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pdfAdult 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
CAPI
Item Text in CAPI
NHIS = National Health Interview Survey
YRBS = Youth Risk Behavior Survey
Data Source
Original Text in Source
Divergence?
1 DEM_INTR I'm going to begin with some general questions about you, your
O_ad
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 What is your age?
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
_ _ CODE AGE IN YEARS
-1 DON’T KNOW
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
-2 REFUSED
Page 1 of 22
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
CAPI
Item Text in CAPI
Data Source
Original Text in Source
4 BP1_ad
Since we last interviewed you on [DATE OF ATSS INTERVIEW],
have you been told by a doctor, nurse, or other health
professional that you have high blood pressure?
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]
1 YES [IF MALE SKIP TO BP2_ad; IF FEMALE, GO TO BP1a_ad]
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 [SKIP TO TOB1_ad]
-2REFUSED [SKIP TO TOB1_ad]
Page 2 of 22
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
CAPI
Item Text in CAPI
Data Source
Original Text in Source
5 BP1a_ad
Was this only when you were pregnant?
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]
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 BRFSS 2011
eating habits to help lower or control your high blood pressure?
1 YES
2 NO
-1DON‘T KNOW
-2REFUSED
Page 3 of 22
(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
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
NHIS = National Health Interview Survey
YRBS = Youth Risk Behavior Survey
# Item
Name in
CAPI
Item Text in CAPI
Data Source
7 BP3_ad
Since we last interviewed you on [DATE], have you cut down on BRFSS 2011
salt to help lower or control your high blood pressure?
1 YES
2 NO
3 (VOLUNTEERED) DO NOT USE SALT
-1 DON‘T KNOW
-2 REFUSED
8 BP4_ad
(Since we last interviewed you on [DATE]), Have you reduced
alcohol use to help lower or control your high blood pressure?
BRFSS 2011
1 YES
2 NO
3 (VOLUNTEERED): DO NOT DRINK
-1 DON‘T KNOW
-2REFUSED
9 BP5_ad
(Since we last interviewed you on [DATE]), Are you exercising to BRFSS 2011
help lower or control your high blood pressure?
1 YES
2 NO
-1 DON‘T KNOW
-2 REFUSED
Page 4 of 22
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
CAPI
Item Text in CAPI
Data Source
Original Text in Source
Divergence?
10 BP6_ad
(Since we last interviewed you on [DATE],) Are you taking
medicine for your high blood pressure?
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
1 YES
2 NO
-1 DON‘T KNOW
-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_a How much do you usually smoke per day? You can either tell me NHIS 2011
d
in number of cigarettes or 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 30 CIGARETTES).
----------________Cigarettes
_____ Packs
-1DON’T KNOW
-2REFUSED
Page 5 of 22
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
CAPI
Item Text in CAPI
NHIS = National Health Interview Survey
YRBS = Youth Risk Behavior Survey
Original Text in Source
Divergence?
13 TOB1b_ad How long has it been since you last smoked a cigarette? You can BRFSS 2011
tell me the number of hours ago, days ago or months ago.
_____ Hours ago
______Days ago
______Months ago
IF TIME WAS MORE THAN 24 MONTHS AGO, CODE 24 MONTHS
-1DON’T KNOW - GO TO TOB2_ad
-2 REFUSED - GO TO TOB2_ad
{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
14 TOB2_ad
During the past 30 days, on how many days did you smoke cigars, Yes
cigarillos, or little cigars?
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
Data Source
YRBS 2011
Page 6 of 22
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
CAPI
Item Text in CAPI
NHIS = National Health Interview Survey
YRBS = Youth Risk Behavior Survey
Original Text in Source
Divergence?
15 TOB2a_ad TOB2a_ad How long has it been since you last smoked a cigar, BRFSS 2011
cigarillo or pipe? You can tell me the number of hours ago, days
ago or months ago.
____Hours ago
__________Days ago
__________Months ago
IF TIME WAS MORE THAN 24 MONTHS AGO, CODE 24 MONTHS
-1 DON’T KNOW - GO TO TOB3_ad
-2 REFUSED - GO TO TOB3_ad
{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 snus every day,
some days, or not at all?
Yes
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
Data Source
BRFSS 2011
Page 7 of 22
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
CAPI
Item Text in CAPI
NHIS = National Health Interview Survey
YRBS = Youth Risk Behavior Survey
Data Source
Original Text in Source
Divergence?
17 TOB3a_ad How long ago did you last use any of those?
_____ Hours ago
______Days ago
______Weeks ago
______Months ago
IF TIME WAS MORE THAN 24 MONTHS AGO, CODE 24 MONTHS
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}
BRFSS 2011
Do you currently use chewing tobacco, snuff, or snus every day,
some days, or not at all?
Yes
18 TOB4_ad
BRFSS 2011
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?
Are you 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
Page 8 of 22
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
CAPI
Item Text in CAPI
19 TOB4a_ad TOB4a_ad. When did you last use any of these things that are
designed to help you quit smoking?
_____ Currently using (e.g. patch)
_____ HOURS AGO
______DAYS AGO
______WEEKS AGO
______MONTHS AGO
IF TIME WAS MORE THAN 24 MONTHS AGO, CODE 24 MONTHS
-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}
20 TOB5_ad
NHIS = National Health Interview Survey
YRBS = Youth Risk Behavior Survey
Data Source
Original Text in Source
Divergence?
RTI
Developed
N/A
N/A
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
During the past 7 days, on how many days were you in the same BRFSS 2011
room with somebody who was smoking cigarettes?
RECORD NUMBER OF DAYS
_____DAYS (RANGE 0-7)
-1 DON’T KNOW/NOT SURE
-2 REFUSED
Page 9 of 22
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
CAPI
Item Text in CAPI
Data Source
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
Original Text in Source
Divergence?
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
-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
23 WGT2_ad During the past 12 months, have you tried to lose weight?
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)
1 YES
2 NO
-1 DON‘T KNOW
-2REFUSED
Page 10 of 22
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
CAPI
Item Text in CAPI
NHIS = National Health Interview Survey
YRBS = Youth Risk Behavior Survey
Data Source
Original Text in Source
Divergence?
24 WGT3_ad_ During the past 30 days, have you gained weight?
YesNo
1 YES
2 NO - GO TO WGT4_AD
-1DON‘T KNOW- GO TO WGT4_AD
-2REFUSED - GO TO WGT4_AD
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
25 WGT3_AD How many pounds? _____ lbs.
NHANES 2012 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
26 WGT4_ad_ During the past 30 days, have you lost weight?
YesNo
NHANES 2011 How much weight {did you/did SP} lose in {your/his/her} most
successful attempt ever to lose weight?
Yes
27 WGT4_AD How many pounds? _____ lbs.
NHANES 2012 How much weight {did you/did SP} lose in {your/his/her} most
successful attempt ever to lose weight?
Yes
28 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.
RTI
Developed
N/A
1 YES
2 NO - GO TO FOOD1_AD
-1 DON‘T KNOW - GO TO FOOD1_AD
-2 REFUSED - GO TO FOOD1_AD
N/A
________[4000 MAX CHARACTERS]
-1 DON‘T KNOW
-2 REFUSED
Page 11 of 22
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
CAPI
Item Text in CAPI
29 FOOD2_ad Have you had anything to drink within the last 30 minutes?
NHIS = National Health Interview Survey
YRBS = Youth Risk Behavior Survey
Data Source
Original Text in Source
Divergence?
RTI
Developed
N/A
N/A
RTI
Developed
N/A
N/A
DG
N/A
N/A
1. Yes
2. No
-1. DON'T KNOW
-2. REFUSED
30 ILL1_ad
Have you had any colds, flus or other illnesses in the last two
weeks?
1. YES
2. NO
-1. DON’T KNOW
-2. REFUSED
31 SAL_INTR The next few questions will help us understand the results of
O_ad
your saliva sample.
32 SAL1_ad
Has a doctor or dentist told you that you had periodontal disease NHANES 2011
(that is, an infection of the soft tissues and bones surrounding
the teeth)?
1 YES
2 NO
-1 DON’T KNOW
-2 REFUSED
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
33 SAL2_ad
Have you brushed your teeth in the last hour?
N/A
N/A
DG
1. YES
2. NO
-1. DON'T KNOW
-2. REFUSED
Page 12 of 22
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
CAPI
Item Text in CAPI
Data Source
Original Text in Source
Divergence?
34 SAL3_ad
The last time you brushed your teeth, did you see any pink or
reddish color when you spit into the sink?
1 YES
2 NO
-1 DON’T KNOW
-2 REFUSED
DG
N/A
N/A
35 SAL4_ad
In the past 24 hours have you had any injuries to your mouth or
any dental work that caused bleeding?
1 YES
2 NO
-1 DON’T KNOW
-2 REFUSED
DG
N/A
N/A
36 SAL5_ad
Do you have any open sores or cuts in your mouth?
DG
N/A
N/A
RTI
Developed
N/A
N/A
44 1
1 YES
2 NO
-1 DON’T KNOW
-2 REFUSED
Height. ADULT HEIGHT
Height Correction: Above waist: __._ (RANGE - 0 - 15 cm)
Below waist: __._ CM (RANGE - 0 - 15 cm)
Standing_Height: MEASURED CM ______.___
Page 13 of 22
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
CAPI
Item Text in CAPI
Data Source
Original Text in Source
Divergence?
45 1a.
THE ADJUSTED HEIGHT IS CALCULATED AS [ADULT HEIGHT] CM.
IS THIS CORRECT?
RTI
Developed
N/A
N/A
RTI
Developed
N/A
N/A
1. YES
2. NO - RETURN TO STANDING HEIGHT AND ENTER THE CORRECT
VALUE
46 2
Adjusted height (calculated by standing height minus height
correction above or below waist)
Comments (drop down box)
EC (Exceeds capacity)
• CNO (Cannot obtain)
• NS (Not straight)
• PLA (Incorrect placement)
• R (refusal)
ADULT WAIST CIRCUMFERENCE
MEASURED CM ______ [ONLY WANT 1 PLACE AFTER DECIMAL]
COMMENTS (DROP DOWN BOX):
CNO (Could not obtain)
CL (Clothing)
R (Refused)
Page 14 of 22
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
CAPI
Item Text in CAPI
Data Source
Original Text in Source
Divergence?
47 3
ADULT WEIGHT
MEASURED KG ______
COMMENTS (DROP DOWN BOX):
RTI
Developed
N/A
N/A
RTI
Developed
N/A
N/A
EC (Exceeds capacity)
CNO (Could not obtain)
CL (Clothing)
MA (Medical appliance)
AM (Amputation)
PLA (Incorrect placement)
R (refusal)
4
CALCULATE BMI
[INSTRUCTIONS TO PROGRAMMER: CALCULATE BEHIND THE
SCENES:
HEIGHT IN INCHES = ADJUSTED HEIGHT X 0.393700787
WAIST CIRCUMFERENCE IN INCHES = WAIST CIRCUMFERENCE X
0.393700787
WEIGHT IN POUNDS = WEIGHT X 2.20462]
HW_RESULTS.
INTERVIEWER: COMPLETE THE BIOMETRICS RESULTS FORM FOR
RESPONDENT AS FOLLOWS –
DATE OF EXAM:
HEIGHT: inches
WEIGHT: lbs
WAIST CIRCUMFERENCE: inches
AFTER YOU COMPLETE THE BLOOD PRESSURE MEASUREMENT,
YOU WILL BE INSTRUCTED TO FILL THAT IN THE BLOOD PRESSURE
SECTION OF THE FORM
Page 15 of 22
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
CAPI
Item Text in CAPI
Data Source
Original Text in Source
Divergence?
37 BP Arm.
ARM USED:
RIGHT
LEFT
RTI
Developed
N/A
N/A
RTI
Developed
N/A
N/A
38 BP_Measu Blood pressure recording screen 1:
re.
Reading 1:
Systolic: ___mg/HG
Diastolic: ___mm/Hg
Pulse___Could not obtain
Reading 2:
Systolic: ___mg/HG
Diastolic: ___mm/Hg
Pulse___Could not obtain
Reading 3:
Systolic: ___mg/HG
Diastolic: ___mm/Hg
Pulse___Could not obtain
Average:
Systolic: ___mg/HG
Diastolic: ___mm/Hg
Pulse___Could not obtain
Page 16 of 22
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
CAPI
Item Text in CAPI
39 BP_Rekey. REKEY THE RESULTS (SCREEN 2):
NHIS = National Health Interview Survey
YRBS = Youth Risk Behavior Survey
Data Source
Original Text in Source
Divergence?
RTI
Developed
N/A
N/A
Reading 1:
Systolic: ___mg/HG
Diastolic: ___mm/Hg
Pulse___Could not obtain
Reading 2:
Systolic: ___mg/HG
Diastolic: ___mm/Hg
Pulse___Could not obtain
Reading 3:
Systolic: ___mg/HG
Diastolic: ___mm/Hg
Pulse___Could not obtain
Average:
Systolic: ___mg/HG
Diastolic: ___mm/Hg
Pulse___Could not obtain
Page 17 of 22
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
CAPI
Item Text in CAPI
NHIS = National Health Interview Survey
YRBS = Youth Risk Behavior Survey
Data Source
40 BP_Result. INTERVIEWER: RECORD RESULTS ON BIOMETRICS RESULTS
RTI
FORM AS FOLLOWS:
Developed
SYSTOLIC BLOOD PRESSURE:
DIASTOLIC BLOOD PRESSURE:
YOUR BLOOD PRESSURE IS:
IF LIST AVERAGE SYSTOLIC = 0 AND LIST DIASTOLIC = 0, LEAVE
BLANK.
IF LIST AVERAGE SYSTOLIC < 120 (BUT >0) OR LIST DIASTOLIC <
80 (BUT > 0), “Normal” [VALUE OF 1]
IF LIST AVERAGE SYSTOLIC = 120-139 OR LIST DIASTOLIC = 80-89,
“Pre-Hypertensive” [VALUE OF 2]
IF LIST AVERAGE SYSTOLIC = 140-159 OR LIST AVERAGE
DIASTOLIC = 90-99, “Elevated (Stage 1 hypertension)” [VALUE OF
3]
IF LIST AVERAGE SYSTOLIC = 160-179 OR LIST AVERAGE
DIASTOLIC = 100-109, “Elevated (Stage 2 hypertension)” [VALUE
OF 4]
IF LIST AVERAGE SYSTOLIC = 180 – 209 OR LIST AVERAGE
DIASTOLIC = 110 – 119, “High (Stage 2 hypertension)” [VALUE OF
5]
IF LIST AVERAGE SYSTOLIC GREATER THAN OR EQUAL TO 210 OR
LIST AVERAGE DIASTOLIC GREATER THAN OR EQUAL TO 120,
“Very High” [VALUE OF 6]
SKIP TO HIGH BREAKOFF_ad
[NOTE TO PROGRAMMER – IF LIST AVERAGE SYSTOLIC FALLS IN
ONE CATEGORY AND LIST AVERAGE DIASTOLIC FALLS IN A
DIFFERENT CATEGORY, SELECT THE CATEGORY WITH THE
HIGHEST VALUE OF THE TWO.]
Original Text in Source
Divergence?
N/A
N/A
Page 18 of 22
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
CAPI
Item Text in CAPI
NHIS = National Health Interview Survey
YRBS = Youth Risk Behavior Survey
Data Source
Original Text in Source
Divergence?
N/A
N/A
RTI
Developed
N/A
N/A
43 MEDS1_ad Now I'd like to talk about medications. What medications are you RTI
currently taking? (Prescription medications) It would be really
Developed
helpful if you could show me the actual medication so I can
record the exact name.
ALLOW TIME FOR R TO GO GET MEDICATION.
KEY MEDICATION NAME FROM PRESCRIPTION LABEL. IF YOU
CANNOT FIND THE NAME OF THE MEDICATION ON THIS LIST,
ENTER IT AS OTHER AND TYPE THE NAME.
N/A
N/A
41 HIGH
Your blood pressure is dangerously high. We suggest you see
RTI
BREAKOFF your doctor today or go to a hospital emergency room to have
Developed
_ad
your blood pressure rechecked. Would you like for me to call 911
for you?
2 YES - DIAL TELEPHONE NUMBER AND HAND THE PHONE TO
RESPONDENT SO THAT HE/SHE MAY TALK TO 911 OPERATOR.
[SKIP TO END]
3 NO
42 HIGH_FOL Is there a friend or relative whom I can call for you?
LOW_ad
1 YES - DIAL TELEPHONE NUMBER AND HAND THE PHONE TO
RESPONDENT SO THAT HE/SHE MAY SPEAK TO THE PERSON.
2 NO
ARE THERE ANY MEDICATIONS TO ENTER?
YES - FI MUST GO TO MEDICATION TABLE
NO - SKIP TO SALIVA COLLECTION
Page 19 of 22
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
CAPI
Item Text in CAPI
Data Source
Original Text in Source
Divergence?
48 5
Now I'd like to collect some saliva from you.
RTI
Developed
N/A
N/A
49 6
SALIVA SAMPLE COLLECTED
YES/NO ______
REFUSED…………………………………………. – 2
UNABLE TO OBTAIN…………………………….. – 5
RTI
Developed
N/A
N/A
50 7
SALIVA SAMPLE #
RTI
Developed
N/A
N/A
RTI
Developed
N/A
N/A
RTI
Developed
N/A
N/A
RTI
Developed
N/A
N/A
DOES R AGREE TO PARTICIPATE (NOTE - BOTH ADULT AND CHILD RTI
MUST AGREE IN ORDER TO ANSWER THE QUESTION AS YES; IF
Developed
ONLY ONE AGREES, CODE NO AND EXPLAIN)
N/A
N/A
ID________
ID________
51 ADULT_ad IS THIS AN ADULT ONLY HOUSEHOLD?
52
YES - SKIP TO END
ADULT ACCELEROMETRY STUDY YES/NO
53 7a.
IS R ELIGIBLE FOR ACCELEROMETER?
ACCELERO
METER
YES
NO - SKIP TO END
54
1 YES
2 NO - REASON WHY NOT: ____________ - SKIP TO END
Page 20 of 22
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
CAPI
Item Text in CAPI
NHIS = National Health Interview Survey
YRBS = Youth Risk Behavior Survey
Data Source
Original Text in Source
Page 21 of 22
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
# Item
Name in
CAPI
Item Text in CAPI
NHIS = National Health Interview Survey
YRBS = Youth Risk Behavior Survey
Data Source
Original Text in Source
Divergence?
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
Page 22 of 22
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| File Modified | 2013-07-18 |
| File Created | 2013-07-18 |