely, or never?]
ALWAYS....................................................
OFTEN ......................................................
SOMETIMES .............................................
RARELY ....................................................
NEVER ......................................................

1
2
3
4
5

HINTS 2007, Final CATI Study Instrument (06-15--07), National Cancer Institute (NCI)

Page 23

BRQ1170.
BR26TanningBed

How many times in the past 12 months have you used a tanning bed or booth?
0 TIMES ....................................................
1-2 TIMES .................................................
3-10 TIMES................................................
11-24 TIMES..............................................
25 TIMES OR MORE .................................

BRQ1175.
BR27TanningProducts

1
2
3
4
5

How many times in the past 12 months have you used sunless tanning creams or
sprays, also know as self-tanning or fake tanning? This includes creams or
lotions that you apply by yourself or mist tans from a tanning salon or other
business.
0 TIMES ....................................................
1-2 TIMES .................................................
3-10 TIMES................................................
11-24 TIMES..............................................
25 TIMES OR MORE .................................

1
2
3
4
5

TOBACCO
Next are some questions about your use of tobacco.
BRQ1185.
BR28Smoke100

Have you smoked at least 100 cigarettes in your entire life?
[IF NEEDED: 5 Packs = 100 Cigarettes.]
YES...........................................................
NO.............................................................

BRQ1190.
BR29SmokeNow

Do you now smoke cigarettes…
every day, ..................................................
some days, or ............................................
not at all?...................................................

BRQ1195.
BR30SmokeDayAlways

1
2 (BRQ1250)

1
2 (BRQ1200)
3 (BRQ1230)

On the average, how many cigarettes do you now smoke a day?
[IF NEEDED: 1 Pack = 20 Cigarettes.]
[IF LESS THAN ONE A DAY, ENTER 0. IF 99 OR MORE, ENTER 99.]
|__|__| (BRQ1220)

BRQ1200.
BR31SmokePast30Days

On how many of the past 30 days, did you smoke a cigarette?
|__|__|

HINTS 2007, Final CATI Study Instrument (06-15--07), National Cancer Institute (NCI)

Page 24

BOX BRQ-3
IF DID NOT SMOKE IN THE PAST 30 DAYS (BRQ1200=0), GO TO
BRQ1210.
OTHERWISE, CONTINUE.
BRQ1205.
BR32SmokeDaySometimes

On the average when you smoked during the past 30 days, about how many
cigarettes did you smoke a day?
[IF NEEDED: 1 Pack = 20 Cigarettes.]
[IF LESS THAN ONE A DAY, ENTER 0. IF 99 OR MORE, ENTER 99.]
|__|__|

BRQ1210.
BR33SmokeEveryDay
Months SS

Have you ever smoked cigarettes every day for at least 6 months?
YES...........................................................
NO.............................................................

BRQ1215.
BR34SmokeDaySomeDay

1
2 (BRQ1220)

When you last smoked every day, how many cigarettes did you usually smoke
each day?
[IF NEEDED: 1 Pack = 20 Cigarettes.]
[IF LESS THAN ONE A DAY, ENTER 0. IF 99 OR MORE, ENTER 99.]
|__|__|

BRQ1220.
BR35TriedQuit

During the past 12 months, have you tried to quit smoking completely?
YES...........................................................
NO.............................................................

BRQ1225.
BR36ConsiderQuit

1
2

Are you seriously considering quitting smoking within the next 6 months?
YES...........................................................
NO.............................................................

1 (BRQ1250)
2 (BRQ1250)

HINTS 2007, Final CATI Study Instrument (06-15--07), National Cancer Institute (NCI)

Page 25

BRQ1230.
BR37WhenQuitSmoke_UNIT

About how long has it been since you completely quit smoking cigarettes?
[ENTER UNIT.]
DAYS ........................................................
WEEKS .....................................................
MONTHS...................................................
YEARS ......................................................

BRQ1235.
BR37WhenQuitSmoke

1
2
3
4

[ENTER NUMBER.]
|__|__|__|__|__|

BRQ1240.
BR38SmokeEveryDay6
Months FS

Have you ever smoked cigarettes every day for at least 6 months?
YES...........................................................
NO.............................................................

BRQ1245.
BR39SmokeDayFormer

1
2 (BRQ1250)

When you last smoked every day, how many cigarettes did you usually smoke
each day?
[IF NEEDED: 1 Pack = 20 Cigarettes.]
[IF LESS THAN ONE A DAY, ENTER 0. IF 99 OR MORE, ENTER 99.]
|__|__|

BRQ1250.
BR40CigLessHarm

Do you believe that some cigarettes are less harmful than others?
YES...........................................................
NO.............................................................

BRQ1265.
BR42TryLessHarmCig

1
2

If a new cigarette were advertised as less harmful than current cigarettes, how
interested would you be in trying it? Would you say…
very interested, ..........................................
somewhat interested, or .............................
not interested? ...........................................

1
2
3 (BRQ1275)

BOX BRQ-4
IF NEVER OR FORMER SMOKER (BRQ1185=2 OR BRQ1190=3)
GO TO BRQ1275.
OTHERWISE, CONTINUE.

HINTS 2007, Final CATI Study Instrument (06-15--07), National Cancer Institute (NCI)

Page 26

BRQ1270.
BR43SaferCigOrQuit

How likely would you be to switch to a safer or less harmful cigarette product
instead of trying to quit smoking? Would you say…
very likely,..................................................
somewhat likely, or.....................................
not at all likely? ..........................................

BRQ1275.
BR44EverTryLessHarm

1
2
3

Have you ever tried a cigarette that had been advertised as less harmful? This
includes products like Eclipse, Advance, and Quest.
YES...........................................................
NO.............................................................

BRQ1280.
BR45SmokelessLessHarm

Do you believe that some smokeless tobacco products, such as chewing tobacco
and snuff, are less harmful than cigarettes?
YES...........................................................
NO.............................................................

BRQ1295.
BR47TryLessHarmSmokeless

1
2

1
2

If a new smokeless tobacco product that didn't require spitting were advertised as
less harmful than current cigarettes, how interested would you be in trying it?
very interested, ..........................................
somewhat interested, or .............................
not interested? ...........................................

1
2
3 (BRQ1305)

BOX BRQ-5
IF NEVER OR FORMER SMOKER (BRQ1185=2 OR BRQ1190=3),
GO TO BRQ1305.
OTHERWISE, CONTINUE.
BRQ1300.
BR48SmokelessOrQuit

How likely would you be to switch to a new smokeless tobacco product instead of
trying to quit smoking? Would you say…
very likely,..................................................
somewhat likely, or.....................................
not at all likely? ..........................................

BRQ1305.
BR49EverTryLessHarm

1
2
3

Have you ever tried a smokeless tobacco product that had been advertised as
less harmful? This includes products like Ariva, Revel, and Camel Snus.
YES...........................................................
NO.............................................................

1
2

HINTS 2007, Final CATI Study Instrument (06-15--07), National Cancer Institute (NCI)

Page 27

BRQ1310.
BR50aAwareQuitlines

There are a number of resources that people use to help them stop smoking.
Before being contacted for this survey, had you ever heard of telephone quit lines
such as a toll-free number to call for help in quitting smoking?
YES...........................................................
NO.............................................................

BRQ1315.
BR51CallQuitline

1
2 (BRQ1330)

Have you ever called a telephone quit line?
YES...........................................................
NO.............................................................

1
2

BOX BRQ-7
IF NEVER SMOKER (BRQ1185=2) OR IF QUIT SMOKING OVER 1
YEAR AGO (BRQ1230= 1 YEAR OR MORE),
GO TO BRQ1325.
OTHERWISE, CONTINUE.
BRQ1320.
BR52SuggestHelpline

In the past 12 months, did any doctor, dentist, nurse, or other health professional
suggest that you call or use a telephone helpline or quit line to help you quit
smoking?
YES...........................................................
NO.............................................................
DID NOT SEE HEALTH CARE PROVIDER
IN LAST 12 MONTHS ..............................

BRQ1325.
BR53FutureCallQuitline

95

How likely would you be to call a smoking cessation telephone quit line in the
future, for any reason? Would you say…
very likely,..................................................
somewhat likely,.........................................
somewhat unlikely, or.................................
very unlikely? .............................................

BRQ1330.
BR50bAwareQuitNow

1
2

1
2
3
4

Before being contacted for this survey, had you ever heard of 1-800-QUIT-NOW?
YES...........................................................
NO.............................................................

1
2

LUNG CANCER
BRQ1335.
BR54HeardLungTest

Have you heard of any tests to find lung cancer before the cancer creates
noticeable problems?
YES...........................................................
NO.............................................................

1
2 (BOX BRQ-8)

HINTS 2007, Final CATI Study Instrument (06-15--07), National Cancer Institute (NCI)

Page 28

BRQ1340.
BR55WhichLungTests

What tests have you heard of?
[CODE ALL THAT APPLY.]
[PROBE: Any other tests?]
CHEST X-RAY/ X-RAY ..............................
SPIRAL CT/ CT SCAN/ HELICAL LOW
DOSE CT SCAN ........................................
BRONCHOSCOPY ....................................
SPUTUM CYTOLOGY (CHECKING SPIT
FOR CANCER CELLS) ..............................
LUNG BIOPSY...........................................
BLOOD TEST ............................................
MRI ...........................................................
HEARD SOMETHING
RECENTLY/SAW
SOMETHING ON NEWS............................
CANNOT RECALL NAME ..........................
OTHER (SPECIFY) ....................................

11
12
13
14
15
16
17
18
19
91

BOX BRQ-8
IF RESPONDENT IS MALE, GO TO BRQ1380.
OTHERWISE, CONTINUE.
CERVICAL CANCER
The next few questions are about getting tested for cervical cancer.
BRQ1355.
BR56HadPapSmear

Sometimes, when a woman has a routine pelvic exam, she also has a Pap test to
test for cancer of the cervix.
Have you ever had a Pap test?
YES...........................................................
NO.............................................................

BRQ1360.
BR57WhenPapSmear

1
2 (BRQ1380)

When did you have your most recent Pap test to check for cervical cancer?
A YEAR AGO OR LESS.............................
MORE THAN 1 BUT NOT MORE THAN
3 YEARS AGO...........................................
MORE THAN 3 BUT NOT MORE THAN
5 YEARS BEFORE ....................................
MORE THAN 5 YEARS AGO .....................

1
2
3
4

HINTS 2007, Final CATI Study Instrument (06-15--07), National Cancer Institute (NCI)

Page 29

BRQ1365.
BR58WhyPapSmear

What was the main reason that you had this Pap test?
ROUTINE ANNUAL PAP SMEAR OR
PART OF ROUTINE PHYSICAL EXAM ......
LAST PAP SMEAR WAS NOT NORMAL....
A SPECIFIC PROBLEM .............................
SHE HAD NEVER HAD ONE AND
THOUGHT SHE SHOULD..........................
PREGNANCY/FOLLOW-UP TO BIRTH ......
OTHER (SPECIFY) ....................................

BRQ1375.
BR59WhenNextPapSmear

2
3
4
5
6
7
8
9

1
2

Have you heard anything about a vaccine or shot to prevent cervical cancer?
YES...........................................................
NO.............................................................

BRQ1390.
BR62HeardHPV

1

Have you ever been treated for genital warts?
YES...........................................................
NO.............................................................

BRQ1385.
BR61Vaccine

4
5
91

When do you expect to have your next Pap test?
A YEAR OR LESS FROM NOW .................
MORE THAN 1 BUT NOT MORE THAN
3 YEARS FROM NOW ...............................
MORE THAN 3 BUT NOT MORE THAN
5 YEARS FROM NOW ...............................
OVER 5 YEARS FROM NOW ....................
AM NOT PLANNING TO HAVE
ANOTHER .................................................
IF I HAVE SYMPTOMS ..............................
WHEN DOCTOR/HEALTH PROVIDER
RECOMMENDS.........................................
AM NOT PLANNING TO HAVE
ANOTHER
BECAUSE I GOT THE HPV VACCINE .......
AM NOT PLANNING TO HAVE
ANOTHER BECAUSE I PLAN TO GET
THE HPV TEST INSTEAD..........................

BRQ1380.
BR60TreatedWarts

1
2
3

1
2

Have you ever heard of HPV? HPV stands for Human Papillomavirus.
It is not HIV, HSV, or herpes.
YES...........................................................
NO.............................................................

1
2

BOX BRQ-9
IF RESPONDENT HAS NOT HEARD OF HPV, GO TO BRQ1455.
IF RESPONDENT IS MALE AND HAS HEARD OF HPV
(BRQ1390=1), ASK BRQ1395, BRQ1420, BRQ1425, AND BRQ1430.
OTHERWISE, CONTINUE.

HINTS 2007, Final CATI Study Instrument (06-15--07), National Cancer Institute (NCI)

Page 30

BRQ1395.
BR63SourceHPVKnowledge

Where have you heard about HPV?
[CODE ALL THAT APPLY.]
[PROBE: Anywhere else?]
DOCTOR, NURSE OR OTHER HEALTH
CARE PROFESSIONAL.............................
FAMILY OR FRIENDS ...............................
NEWSPAPER OR MAGAZINE ...................
SAW AN AD ON TELEVISION....................
TELEVISION NEWS ..................................
OTHER TELEVISION (i.e., Oprah or ER) ....
INTERNET.................................................
RADIO.......................................................
DON'T REMEMBER...................................
OTHER (SPECIFY) ....................................

11
12
13
14
15
16
17
18
19
91

[IF R SAYS THEY HAVE IT, PROBE TO SEE IF THEY HEARD ABOUT IT
FROM A DOCTOR, NURSE, OR OTHER HEALTH CARE PROFESSIONAL]
BRQ1405.
BR64EverHadHPV

Have you ever been told by a health care provider that you had a human
papillomavirus or HPV infection?
YES...........................................................
NO.............................................................

1
2

BOX BRQ-10
IF RESPONDENT HAS NOT HEARD OF A VACCINE TO PREVENT
CERVICAL CANCER (BRQ1385=2), GO TO BRQ1415.
OTHERWISE, CONTINUE.
BRQ1410.
BR65DiscussHPVVaccine

Has a health care provider such as a doctor or nurse ever talked to you about a
HPV vaccine or shot?
YES...........................................................
NO.............................................................

BRQ1415.
BR66DiscussHPVTest

Has a health care provider such as a doctor or nurse ever talked to you about a
HPV test?
YES...........................................................
NO.............................................................

BRQ1420.
BR67HPVCauseCancer

1
2

1
2

Next are some questions on your opinion about HPV.
Do you think HPV can cause cervical cancer?
YES...........................................................
NO.............................................................

1
2

HINTS 2007, Final CATI Study Instrument (06-15--07), National Cancer Institute (NCI)

Page 31

BRQ1425.
BR68HPVSTD

Do you think you can get HPV through sexual contact?
YES...........................................................
NO.............................................................

BRQ1430.
BR69HPVRare

1
2

Do you think that HPV infection is rare?
YES...........................................................
NO.............................................................

1
2

BOX BRQ-11
IF RESPONDENT IS MALE, GO TO BRQ1455.
OTHERWISE, CONTINUE.
BRQ1435.
BR70HPVGoAway

Do you think HPV can go away on its own, without treatment?
YES...........................................................
NO.............................................................

BRQ1440.
BR71HPVCauseAbnormalPa

Do you think HPV can cause abnormal Pap tests?
YES...........................................................
NO.............................................................

BRQ1445.
BR72WomanKnowsHPV

1
2

Do you think women who get the HPV vaccine or shot should continue to get
screened for cervical cancer with the Pap test?
YES...........................................................
NO.............................................................

BRQ1455.
BR74VaccineForDaughter

1
2

Do you think a woman can usually tell when she is infected with HPV?
YES...........................................................
NO.............................................................

BRQ1450.
BR73ScreeningAfterVaccine

1
2

1
2

A vaccine or shot that protects against HPV, a virus that can cause cervical
cancer, was recently recommended for girls ages 9-12. If you had a daughter
that age, would you have her get it?
YES...........................................................
NO.............................................................
NOT SURE/ IT DEPENDS..........................
DON’T KNOW............................................

1 (BOX BRQ-12)
2
3
4

HINTS 2007, Final CATI Study Instrument (06-15--07), National Cancer Institute (NCI)

Page 32

BRQ1460.
BR75WhyNoVaccineFor
Daughter

What is the main reason you would not have her get it?
SHE DOESN'T NEED THE VACCINE
OR SHOT ..................................................
MY CHILD IS NOT SEXUALLY ACTIVE .....
IT IS TOO EXPENSIVE..............................
VACCINATIONS (SHOTS TO PREVENT
SICKNESS) IN GENERAL ARE NOT
NECESSARY.............................................
I DON'T KNOW WHERE TO GET IT...........
MY CHILD'S DOCTOR HAS NOT
RECOMMENDED IT ..................................
I AM WORRIED ABOUT THE SAFETY OF
THE VACCINE...........................................
MY PARTNER IS AGAINST IT ...................
I DON'T BELIEVE IT WILL WORK..............
MY MOTHER OR OTHERS IN MY
FAMILY ARE AGAINST IT..........................
I AM WORRIED THAT THE VACCINE OR
SHOT MIGHT PROMOTE SEXUAL
ACTIVITY ..................................................
I WORRY WHAT OTHERS WOULD
THINK IF THEY FOUND OUT SHE
GOT IT ......................................................
OTHER (SPECIFY) ....................................

1
2
3
4
5
6
7
8
9
10
11
12
91

COLON CANCER
BOX BRQ-12
IF RESPONDENT IS 45 YEARS OR OLDER, CONTINUE.
OTHERWISE, GO TO NEXT SECTION.
BRQ1470.
BR76WhenDiscussTest

The next few questions are about getting tested for colon cancer. First I’ll ask
you some questions about discussions you might have had about colon cancer
testing. Then I’ll ask you about any tests you might have had.
Think about the last time a doctor, nurse or other health professional told you that
you should get a test to check for colon cancer. When did that discussion take
place?
A YEAR AGO OR LESS.............................
MORE THAN 1 BUT NOT MORE THAN
2 YEARS AGO...........................................
MORE THAN 2 BUT NOT MORE THAN
5 YEARS AGO...........................................
OVER 5 YEARS AGO ................................
I CAN'T REMEMBER .................................
NO HEALTH PROFESSIONAL HAS TOLD
ME I SHOULD GET A TEST TO CHECK
FOR COLON CANCER ..............................

1
2
3
4 (BRQ1530)
5 (BRQ1530)
6 (BRQ1530)

[PROBE: IF R CAN’T REMEMBER, PROBE TO SEE IF THE DISCUSSION
WAS WITHIN THE LAST 5 YEARS]

HINTS 2007, Final CATI Study Instrument (06-15--07), National Cancer Institute (NCI)

Page 33

BRQ1475.
BR77WhoDiscussedTestDOCTOR Who talked to you about getting a test to check for colon cancer? Was it a
doctor?
YES...........................................................
NO.............................................................
BRQ1476.
BR77WhoDiscussedTestNURSE

1
2

Who talked to you about getting a test to check for colon cancer? Was it a nurse?
YES...........................................................
NO.............................................................

1
2

BRQ1477.
BR77WhoDiscussedTestHEALTHPRO Who talked to you about getting a test to check for colon cancer? Was another

health professional?
YES...........................................................
NO.............................................................

1
2

[HIGHEST PROFESSIONAL (BRQ1475 through BRQ1477) WILL BE USED TO FILL SUBSEQUENT QUESTIONS.]
BRQ1480.
BR79DescribeBloodTest

The last time you were told you should be tested for colon cancer, which of the
following tests did the {doctor/ nurse/ other health professional} describe?
Did the {doctor/ nurse/ other health professional} describe the stool blood test or
fecal occult blood test?
[IF NEEDED: A stool or fecal blood test is done at home to check for colon
cancer. You send your stool sample to the doctor’s office or lab for testing.]
YES...........................................................
NO.............................................................

BRQ1485.
BR79DescribeCol

1
2

[IF NEEDED: The last time you were told you should be tested for colon cancer,
which of the following tests did the {doctor/ nurse/ other health professional}
describe?]
Did the {doctor/ nurse/ other health professional} describe colonoscopy?
[IF NEEDED: A sigmoidoscopy and a colonoscopy are both tests that examine
the bowel by inserting a tube in the rectum. The difference is that during a
sigmoidoscopy, you are awake and can drive yourself home after the test;
however, during a colonscopy, you may feel sleepy and you need someone to
drive you home.]
YES...........................................................
NO.............................................................

1
2

HINTS 2007, Final CATI Study Instrument (06-15--07), National Cancer Institute (NCI)

Page 34

BRQ1490.
BR80DescribeSig

[IF NEEDED: The last time you were told you should be tested for colon cancer,
which of the following tests did the {doctor/ nurse/ other health professional}
describe?
Did the {doctor/ nurse/ other health professional} describe sigmoidoscopy?
[IF NEEDED: A sigmoidoscopy and a colonoscopy are both tests that examine
the bowel by inserting a tube in the rectum. The difference is that during a
sigmoidoscopy, you are awake and can drive yourself home after the test;
however, during a colonscopy, you may feel sleepy and you need someone to
drive you home.]
YES...........................................................
NO.............................................................

BRQ1495.
BR81DescribeOtherTests

1
2

[IF NEEDED: The last time you were told you should be tested for colon cancer,
which of the following tests did the {doctor/ nurse/ other health professional}
describe?
Did the {doctor/ nurse/ other health professional} describe any other tests?
YES...........................................................
NO.............................................................

BRQ1500.
BR82TestDescribed

1
2 (BRQ1505)

What test did the {doctor/ nurse/ other health professional} describe?
_______________________

BRQ1505.
BR83RecommendTest

The last time you were told you should be tested for colon cancer, did the
{doctor/ nurse/ other health professional} recommend to you any particular test?
YES...........................................................
NO.............................................................

BRQ1510.
BR84TestRecommended

1
2 (BRQ1520)

Which test to check for colon cancer did the {doctor/ nurse/ other health
professional} recommend to you?
[CODE ALL THAT APPLY.]
STOOL BLOOD TEST/FECAL OCCULT
BLOOD TEST ............................................
SIGMOIDOSCOPY ....................................
COLONOSCOPY.......................................
OTHER (SPECIFY) ....................................

11
12
13
91

HINTS 2007, Final CATI Study Instrument (06-15--07), National Cancer Institute (NCI)

Page 35

BRQ1520.
BR85TestDecision

Who decided whether you should have a test to check for colon cancer?
Would you say…
you mainly decided,....................................
you and the {doctor/ nurse/ other health
professional} decided together, or ..............
the {doctor/ nurse/ other health
professional} mainly decided?.....................

BRQ1525.
BR86InfoSatisfied

1
2
3

Thinking about the last time a {doctor/ nurse/ other health professional} talked to
you about being checked for colon cancer, did he or she encourage you to ask
questions or express any concerns you had about colon cancer testing?
Would you say…
yes, definitely, ............................................
yes, somewhat, or ......................................
no, not at all? .............................................
DID NOT HAVE ANY QUESTIONS OR
CONCERNS ABOUT COLON CANCER
TESTING ...................................................

BRQ1530.
BR87HadStoolBlood

1
2
3
4

[IF NEEDED: Just to review]
A stool or fecal blood test is done at home to check for colon cancer. You send
your stool sample to the doctor’s office or lab for testing. Have you ever done a
stool blood test using a home kit?
YES...........................................................
NO.............................................................

BRQ1535.
BR88WhenStoolBlood

When did you do your most recent stool blood test using a home kit to check for
colon cancer?
A YEAR AGO OR LESS.............................
MORE THAN 1 BUT NOT MORE THAN
2 YEARS AGO...........................................
MORE THAN 2 BUT NOT MORE THAN
5 YEARS AGO...........................................
OVER 5 YEARS AGO ................................

BRQ1540.
BR89WhyStoolBlood

1
2 (BRQ1545)

1
2
3
4

What was the main reason you did your most recent stool blood test using a
home kit? Was it…
part of a routine exam,................................
because of a problem, or ............................
some other reason? ...................................

1
2
3

HINTS 2007, Final CATI Study Instrument (06-15--07), National Cancer Institute (NCI)

Page 36

BRQ1545.
BR90HadCol

[IF NEEDED: Just to review]
A sigmoidoscopy and a colonoscopy are both tests that examine the bowel by
inserting a tube in the rectum. The difference is that during a sigmoidoscopy, you
are awake and can drive yourself home after the test; however, during a
colonoscopy, you may feel sleepy and you need someone to drive you home.
Have you ever had a colonoscopy?
YES...........................................................
NO.............................................................

BRQ1550.
BR91WhenCol

When did you have your most recent colonoscopy to check for colon cancer?
A YEAR AGO OR LESS.............................
MORE THAN 1 BUT NOT MORE THAN
5 YEARS AGO...........................................
MORE THAN 5 BUT NOT MORE THAN
10 YEARS AGO.........................................
OVER 10 YEARS AGO...................................

BRQ1555.
BR92WhyCol

3
4

1
2
3

1
2 (BRQ1575)

When did you have your most recent sigmoidoscopy to check for colon cancer?
A YEAR AGO OR LESS.............................
MORE THAN 1 BUT NOT MORE THAN
5 YEARS AGO...........................................
MORE THAN 5 BUT NOT MORE THAN
10 YEARS AGO.........................................
OVER 10 YEARS AGO ..............................

BRQ1570.
BR95WhySig

2

Have you ever had a sigmoidoscopy?
YES...........................................................
NO.............................................................

BRQ1565.
BR94WhenSig

1

What was the main reason you had your most recent colonoscopy? Was it. . .
part of a routine exam,................................
because of a problem, or ............................
some other reason? ...................................

BRQ1560.
BR93HadSig

1
2 (BRQ1560)

1
2
3
4

What was the main reason you had your most recent sigmoidoscopy? Was it…
part of a routine exam,................................
because of a problem, or ............................
some other reason? ...................................

1
2
3

HINTS 2007, Final CATI Study Instrument (06-15--07), National Cancer Institute (NCI)

Page 37

BRQ1575.
BR96MostEffectiveTest

We’ve asked about three tests to find colon cancer, the stool blood test,
colonoscopy, and sigmoidoscopy. Do you believe these tests are about equally
effective in finding colon cancer, or are some more effective than others?”
EQUALLY EFFECTIVE ..............................
SOME ARE MORE EFFECTIVE THAN
OTHERS....................................................

BRQ1580.
BR97WhichMostEffective

1 (NEXT SECTION)
2

Which test do you believe is more effective in finding colon cancer?
[CODE ALL THAT APPLY]
STOOL BLOOD TEST/FECAL OCCULT
BLOOD TEST ............................................
COLONOSCOPY.......................................
SIGMOIDOSCOPY ....................................

11
12
13

HINTS 2007, Final CATI Study Instrument (06-15--07), National Cancer Institute (NCI)

Page 38

CANCER

NUMERACY
The next few questions are about communicating health information with numbers
CSQ1005.
CS01WordsOrNumbers

People can talk about the chance of something happening using either words,
like "it rarely happens" or numbers, like "there's a 5% chance." When people tell
you the chance of something happening do you prefer they use words or
numbers?
GENERALLY PREFER WORDS ................
GENERALLY PREFER NUMBERS.............
NO PREFERENCE ....................................

1
2
3

The next three questions are about using numbers and statistics in health information.
CSQ1010.
CS02MedStats

In general, how easy or hard do you find it to understand medical statistics?
Would you say…
Very easy,..................................................
Easy,, ........................................................
Hard, or .....................................................
Very hard...................................................

CSQ1015.
CS03AttentionStats

1
2
3
4

How much do you agree or disagree with the following statements?
In general, I feel uncomfortable with health information that has a lot of numbers
and statistics. Would you say you…
strongly agree,
somewhat agree,........................................
somewhat disagree, or ...............................
strongly disagree?......................................

CSQ1020.
CS04NumbersHelpful

1
2
3
4

In general, I depend on numbers and statistics to help me make decisions about
my health.
[IF NEEDED: Would you say you strongly agree, somewhat agree, neither agree
nor disagree, somewhat disagree, or strongly disagree?]
STRONGLY AGREE ..................................
SOMEWHAT AGREE.................................
SOMEWHAT DISAGREE ...........................
STRONGLY DISAGREE ............................

1
2
3
4

HINTS 2007, Final CATI Study Instrument (06-15--07), National Cancer Institute (NCI)

Page 1

CANCER COGNITION
I'm going to read several statements about cancer. For each, just tell me how much you agree or disagree, and try to
think about cancer in general when answering.
CSQ1025.
CS05CancerFatal

When I think of cancer, I automatically think of death. Would you say you…
strongly agree, ...........................................
somewhat agree,........................................
somewhat disagree, or ...............................
strongly disagree?......................................

CSQ1030.
CS06ChanceGetCancer

How likely do you think it is that you will develop cancer in the future? Would you
say your chance of getting cancer is…
very low, ....................................................
somewhat low, ...........................................
moderate, ..................................................
somewhat high, or......................................
very high?..................................................

CSQ1035.
CS07FreqWorryCancer

1
2
3
4
5

How often do you worry about getting cancer? Would you say…
rarely or never,...........................................
sometimes, ................................................
often, or .....................................................
all the time? ...............................................

CSQ1040.
CS08BehaviorCausesCancer

1
2
3
4

1
2
3
4

How much do you agree or disagree with the following statements?
Cancer is most often caused by a person's behavior or lifestyle. Would you say
you…
strongly agree, ...........................................
somewhat agree,........................................
somewhat disagree, or ...............................
strongly disagree?......................................

CSQ1045.
CS09CheckEarlyDetect

1
2
3
4

Getting checked regularly for cancer helps find cancer when it's easy to treat.
[IF NEEDED: Would you say you strongly agree, somewhat agree, somewhat
disagree, or strongly disagree?]
STRONGLY AGREE ..................................
SOMEWHAT AGREE.................................
SOMEWHAT DISAGREE ...........................
STRONGLY DISAGREE ............................

1
2
3
4

HINTS 2007, Final CATI Study Instrument (06-15--07), National Cancer Institute (NCI)

Page 2

CSQ1050.
CS10KnowPriorToDiagnosis

People can tell they might have cancer before being diagnosed.
[IF NEEDED: Would you say you strongly agree, somewhat agree, somewhat
disagree, or strongly disagree?]
STRONGLY AGREE ..................................
SOMEWHAT AGREE.................................
SOMEWHAT DISAGREE ...........................
STRONGLY DISAGREE ............................

CSQ1055.
CS11EarlyDetectCured

1
2
3
4

Cancer is an illness that when detected early can typically be cured.
[IF NEEDED: Would you say you strongly agree, somewhat agree, somewhat
disagree, or strongly disagree?]
STRONGLY AGREE ..................................
SOMEWHAT AGREE.................................
SOMEWHAT DISAGREE ...........................
STRONGLY DISAGREE ............................

CSQ1060.
CS12EverythingCauseCancer

1
2
3
4

It seems like everything causes cancer.
[IF NEEDED: Would you say you strongly agree, somewhat agree, somewhat
disagree, or strongly disagree?]
STRONGLY AGREE ..................................
SOMEWHAT AGREE.................................
SOMEWHAT DISAGREE ...........................
STRONGLY DISAGREE ............................

CSQ1065.
CS13PreventNotPossible

1
2
3
4

There's not much you can do to lower your chances of getting cancer.
[IF NEEDED: Would you say you strongly agree, somewhat agree, somewhat
disagree, or strongly disagree?]
STRONGLY AGREE ..................................
SOMEWHAT AGREE.................................
SOMEWHAT DISAGREE ...........................
STRONGLY DISAGREE ............................

1
2
3
4

CSQ1070.
CS14TooManyRecommendations There are so many different recommendations about preventing cancer, it's hard
to know which ones to follow.
[IF NEEDED: Would you say you strongly agree, somewhat agree, somewhat
disagree, or strongly disagree?]
STRONGLY AGREE ..................................
SOMEWHAT AGREE.................................
SOMEWHAT DISAGREE ...........................
STRONGLY DISAGREE ............................

1
2
3
4

HINTS 2007, Final CATI Study Instrument (06-15--07), National Cancer Institute (NCI)

Page 3

CSQ1075.
CS15SurviveFiveYears

Overall, how many people who develop cancer do you think survive at least 5
years? Would you say…
less than 25 percent, ..................................
about 25 percent, .......................................
about 50 percent, .......................................
about 75 percent, or ...................................
nearly all? ..................................................

CSQ1080.
CS16FirstCancer

1
2
3
4
5

When you hear the word cancer, what type of cancer comes to mind first?
BLADDER CANCER ..................................
BONE CANCER.........................................
BREAST CANCER.....................................
CERVICAL CANCER
(CANCER OF THE CERVIX)...................
COLON CANCER ......................................
ENDOMETRIAL CANCER
(CANCER OF THE UTERUS) .................
HEAD AND NECK CANCER ......................
HODGKIN'S LYMPHOMA ..........................
LEUKEMIA/BLOOD CANCER ....................
LIVER CANCER.........................................
LUNG CANCER.........................................
MELANOMA ..............................................
NON-HODGKIN'S LYMPHOMA..................
OTHER SKIN CANCER..............................
ORAL CANCER .........................................
OVARIAN CANCER ...................................
PANCREATIC CANCER ............................
PHARYNGEAL (THROAT) CANCER..........
PROSTATE CANCER ................................
RECTAL CANCER.....................................
RENAL (KIDNEY) CANCER .......................
STOMACH CANCER .................................
OTHER (SPECIFY) ....................................

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
91

CANCER HISTORY
CSQ1090.
CS17EverHadCancer

Have you ever been diagnosed as having cancer?
YES...........................................................
NO.............................................................

1
2 (CSQ1130)

HINTS 2007, Final CATI Study Instrument (06-15--07), National Cancer Institute (NCI)

Page 4

CSQ1095.
CS18TypeofSPsCancer

What type of cancer did you have?
[CODE ALL THAT APPLY.]
[PROBE: Any other type?]
BLADDER CANCER ..................................
BONE CANCER.........................................
BREAST CANCER.....................................
CERVICAL CANCER
(CANCER OF THE CERVIX)...................
COLON CANCER ......................................
ENDOMETRIAL CANCER
(CANCER OF THE UTERUS) .................
HEAD AND NECK CANCER ......................
HODGKIN'S LYMPHOMA ..........................
LEUKEMIA/BLOOD CANCER ....................
LIVER CANCER.........................................
LUNG CANCER.........................................
MELANOMA ..............................................
NON-HODGKIN'S LYMPHOMA..................
OTHER SKIN CANCER..............................
ORAL CANCER .........................................
OVARIAN CANCER ...................................
PANCREATIC CANCER ............................
PHARYNGEAL (THROAT) CANCER..........
PROSTATE CANCER ................................
RECTAL CANCER.....................................
RENAL (KIDNEY) CANCER .......................
STOMACH CANCER .................................
OTHER (SPECIFY) ....................................

CSQ1105.
CS19WhenDiagnosedCancer
_UNIT

10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
91

At what age or in what year were you first told that you had cancer?
[ENTER UNIT.]
AGE...........................................................
YEAR ........................................................

CSQ1110.
CS19WhenDiagnosedCancer

1
2

[ENTER NUMBER.]
|__|__|__|__|

CSQ1115.
CS20UndergoCancerTreatment

Did you ever receive any treatment for your cancer?
YES...........................................................
NO.............................................................

1
2 (CSQ1130)

HINTS 2007, Final CATI Study Instrument (06-15--07), National Cancer Institute (NCI)

Page 5

CSQ1120.
CS21HowLongFinish
Treatment_UNIT

How long ago did you finish your most recent treatment?

[ENTER UNIT.]
MONTHS...................................................
YEARS ......................................................
STILL IN TREATMENT...............................
CSQ1125.
CS21HowLongFinish
Treatment

1
2
3

[ENTER NUMBER.]
|__|__|__|

CSQ1130.
CS22FamilyEverHadCancer

Have any of your family members ever had cancer?
[IF INDICATE “DOESN’T HAVE FAMILY,” CODE AS “NO FAMILY.”]
YES...........................................................
NO.............................................................
NO FAMILY ...............................................

1
2
3

HINTS 2007, Final CATI Study Instrument (06-15--07), National Cancer Institute (NCI)

Page 6

HEALTH STATUS AND DEMOGRAPHICS

HEALTH STATUS
HDQ1005.
HD01GeneralHealth

In general, would you say your health is…
excellent, ...................................................
very good,..................................................
good, .........................................................
fair, or ........................................................
poor?.........................................................

HDQ1010.
HD02aDiabetes

1
2
3
4
5

Has a doctor ever told you that you had any of the following health conditions?
Diabetes or high blood sugar?
YES...........................................................
NO.............................................................

HDQ1015.
HD02bHypertension

1
2

[Has a doctor ever told you that you had any of the following health conditions?]
High blood pressure or hypertension?
YES...........................................................
NO.............................................................

HDQ1020.
HD02cHeartCondition

1
2

[Has a doctor ever told you that you had any of the following health conditions?]
A heart condition such as a heart attack, angina, or congestive heart failure?
YES...........................................................
NO.............................................................

HDQ1025.
HD02dLungDisease

1
2

[Has a doctor ever told you that you had any of the following health conditions?\
Chronic lung disease, asthma, emphysema, or chronic bronchitis?
YES...........................................................
NO.............................................................

HDQ1030.
HD02eArthritis

1
2

[Has a doctor ever told you that you had any of the following health conditions?]
Arthritis or rheumatism?
YES...........................................................
NO.............................................................

1
2

HINTS 2007, Final CATI Study Instrument (06-15--07), National Cancer Institute (NCI)

Page 7

HDQ1035.
HD02fDepression

[Has a doctor ever told you that you had any of the following health conditions?]
Depression or anxiety disorder?
YES...........................................................
NO.............................................................

HDQ1045.
HD03aSad

1
2

Next are some questions about feelings you may have experienced over the past
30 days.
During the past 30 days, how often did you feel so sad that nothing could cheer
you up? 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?
ALL OF THE TIME .....................................
MOST OF THE TIME .................................
SOME OF THE TIME .................................
A LITTLE OF THE TIME.............................
NONE OF THE TIME .................................

HDQ1050.
HD03bNervous

1
2
3
4
5

[During the past 30 days, how often did you feel…] nervous?
[IF NEEDED: 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?]
ALL OF THE TIME .....................................
MOST OF THE TIME .................................
SOME OF THE TIME .................................
A LITTLE OF THE TIME.............................
NONE OF THE TIME .................................

HDQ1055.
HD03cRestless

1
2
3
4
5

[During the past 30 days, how often did you feel…] restless or fidgety?
[IF NEEDED: 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?]
ALL OF THE TIME .....................................
MOST OF THE TIME .................................
SOME OF THE TIME .................................
A LITTLE OF THE TIME.............................
NONE OF THE TIME .................................

HDQ1060.
HD03dHopeless

1
2
3
4
5

[During the past 30 days, how often did you feel… ] hopeless?
[IF NEEDED: 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?]
ALL OF THE TIME .....................................
MOST OF THE TIME .................................
SOME OF THE TIME .................................
A LITTLE OF THE TIME.............................
NONE OF THE TIME .................................

1
2
3
4
5

HINTS 2007, Final CATI Study Instrument (06-15--07), National Cancer Institute (NCI)

Page 8

HDQ1065.
HD03eEffort

[During the past 30 days, how often did you feel…] that everything was an effort?
[IF NEEDED: 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?]
ALL OF THE TIME .....................................
MOST OF THE TIME .................................
SOME OF THE TIME .................................
A LITTLE OF THE TIME.............................
NONE OF THE TIME .................................

HDQ1070.
HD03fWorthless

1
2
3
4
5

[During the past 30 days, how often did you feel…] worthless?
[IF NEEDED: 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?]
ALL OF THE TIME .....................................
MOST OF THE TIME .................................
SOME OF THE TIME .................................
A LITTLE OF THE TIME.............................
NONE OF THE TIME .................................

HDQ1075.
HD04Drinking

1
2
3
4
5

In the past 12 months, has there ever been a time when you drank 5 or more
alcoholic beverages almost every day?
[IF NEEDED: By drink, I mean a 12-oz beer, a 4-oz glass of wine, or an ounce of
liquor.]
YES...........................................................
NO.............................................................

1
2

DEMOGRAPHICS
There are just a few final questions about you and your household.
HDQ1085.
HD05OccupationStatus

What is your current occupational status? Would you say…
employed ...................................................
unemployed ...............................................
homemaker,...............................................
student,......................................................
retired, or ...................................................
disabled? ...................................................
OTHER (SPECIFY)? ..................................

HDQ1095.
HD06MaritalStatus

1
2
3
4
5
6
91

What is your marital status? Would you say…
married, .....................................................
living as married, ........................................
divorced,....................................................
widowed,....................................................
separated, or..............................................
single, never been married? .......................

1
2
3
4
5
6

HINTS 2007, Final CATI Study Instrument (06-15--07), National Cancer Institute (NCI)

Page 9

HDQ1100.
HD07Education

What is the highest grade or level of schooling you completed?
LESS THAN 8 YEARS ...............................
8 THROUGH 11 YEARS ............................
12 YEARS OR COMPLETED HIGH
SCHOOL................................................
POST HIGH SCHOOL TRAINING OTHER
THAN COLLEGE (VOCATIONAL OR
TECHNICAL)..........................................
SOME COLLEGE.......................................
COLLEGE GRADUATE..............................
POSTGRADUATE......................................

HDQ1105.
HD08Hispanic

3
4
5
6
6

Are you Hispanic or Latino?
YES...........................................................
NO.............................................................

HDQ1110.
HD09Race

1
2

1
2

Which one or more of the following would you say is your race? Are you
American Indian or Alaska Native, Asian, Black or African American, Native
Hawaiian or other Pacific Islander, or White?
[CODE ALL THAT APPLY. IF R SAYS “HISPANIC,” PROBE FOR ONE OF THE
LISTED RACE CATEGORIES.]
WHITE.......................................................
BLACK/AFRICAN AMERICAN....................
ASIAN .......................................................
AMERICAN INDIAN/ALASKA NATIVE........
NATIVE HAWAIIAN/OTHER PACIFIC .......

HDQ1115.
HD10BornInUSA

Were you born in the United States?
YES...........................................................
NO.............................................................

HDQ1120.
HD11YearCameToUSA

11
12
13
14
15

1 (HDQ1125)
2

In what year did you come to live in the United States?
|__|__|__|__|

HDQ1130.
HD13ChildrenInHH

How many children under the age of 18 live in your household?
|__|__|

BOX HDQ-1
IF NO CHILDREN (HDQ1130=0), GO TO HDQ1145.
OTHERWISE, CONTINUE.

HINTS 2007, Final CATI Study Instrument (06-15--07), National Cancer Institute (NCI)

Page 10

HDQ1135.
HD14FemaleChildren

Are any of the children in your household female?
YES...........................................................
NO.............................................................

HDQ1145.
HD15Income

1
2

{Thinking about members of your family living in this household, what/What} is
your {combined} annual income, meaning the total pre-tax income from all
sources earned in the past year?
|__|__|__|__|__|__|__|__| (HDQ1200)

IF DK OR RF, ASK: Is your annual household income from all sources…
HDQ1150.
HD15aIncome25Thousand

Is your annual household income from all sources…
less than $25,000?
YES...........................................................
NO.............................................................

HDQ1155.
HD15bIncome20Thousand

1
2 (HDQ1170)

[Is your annual household income from all sources…]
less than $20,000?
YES...........................................................
NO.............................................................

HDQ1160.
HD15cIncome15Thousand

1
2 (HDQ1200)

[Is your annual household income from all sources…]
less than $15,000?
YES...........................................................
NO.............................................................

HDQ1165.
HD15dIncome10Thousand

1
2 (HDQ1200)

[Is your annual household income from all sources…]
less than $10,000?
YES...........................................................
NO.............................................................

HDQ1170.
HD15eIncome35Thousand

1 (HDQ1200)
2 (HDQ1200)

[Is your annual household income from all sources…]
less than $35,000?
YES...........................................................
NO.............................................................

1 (HDQ1200)
2

HINTS 2007, Final CATI Study Instrument (06-15--07), National Cancer Institute (NCI)

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HDQ1175.
HD15fIncome50Thousand

[Is your annual household income from all sources…]
less than $50,000 ($35,000 to less than $50,000)?
YES...........................................................
NO.............................................................

HDQ1180.
HD15gIncome75Thousand

1 (HDQ1200)
2

[Is your annual household income from all sources…]
less than $75,000 ($50,000 to less than $75,000)?
YES...........................................................
NO.............................................................

HDQ1185.
HD15hIncome100Thousand

1 (HDQ1200)
2

[Is your annual household income from all sources…]
less than $100,000 ($75,000 to less than $100,000)?
YES...........................................................
NO.............................................................

HDQ1190.
HD15iIncomeOver100Thousand

1 (HDQ1200)
2

[Is your annual household income from all sources…]
less than $200,000 ($100,000 to less than $200,000)?
YES...........................................................
NO.............................................................

HDQ1195.
HD15jIncomeOver200Thousand

1 (HDQ1200)
2

[Is your annual household income from all sources…]
$200,000 or more?
YES...........................................................
NO.............................................................

HDQ1200.
HD16RentOrOwn

1
2

Do you currently rent or own your home?
OWN .........................................................
RENT ........................................................
OCCUPIED WITHOUT PAYING
MONETARY RENT.................................

1
2
3

HINTS 2007, Final CATI Study Instrument (06-15--07), National Cancer Institute (NCI)

Page 12

DEBRIEFING QUESTIONS

There are just a few final questions about your participation in this study.
BOX DBQ-1
IF RESPONDENT IS IN THE RDD SAMPLE, GO TO
END STATEMENT.
IF RESPONDENT FROM MAIL SAMPLE COMPLETED CATI
INTERVIEW, GO TO DBQ1030.
OTHERWISE, CONTINUE
MAIL QUESTIONNAIRE
DBQ1005.
DB01StartStopSurvey

Did you complete this survey all in one sitting, or did you do it in more than one
sitting?
I completed the survey all in one sitting.......
I completed the survey in more than one
sitting .....................................................

DBQ1010.
DB02SomeoneInRoom

2

Did anyone help you complete this survey?
YES...........................................................
NO.............................................................

DBQ1015.
DB03SurveyTime

1

1
2

How long did it take you to complete the survey?
_______________________

DBQ1020.
DB07PhoneInHome

Is there at least one phone inside your home that is currently working and is not a
cellular telephone?
YES...........................................................
NO.............................................................

DBQ1025.
DB08CellPhone

1
2

Does anyone in your family have a working cellular phone?
YES...........................................................
NO.............................................................

1 (END STATEMENT)
2 (END STATEMENT)

CATI FROM MAIL SAMPLE
DBQ1030.
DB04ReceiveSurvey

Did you receive a questionnaire for this study in the mail?
YES...........................................................
NO.............................................................

1
2

HINTS 2007, Final CATI Study Instrument (06-15--07), National Cancer Institute (NCI)

Page 13

DBQ1035.
DB05aTypeOfAddress

At which of the following types of addresses does your household currently
receive residential mail? Is it a street address with a house or building number?
YES...........................................................
NO.............................................................

DBQ1036.
DB05bTypeOfAddress

At which of the following types of addresses does your household currently
receive residential mail? Is it a an address with a rural route number?
YES...........................................................
NO.............................................................

DBQ1037.
DB05cTypeOfAddress

11
12

At which of the following types of addresses does your household currently
receive residential mail? Is it a commercial mail box establishment such as
Mailboxes R Us or Mailboxes, Etc?
YES...........................................................
NO.............................................................

DBQ1040.
DB06ZipCode

11
12

At which of the following types of addresses does your household currently
receive residential mail? Is it a U.S. Post Office Box?
YES...........................................................
NO.............................................................

DBQ1038.
DB05dTypeOfAddress

11
12

11
12

What is your ZIP code?
_______________________

END STATEMENT:
If you have any questions about cancer or what some information about cancer, you can call 1-800-4-CANCER or go
to the National Cancer Institute’s web site at: www.cancer.gov.
Those are all of the questions I have for you. Thank you for your time.

HINTS 2007, Final CATI Study Instrument (06-15--07), National Cancer Institute (NCI)

Page 14