Appendix J_rev extend instru

Appendix J
Extended Instrument

OMB # 0925-0538
Expiration Date: 11/30/2008

Health Information National
Trends Survey 2007
(HINTS 2007)
ENGLISH INTERVIEW EXTENDED INSTRUMENT
December 2007

NATIONAL CANCER INSTITUTE (NCI)
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 (0925-0538). Do not
return the completed form to this address.

TABLE OF CONTENTS

Health Communication ..............................................................................

1

Health Information Seeking...........................................................................
Cancer Information Seeking..........................................................................
Internet Use..................................................................................................

1
5
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
14
15
15
15

Behavior and Risk Factors........................................................................

16

Energy Balance ............................................................................................
Sun Exposure...............................................................................................
Tobacco Use ................................................................................................
Lung Cancer.................................................................................................
Cervical Cancer............................................................................................
Colon Cancer ...............................................................................................

16
19
20
23
24
27

Cancer

....................................................................................................

32

Numeracy.....................................................................................................
Cancer Cognition..........................................................................................
Cancer History..............................................................................................

32
33
35

Health Status and Demographics.............................................................

38

Health Status................................................................................................
Demographics ..............................................................................................

38
39

HINTS 2007, Extended CATI Study Instrument, National Cancer Institute (NCI)

Page i

HEALTH COMMUNICATION

HEALTH INFORMATION SEEKING
HC-01.
HC01SeekHealthInfo

Have you ever looked for information about health or medical topics from any
source?
YES...........................................................
NO.............................................................

HC-02.
HC02WhereSeekHealthInfo
HC02WhereSeekHeathInfo_OS

1
2 (HC-06)

The most recent time you looked for information about health
or medical topics, 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) ....................................

HC-02b.
HC02bLookElsewhere

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

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

HINTS 2007, Extended CATI Study Instrument, National Cancer Institute (NCI)

1
2 (HC-04)

Page 1

HC-03.

Where else did you look or go?

HC03WhereSeekHealthInfo2
HC03WhereSeekHealthInfo2_OS

[CODE ALL THAT APPLY.]
[PROBE: 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) ....................................

HC-04.
HC04WhoLookingFor

HC05aLotOfEffort

21
22
91

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

HC-05a.

11
12
13
14
15
16
17
18
19
20

1
2
3

Based on the results of your most recent search for information about health or
medical topics, 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 R HAS MADE MORE THAN ONE SEARCH, PROBE FOR THE MOST
RECENT SEARCH.]
strongly agree, ...........................................
somewhat agree,........................................
somewhat disagree, or ...............................
strongly disagree?......................................

HC-05b.
HC05bFrustrated

1
2
3
4

[Based on the results of your most recent search for information about health or
medical topics, 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 ............................

HINTS 2007, Extended CATI Study Instrument, National Cancer Institute (NCI)

1
2
3
4

Page 2

HC-05c.
HC05cConcernedQuality

[Based on the results of your most recent search for information about health or
medical topics, 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 ............................

HC-05d.
HC05dTooHardUnderstand

1
2
3
4

[Based on the results of your most recent search for information about health or
medical topics, 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 ............................

HC-06.
HC06ConfidentGetHealthInfo

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

[HC-07a THROUGH HC-07i WILL BE ASKED IN A RANDOM ORDER]
HC-07a.
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 ..............................................

HC-07b.
HC07bTrustFamily

1
2
3
4

[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 ..............................................

HINTS 2007, Extended CATI Study Instrument, National Cancer Institute (NCI)

1
2
3
4

Page 3

HC-07c.
HC07cTrustNewsMag

[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 ..............................................

HC-07d.
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 ..............................................

HC-07e.
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 ..............................................

HC-07f.
HC07fTrustTV

1
2
3
4

[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 ..............................................

HINTS 2007, Extended CATI Study Instrument, National Cancer Institute (NCI)

1
2
3
4

Page 4

HC-07g.
HC07gTrustGov

[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 ..............................................

HC-07h.
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 ..............................................

HC-07i.
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

CANCER INFORMATION SEEKING
HC-08.

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

HC08SeekCancerInfo

YES...........................................................
NO.............................................................

HINTS 2007, Extended CATI Study Instrument, National Cancer Institute (NCI)

1
2 (Intro to HC-15)

Page 5

HC-09.

Think about the most recent time you looked for cancer-related information

HC09WhenSeekCancerInfo_ NUMBER from any source.
HC09WhenSeekCancerInfo_UNIT

About how long ago was that?
[ENTER NUMBER.]
|__|__|
[ENTER UNIT.]
DAYS AGO................................................
WEEKS AGO.............................................
MONTHS AGO ..........................................
YEARS AGO..............................................

1
2
3
4

HC-10.

What type of information were you looking for in your most recent search?

HC10WhatCancerInfoLookFor
HC10WhatCancerInfoLookFor_OS

[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) ....................................

HINTS 2007, Extended CATI Study Instrument, National Cancer Institute (NCI)

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

Page 6

HC-11.

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

HC11WhereSeekCancerInfo
HC11WhereSeekCancerInfo_OS

[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

QUESTIONS HC-12 THROUGH HC-14 DELETED.

INTERNET USE
The next few questions are about various ways you might get health information.
HC-15.
HC15UseInternet

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

HC-16.

Where do you go to use the Internet?

HC16WhereUseInternet
HC16WhereUseInternet_OS

[CODE ALL THAT APPLY.]

1
2 (NEXT SECTION)

[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
(HC-16=11), ASK HC-17.
OTHERWISE, GO TO HC-18a.

HINTS 2007, Extended CATI Study Instrument, National Cancer Institute (NCI)

Page 7

HC-17.
HC17AccessInternetHome
HC17AccessInternetHome_OS

HC-18a.
HC18aBuyMedicine

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?........................................

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?
Have you bought medicine or vitamins on-line?
YES...........................................................
NO.............................................................

HC-18b.
HC18bSupportGroup

1
2

[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.............................................................

HC-18c.
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.............................................................

HC-18d.
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.............................................................

HC-18e.
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.............................................................

HINTS 2007, Extended CATI Study Instrument, National Cancer Institute (NCI)

1
2

Page 8

HC-18f.
HC18fPDA

[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.............................................................

HC-18g.
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.............................................................

HC-18h.
HC18hBlog

1
2

[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.............................................................

HC-18i.
HC18iPHR

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.............................................................

HINTS 2007, Extended CATI Study Instrument, National Cancer Institute (NCI)

1
2

Page 9

HEALTH SERVICES

HEALTH CARE USE
The next few questions are about your use of health care services.
HS-01.
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.............................................................

HS-02.
HS02WhatTypeProvider

1
2 (HS-03)

What kind of health professional do you see most often? Do you see a doctor,
nurse, or some other health professional?

HS02WhatTypeProvider_OS

DOCTOR...................................................
NURSE......................................................
OTHER (SPECIFY) ....................................
HS-03.
HS03FreqGoProvider

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?
NONE........................................................
1 TIME.......................................................
2 TIMES ....................................................
3 TIMES ....................................................
4 TIMES ....................................................
5-9 TIMES .................................................
10 OR MORE TIMES .................................

HS-04.
HS04Insurance

HS05CAMCare

0
1
2
3
4
5
6

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.............................................................

HS-05.

1
2
91

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 (HS-03=0),
GO TO HS-11.
OTHERWISE, CONTINUE.

HINTS 2007, Extended CATI Study Instrument, National Cancer Institute (NCI)

Page 10

BOX HSQ-2
IF DID NOT USE CAM THERAPIES (HS-05=2), GO TO HS-07a.
OTHERWISE, CONTINUE.
HS-06.

Did you discuss your use of unconventional therapies with any of your doctors?

HS06DiscussCAM

YES...........................................................
NO.............................................................

1
2

HEALTH CARE EXPERIENCE
HS-07a.
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? .......................................................

HS-07b.
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 ......................................................

HS-07c.
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 ......................................................

HS-07d.
HS07dUnderstoodNextSteps

1
2
3
4

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 ......................................................

HINTS 2007, Extended CATI Study Instrument, National Cancer Institute (NCI)

1
2
3
4

Page 11

HS-07e.
HS07eHelpUncertainty

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 ......................................................

HS-07f.
HS07fDrTakeCareNeeds

1
2
3
4

In the past 12 months, how often did you feel you could rely on 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 ......................................................

HS-08.
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 (HC-15=2), GO TO HS-11.
OTHERWISE, CONTINUE.
HS-09.
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.............................................................

HS-10.
HS10DoctorInterested

1
2 (HS-11)

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? ...................................

HINTS 2007, Extended CATI Study Instrument, National Cancer Institute (NCI)

1
2
3
4

Page 12

HS-11.
HS11TakeCareHealth

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
HS-12.
HS12AvoidDoc

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 ........................................................
NOT TRUE ................................................

HS-13.
HS13BodyExam

1
2 (HS-17)

Here are some reasons people give for not wanting to see their health care
provider [or doctor]. Please tell me if you agree with the following statements.
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?......................................

HS-14.

1
2
3
4

I avoid seeing my doctor because I fear I may have a serious illness.

HS14FearIllness

[IF NEEDED: Would you say you strongly agree, somewhat agree, somewhat
disagree, or strongly disagree.]
STRONGLY AGREE ..................................
SOMEWHAT AGREE.................................
SOMEWHAT DISAGREE ...........................
STRONGLY DISAGREE ............................
HS-15.

1
2
3
4

I avoid seeing my doctor because it makes me think about dying.

HS15Dying

[IF NEEDED: Would you say you strongly agree, somewhat agree, somewhat
disagree, or strongly disagree.]
STRONGLY AGREE ..................................
SOMEWHAT AGREE.................................
SOMEWHAT DISAGREE ...........................
STRONGLY DISAGREE ............................

HINTS 2007, Extended CATI Study Instrument, National Cancer Institute (NCI)

1
2
3
4

Page 13

HS-16.
HS16WhyAvoidDr
HS16WhyAvoidDr_OS

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

1
2

[SPECIFY:]
_______________________

HEALTH RECORDS
HS-17.
HS17ProviderMaintainEMR

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

HS-18.
HS18EMR

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?....................................

HS-19.
HS19PHR

1
2

1
2
3

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
How much do you agree or disagree with the following statements?
HS-20.
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? .....................................

HS-21.
HS21NonlinkedInfoUsed

1
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 ............................

HINTS 2007, Extended CATI Study Instrument, National Cancer Institute (NCI)

1
2
3
4

Page 14

GENETIC TESTS
HS-22.
HS22HeardGeneticTest

Genetic tests that analyze your DNA, diet, and lifestyle for potential health risks
are currently being marketed by companies directly to consumers. Have you
heard or read about these genetic tests?
YES...........................................................
NO.............................................................

HS-23.

1
2 (HS-25)

Have you ever had a genetic test?

HS23HadGeneticTest

YES...........................................................
NO.............................................................

1
2

QUESTION HS-24 DELETED.

CLINICAL TRIALS
HS-25.
HS25HeardOfClinicalTrial

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 heard of a clinical trial?
YES...........................................................
NO.............................................................

1
2

QUESTION HS-26 DELETED.

INFORMATION SOURCES
HS-27.
HS27NCI

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

HS-28.

1
2

[Before being contacted for this study had you ever heard of…]

HS28CDC

CDC or the Centers for Disease Control and Prevention?
YES...........................................................
NO.............................................................
HS-29.

1
2

[Before being contacted for this study had you ever heard of…]

HS29ACS

the American Cancer Society?
YES...........................................................
NO.............................................................

HINTS 2007, Extended CATI Study Instrument, National Cancer Institute (NCI)

1
2

Page 15

BEHAVIOR AND RISK FACTORS

ENERGY BALANCE
BR-01.

The next few questions are about your fruit and vegetable consumption.

BR01Fruits

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.
|__|__|
BR-02.
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.
|__|__|

BR-03.
BR03NumberServings

How many servings of fruits and vegetables do you think the average adult
should eat each day for good health?
[IF NONE, ENTER 0]
[IF R GIVES RANGE, PROBE FOR AN EXACT NUMBER.
IF DON’T KNOW, DO NOT PROBE.]
|__|__|

BR-04.
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, yoga, golf, gardening, or walking for exercise?
YES...........................................................
NO.............................................................

BR-05.
BR05TimesModerateExercise

1
2 (BR-07)

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.]
[IF NONE, ENTER 0]
|__|__|

HINTS 2007, Extended CATI Study Instrument, National Cancer Institute (NCI)

Page 16

BOX BRQ-1
IF DOES NOT EXERCISE IN A TYPICAL WEEK (BR-05=0),
GO TO BR-07.
OTHERWISE, CONTINUE.
BR-06.

On the days that you do any physical activity or exercise of at least

BR06HowLongModerateExercise_UNIT moderate intensity, how long are you typically doing these activities?
BR06HowLongModerateExercise_
MinutesNUM
BR06HowLongModerateExercise_
HoursNUM
BR06HowLongModerateExercise_
HRS_NUM
BR06HowLongModerateExercise_
MIN_NUM

[ENTER UNIT.]
MINUTES ..................................................
HOURS .....................................................
HOURS AND MINUTES.............................

1
2
3

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

BR-07.
BR07RecommendDaysExercise

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

|__|__|
BR-08.
BR08RecommendTimeExercise_UNIT
BR08RecommendTimeExercise_
MinutesNUM
BR08RecommendTimeExercise_
HoursNUM
BR08RecommendTimeExercise_
HRS_NUM
BR08 RecommendTimeExercise_

MIN_NUM

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

1
2
3

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

BR-09.
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

BR-10.

About how tall are you without shoes?

BR10Height_Feet
BR10Height_Inches

[ROUND FRACTIONS OF INCHES DOWN TO WHOLE INCH.]
[ENTER FEET.]
|__|__|
[ENTER INCHES.]
|__|__|

HINTS 2007, Extended CATI Study Instrument, National Cancer Institute (NCI)

Page 17

BR-11.

About how much do you weigh without shoes?

BR11Weight

[ROUND FRACTIONS UP TO WHOLE NUMBER.]
|__|__|__|
BR-11b.
BRQHealthyWeight

There are so many different messages about whether being overweight is
harmful to one’s health it is hard to know what weight one should maintain to be
healthy. Would you say you….
Strongly agree,...........................................
Somewhat agree, .......................................
Somewhat disagree, or...............................
Strongly disagree? .....................................

BR-12.

1
2
3
4

Right now do you feel you are…

BR12WeightPerception

overweight, ................................................
slightly overweight,.....................................
underweight, .............................................
slightly underweight, or...............................
just about the right weight for you?..............
BR-13.

1
2
3
4
5

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

BR13TryLoseWeight

YES...........................................................
NO.............................................................

1
2

QUESTIONS BR-14 AND BR-15 DELETED.

BR-16.

Do you agree or disagree with the following statement about Vitamin D?

BR16SunVitD

Sunlight helps the body produce Vitamin D naturally. Would you say you…
Agree, or....................................................
Disagree? ..................................................

1
2

QUESTIONS BR-17 THROUGH BR-21 DELETED.

BR-22.

To what extent do you believe that obesity is inherited? Would you say…

BR22GenesDetermineWeight

A lot, ..........................................................
Some,........................................................
A little, or....................................................
Not at all? ..................................................

1
2
3
4

QUESTION BR-23 DELETED.

HINTS 2007, Extended CATI Study Instrument, National Cancer Institute (NCI)

Page 18

BR-24.
BR24ObesityNotInherited

To what extent do you believe that obesity 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

SUN EXPOSURE
BR-25a.
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 99.]
always, ......................................................
often, .........................................................
sometimes, ................................................
rarely, or ....................................................
never? .......................................................
DOES NOT GO OUT ON SUNNY DAY.......

BR-25b.

1
2
3
4
5
95 (BR-26)

[How often do you…]

BR25bShoulderSleeveShirt

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 ......................................................
BR-25c.

1
2
3
4
5

[How often do you…]

BR25cHat

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

HINTS 2007, Extended CATI Study Instrument, National Cancer Institute (NCI)

1
2
3
4
5

Page 19

BR-25d.

[How often do you…]

BR25dShade

stay in the shade or under an umbrella?
[IF NEEDED: Would you say always, often, sometimes, rarely, or never?]
ALWAYS....................................................
OFTEN ......................................................
SOMETIMES .............................................
RARELY ....................................................
NEVER ......................................................
BR-26.

1
2
3
4
5

How many times in the past 12 months have you used a tanning bed or booth?

BR26TanningBed

0 TIMES ....................................................
1-2 TIMES .................................................
3-10 TIMES................................................
11-24 TIMES..............................................
25 TIMES OR MORE .................................
BR-27.
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 USE
Next are some questions about your use of tobacco.
BR-28.

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

BR28Smoke100

[IF NEEDED: 5 Packs = 100 Cigarettes.]
YES...........................................................
NO.............................................................
BR-29.

1
2 (BR-40)

Do you now smoke cigarettes…

BR29SmokeNow

every day, ..................................................
some days, or ............................................
not at all?...................................................
BR-30.

1
2 (BR-31)
3 (BR-37)

On the average, how many cigarettes do you now smoke a day?

BR30SmokeDayAlways

[IF NEEDED: 1 Pack = 20 Cigarettes.]
[IF LESS THAN ONE A DAY, ENTER 0. IF 99 OR MORE, ENTER 99.]
|__|__| (BR-35)

HINTS 2007, Extended CATI Study Instrument, National Cancer Institute (NCI)

Page 20

BR-31.

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

BR31SmokePast30Days

|__|__|
BOX BRQ-3
IF DID NOT SMOKE IN THE PAST 30 DAYS (BR-31=0),
GO TO BR-33.
OTHERWISE, CONTINUE.
BR-32.
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.]
|__|__|

BR-33.

Have you ever smoked cigarettes every day for at least 6 months?

BR33SmokeEveryDay6MonthsSS

YES...........................................................
NO.............................................................
BR-34.
BR34SmokeDaySomeDay

1
2 (BR-35)

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.]
|__|__|

BR-35.

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

BR35TriedQuit

YES...........................................................
NO.............................................................
BR-36.

1
2

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

BR36ConsiderQuit

YES...........................................................
NO.............................................................

1 (BR-40)
2 (BR-40)

BR-37.

About how long has it been since you completely quit smoking cigarettes?

BR37WhenQuitSmoke_NUMBER
BR37WhemQuitSmoke_UNIT

[ENTER NUMBER.]
|__|__|__|__|__|
[ENTER UNIT.]
DAYS ........................................................
WEEKS .....................................................
MONTHS...................................................
YEARS ......................................................

HINTS 2007, Extended CATI Study Instrument, National Cancer Institute (NCI)

1
2
3
4

Page 21

BR-38.

Have you ever smoked cigarettes every day for at least 6 months?

BR38SmokeEveryDay6 MonthsFS

YES...........................................................
NO.............................................................
BR-39.
BR39SmokeDayFormer

1
2 (BR-40)

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.]
|__|__|

BR-40.

Do you believe that some cigarettes are less harmful than others?

BR40CigLessHarm

YES...........................................................
NO.............................................................

1
2

QUESTIONS BR-41 THROUGH BR-44 DELETED.

BR-45.
BR45SmokelessLessHarm

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

BR-46.

1
2

There are a number of resources that people use to help them stop smoking.

BR50aAwareQuitlines

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.............................................................

1
2 (BR-53a)

QUESTIONS BR-47 THROUGH BR-50 DELETED.

BR-51.

Have you ever called a telephone quit line?

BR51CallQuitline

YES...........................................................
NO.............................................................

1
2

BOX BRQ-7
IF NEVER SMOKER (BR-28=2) OR IF QUIT SMOKING OVER 1
YEAR AGO (BR-37= 1 YEAR OR MORE),
GO TO BR-53.
OTHERWISE, CONTINUE.

HINTS 2007, Extended CATI Study Instrument, National Cancer Institute (NCI)

Page 22

BR-52.
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 ..............................

BR-53.
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? .............................................

BR-53a.

1
2

1
2
3
4

Before being contacted for this survey, had you ever heard of 1-800-QUIT-NOW?

BR50bAwareQuitNow

YES...........................................................
NO.............................................................

1
2

LUNG CANCER
BR-54.
BR54HeardLungTest

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

BR-55.

What tests have you heard of?

BR55WhichLungTests
BR55WhichLungTests_OS

[CODE ALL THAT APPLY.]

1
2 (BOX BRQ-8)

[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 BR-60.
OTHERWISE, CONTINUE.

HINTS 2007, Extended CATI Study Instrument, National Cancer Institute (NCI)

Page 23

CERVICAL CANCER
The next few questions are about getting tested for cervical cancer.
BR-56.

Have you ever had a Pap Smear or Pap test?

BR56HadPapTest

YES...........................................................
NO.............................................................
BR-57.

1
2 (BR-60)

When did you have your most recent Pap test?

BR57WhenPapTest

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 .....................
BR-58.
BR58WhyPapTest
BR58WhyPapTest_OS

BR-59.

1
2
3
4

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

1
2
3
4
5
91

When do you expect to have your next Pap test?

BR59WhenNextPapTest

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 ....................
NOT PLANNING TO HAVE
ANOTHER .................................................
IF I HAVE SYMPTOMS ..............................
WHEN DOCTOR/HEALTH PROVIDER
RECOMMENDS.........................................
GOT THE HPV VACCINE SO NOT
PLANNING TO HAVE ANOTHER...............
PLAN TO GET THE HPV TEST INSTEAD
SO NOT PLANNING TO HAVE ANOTHER
PAP...........................................................
BR-60.

1
2
3
4
5
6
7
8
9

Have you ever been treated for genital warts?

BR60TreatedWarts

YES...........................................................
NO.............................................................

HINTS 2007, Extended CATI Study Instrument, National Cancer Institute (NCI)

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2

Page 24

BR-61a.

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

BR62HeardHPV

YES...........................................................
NO.............................................................
BR-61b.

1
2

A vaccine to prevent HPV infection is available and is called the cervical cancer
vaccine or HPV shot. Before today, have you ever heard of the cervical cancer
vaccine or HPV shot?

BR61Vaccine

YES...........................................................
NO.............................................................

1
2

BOX BRQ-9
IF RESPONDENT HAS NOT HEARD OF HPV (BR-61a=2) ,
GO TO BR-74.
IF RESPONDENT IS MALE AND HAS HEARD OF HPV (BR-61a=1),
ASK BR-63, BR-67, AND BR-68.
OTHERWISE, CONTINUE.

QUESTION B-62 DELETED.

BR-63.

Where have you heard about HPV?

BR63SourceHPVKnowledge
BR63SourceHPVKnowledge_OS

[CODE ALL THAT APPLY.]
[PROBE: Anywhere else?]
DOCTOR, NURSE OR OTHER HEALTH
CARE PROFESSIONAL.............................
FAMILY OR FRIENDS ...............................
NEWSPAPER OR MAGAZINE ...................
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]
BR-64.
BR64EverHadHPV

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

HINTS 2007, Extended CATI Study Instrument, National Cancer Institute (NCI)

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2

Page 25

BOX BRQ-10
IF RESPONDENT HAS NOT HEARD OF A CERVICAL CANCER or
HPV SHOT (BR-61=2), GO TO BR-66.
OTHERWISE, CONTINUE.
BR-65.
BR65DiscussHPVVaccine

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

BR-66.
BR66DiscussHPVTest

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

BR-67.

1
2

1
2

Next are some questions on your opinion about HPV.

BR67HPVCauseCancer

Do you think HPV can cause cervical cancer?
YES...........................................................
NO.............................................................
BR-68.

1
2

Do you think you can get HPV through sexual contact?

BR68HPVSTD

YES...........................................................
NO.............................................................

1
2

QUESTION BR-69 DELETED.

BOX BRQ-11
IF RESPONDENT IS MALE, GO TO BR-74.
OTHERWISE, CONTINUE.
BR-70.

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

BR70HPVGoAway

YES...........................................................
NO.............................................................

1
2

QUESTIONS BR-71 AND BR-72 DELETED.

BR-73.
BR73ScreeningAfterVaccine

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

HINTS 2007, Extended CATI Study Instrument, National Cancer Institute (NCI)

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2

Page 26

BR-74.

A vaccine to prevent the human papillomavirus or HPV infection is recommended
for girls aged 11-12 and is called the cervical cancer vaccine, HPV shot, or
GARDASIL®. If you had a daughter that age, would you have her get it?

BR74VaccineForDaughter

YES...........................................................
NO.............................................................
NOT SURE/ IT DEPENDS..........................
DON’T KNOW............................................
BR-75.

1 (BOX BRQ-12)
2
3
4

What is the main reason you would not have her get it?

BR75WhyNoVaccineForDaughter
BR75WhyNoVaccineForDaughter_OS

DOES NOT NEED VACCINE........................ 1
NOT SEXUALLY ACTIVE............................. 2
TOO EXPENSIVE ........................................ 3
TOO OLD FOR VACCINE ............................ 4
DOCTOR DIDN’T RECOMMEND IT ............. 5
WORRIED ABOUT SAFETY OF VACCINE... 6
DON’T KNOW WHERE TO GET VACCINE .. 7
MY SPOUSE/FAMILY MEMBER IS
AGAINST IT................................................. 8
DON’T KNOW ENOUGH ABOUT VACCINE . 9
ALREADY HAVE HPV………………………… 10
OTHER (SPECIFY) ...................................... 11

COLON CANCER
BOX BRQ-12
IF RESPONDENT IS 45 YEARS OR OLDER, CONTINUE.
OTHERWISE, GO TO NEXT SECTION.
BR-76.
BR76WhenDiscussColonTest

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 .................................
NEVER DISCUSSED WITH HEALTH
PROFESSIONAL .......................................

1
2
3
4 (BR-87)
5 (BR-87)
6 (BR-87)

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

HINTS 2007, Extended CATI Study Instrument, National Cancer Institute (NCI)

Page 27

BR-77a.
BR77WhoDiscussedTestDOCTOR

Who talked to you the last time about getting a test to check for colon cancer?
Was it a doctor?
YES...........................................................
NO.............................................................

BR-77b.
BR77WhoDiscussedTestNURSE

1
2

[Who talked to you the last time about getting a test to check for colon cancer?
Was it…]
a nurse?
YES...........................................................
NO.............................................................

BR-77c.

[Who

1
2

talked to you the last time about getting a test to check for colon cancer?

BR77WhoDiscussedTestHEALTHPRO Was it…]

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

1
2

[HIGHEST PROFESSIONAL (BR-77a through BR77c) WILL BE USED TO FILL SUBSEQUENT QUESTIONS.]
BR-78.
BR78DescribeBloodTest

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?
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.
Did the {doctor/ nurse/ other health professional} describe the stool blood test or
fecal occult blood test?
YES...........................................................
NO.............................................................

BR-79.
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?]
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.

Did the {doctor/ nurse/ other health professional} describe colonoscopy?
YES...........................................................
NO.............................................................

HINTS 2007, Extended CATI Study Instrument, National Cancer Institute (NCI)

1
2

Page 28

BR-80.
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.............................................................

BR-81.
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.............................................................

BR-82.

1
2 (BR-83)

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

BR82TestDescribed

_______________________
BR-83.
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.............................................................

BR-84.
BR84TestRecommended
BR84TestRecommended_OS

1
2 (BR-90)

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

QUESTIONS BR-85 AND BR-86 DELETED.

BR-87.
BR87HadStoolBlood

[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.]
Have you ever done a stool blood test using a home kit?
YES...........................................................
NO.............................................................

HINTS 2007, Extended CATI Study Instrument, National Cancer Institute (NCI)

1
2 (BR-90)

Page 29

BR-88.
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 ................................

BR-89.
BR89WhyStoolBlood

BR-90.

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? ...................................

BR90HadCol

1

1
2
3

[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 colonoscopy, you may feel sleepy and you need someone to
drive you home.]
Have you ever had a colonoscopy?
YES...........................................................
NO.............................................................

BR-91.

1
2 (BR-93)

When did you have your most recent colonoscopy to check for colon cancer?

BR91WhenCol

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 ..............................
BR-92.

1
2
3
4

What was the main reason you had your most recent colonoscopy? Was it. . .

BR92WhyCol

part of a routine exam,................................
because of a problem, or ............................
some other reason? ...................................
BR-93.

1
2
3

Have you ever had a sigmoidoscopy?

BR93HadSig

YES...........................................................
NO.............................................................
BR-94.

1
2 (BR-96)

When did you have your most recent sigmoidoscopy to check for colon cancer?

BR94WhenSig

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 ..............................

HINTS 2007, Extended CATI Study Instrument, National Cancer Institute (NCI)

1
2
3
4

Page 30

BR-95.

What was the main reason you had your most recent sigmoidoscopy? Was it…

BR95WhySig

part of a routine exam,................................
because of a problem, or ............................
some other reason? ...................................
BR-96.
BR96EffectivenessOfTest

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....................................................

BR-97.

1
2
3

1 (NEXT SECTION)
2

Which test do you believe is more effective in finding colon cancer?

BR97MostEffectiveTest

[CODE ALL THAT APPLY]
STOOL BLOOD TEST/FECAL OCCULT
BLOOD TEST ............................................
COLONOSCOPY.......................................
SIGMOIDOSCOPY ....................................

HINTS 2007, Extended CATI Study Instrument, National Cancer Institute (NCI)

11
12
13

Page 31

CANCER

NUMERACY
The next three questions are about communicating health information with numbers

QUESTION CS-01 DELETED.

CS-02.
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...................................................

CS-03.

1
2
3
4

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

CS03AttentionStats

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?......................................
CS-04.
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 ............................

CS-05.
CS01WordsOrNumbers

1
2
3
4

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?
PREFER WORDS......................................
PREFER NUMBERS..................................
NO PREFERENCE ....................................

HINTS 2007, Extended CATI Study Instrument, National Cancer Institute (NCI)

1
2
3

Page 32

CANCER COGNITION
CS-06.
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?..................................................

CS-07.

1
2
3
4
5

How often do you worry about getting cancer? Would you say…

CS07FreqWorryCancer

rarely or never,...........................................
sometimes, ................................................
often, or .....................................................
all the time? ...............................................
CS-07a.

1
2
3
4

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

CS05CancerFatal

When I think of cancer, I automatically think of death. Would you say you…
strongly agree, ...........................................
somewhat agree,........................................
somewhat disagree, or ...............................
strongly disagree?......................................
CS-08.
CS08BehaviorCausesCancer

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?......................................

CS-09.

1
2
3
4

1
2
3
4

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

CS09CheckEarlyDetect

[IF NEEDED: Would you say you strongly agree, somewhat agree, somewhat
disagree, or strongly disagree?]
STRONGLY AGREE ..................................
SOMEWHAT AGREE.................................
SOMEWHAT DISAGREE ...........................
STRONGLY DISAGREE ............................
CS-10.

1
2
3
4

People can tell they might have cancer before being diagnosed.

CS10KnowPriorToDiagnosis

[IF NEEDED: Would you say you strongly agree, somewhat agree, somewhat
disagree, or strongly disagree?]
STRONGLY AGREE ..................................
SOMEWHAT AGREE.................................
SOMEWHAT DISAGREE ...........................
STRONGLY DISAGREE ............................

HINTS 2007, Extended CATI Study Instrument, National Cancer Institute (NCI)

1
2
3
4

Page 33

CS-11.

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

CS11EarlyDetectCured

[IF NEEDED: Would you say you strongly agree, somewhat agree, somewhat
disagree, or strongly disagree?]
STRONGLY AGREE ..................................
SOMEWHAT AGREE.................................
SOMEWHAT DISAGREE ...........................
STRONGLY DISAGREE ............................
CS-12.

1
2
3
4

It seems like everything causes cancer.

CS12EverythingCauseCancer

[IF NEEDED: Would you say you strongly agree, somewhat agree, somewhat
disagree, or strongly disagree?]
STRONGLY AGREE ..................................
SOMEWHAT AGREE.................................
SOMEWHAT DISAGREE ...........................
STRONGLY DISAGREE ............................
CS-13.

1
2
3
4

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

CS13PreventNotPossible

[IF NEEDED: Would you say you strongly agree, somewhat agree, somewhat
disagree, or strongly disagree?]
STRONGLY AGREE ..................................
SOMEWHAT AGREE.................................
SOMEWHAT DISAGREE ...........................
STRONGLY DISAGREE ............................
CS-14.
CS14TooManyRecommendations

1
2
3
4

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 ............................

CS-15.
CS15SurviveFiveYears

1
2
3
4

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? ..................................................

HINTS 2007, Extended CATI Study Instrument, National Cancer Institute (NCI)

1
2
3
4
5

Page 34

CS-16.
CS16FirstCancer
CS16FirstCancer_OS

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
CS-17.

Have you ever been diagnosed as having cancer?

CS17EverHadCancer

YES...........................................................
NO.............................................................

HINTS 2007, Extended CATI Study Instrument, National Cancer Institute (NCI)

1
2 (CS-22)

Page 35

CS-18.

What type of cancer did you have?

CS18TypeofSPsCancer
CS18TypeofSPsCancer_OS

[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) ....................................

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

CS-19.
CS19WhenDiagnosedCancer_UNIT
CS19WhenDiagnosedCancer_AGE
CS19WhenDiagnosedCancer_YEAR

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

1
2

[ENTER NUMBER.]
|__|__|__|__|
CS-20.

Did you ever receive any treatment for your cancer?

CS20UndergoCancerTreatment

YES...........................................................
NO.............................................................

HINTS 2007, Extended CATI Study Instrument, National Cancer Institute (NCI)

1
2 (CS-22)

Page 36

CS-21.
CS21HowLongFinishTreatment_Unit
CS21HowLongFinishTreatment_
MonthsNUM
CS21HowLongFinishTreatment_
YearsNUM
CS21HowLongFinishTreatment_
YMTHSNum
CS21HowLongFinishTreatment_
YEARSMNum

How long ago did you finish your most recent treatment?
[ENTER UNIT.]
MONTHS...................................................
YEARS ......................................................
YEARS AND MONTHS ..............................
STILL IN TREATMENT...............................

1
2
3
4

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

CS-22.

Have any of your family members ever had cancer?

CS22FamilyEverHadCancer

YES...........................................................
NO.............................................................
HAS NO FAMILY .......................................

HINTS 2007, Extended CATI Study Instrument, National Cancer Institute (NCI)

1
2
3

Page 37

HEALTH STATUS AND DEMOGRAPHICS

HEALTH STATUS
HD-01.

In general, would you say your health is…

HD01GeneralHealth

excellent, ...................................................
very good,..................................................
good, .........................................................
fair, or ........................................................
poor?.........................................................

1
2
3
4
5

QUESTION HD-02 DELETED.

HD-03a.
HD03aSad

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 .................................

HD-03b.

1
2
3
4
5

[During the past 30 days, how often did you feel…]

HD03bNervous

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 .................................
HD-03c.

1
2
3
4
5

[During the past 30 days, how often did you feel…]

HD03cRestless

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 .................................

HINTS 2007, Extended CATI Study Instrument, National Cancer Institute (NCI)

1
2
3
4
5

Page 38

HD-03d.

[During the past 30 days, how often did you feel… ]

HD03dHopeless

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 .................................
HD-03e.

1
2
3
4
5

[During the past 30 days, how often did you feel…]

HD03eEffort

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 .................................
HD-03f.

1
2
3
4
5

[During the past 30 days, how often did you feel…]

HD03fWorthless

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 .................................

1
2
3
4
5

QUESTION HD-04 DELETED.

DEMOGRAPHICS
There next questions are about you and your household.
HD-05.
HD05OccupationStatus
HD05OccupationStatus_OS

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

HINTS 2007, Extended CATI Study Instrument, National Cancer Institute (NCI)

1
2
3
4
5
6
91

Page 39

HD-06.

What is your marital status? Would you say…

HD06MaritalStatus

married, .....................................................
living as married, ........................................
divorced,....................................................
widowed,....................................................
separated, or..............................................
single, never been married? .......................
HD-07.

1
2
3
4
5
6

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

HD07Education

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......................................
HD-08.

1
2
3
4
5
6
6

Are you Hispanic or Latino?

HD08Hispanic

YES...........................................................
NO.............................................................
HD-09.
HD09Race

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 .......

HD-10.

11
12
13
14
15

Were you born in the United States?

HD10BornInUSA

YES...........................................................
NO.............................................................
HD-11.

1 (HD-13)
2

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

HD11YearCameToUSA

|__|__|__|__|

QUESTION HD-12 DELETED.

HD-13.

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

HD13ChildrenInHH

|__|__|
HINTS 2007, Extended CATI Study Instrument, National Cancer Institute (NCI)

Page 40

BOX HDQ-1
IF NO CHILDREN (HD-13=0), GO TO HD-15.
OTHERWISE, CONTINUE.
HD-14.

Are any of the children in your household female?

HD14FemaleChildren

YES...........................................................
NO.............................................................
HD-15.
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?
|__|__|__|__|__|__|__|__| (HD-16)

IF DK OR RF, ASK: Is your annual household income from all sources…
HD-15a.

Is your annual household income from all sources…

HD15aIncome25Thousand

less than $25,000?
YES...........................................................
NO.............................................................
HD-15b.

1
2 (HD-15e)

[Is your annual household income from all sources…]

HD15bIncome20Thousand

less than $20,000?
YES...........................................................
NO.............................................................
HD-15c.

1
2 (HD-16)

[Is your annual household income from all sources…]

HD15cIncome15Thousand

less than $15,000?
YES...........................................................
NO.............................................................
HD-15d.

1
2 (HD-16)

[Is your annual household income from all sources…]

HD15dIncome10Thousand

less than $10,000?
YES...........................................................
NO.............................................................
HD-15e.

1 (HD-16)
2 (HD-16)

[Is your annual household income from all sources…]

HD15eIncome35Thousand

less than $35,000?
YES...........................................................
NO.............................................................

HINTS 2007, Extended CATI Study Instrument, National Cancer Institute (NCI)

1 (HD-16)
2

Page 41

HD-15f.

[Is your annual household income from all sources…]

HD15fIncome50Thousand

less than $50,000 ($35,000 to less than $50,000)?
YES...........................................................
NO.............................................................
HD-15g.

1 (HD-16)
2

[Is your annual household income from all sources…]

HD15gIncome75Thousand

less than $75,000 ($50,000 to less than $75,000)?
YES...........................................................
NO.............................................................
HD-15h.

1 (HD-16)
2

[Is your annual household income from all sources…]

HD15hIncome100Thousand

less than $100,000 ($75,000 to less than $100,000)?
YES...........................................................
NO.............................................................
HD-15i.

1 (HD-16)
2

[Is your annual household income from all sources…]

HD15iIncomeOver100Thousand

less than $200,000 ($100,000 to less than $200,000)?
YES...........................................................
NO.............................................................
HD-15j.

1 (HD-16)
2

[Is your annual household income from all sources…]

HD15jIncomeOver200Thousand

$200,000 or more?
YES...........................................................
NO.............................................................
HD-16.

1
2

Do you currently rent or own your home?

HD16RentOrOwn

OWN .........................................................
RENT ........................................................
OCCUPIED WITHOUT PAYING
MONETARY RENT.................................

1
2
3

END STATEMENT:
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.
Those are all of the questions I have for you.
Thank you for your time.

HINTS 2007, Extended CATI Study Instrument, National Cancer Institute (NCI)

Page 42