National-Scale Activity Survey - Baseline Survey

OMB Control Number 2060-XXXX

Approval Expires xx/xx/xxxx

Baseline Survey

The next set of questions asks about your outdoor activities yesterday. We know it can be hard to remember, but please try to answer as accurately as you can.

1. Thinking about yesterday, did you spend any time outside between the time you woke up and 12:00 noon? Please only include times when you were outside for at least 10 minutes continuously. Do not include time spent in your car or other vehicle.

   1. Yes [skip to Q3]

   2. No[skip to Q5]

   3. Don’t know

2. [if Don’t know] Okay, let’s start when you woke up; think carefully about each activity you did after you woke up and before noon. Did you do anything outside for at least 10 minutes?

   1. Yes

   2. No [skip to Q5]

3. How much time did you spend outside? Please provide your best estimate.

   1. Hours___, minutes_______

4. Now I want to ask you about your activities when you were outside. During this time, did you engage in moderate or vigorous physical activity? Moderate activities cause only light sweating or a slight to moderate increase in breathing or heart rate. Some examples are brisk walking, bicycling for pleasure, golf, or dancing. Vigorous activities cause heavy sweating or large increases in breathing or heart rate.

   1. Yes

   2. No

5. Now let’s move on. Did you spend any time outside between 12:00 noon and 4:00 pm in the afternoon? Again, please only include times when you were outside for at least 10 minutes continuously and do not include time spent in your car or other vehicle.

1. Yes[skip to Q7]

2. No [skip to Q9]

3. Don’t know

6. [if Don’t know] Okay, let’s start at noon; think carefully about each activity you did after noon and before 4:00 pm. Did you do anything outside for at least 10 minutes?

   1. Yes

   2. No [skip to Q9]

7. How much time did you spend outside? Please provide your best estimate.

   1. Hours___, minutes_______

8. During this time, did you engage in any moderate or vigorous physical activity? Remember, Moderate activities cause only light sweating or a slight to moderate increase in breathing or heart rate. Some examples are brisk walking, bicycling for pleasure, golf, or dancing. Vigorous activities cause heavy sweating or large increases in breathing or heart rate.

   1. Yes

   2. No

9. Now, please think about the end of the day. Did you spend any time outside after 4:00 pm? Again, please only include times when you were outside for at least 10 minutes continuously and do not include time spent in your car or other vehicle.

   1. Yes [skip to Q11]

   2. No [skip to Q13]

   3. Don’t know

10. [if Don’t know] Okay, let’s start with 4:00 pm; think carefully about each activity you did after 4:00 pm. Did you do anything outside for at least 10 minutes?

    1. Yes

    2. No [skip to Q13]

11. How much time did you spend outside? Please provide your best estimate.

    1. Hours___, minutes_______

12. During this time, did you engage in any moderate or vigorous physical activity? Remember, Moderate activities cause only light sweating or a slight to moderate increase in breathing or heart rate. Some examples are brisk walking, bicycling for pleasure, golf, or dancing. Vigorous activities cause heavy sweating or large increases in breathing or heart rate.

    1. Yes

    2. No

13. Yesterday, how much time total did you spend driving or riding in a vehicle? Again, please give us your best estimate.

    1. ____ hours and ____ minutes

14. During a typical week in the summer (June, July or August) do you exercise or engage in other moderate or vigorous physical activity at least 2 times a week for your job or for leisure? This could be either indoors or outdoors.

    1. Yes

    2. No [skip to Q17]

15. In the summer, does your physical activity usually take place only indoors, only outdoors, or both indoors and outdoors?

    1. Only indoors [skip to Q17]

    2. Only outdoors

    3. Both indoors and outdoors

16. Thinking about the times you are outdoors and physically active in the summer, on average how many minutes of moderate or vigorous physical activity do you do per day on days when you are active? This could be activity for work or leisure.

    1. ________minutes

17. These next questions are about your health. Would you say that in general your health is excellent, very good, good, fair or poor?

    1. Excellent

    2. Very good

    3. Good

    4. Fair

    5. Poor

18. Do you have any allergies to grasses, pollen, or other plants?

    1. Yes

    2. No

    3. Don’t know

19. Has a doctor ever told you that you have high blood pressure?

    1. Yes

    2. No

    3. Don’t know

20. Has a doctor ever told you that you have heart disease?

    1. Yes

    2. No

    3. Don’t know

21. Has a doctor ever told you that you have heart failure or congestive heart failure?

    1. Yes

    2. No

    3. Don’t know

22. Has a doctor ever told you that you had a stroke?

    1. Yes

    2. No

    3. Don’t know

23. Has a doctor ever told you that you have asthma?

    1. Yes

    2. No

    3. Don’t know

24. Do you still have asthma?

    1. Yes

    2. No

    3. Don’t know

25. Has a doctor ever told you that you have a lung disease other than asthma, such as emphysema or COPD? COPD means Chronic Obstructive Pulmonary Disease and is also known as Chronic Lower Respiratory Disease. Do not include Tuberculosis (TB).

    1. Yes

    2. No

    3. Don’t know

26. Do you have any other health conditions that limit the amount of time you spend outdoors?

    1. yes

    2. no

27. What type of vehicle do you usually drive?

    1. Regular fuel car

    2. Hybrid or biofuel car

    3. Minivan

    4. Full-size Passenger Van

    5. SUV

    6. Motorcycle

    7. Pickup

    8. Other, __________

    9. I do not drive

28. How would you describe where you live?

    1. Urban setting

    2. Suburban setting

    3. Rural setting

29. How many years have you lived in [name of city]?

    1. ____Years

30. Do you speak a language other than English at home?

    1. Yes

    2. No [skip to Q32]

31. If yes, what language____________

32. Are you currently employed?

    1. Yes

    2. No [skip to Q40]

33. How many jobs do you currently have?

    1. 1

    2. 2

    3. 3

    4. 4

    5. More than 4

34. In an average week how many hours do you work in total for all paid jobs?

    1. 0-10 hours

    2. 11-20 hours

    3. 21-30 hours

    4. 31-40 hours

    5. 41-50 hours

    6. 51-60 hours

    7. More than 60 hours

If you have more than one job, answer the next five questions for the job at which you spend the most hours.

35. When you are at work, which of the following best describes what you do?

    1. Mostly sitting (at a desk or table) or

    2. Mostly standing

    3. Mostly walking, but not heavy labor

    4. Mostly heavy labor or physically demanding work

36. When you are at work, which of the following best describes how much time you spend outdoors?

    1. All or most of my time at work is spent outdoors

    2. About half my time at work is spent outdoors

    3. A quarter or less of my time at work is spent outdoors

    4. I do not spend any time at work outdoors

37. How did you usually get to work last week? If you usually use more than one method of transportation during your trip to work, select the one used for most of the distance.

    1. Alone in a car, truck, or van

    2. With at least one other adult in a car, truck, or van

    3. Bus, trolley, or streetcar

    4. Subway, elevated train, or railroad

    5. Ferryboat

    6. Motorcycle

    7. Bicycle

    8. Walked

    9. Worked at home [skip to Q40]

    10. Other

38. How many minutes did it usually take you to get from home to work last week?

    1. ____ minutes

39. How many miles is your one way trip to work?

    1. ____miles

40. Do you own any of the following?

    1. Wood stove

    2. Wood burning fire place

    3. Natural gas fire place

    4. Motorboat or personal watercraft (PWC)

    5. Motorhome or RV

    6. Snowmobile

    7. Bicycle

41. Which best describes the building you live in?

    1. A mobile home

    2. A one-family house detached from any other house

    3. A one-family house attached to one or more other houses

    4. A building with 2 apartments

    5. A building with 3 or more apartments

    6. Boat, RV, van, etc.

    7. Other, ______________

42. Which of the following income categories best describes your total 2007 household income before taxes?

    1. Less than $10,000

    2. $10,000 to $14,999

    3. $15,000 to $24,999

    4. $25,000 to $34,999

    5. $35,000 to $49,999

    6. $50,000 to $74,999

    7. $75,000 to $99,999

    8. $100,000 to $149,999

    9. $150,000 to $199,999

    10. $200,000 or more

43. When it comes to politics do you usually think of yourself as

    1. Extremely liberal

    2. Liberal

    3. Slightly liberal

    4. Moderate or middle of the road

    5. Slightly conservative

    6. Conservative

    7. Extremely conservative

    8. I haven’t thought about this much

44. Please rate the following statements for yourself

	1 Not true	2	3	4	5 Very True
It would be hard for me to break any of my bad habits.
I always know why I like things.

Thank you for completing the survey. This survey is part of a research project on daily activities. You have been selected to participate in the next step in the research project. To collect more information about individuals’ activities, we will be sending you a set of activity diaries. An activity diary is a survey that asks you questions about what you did during the day. The data from these diaries will be used to provide a better understanding of how people spend their day. The data collected from these diaries will be kept confidential – as always, your name will never be associated with the information from the surveys you take.

We will be sending you a total of 7 activity diaries this summer. First, we will ask you to fill out diaries for 4 days in a row and then later in the summer you will fill out diaries for another 3 days in a row. To alert you that a diary will be coming, you will receive an email 2 days before we send the first diary. We designed the diaries so that they will be easy to fill out, so the diary surveys shouldn’t take more than about 10 minutes to complete.

Your participation in this survey is very important for the overall success of the research project. You are part of a group of 1,600 people who will be completing activity diaries, and for our sample to be representative we need everyone to participate.

To thank you for your participation, you will receive a $36 bonus for completing all the surveys in this project.

The public reporting and recordkeeping burden for this collection of information is estimated to average 15 minutes per response. Send comments on the Agency's need for this information, the accuracy of the provided burden estimates, and any suggested methods for minimizing respondent burden, including through the use of automated collection techniques to the Director, Collection Strategies Division, U.S. Environmental Protection Agency (2822T), 1200 Pennsylvania Ave., NW, Washington, D.C. 20460. Include the OMB control number in any correspondence. Do not send the completed survey to this address.