12c - Adult Biometric Measures - Documentation

Adult Biometric Measures - Documentation of Question Provenance
BRFSS = Behavioral Risk Factor Surveillance System
DG = Doug Granger, Expert in saliva sample collection1
NHANES = National Health and Nutrition Examination Survey

NHIS = National Health Interview Survey
YRBS = Youth Risk Behavior Survey

# Item Name in Item Text in CAPI
CAPI

Data Source

Original Text in Source

Divergence?

1 DEM_INTRO_ I'm going to begin with some general questions about you,
ad
your health and recent activities that are related to the
biometric measures we will be collecting today

RTI
Developed

N/A

N/A

2 DEM1_ad

BRFSS 2011

What is your age?
(108-109)
_ _ Code age in years
0 7 Don‘t know / Not sure
0 9 Refused

No

RTI
Developed

N/A

N/A

What is your age?
_ _ CODE AGE IN YEARS
-1 DON’T KNOW/NOT SURE
2 REFUSED
IF MALE, SKIP TO BP1_AD

3 DEM2_ad

To your knowledge, are you now pregnant?
1 YES
2 NO
-1 DON‘T KNOW / NOT SURE
-2 REFUSED

4 BP1_ad

Since we last interviewed you on [DATE OF ATSS INTERVIEW], BRFSS 2011
have you been told by a doctor, nurse, or other health
professional that you have high blood pressure?
1 YES
2 (VOLUNTEERED): YES, BUT FEMALE TOLD ONLY DURING
PREGNANCY [SKIP TO TOB1_ad]
3 NO [SKIP TO TOB1_ad]
4 (VOLUNTEERED): TOLD BORDERLINE HIGH OR PREHYPERTENSIVE [SKIP TO TOB1_ad]
-1DON‘T KNOW / NOT SURE [SKIP TO TOB1_ad]
-2REFUSED [SKIP TO TOB1_ad]
IF MALE, SKIP TO BP2_ad

Page 1 of 13

Have you EVER been told by a doctor, nurse, or other health
Yes
professional that you have
high blood pressure?
‖
(84)
Read only if necessary: By ―other health professional we mean a
nurse practitioner, a physician‘s assistant, or some other licensed
health professional.
If “Yes” and respondent is female, ask: “Was this only when you
were pregnant?”
1 Yes
2 Yes, but female told only during pregnancy [Go to next section]
3 No [Go to next section]
4 Told borderline high or pre-hypertensive [Go to next section]
7 Don‘t know / Not sure [Go to next section]
9 Refused [Go to next section]

Adult Biometric Measures - Documentation of Question Provenance
BRFSS = Behavioral Risk Factor Surveillance System
DG = Doug Granger, Expert in saliva sample collection1
NHANES = National Health and Nutrition Examination Survey

NHIS = National Health Interview Survey
YRBS = Youth Risk Behavior Survey

# Item Name in Item Text in CAPI
CAPI

Data Source

Original Text in Source

5 BP1a_ad

BRFSS 2011

Have you EVER been told by a doctor, nurse, or other health
Yes
professional that you have
high blood pressure?
‖
(84)
Read only if necessary: By ―other health professional we mean a
nurse practitioner, a physician‘s assistant, or some other licensed
health professional.
If “Yes” and respondent is female, ask: “Was this only when you
were pregnant?”
1 Yes
2 Yes, but female told only during pregnancy [Go to next section]
3 No [Go to next section]
4 Told borderline high or pre-hypertensive [Go to next section]
7 Don‘t know / Not sure [Go to next section]
9 Refused [Go to next section]

BRFSS 2011

(Are you) changing your eating habits (to help lower or control
your high blood pressure)?
(316)
1 Yes
2 No
7 Don‘t know / Not sure
9 Refused

Was this only when you were pregnant?
1 YES [SKIP TO TOB1_ad]
2 NO
-1 DON’T KNOW [SKIP TO TOB1_ad]
-2 REFUSED [SKIP TO TOB1_ad]

6 BP2_ad

Since we last interviewed you on [DATE], have you changed
your eating habits to help lower or control your high blood
pressure?
1 YES
2 NO
-1DON‘T KNOW / NOT SURE
-2REFUSED

Page 2 of 13

Divergence?

Yes

Adult Biometric Measures - Documentation of Question Provenance
BRFSS = Behavioral Risk Factor Surveillance System
DG = Doug Granger, Expert in saliva sample collection1
NHANES = National Health and Nutrition Examination Survey
# Item Name in Item Text in CAPI
CAPI
7 BP3_ad

NHIS = National Health Interview Survey
YRBS = Youth Risk Behavior Survey
Data Source

Since we last interviewed you on [DATE], have you cut down BRFSS 2011
on salt to help lower or control your high blood pressure?
1 YES
2 NO
3 (VOLUNTEERED) DO NOT USE SALT
-1 DON‘T KNOW / NOT SURE
-2 REFUSED

8 BP4_ad

(Since we last interviewed you on [DATE]), Have you reduced BRFSS 2011
alcohol use to help lower or control your high blood pressure?
1 YES
2 NO
3 (VOLUNTEERED): DO NOT DRINK
-1 DON‘T KNOW / NOT SURE
-2REFUSED

9 BP5_ad

(Since we last interviewed you on [DATE]), Are you exercising BRFSS 2011
to help lower or control your high blood pressure?
1 YES
2 NO
-1 DON‘T KNOW / NOT SURE
-2 REFUSED

Page 3 of 13

Original Text in Source

Divergence?

(Are you) cutting down on salt (to help lower or control your high
blood pressure)?
(317)
1 Yes
2 No
3 Do not use salt
7 Don‘t know / Not sure
9 Refused

Yes

(Are you) reducing alcohol use (to help lower or control your high
blood pressure)?
(318)
1 Yes
2 No
3 Do not drink
7 Don‘t know / Not sure
9 Refused

Yes

(Are you) exercising (to help lower or control your high blood
pressure)?
(319)
1 Yes
2 No
7 Don‘t know / Not sure
9 Refused

Yes

Adult Biometric Measures - Documentation of Question Provenance
BRFSS = Behavioral Risk Factor Surveillance System
DG = Doug Granger, Expert in saliva sample collection1
NHANES = National Health and Nutrition Examination Survey

NHIS = National Health Interview Survey
YRBS = Youth Risk Behavior Survey

# Item Name in Item Text in CAPI
CAPI

Data Source

Original Text in Source

Divergence?

10 BP6_ad

BRFSS 2011

Are you currently taking medicine for your high blood pressure?
(85)
1 Yes
2 No
7 Don‘t know / Not sure
9 Refused

Yes

BRFSS 2011

Do you now smoke cigarettes every day, some days, or not at all?
1 Every day
2 Some days
3 Not at all[Go to Q7.4]
7 Don't know/ Not Sure [Go to Q7.5]
9 Refused [Go to Q7.5]

Yes

On the average, how many cigarettes do you now smoke a day?
01-94 1 - 94 cigarettes
95 95+ cigarettes
97 Refused
99 Don't know

Yes

(Since we last interviewed you on [DATE],) Are you taking
medicine for your high blood pressure?
1 YES
2 NO [SKIP TO TOB1_AD]
-1 DON‘T KNOW / NOT SURE [SKIP TO TOB1_AD]
-2 REFUSED

11 TOB1_ad

Do you currently smoke cigarettes?
1 Yes
2 No – SKIP TO QUESTION TOB2_ ad
-1 DON’T KNOW – SKIP TO QUESTION TOB2_ad
-2 REFUSED – SKIP TO QUESTION TOB2_ad

12 TOB1_a_ad

How much do you usually smoke per day? You can either tell NHIS 2011
me in number of cigarettes on in packs per day. (NOTE TO
INTERVIEWER: A PACK OF CIGARETTES CONTAINS 20
CIGARETTES. IF THE RESPONDENT ANSWERS A PACK AND A
HALF, CODE AS 10 CIGARETTES).
----------________Cigarettes
_____ Packs
-1DON’T KNOW
-2REFUSED

Page 4 of 13

Adult Biometric Measures - Documentation of Question Provenance
BRFSS = Behavioral Risk Factor Surveillance System
DG = Doug Granger, Expert in saliva sample collection1
NHANES = National Health and Nutrition Examination Survey
# Item Name in Item Text in CAPI
CAPI

NHIS = National Health Interview Survey
YRBS = Youth Risk Behavior Survey
Data Source

Original Text in Source

Divergence?

Yes

13 TOB1b_ad

How long has it been since you last smoked a cigarette? You BRFSS 2011
can tell me the number of hours ago, days ago or months ago.
_____ Hours ago
______Days ago
______Months ago
-1DON’T KNOW
-2 REFUSED
{HARD CHECK TEXT: PLEASE MAKE SURE THAT YOU HAVE
ENTERED BOTH A NUMERIC AMOUNT IN THE TEXT FIELD AND
SELECTED A TIME PERIOD}

How long has it been since you last smoked a cigarette, even one
or two puffs?
0 1 Within the past month (less than 1 month ago)
0 2 Within the past 3 months (1 month but less than 3 months
ago)
0 3 Within the past 6 months (3 months but less than 6 months
ago)
0 4 Within the past year (6 months but less than 1 year ago)
0 5 Within the past 5 years (1 year but less than 5 years ago)
0 6 Within the past 10 years (5 years but less than 10 years ago)
0 7 10 years or more
7 7 Don‘t know / Not sure
9 9 Refused

14 TOB2_ad

TOB2_ad Do you currently smoke cigars, cigarillos or a pipe
(tobacco only)?
1 Yes
2 No – SKIP TO QUESTION TOB3_ ad
-1 DON’T KNOW – SKIP TO QUESTION TOB3_ad
-2 REFUSED – SKIP TO QUESTION TOB3_ad

During the past 30 days, on how many days did you smoke cigars, Yes
cigarillos, or little cigars?

YRBS 2011

Page 5 of 13

Adult Biometric Measures - Documentation of Question Provenance
BRFSS = Behavioral Risk Factor Surveillance System
DG = Doug Granger, Expert in saliva sample collection1
NHANES = National Health and Nutrition Examination Survey
# Item Name in Item Text in CAPI
CAPI

NHIS = National Health Interview Survey
YRBS = Youth Risk Behavior Survey
Data Source

Original Text in Source

Divergence?

15 TOB2a_ad

TOB2a_ad How long has it been since you last smoked a
BRFSS 2011
cigar, cigarillo or pipe? You can tell me the number of hours
ago, days ago or months ago.
____Hours ago
__________Days ago
__________Months ago
-1 DON’T KNOW
-2 REFUSED
{HARD CHECK TEXT: PLEASE MAKE SURE THAT YOU HAVE
ENTERED BOTH A NUMERIC AMOUNT IN THE TEXT FIELD AND
SELECTED A TIME PERIOD}

How long has it been since you last smoked a cigarette, even one
or two puffs?
0 1 Within the past month (less than 1 month ago)
0 2 Within the past 3 months (1 month but less than 3 months
ago)
0 3 Within the past 6 months (3 months but less than 6 months
ago)
0 4 Within the past year (6 months but less than 1 year ago)
0 5 Within the past 5 years (1 year but less than 5 years ago)
0 6 Within the past 10 years (5 years but less than 10 years ago)
0 7 10 years or more
7 7 Don‘t know / Not sure
9 9 Refused

Yes

16 TOB3_ad

Do you currently use chewing tobacco, snuff, or dip such as
Redman, Skoal, or Copenhagen?
1 Yes
2 No – SKIP TO QUESTION TOB4_ad
-1 DON’T KNOW – SKIP TO QUESTION TOB4_ad
-2 REFUSED – SKIP TO QUESTION TOB4_ad

Do you currently use chewing tobacco, snuff, or snus every day,
some days, or not at all?

Yes

BRFSS 2011

Page 6 of 13

Adult Biometric Measures - Documentation of Question Provenance
BRFSS = Behavioral Risk Factor Surveillance System
DG = Doug Granger, Expert in saliva sample collection1
NHANES = National Health and Nutrition Examination Survey
# Item Name in Item Text in CAPI
CAPI

NHIS = National Health Interview Survey
YRBS = Youth Risk Behavior Survey
Data Source

Original Text in Source

Divergence?

Yes

17 TOB3a_ad

How long ago did you last use any of those?
BRFSS 2011
_____ Hours ago
______Days ago
______Weeks ago
______Months ago
DON’T KNOW
REFUSED
{HARD CHECK TEXT: PLEASE MAKE SURE THAT YOU HAVE
ENTERED BOTH A NUMERIC AMOUNT IN THE TEXT FIELD AND
SELECTED A TIME PERIOD}

Do you currently use chewing tobacco, snuff, or snus every day,
some days, or not at all?

18 TOB4_ad

Are currently using anything to help you quit smoking like a
nicotine patch, nicotine gum, nasal spray or inhaler?
1YES
2NO – SKIP TO QUESTION TOB5_ad
-1DON’T KNOW – SKIP TO QUESTION TOB5_ad
-2REFUSED – SKIP TO QUESTION TOB5_ad

When you quit smoking…The last time you tried to quit
Yes
smoking…did you use any of the following medications: a nicotine
patch, nicotine gum, nicotine lozenges, nicotine nasal spray, a
nicotine inhaler, or pills such as Wellbutrin, Zyban, buproprion,
Chantix, or varenicline to help you quit?

19 TOB4a_ad

TOB4a_ad. When did you last use any of these things that are RTI
designed to help you quit smoking?
Developed
_____ Currently using (e.g. patch)
_____ HOURS AGO
______DAYS AGO
______WEEKS AGO
______MONTHS AGO
-1 DON’T KNOW
-2 REFUSED
{HARD CHECK TEXT: PLEASE MAKE SURE THAT YOU HAVE
ENTERED BOTH A NUMERIC AMOUNT IN THE TEXT FIELD AND
SELECTED A TIME PERIOD}

BRFSS 2011

Page 7 of 13

N/A

N/A

Adult Biometric Measures - Documentation of Question Provenance
BRFSS = Behavioral Risk Factor Surveillance System
DG = Doug Granger, Expert in saliva sample collection1
NHANES = National Health and Nutrition Examination Survey

NHIS = National Health Interview Survey
YRBS = Youth Risk Behavior Survey

# Item Name in Item Text in CAPI
CAPI

Data Source

Original Text in Source

Divergence?

20 TOB5_ad

During the past 7 days, on how many days were you in the
same room with somebody who was smoking cigarettes?
RECORD NUMBER OF DAYS
_____DAYS (RANGE 0-7)
-1 DON’T KNOW/NOT SURE
-2 REFUSED

BRFSS 2011

Not counting decks, porches, or garages, during the past 7 days,
that is, since last [TODAY'S DAY OF WEEK], on how many days did
someone other than you smoke tobacco inside our home while
you were at home?

Yes

21 TOB6_ad

During the past 7 days, that is since , not counting at
home, on how many days did you breathe smoke from
someone else who was smoking in an indoor public place?
Include the place you work if people smoke indoors there.
IF NEEDED, SAY: Examples of indoor public places are indoor
areas of stores, restaurants, bars, casinos, clubs, and sports
arenas.
RECORD NUMBER OF DAYS
_____ NUMBER OF DAYS (RANGE 0-7)
-1 DON’T KNOW
-2 REFUSED

BRFSS 2011

Now I‘m going to ask you about smoke you might have breathed Yes
at work because someone else was smoking indoors. During the
past 7 days, that is, since last [TODAY‟S DAY OF THE WEEK], on
how many days did you breathe the smoke at your workplace from
someone other than you who was smoking tobacco?
_ _ Number of days [01-07]
8 8 None
7 7 Don‘t know / Not sure
9 9 Refused

22 WGT1_ad

Do you consider yourself now to be…
1 overweight
2 underweight
3 about right
-1 DON‘T KNOW / NOT SURE
-2 REFUSED

NHANES 2011 {Do you/Does SP} consider {your/his/her}self now to be . . . [If {you Yes
are/she is} currently pregnant, what did {you/she} consider
{your/her}self to be before {you were/she was} pregnant?]
overweight, ….......1
underweight, or ....... 2
about the right weight? ....... 3
REFUSED .............. 7
DON’T KNOW .................... 9

Page 8 of 13

Adult Biometric Measures - Documentation of Question Provenance
BRFSS = Behavioral Risk Factor Surveillance System
DG = Doug Granger, Expert in saliva sample collection1
NHANES = National Health and Nutrition Examination Survey

NHIS = National Health Interview Survey
YRBS = Youth Risk Behavior Survey

# Item Name in Item Text in CAPI
CAPI

Data Source

23 WGT2_ad

NHANES 2011 During the past 12 months, {have you/has SP} tried to lose weight? No
YES ..........1
NO.......... 2 (WHQ.090)
REFUSED ...7 (WHQ.090)
DON’T KNOW ....9 (WHQ.090)

During the past 12 months, have you tried to lose weight?
1 YES
2 NO
-1 DON‘T KNOW / NOT SURE
-2REFUSED

24 WGT3_ad

During the past 30 days, have you gained weight?
1 YES - How many pounds?_________ lbs./kg
2 NO
-1DON‘T KNOW / NOT SURE
-2REFUSED

25 WGT4_ad

During the past 30 days, have you lost weight?

Original Text in Source

Divergence?

NHANES 2011 During the past 12 months, {have you/has SP} done anything to
keep from gaining weight?
YES .............. 1
NO............... 2 (WHQ.210)
REFUSED .......7 (WHQ.210)
DON’T KNOW ....9 (WHQ.210)

Yes

NHANES 2011 How much weight {did you/did SP} lose in {your/his/her} most
successful attempt ever to lose weight?

Yes

RTI
Developed

N/A

1 YES - How many pounds?_________ lbs./kg
2 NO
-1 DON‘T KNOW / NOT SURE
-2 REFUSED
26 FOOD1_ad

What food or foods did you eat during your last meal or
snack? Please tell me all the food and drinks you have had
during your last meal or snack.
________[5000 MAX CHARACTERS]
-1 DON‘T KNOW / NOT SURE
-2 REFUSED

Page 9 of 13

N/A

Adult Biometric Measures - Documentation of Question Provenance
BRFSS = Behavioral Risk Factor Surveillance System
DG = Doug Granger, Expert in saliva sample collection1
NHANES = National Health and Nutrition Examination Survey

NHIS = National Health Interview Survey
YRBS = Youth Risk Behavior Survey

# Item Name in Item Text in CAPI
CAPI

Data Source

Original Text in Source

Divergence?

27 FOOD2_ad

RTI
Developed

N/A

N/A

28 FOOD3_ad

[ASK IF FOOD2_ad_cy=1, ELSE SKIP] And what time was that? RTI
(At what time did you last eat or drink anything besides
Developed
water?)
____ HOUR [1 – 12]
_____ MINUTES [0-59]
1. AM
2. PM
-1 DON‘T KNOW / NOT SURE
-2 REFUSED

N/A

N/A

29 ILL1_ad

Have you had any colds, flus or other illnesses in the last two
weeks?

N/A

N/A

When did you last eat or drink anything besides water? Was
that….
1. Today
2. Yesterday
3. Sometime earlier
-1 DON‘T KNOW / NOT SURE
-2 REFUSED

RTI
Developed

1. YES
2. NO
-1. DON’T KNOW/NOT SURE
-2. REFUSED
30 SAL_INTRO_a The next few questions will help us understand the results of
d
your saliva sample.

DG

Page 10 of 13

Adult Biometric Measures - Documentation of Question Provenance
BRFSS = Behavioral Risk Factor Surveillance System
DG = Doug Granger, Expert in saliva sample collection1
NHANES = National Health and Nutrition Examination Survey

NHIS = National Health Interview Survey
YRBS = Youth Risk Behavior Survey

# Item Name in Item Text in CAPI
CAPI

Data Source

Original Text in Source

31 SAL1_ad

Has a doctor or dentist told you that you had periodontal
disease (that is, an infection of the soft tissues and bones
surrounding the teeth)?
1 YES
2 NO
-1 DON’T KNOW/NOT SURE
-2 REFUSED

NHANES 2011 Gum disease is a common problem with the mouth. People with
gum disease might have swollen gums, receding gums, sore or
infected gums or loose teeth. {Do you/Does SP} think {you/s/he}
might have gum disease?
YES....1
NO.....2
REFUSED......7
DON'T KNOW.......9

Yes

32 SAL2_ad

Before this visit, when was the last time you brushed your
teeth?
Time: ____________
INDICATE: AM/PM

DG

N/A

N/A

33 SAL3_ad

The last time you brushed your teeth, did you see any pink or DG
reddish color when you spit into the sink?
1 YES
2 NO
-1 DON’T KNOW/NOT SURE
-2 REFUSED

N/A

N/A

34 SAL4_ad

In the past 24 hours have you had any injuries to your mouth DG
or any dental work that caused bleeding?
1 YES
2 NO
-1 DON’T KNOW/NOT SURE
-2 REFUSED

N/A

N/A

Page 11 of 13

Divergence?

Adult Biometric Measures - Documentation of Question Provenance
BRFSS = Behavioral Risk Factor Surveillance System
DG = Doug Granger, Expert in saliva sample collection1
NHANES = National Health and Nutrition Examination Survey

NHIS = National Health Interview Survey
YRBS = Youth Risk Behavior Survey

# Item Name in Item Text in CAPI
CAPI

Data Source

Original Text in Source

Divergence?

35 SAL5_ad

DG

N/A

N/A

N/A

N/A

RTI
Developed

N/A

N/A

Now I'd like to talk about medications. What medications are RTI
you currently taking? (Prescription medications, OTC,
Developed
vitamins, dietary supplements, etc.) It would be really helpful
if you could show me the actual medication so I can record
the doseage.

N/A

N/A

N/A

N/A

Do you have any open sores or cuts in your mouth?

1 YES
2 NO
-1 DON’T KNOW/NOT SURE
-2 REFUSED
36 BP_INTRO_ad Next, I would like to measure your blood pressure.
37 BP_1_ad

ARM SELECTED:
1 RIGHT
2 LEFT
ENTER ARM MEASUREMENT
_____CM
-1 UNABLE TO OBTAIN – SKIP TO HEIGHT
-2 REFUSED

38 MEDS1_ad

ALLOW TIME FOR R TO GO GET MEDICATION
For each medication, please tell me the name, the doseage,
how often you take it, how you take it, why you take it, when
started
taking it and when you stopped taking it.
39 OTHER_BIO_1 you
ADULT
HEIGHT
RTI
MEASURED CM ______
Developed
UNABLE TO OBTAIN……………..998
REFUSED……………….………….-29

Page 12 of 13

Adult Biometric Measures - Documentation of Question Provenance
BRFSS = Behavioral Risk Factor Surveillance System
DG = Doug Granger, Expert in saliva sample collection1
NHANES = National Health and Nutrition Examination Survey

NHIS = National Health Interview Survey
YRBS = Youth Risk Behavior Survey

# Item Name in Item Text in CAPI
CAPI

Data Source

Original Text in Source

Divergence?

40 OTHER_BIO_2 ADULT WAIST CIRCUMFERENCE
MEASURED CM ______
UNABLE TO OBTAIN………….………998
REFUSED……………………………….-29

RTI
Developed

N/A

N/A

41 OTHER_BIO_3 ADULT WEIGHT
MEASURED KG ______
UNABLE TO OBTAIN…………...…..998
REFUSED………………………..……-29

RTI
Developed

N/A

N/A

42 OTHER_BIO_5 SALIVA SAMPLE COLLECTED
YES/NO ______
REFUSED…………………………………………. – 2
UNABLE TO OBTAIN…………………………….. – 5

RTI
Developed

N/A

N/A

43 OTHER_BIO_6 SALIVA SAMPLE #

RTI
Developed

N/A

N/A

ID________
ID________

1. Granger, D. A., Kivlighan, K. T., Fortunato, C., Harmon, A. G., Hibel, L. C., Schwartz, E. B., Whembolua, G. (2007). Integration of salivary biomarkers into developmental and
behaviorally-oriented research: Problems and solutions for collecting specimens. Physiology and Behavior, 92 (4), 585-590.

Page 13 of 13