Source/history of questions included on the 2017 BRFSS Field Test Questionnaire of Proposed Changes in the 2018 BRFSS

Attachment 13d: Source/history of questions included on the 2017 BRFSS Field Test Questionnaire of Proposed Changes in the 2018 BRFSS

Module/ Section Name	Question(s)	Comments on inclusion and prior use
Core Section 1: Health Status	Would you say that in general your health is—	General introductory question. No change from previous. Included for the flow of communication with respondent.
Core Section 2: Health Days	Now thinking about your physical health, which includes physical illness and injury, for how many days during the past 30 days was your physical health not good? Now thinking about your mental health, which includes stress, depression, and problems with emotions, for how many days during the past 30 days was your mental health not good? During the past 30 days, for about how many days did poor physical or mental health keep you from doing your usual activities, such as self-care, work, or recreation?	General introductory question section. No change from previous approval. Included for the flow of communication with respondent.
Core Section 3: Demographics	General demographics	Changes in respondent sex question to allow for differences between sex at birth and current sex. SOGI module inserted for field test to ascertain whether changes in respondent sex will impact responses to SOGI questions. Addition of question on food stamps to be included as option in 2018 questionnaire.

Module/ Section Name	Question(s)	Comments on inclusion and prior use
Module Section 4: Depression/ Anxiety	4.1 Over the last 2 weeks, how often have you been bothered by having little interest or pleasure in doing things. Would you say this happens... Read: 1 never, 2 for several days, 3 for more than half the days or 4 nearly every day. Do not read: 7 Don’t know/ Not sure 9 Refused 4.2 Over the last 2 weeks, how often have you been bothered by feeling down, depressed or hopeless? Would you say this happens… Read: 1 never, 2 for several days, 3 for more than half the days or 4 nearly every day. Do not read: 7 Don’t know/ Not sure 9 Refused 4.3 Over the last 2 weeks, how often have you been bothered by feeling nervous, anxious or on edge? Would you say this happens… Read: 1 never, 2 for several days, 3 for more than half the days or 4 nearly every day. Do not read: 7 Don’t know/ Not sure 9 Refused 4.4 Over the last 2 weeks, how often have you been bothered by not being able to stop or control worrying? Would you say this happens… Read: 1 never, 2 for several days, 3 for more than half the days or 4 nearly every day. Do not read: 7 Don’t know/ Not sure 9 Refused	These questions have been used in modified versions in the BRFSS, NSDUH and many other surveys. Generally the Anxiety and Depression module is 8 questions, but this modified version is being tested to ascertain whether a shorter, less burdensome version is feasible.
Section 5: Indoor Tanning and Excess Sun Exposure	5.1 Not including spray-on tans, during the past 12 months, how many times have you used an indoor tanning device such as a sunlamp, tanning bed, or booth even one time? Do Not Read: Enter number (0-365) __ __ __ 777 Don’t know/ Not sure 999 Refused 5.2    During the past 12 months, how many times have you had a sunburn? Do not read: Enter number (0-365) __ __ __ 777 Don’t know/ Not sure 999 Refused 5.3    When you go outside on a warm sunny day for more than one hour, how often do you try to protect yourself from the sun (for example, using sunscreen, wearing a wide-brimmed hat, or wearing a long-sleeved shirt)? Is that…. Read 1 Always 2 Most of the time 3 Sometimes 4 Rarely 5 Never Do not Read 6 Don’t go out in the sun 7 Don’t know/ Not sure 9 Refused 5.4    In the summer, on average, how long are you outside per day between 10am and 4pm on weekdays? Do not read: 1 Less than half an hour 2 (more than half an hour) up to 1 hour 3 (more than 1 hour) up to 2 hours 4 (more than 2 hours) up to 3 hours 5 (more than 3 hours) up to 4 hours 6 (more than 4 hours) up to 5 hours 7 Up to 6 hours 77 Don’t know/ Not sure 99 Refused 5.5    In the summer, on average, how long are you outside per day between 10am and 4pm on weekends? Do not read: 1 Less than half an hour 2 (more than half an hour) up to 1 hour 3 (more than 1 hour) up to 2 hours 4 (more than 2 hours) up to 3 hours 5 (more than 3 hours) up to 4 hours 6 (more than 4 hours) up to 5 hours 7 Up to 6 hours 77 Don’t know/ Not sure 99 Refused	The question on indoor tanning is new and not offered on other surveys. It has been cognitively tested and will be offered to the states as a single optional module (Indoor Tanning). The 4 questions on sun exposure are taken from the National Health Interview Survey with minor changes to account for the mode of data collection.
Section 6: Colorectal Cancer Screening (2 options randomized)	Option 1 6.1.1 A blood stool test is a test that may use a special kit at home to determine whether the stool contains blood. Have you ever had this test using a home kit? Do not read: 1 Yes 2 No [Go to Q3] 7 Don't know / Not sure [Go to Q3] 9 Refused [Go to Q3] 6.1.2 How long has it been since you had your last blood stool test using a home kit? Do not read: 1 Within the past year (anytime less than 12 months ago) 2 Within the past 2 years (1 year but less than 2 years ago) 3 Within the past 3 years (2 years but less than 3 years ago) 4 Within the past 5 years (3 years but less than 5 years ago) 5 5 or more years ago 7 Don't know / Not sure 9 Refused 6.1.3. A sigmoidoscopy uses a flexible tube that is inserted in the rectum to look for problems. Have you ever had a sigmoidoscopy? Do not read: 1 Yes 2 No [Go to Q5] 7 Don’t know / Not sure [Go to Q5] 9 Refused [Go to Q5] 6.1.4 How long has it been since you had your last sigmoidoscopy? Do not read: 1 Within the past year (anytime less than 12 months ago) 2 Within the past 2 years (1 year but less than 2 years ago) 3 Within the past 3 years (2 years but less than 3 years ago) 4 Within the past 5 years (3 years but less than 5 years ago) 5 Within the past 10 years (5 years but less than 10 years ago) 6 10 or more years ago 7 Don't know / Not sure 9 Refused 6.1.5 A colonoscopy uses a flexible tube that is longer than a sigmoidoscopy. For this test, you are usually given medication through a needle in your arm to make you sleepy and told to have someone else drive you home after the test. Have you ever had a colonoscopy? Do not read: 1 Yes 2 No [Go to Q7] 7 Don’t know / Not sure [Go to Q7] 9 Refused [Go to Q7] 6.1 6 How long has it been since you had your last colonoscopy? Do not read: 1 Within the past year (anytime less than 12 months ago) 2 Within the past 2 years (1 year but less than 2 years ago) 3 Within the past 3 years (2 years but less than 3 years ago) 4 Within the past 5 years (3 years but less than 5 years ago) 5 Within the past 10 years (5 years but less than 10 years ago) 6 10 or more years ago 7 Don't know / Not sure 9 Refused 6.1.7 There are several new colorectal cancer screening tests. One is the multi-targeted stool DNA test. It is similar to the blood stool test and looks for blood in the stool. It also looks at changes in DNA, which may be a sign of cancer. Have you ever had a multi-targeted stool DNA test? Do not read: 1 Yes 2 No [Go to Q9] 7 Don’t know / Not sure [Go to Q9] 9 Refused [Go to Q9] 6.1.8. How long has it been since you had your last multi-targeted stool DNA test? Do not read: 1 Within the past year (anytime less than 12 months ago) 2 Within the past 2 years (1 year but less than 2 years ago) 3 Within the past 3 years (2 years but less than 3 years ago) 4 Within the past 5 years (3 years but less than 5 years ago) 5 Within the past 10 years (5 years but less than 10 years ago) 6 10 or more years ago 7 Don't know / Not sure 9 Refused 6.1.9. The other new test is a CT colonography and uses a series of X-rays to take pictures of the inside of the colon. Have you ever had a CT colonography? Do not read: 1 Yes 2 No [End module] 7 Don’t know / Not sure [End module] 9 Refused [End module] 6.1.10 How long has it been since you had your last CT colonography? Do not read: 1 Within the past year (anytime less than 12 months ago) 2 Within the past 2 years (1 year but less than 2 years ago) 3 Within the past 3 years (2 years but less than 3 years ago) 4 Within the past 5 years (3 years but less than 5 years ago) 5 Within the past 10 years (5 years but less than 10 years ago) 6 10 or more years ago 7 Don't know / Not sure 9 Refused Option 2: 6.2.1. There are several kinds of tests for colorectal cancer including a stool test, a flexible sigmoidoscopy, a colonoscopy, and a virtual colonoscopy. Stool tests include using a special kit at home to determine whether the stool contains blood. A flexible sigmoidoscopy and colonoscopy view the inside of the rectum and colon for signs of cancer or other health problems. The colonoscopy includes getting medication through a needle in your arm to make you sleepy and you were told to have someone else drive you home after the test. The virtual colonoscopy uses x-rays so that a doctor can see images of the colon on a computer screen. Have you ever had a test for colorectal cancer screening? Do not read: 1 Yes 2 No [Go to next module] 7 Don't know / Not sure [Go to next module] 9 Refused [Go to next module] 6.2.2. How long has it been since you had your last test for colorectal cancer screening? Do not read: 1 Within the past year (anytime less than 12 months ago) 2 Within the past 2 years (1 year but less than 2 years ago) 3 Within the past 3 years (2 years but less than 3 years ago) 4 Within the past 5 years (3 years but less than 5 years ago) 5 5 or more years ago 7 Don't know / Not sure [Go to next module] 9 Refused [Go to next module] 6.2.3. Was that colorectal cancer screening test a: Read: 1 Blood stool test (FIT, gFOBT) [go to Q4] 2 Blood stool test that tested for DNA (multi-targeted stool DNA test; FIT-DNA test) [go to next module] 3 Flexible sigmoidoscopy [go to Q6] 4 Colonoscopy [Go to next module] 5 Virtual colonoscopy [Go to next module] Do not read: 7 Don't know / Not sure [Go to next module] 9 Refused [Go to next module] 6.2.4. A sigmoidoscopy uses a flexible tube that is inserted in the rectum to look for problems. Did you also have a flexible sigmoidoscopy with the blood stool test? Do not read: 1 Yes 2 No [Go to next module] 7 Don't know / Not sure [Go to next module] 9 Refused [Go to next module] 6.2.5. How long has it been since you had your last sigmoidoscopy? Do not read: 1 Within the past year (anytime less than 12 months ago) 2 Within the past 2 years (1 year but less than 2 years ago) 3 Within the past 3 years (2 years but less than 3 years ago) 4 Within the past 5 years (3 years but less than 5 years ago) 5 5 or more years ago 7 Don't know / Not sure [Go to next module] 9 Refused [Go to next module] 6.2.6. Did you also have a blood stool test with the flexible sigmoidoscopy? A blood stool test is a test that may use a special kit at home to determine whether the stool contains blood. Do not read: 1 Yes 2 No [Go to next module] 7 Don't know / Not sure [Go to next module] 9 Refused [Go to next module] 6.2.7. How long has it been since you had your last blood stool test? Do not read: 1 Within the past year (anytime less than 12 months ago) 2 Within the past 2 years (1 year but less than 2 years ago) 3 Within the past 3 years (2 years but less than 3 years ago) 4 Within the past 5 years (3 years but less than 5 years ago) 5 5 or more years ago 7 Don't know / Not sure [Go to next module] 9 Refused [Go to next module]	The recommendations for colorectal cancer screening have been changed to allow for new forms of testing. This change in screening mandates changes in the current questions to ensure that the prevalence estimate of persons complying with the recommendations is accurate. The BRFSS will modify the core sections to include DNA, home kits and CT colonographies. Two options of question format will be tested to determine the burden on respondents that the options pose (in terms of time to administer and ease of understanding).