HINTS Mail Quex 2007 SHORT Version _7-5_combined

Health
Information
National Trends Survey

National Institutes of Health
U.S. Department of Health and Human Services
OMB # XXX-XXXX
Expiration Date: XX/XX/XXXX
S 22719.0607.8137041001

Dear Sir or Madam:
I’m writing to ask you to take part in an important national survey sponsored by the U.S. Department of Health
and Human Services. The Health Information National Trends Survey has interviewed thousands of people in the last
few years. From it we’ve learned that:

ƒ

About 4 out of 5 adults believe that there are so many recommendations about nutrition that it is
hard to know which ones to follow.

ƒ

About one in four adults read the health section of a newspaper or magazine every week.

ƒ

Almost half of all adults don’t know the age at which to begin screening for certain types of cancer.

With information like this, the survey can help the government and companies get valuable information on health
to you and your family.
Your household was chosen at random for this survey and cannot be replaced. We ask that each adult in this
household complete a questionnaire and return it to us in the postage-paid envelope at your earliest convenience.
What you have to say will help us find out how we can best provide the health information people need.
Westat, a research firm under contract with the U.S. Department of Health and Human Services, is administering
the survey. Your answers will be kept confidential to the extent provided by law. More information about the study is
provided on the back cover of this booklet.
Thank you in advance for your cooperation. If you have any questions about the study or you would like to
request more questionnaires, please call Westat toll-free at 1–888–636-6540.

Sincerely,

Bradford W. Hesse, Ph.D.
HINTS Project Officer
Chief, Health Communication and Informatics
Research Branch
National Institutes of Health
U.S. Dept of Health and Human Services

Si prefiere recibir la encuesta en Español, por favor llame 1-888-636-6536.
The Health Information National Trends Survey is authorized under 42 USC, Section 285a

‹

In the box below, please enter the number of adults (age 18 or older) living in
this household:
Number of adults in household

‹

Each adult in your household should fill out one questionnaire. Please be sure
that each adult has an opportunity to fill out a questionnaire. This is very
important to the success of the study.

‹

If more questionnaires are needed, please call 1–888–636-6540.

‹

Not all of the questions will apply to you – you will sometimes be asked to skip
questions based on your answers. In addition, certain sections of the
questionnaire may not apply to you.

‹

To answer a question, simply check the box that best represents your answer.

‹

Please choose only one answer per question, unless the question indicates
Mark all that apply. Your best estimate is fine.

The Privacy Act requires us to tell you that we are authorized to collect this information by Section 411.285a,
42 USC. You do not have to provide the information requested. However, the information you provide will
help the National Cancer Institute’s ongoing efforts to promote good health and prevent disease. There are
no penalties should you choose not to participate in this study.
Public reporting burden for this collection of information is estimated to average 25 minutes per response,
including the time for reviewing instructions, searching existing data sources, gathering and maintaining the
data needed, and completing and reviewing the collection of information. An agency may not conduct or
sponsor, and a person is not required to respond to, a collection of information unless it displays a currently
valid OMB control number. Send comments regarding this burden estimate or any other aspect of this
collection of information, including suggestions for reducing this burden, to: NIH, Project Clearance Branch,
6705 Rockledge Drive, MSC 7974, Bethesda, MD 20892-7974, ATTN: PRA (0925-xxxx*). Do not return the
completed form to this address.

A5.
Section A
Seeking Information about Health
A1.

Based on the results of your most recent
search for health information, how much do
you agree or disagree with each of the
following statements?

Have you ever looked for health information
from any source?
Yes

a. It took a lot of effort to get the
information you needed………

NoÆ Go to Question A6

A2.

b. You felt frustrated during your
search for the information……

The most recent time you looked for health
information, where did you go first?

c. You were concerned about
the quality of the information...

Mark only one.
Books

Magazines

Brochures,
pamphlets, etc.

Newspapers

d. The information you found
was hard to understand………

Telephone information
number

A6.

Cancer
organization
Family
Friend/co-worker
Health care
provider

Complementary,
alternative, or
unconventional
practitioner

Completely confident
Very confident

OtherÆ Please
specify below:

Somewhat confident

Internet

A little confident

Library

A3.

Not confident at all

Did you look or go anywhere else?

A7.

Mark all that apply.
No, nowhere else

Magazines

Books

Newspapers

Brochures,
pamphlets, etc.

Telephone information
number

Cancer
organization

Complementary,
alternative, or
unconventional
practitioner

Family
Friend/co-worker
Doctor or health
care provider

In general, how much would you trust
information about health or medical topics
from each of the following?

a. A doctor ..................................
b. Family or friends .....................
c. Newspapers or magazines .....
d. Radio ......................................

OtherÆ Please
specify below:

e. The Internet ............................
f.

Television................................

Internet

g. Government health agencies..

Library

h. Charitable organizations .........
i.

A4.

Overall, how confident are you that you could
get health-related advice or information if you
needed it?

The most recent time you looked for health
information, who was it for?
Myself
Someone else
Both myself and someone else

Question A6 appears in the next column.
1

Religious organizations and
leaders ....................................

B4.
Section B
Seeking Information about Cancer

The most recent time you looked for cancer
information, where did you go first?
Mark only one.
Books

B1.

Have you ever looked for information about
cancer from any source?

Brochures, pamphlets, etc.
Cancer organization

Yes

Family

NoÆ Go to Section C

Friend/co-worker

B2.

Doctor or health care provider

Think about the most recent time you looked
for cancer information. About how long ago
was that?

Internet
Library

Write a number in one box below

Magazines

Days

Weeks

Months

Years

Newspapers
Telephone information number
Complementary, alternative, or
unconventional practitioner

B3.

What type of information were you looking
for?

OtherÆ Please specify below:

Mark all that apply.
Specific cancer
Cancer organizations
Causes of cancer/Risk factors for cancer
Coping with cancer/Dealing with cancer

Section C
Use of the Internet

Diagnosis of cancer
Information on cancer in general
Paying for medical care

C1.

Insurance
Prevention of cancer

Do you ever go on-line to access the Internet
or World Wide Web, or to send and receive
e-mail?

Prognosis/Recovery from cancer

Yes

Screening/Testing/Early detection

NoÆ Go to Section D

Symptoms of cancer

C2.

Treatment/Cures for cancer

Where do you go on-line to use the Internet?
Mark all that apply.

Where to get medical care
Information on complementary, alternative, or
unconventional treatments
OtherÆ Please specify below:

Home

Community Center

Work

Someone else’s house

School

Some other place

Public Library

Section C appears in the next column.

Section D appears on the next page.
2

C3.

When you use the internet at home, how do
you mainly access it?

Section D
Your Use of Health Care Services

Do not use the internet at home
Telephone
modem

Wireless device
(such as a PDA)

Cable/satellite
modem

Another wayÆ Please
specify below:

D1.

Not including psychiatrists and other mental
health professionals, is there a particular
doctor, nurse, or other health professional
that you see most often?
Yes

DSL modem

NoÆ Go to Question D2

C4.

D1a. What kind of health professional do you see
most often?

Below are some ways people use the
Internet. Some people have done these
things, but other people have not. Please tell
us whether or not you have done each of
these things while using the internet in the
past 12 months.

A doctor
A nurse
Other health professionalÆ Please specify
below:

Yes No

a. Bought medicine or vitamins online ......

D2.

b. Participated in an online support group
for people with a similar health or
medical issue ........................................
c. Used e-mail or the Internet to
communicate with a doctor or a
doctor’s office........................................

Yes
No

d. Used a website to help you with your
diet, weight, or physical activity.............

D3.

e. Looked for a healthcare provider ..........
f.

Downloaded to a portable device, such
as an iPod, cell phone, or PDA .............

In 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?
NoneÆ Go to Question D8

g. Visited a “social networking” site, such
as myspace or Second Life ..................
h. Wrote in an online diary or blog ............
i.

Do you have any kind of health care
coverage, including health insurance, prepaid
plans such as HMOs, or government plans
such as Medicare?

Kept track of personal health
information, such as care received,
test results, or upcoming medical
appointments ........................................

1 time

4 times

2 times

5 to 9 times

3 times

10 or more times

Question D8 appears on the next page.
3

D4.

The following questions are about your
communication with all doctors, nurses, or
other health professionals you saw during the
past 12 months. How often did they do each
of the following?

D7a. 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?
Very interested
Somewhat interested
A little interested

a. Give you the chance to ask all
the health-related questions
you had....................................

Not at all interested

D8.

b. Give the attention you needed
to your feelings and emotions..

Overall, how confident are you about your
ability to take good care of your health?
Completely confident

c. Involve you in decisions about
your health care as much as
you wanted...............................

Very confident
Somewhat confident

d. Make sure you understood the
things you needed to do to
take care of your health............

A little confident
Not confident at all

e. Help you deal with feelings of
uncertainty about your health
or health care...........................
D5.

Section E
Views About Medical Information and Research

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?

E1.

Always

As far as you know, do your healthcare
providers maintain your medical information
in a portable, electronic format?
Yes

Usually

No

Sometimes
Never

E2.
D6.

Overall, how would you rate the quality of
health care you received in the last 12
months?
Excellent

Please indicate how important each of the
following statements is to you.

a. Health care providers should be
able to share your medical
information with each other
electronically ....................................

Very good
Good
Fair

b. You should be able to get to your
own medical information
electronically ....................................

Poor

D7.

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
NoÆ Go to Question D8

Question D8 appears in the next column.
4

E3. Please indicate how much you agree or
disagree with each of the following
statements.

E4.

Have you ever had a genetic test?
Yes
NoÆ Go to Question E5

E4a. How useful was the genetic test to you or
your physician?

a. In general, I think that the
information I give doctors is
safely guarded......................

Very useful
Somewhat useful

b. Scientists doing research
should be able to review
my medical information if
the information cannot be
linked to me personally ........

Not at all useful

E5.

c. 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..............

For each of the following organizations,
please tell us if you had heard of it before
being contacted for this study.
Yes No

a. National Cancer Institute...........
b. CDC or the Centers for Disease
Control and Prevention ...................
c. The American Cancer Society ........

Section F
Nutrition and Physical Activity
The next two questions ask about fruits and vegetables. The following boxes provide some examples of how
much counts as 1 cup.
1 cup of fruit could be:
1 small apple
1 large banana
1 large orange
8 large strawberries
1 medium pear
2 large plums
32 seedless grapes
1 cup (8 oz.) of 100% juice
½ cup of dried fruit
1 small wedge of watermelon (1 inch thick)

F1.

1 cup of vegetables could be:
3 broccoli spears, 5 in. long
1 cup of cooked leafy greens
2 cups of lettuce or raw greens
12 baby carrots
1 medium potato
1 large sweet potato
1 large ear of corn
1 large raw tomato
2 large celery stalks
1 cup of cooked beans

About how many cups of fruit (including 100%
pure fruit juice) do you eat or drink each day?

F2.

Mark only one.
None

2 to 3 cups

½ cup or less

3 to 4 cups

½ to 1 cup

4 cups or more

1 to 2 cups

About how many cups of vegetables
(including 100% vegetable juice) do you eat
or drink each day? Mark only one.
None

2 to 3 cups

½ cup or less

3 to 4 cups

½ to 1 cup

4 cups or more

1 to 2 cups

5

F3.

How many servings of fruits and vegetables
do you think a person should eat each day for
good health?

F6.

On those days, how long should the average
adult be physically active to stay healthy?
Write a number in one box below

Number of servings

F4.

Minutes

During the past month, did you participate in
any physical activities or exercises such as
running, calisthenics, golf, gardening, or
walking for exercise?

F7.

Yes

Hours

About how tall are you without shoes?

Feet

Inches

NoÆ Go to Question F5

F8.
F4a. 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?
Moderate-intensity activities make you
breathe somewhat harder than normal.

About how much do you weigh without
shoes?
Weight in pounds

F9.

Right now, do you feel you are…
Overweight

NoneÆ Go to Question F5

Slightly overweight

1 day per week

Slightly underweight

2 days per week

Underweight

3 days per week

Just about the right weight for you

4 days per week
5 days per week

F10. Have you tried to lose any weight in the past
12 months?

6 days per week
7 days per week

Yes
No

F4b. On the days that you do any physical activity
or exercise of at least moderate intensity,
how long are you typically doing these
activities?

F11. Do you agree or disagree that sunlight helps
the body produce vitamin D naturally?
Agree

Write a number in one box below
Minutes

F5.

Disagree
Hours

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

6

Section G
Sun Exposure
G1. When you are outside during the summer on a warm sunny day,
how often do you do each of the following?
Always
Often

Sometimes

Rarely

Never

Do not go out
on sunny day

a. Wear sunscreen ......................................
b. Wear a shirt with sleeves that cover
your shoulders .........................................
c. Wear a hat...............................................
d. Stay in the shade or under an umbrella...
G2.

How many times in the past 12 months have you...

0 times

1 to 2
times

3 to 10
times

11 to 24
times

25 times
or more

a. Used a tanning bed or booth? ...........................
b. Used sunless tanning creams or sprays, also
known 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…………………………………….

H4.
Section H
Tobacco Use
H1.

Are you seriously considering quitting
smoking within the next 6 months?

{

Have you smoked at least 100 cigarettes in
your entire life?
Yes

H5.

NoÆ Go to Question H6

YesÆ Go to Question H6
NoÆ Go to Question H6

About how long has it been since you
completely quit smoking cigarettes?
Write a number in one box below

H2.

How often do you now smoke cigarettes?

Days

Weeks

Months

Years

Every day
Some daysÆ Go to Question H3
Not at allÆ Go to Question H5

H6.

H2a. On the average, how many cigarettes do
you now smoke a day?
Number of cigarettes per day

There are a number of resources that people
use to help them stop smoking. Before being
contacted for this survey (and regardless of
whether or not you smoke), had you ever
heard of telephone quitlines such as a tollfree number to call for help in quitting
smoking?
Yes

H3.

In the past 12 months, have you tried to quit
smoking completely?

NoÆ Go to Question H7

Yes

H6a. Have you ever called a telephone quitline?

No

Yes
No

Question H5 appears in the next column.
Question H7 appears on the next page.
Question H6 appears in the next column.

7

H6b.

I3.

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?

1 year ago or less
More than 1 but not more than 3 years ago

I have not smoked in the past 12 months

More than 3 but not more than 5 years ago

Yes

More than 5 years ago

No

H6c.

When did you have your most recent Pap test
to check for cervical cancer?

I4.

How likely would you be to call a smoking
cessation telephone quitline in the future, for
any reason?

What was the main reason that you had this
Pap test? Mark only one.
Routine annual Pap test or part of routine
physical exam

Very likely

Last Pap test was not normal

Somewhat likely

A specific problem

Somewhat unlikely

Never had one and thought you should

Very unlikely

Pregnancy/Followup to birth
OtherÆ Please specify below:

H7.

Before being contacted for this survey, had
you ever heard of 1-800-QUIT-NOW?
Yes
No

H8.

I5.

Have you heard of any tests to find lung
cancer before the cancer creates noticeable
problems?

When do you expect to have your next Pap
test? Mark only one.
A year or less from now
More than 1 but not more than 3 years
from now

Yes

More than 3 but not more than 5 years
from now

No

Over 5 years from now
Am not planning to have another

Section I
HPV and Cervical Cancer
I1.

If I have symptoms
When doctor/health care provider
recommends

Are you male or female?

I am not planning to have another because
I got or am planning to get the HPV vaccine

Female
MaleÆ Go to Question I6

I2.

I am not planning to have another because
I got or am planning to get the HPV test
instead

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?

I6.

Yes

Have you ever been told by a health care
provider that you had a human papillomavirus
or HPV infection?
Yes

NoÆ Go to Question I6

No

Question I6 appears in the next column.
8

I7.

I8.

I11. Do you think HPV can go away on its own,
without any treatment?

Have you heard anything about a vaccine or
shot to prevent cervical cancer?
Yes

Yes

No

No

I12. 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?

Have you ever heard of HPV? HPV stands for
Human Papillomavirus. It is not HIV, HSV, or
herpes.
Yes

YesÆ Go to Question I13

NoÆ Go to Question I12

No

I8a. Where have you heard about HPV?
Mark all that apply.

Not sure/It depends

I12a. What is the main reason you would not have
her get it? Mark only one.

Doctor, nurse or other health care
professional
Family or friends

She doesn't need the vaccine or shot

Newspaper or magazine

My child is not sexually active

Television

It is too expensive

Internet

Vaccinations (shots to prevent sickness) in
general are not necessary

Radio
Don't remember

I don't know where to get it

OtherÆ Please specify below:

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

Next are some questions on your opinion about
HPV.
I9.

I am worried that the vaccine or shot might
promote sexual activity

Do you think HPV can cause cervical cancer?
Yes

I worry what others would think if they found
out she got it

No

OtherÆ Please specify below:

I10. Do you think you can get HPV through sexual
contact?
Yes
No

I13. Have you ever been treated for genital warts?
Yes
No
Question I12 appears in the next column.
9

J4. The last time you were told you should be
tested for colon cancer, which tests did the
health professional describe?

Section J
Colon Cancer

Yes No

J1.

Are you 45 years old or older?

a. Stool or fecal blood test..............

Yes

b. Colonoscopy...............................

NoÆ Go to Section K

c. Sigmoidoscopy...........................
J5.

The next few questions are about getting tested
for colon cancer.

Did the health professional describe any
other tests?
Yes

J2. 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?

NoÆ Go to Question J6

J5a. What test did the health professional
describe? Please specify below:

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

J6.

Over 5 years agoÆ Go to Question J7
I do not remember Æ Go to Question J7
No health professional has told me I should
get this testÆ Go to Question J7

The last time you were told you should be
tested for colon cancer, did the health
professional recommend to you any particular
test?
Yes
NoÆ Go to Question J7

J3. Who talked to you about getting a test to
check for colon cancer? Mark all that apply.
J6a. Which test to check for colon cancer did the
health professional recommend to you?
Mark all that apply.

Doctor
Nurse
Other health professional

Stool blood test/fecal occult blood test
Sigmoidoscopy
Colonoscopy
Other Please specify below:

A stool or fecal occult 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. This does not include drugstore or
pharmacy test kits.

J7.

A colonoscopy and a sigmoidoscopy are
both tests that examine the bowel by inserting
a tube in the rectum.

Have you ever done a stool blood test, also
known as a fecal occult blood test?
Yes
NoÆ Go to Question J8

- During a colonoscopy, you may feel sleepy
and need someone to drive you home.
- During a sigmoidoscopy, you are awake
and can drive yourself home after the test

Question J7 appears in the next column.
Section K appears on the next page.

Question J8 appears on the next page.
10

J9b. What was the main reason you had your
most recent sigmoidoscopy?

J7a. When did you do your most recent stool
blood test/fecal occult blood test?
A year ago or less

Part of a routine exam

More than 1 but not more than 2 years ago

Because of a problem

More than 2 but not more than 5 years ago

Some other reason

Over 5 years ago

J10. 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?

J7b. What was the main reason you did your most
recent stool blood test/fecal occult blood test?
Mark only one.
Part of a routine exam
Because of a problem

Equally effectiveÆ Go to Section K

Some other reason

J8.

Some are more effective than others

Have you ever had a colonoscopy?

J10a. Which test (or tests) do you believe is more
effective in finding colon cancer?
Mark one or two.

Yes
NoÆ Go to Question J9

Stool blood test/fecal occult blood test

J8a. When did you have your most recent
colonoscopy?

Colonoscopy
Sigmoidoscopy

A year ago or less
More than 1 but not more than 5 years ago

Section K
Communicating Health
Information with Numbers

More than 5 but not more than 10 years ago
Over 10 years ago

K1.

J8b. What was the main reason you had your
most recent colonoscopy? Mark only one.
Part of a routine exam
Because of a problem
Some other reason

J9.

People can talk about the chance of
something happening using either words, like
"It rarely happens" or numbers, like "There's
a five percent chance."
When people tell you the chance of something
happening do you prefer they use words or
numbers?
Generally prefer words

Have you ever had a sigmoidoscopy?
Yes

Generally prefer numbers

NoÆ Go to Question J10

No preference

K2.

J9a. When did you have your most recent
sigmoidoscopy?

In general, how easy or hard do you find it to
understand medical statistics?
Very easy

A year ago or less

Easy

More than 1 but not more than 5 years ago

Hard

More than 5 but not more than 10 years ago

Very hard

Over 10 years ago

Question J10 appears in the next column.
11

K3.

L3.

How much do you agree or disagree with the
following statement?
In general, I depend on numbers and
statistics to help me make decisions about
my health.

Rarely or never
Sometimes
Often

Strongly agree

All the time

Somewhat agree
Somewhat disagree

L4.

Strongly disagree

K4.

How often do you worry about getting
cancer?

How much do you agree or disagree with
each of the following statements?

Which of the following numbers represents
the biggest risk of getting a disease?
a. Cancer is most often caused
by a person's behavior or
lifestyle…………………………

1 in 100
1 in 1,000
1 in 10

b. Getting checked regularly for
cancer helps find cancer when
it's easy to treat……………….

Section L
Beliefs About Cancer

c. People can tell they might
have cancer before being
diagnosed……………………...

This section contains several questions about
cancer. For each, try to think about cancer
in general when answering.

d. Cancer is an illness that when
detected early can typically be
cured……………………………

L1.

e. It seems like everything
causes cancer…………………

How much do you agree or disagree with this
statement?

f.

When I think of cancer, I automatically think
of death.

There's not much you can do
to lower your chances of
getting cancer………..……….

g. There are so many different
recommendations about
preventing cancer, it's hard to
know which ones to follow…...

Strongly agree
Somewhat agree
Somewhat disagree
Strongly disagree

L5.
L2.

How likely do you think it is that you will
develop cancer in the future?

Overall, how many people who develop
cancer do you think survive at least 5 years?
Less than 25 percent

Very low

About 25 percent

Somewhat low

About 50 percent

Moderate

About 75 percent

Somewhat high

Nearly all

Very high

12

L6.

When you hear the word cancer, what type of
cancer comes to mind first?

M2. At what age were you first told that you had
cancer?

Please specify below:

Age

M3. Did you ever receive any treatment for your
cancer?
Yes

Section M
Your Cancer History

NoÆ Go to Question M4

M1. Have you ever been diagnosed as having
cancer?

M3a. How long ago did you finish your most recent
treatment?

Yes
I am still in treatmentÆ Go to Question M4

NoÆ Go to Question M4

Write a number in one box below

M1a. What type of cancer did you have?

Months

Years

Mark all that apply.
Bladder cancer
Bone cancer

M4. Have any of your family members ever had
cancer?

Breast cancer
Cervical cancer (cancer of the cervix)

Yes

Colon cancer

No

Endometrial cancer (cancer of the uterus)

Have no family

Head and neck cancer
Hodgkin's lymphoma

Section N
Your Health Status

Leukemia/blood cancer
Liver cancer
Lung cancer

N1.

Melanoma

In general, would you say your health is…
Excellent

Non-Hodgkin's lymphoma

Very good

Other skin cancer

Good

Oral cancer

Fair

Ovarian cancer

Poor

Pancreatic cancer
Pharyngeal (throat) cancer
Prostate cancer
Rectal cancer
Renal (kidney) cancer
Stomach cancer
OtherÆ Please specify below:

Question M4 appears in the next column.
13

N2.

Next are some questions about feelings you
may have experienced over the past 30 days.

O4.

What is your marital status?
Married

How often did you feel each of the following
during the past 30 days?

Living as married
Divorced
Widowed
Separated
Single, never been married

a. So sad that
nothing could
cheer you up ........

O5.

b. Nervous ...............
c. Restless or
fidgety ..................

Less than 8 years
8 through 11 years

d. Hopeless..............

12 years or completed high school

e. That everything
was an effort ........
f.

What is the highest grade or level of
schooling you completed?

Post-high school training other than college
(vocational or technical)

Worthless.............

Some college
College graduate
Postgraduate

Section O
About You and Your Household
O1.

O6.

Are you Hispanic or Latino?
Yes

What is your age?

No
years old

O7.
O2.

Are you male or female?

Which one or more of the following would you
say is your race? Mark all that apply.
White

Male

Black/African American

Female

American Indian/Alaska Native

O3.

What is your current occupational status?

Asian

Mark only one.

Native Hawaiian/other Pacific Islander

Employed

Student

Unemployed

Retired

Homemaker

Disabled

O8.

Were you born in the United States?
YesÆ Go to Question O9

OtherÆ Please specify below:

No

O8a. In what year did you come to live in the
United States?
Year

Question O9 appears on the next page.
14

O9.

O16. How long did it take you to complete the
survey?

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

Write a number in one box below

Number of children under 18

Minutes

O10. Are any of the children in your household
female?

Hours

O17. Is there at least one telephone inside your
home that is currently working and is not a
cell phone?

Yes
No

Yes

No children in household under 18

No

O11. Thinking about members of your family living
in this household, what is your combined
annual income, meaning the total pre-tax
income from all sources earned in the past
year?

O18. Does anyone in your family have a working
cell phone?
Yes
No

$0 to $9,999

O19. At which of the following types of addresses
does your household currently receive
residential mail? Mark all that apply.

$10,000 to $14,999
$15,000 to $19,999
$20,000 to $34,999
$35,000 to $49,999

A street address with a house or building
number

$50,000 to $74,999

An address with a rural route number

$75,000 to $99,999

A U.S. post office box (P.O. Box)

$100,000 to $199,999

A commercial mail box establishment (such
as Mailboxes are Us, Mailboxes, Etc.)

$200,000 or more

Thank you! 

O12. Do you currently rent or own your home?
Own

Please remember that we would like all
persons age 18 years or older in this
household to complete a questionnaire. If more
questionnaires are needed, please call
1–888–636-6540.

Rent
Occupy without paying monetary rent

O13. Did you complete this survey all in one sitting,
or did you do it in more than one sitting?

Please return this questionnaire in the postagepaid envelope provided. If you have lost the
envelope, mail the completed questionnaire to:

I completed the survey all in one sitting.
I completed the survey in more than one
sitting.

HINTS Study, TB XXX
Westat
1650 Research Blvd.
Rockville, MD 20850

O14. Did anyone help you complete this survey?
Yes
No

If you have any questions about cancer or want
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.

15

Some Frequently Asked Questions
about the
Health Information National Trends Survey
Q: What is the study about? What kind of questions will you be asking?
A: The study concerns health and how people receive health information. For example, we will ask how
you usually get information about how to stay healthy, the sources of information you most trust, and
how you might like to get such information in the future. We will also ask about your beliefs on what
contributes to good health, how best to prevent cancer, your participation in various health-related
activities, and related topics.
Q: How will the study results be used? What will be done with my information?
A: Findings will help the U.S. Department of Health and Human Services promote good health and
prevent disease, by determining ways of better communicating accurate health information to people.
Q: How did you get my address?
A: Your address was randomly selected from among all of the known home addresses in the nation. It was
selected using scientific sampling methods.
Q: Why should I take part in this study? Do I have to do this?
A: Your participation is voluntary, and you may refuse to answer any questions or withdraw from the study
at any time. Your household was selected randomly using scientific sampling methods, in order to
reach a sample that reflects the entire population of the United States. You represent thousands of
other households like yours, and you cannot be replaced. Your answers and opinions are very
important to the success of this study, as you represent others who share your knowledge and beliefs.
Q: Will my answers to the survey be kept confidential?
A: Yes. Your answers will not be revealed to anyone but the researchers in a way that identifies you or
your household, to the extent provided by law.
Q: How long will it take to answer the questions?
A: About 20 to 30 minutes.
Q: Who is sponsoring the study? Is this study approved by the Federal Government?
A: The study is sponsored by the U.S. Department of Health and Human Services. The study has been
approved by the Office of Management and Budget (OMB), the office that reviews all federallysponsored surveys. The OMB approval number assigned to this study is xxxx-xxxx.
Q: Who is Westat?
A: Westat is a research company located in Rockville, Maryland. Westat is conducting this survey under
contract to the U.S. Department of Health and Human Services.