0920-1061 2021BRFSS Att 3 Core Questionnaire Sections by Year

Behavioral Risk Factor Surveillance System (BRFSS)

2021BRFSS Att 3 Core Questionnaire Sections by Year

OMB: 0920-1061

Document [docx]
Download: docx | pdf


Attachment 3: BRFSS Core Questionnaire Sections by Topic and Year of Administration










Annual Core Questions



Core Section 1: Health Status



Question Number

Question text

Variable names

Responses

(DO NOT READ UNLESS OTHERWISE NOTED)

SKIP INFO/ CATI Note

Interviewer Note (s)

Column(s)

CHS.01


Would you say that in general your health is—

GENHLTH

Read:

1 Excellent

2 Very Good

3 Good

4 Fair

5 Poor

Do not read:

7 Don’t know/Not sure

9 Refused








Core Section 2: Healthy Days



Question Number

Question text

Variable names

Responses

(DO NOT READ UNLESS OTHERWISE NOTED)

SKIP INFO/ CATI Note

Interviewer Note (s)

Column(s)

CHD.01


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?

PHYSHLTH

_ _ Number of days (01-30)

88 None

77 Don’t know/not sure

99 Refused


88 may be coded if respondent says “never” or “none” It is not necessary to ask respondents to provide a number if they indicate that this never occurs.


CHD.02

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?

MENTHLTH

_ _ Number of days (01-30)

88 None

77 Don’t know/not sure

99 Refused


88 may be coded if respondent says “never” or “none” It is not necessary to ask respondents to provide a number if they indicate that this never occurs.






Skip CHD.03 if CHD.01, PHYSHLTH, is 88 and CHD.02, MENTHLTH, is 88



CHD.03

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?

POORHLTH

_ _ Number of days (01-30)

88 None

77 Don’t know/not sure

99 Refused


88 may be coded if respondent says “never” or “none” It is not necessary to ask respondents to provide a number if they indicate that this never occurs.






Core Section 3: Health Care Access



Question Number

Question text

Variable names

Responses

(DO NOT READ UNLESS OTHERWISE NOTED)

SKIP INFO/ CATI Note

Interviewer Note (s)

Column(s)

CHCA.01


What is the current primary source of your health insurance?

***NEW***


Read if necessary:


01 A plan purchased through an employer or union (including plans purchased through another person's employer)

02 A private nongovernmental plan that you or another family member buys on your own

03 Medicare

04 Medigap

05 Medicaid

06 Children's Health Insurance Program (CHIP)

07 Military related health care: TRICARE (CHAMPUS) / VA health care / CHAMP- VA

08 Indian Health Service

09 State sponsored health plan

10 Other government program

88 No coverage of any type


77 Don’t Know/Not Sure 99 Refused



If respondent has multiple sources of insurance, ask for the one used most often.

If respondents give the name of a health plan rather than the type of coverage

ask whether this is insurance purchased independently, through their employer, or whether it is through Medicaid or CHIP.



CHCA.02

Do you have one person or a group of doctors that you think of as your personal health care provider?

***NEW***


1 Yes, only one

2 More than one

3 No

7 Don’t know / Not sure

9 Refused


If no, read: Is there more than one, or is there no person who you think of as your personal doctor or health care provider?


CHCA.03

Was there a time in the past 12 months when you needed to see a doctor but could not because you could not afford it?

***NEW***


1 Yes

2 No

7 Don’t know / Not sure

9 Refused




CHCA.04

About how long has it been since you last visited a doctor for a routine checkup?

CHECKUP1

Read if necessary:

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 5 years (2 years but less than 5 years ago)

4 5 or more years ago

Do not read:

7 Don’t know / Not sure

8 Never

9 Refused


Read if necessary: A routine checkup is a general physical exam, not an exam for a specific injury, illness, or condition.






Core Section 4: Exercise



Question Number

Question text

Variable names

Responses

(DO NOT READ UNLESS OTHERWISE NOTED)

SKIP INFO/ CATI Note

Interviewer Note (s)

Column(s)

CEX.01


During the past month, other than your regular job, did you participate in any physical activities or exercises such as running, calisthenics, golf, gardening, or walking for exercise?

EXERANY2

1 Yes

2 No

7 Don’t know / Not sure

9 Refused


Do not read: If respondent does not have a regular job or is retired, they may count any physical activity or exercise they do








Core Section 7: Chronic Health Conditions



Question Number

Question text

Variable names

Responses

(DO NOT READ UNLESS OTHERWISE NOTED)

SKIP INFO/ CATI Note

Interviewer Note (s)

Column(s)

Prologue

Has a doctor, nurse, or other health professional ever told you that you had any of the following? For each, tell me Yes, No, Or You’re Not Sure.






CCHC.01


Ever told you that you had a heart attack also called a myocardial infarction?

CVDINFR4


1 Yes

2 No

7 Don’t know / Not sure

9 Refused




CCHC.02

(Ever told) (you had) angina or coronary heart disease?

CVDCRHD4


1 Yes

2 No

7 Don’t know / Not sure

9 Refused




CCHC.03

(Ever told) (you had) a stroke?

CVDSTRK3


1 Yes

2 No

7 Don’t know / Not sure

9 Refused




CCHC.04

(Ever told) (you had) asthma?

ASTHMA3

1 Yes




2 No

7 Don’t know / Not sure

9 Refused

Go to CCHC.06


CCHC.05

Do you still have asthma?

ASTHNOW

1 Yes

2 No

7 Don’t know / Not sure

9 Refused




CCHC.06

(Ever told) (you had) skin cancer?

CHCSCNCR


1 Yes

2 No

7 Don’t know / Not sure

9 Refused




CCHC.07

(Ever told) (you had) any other types of cancer?

CHCOCNCR


1 Yes

2 No

7 Don’t know / Not sure

9 Refused




CCHC.08

(Ever told) (you had) C.O.P.D. (chronic obstructive pulmonary disease), emphysema or chronic bronchitis?

CHCCOPD3


1 Yes

2 No

7 Don’t know / Not sure

9 Refused




CCHC.09

(Ever told) (you had) a depressive disorder (including depression, major depression, dysthymia, or minor depression)?

ADDEPEV3


1 Yes

2 No

7 Don’t know / Not sure

9 Refused




CCHC.10

Not including kidney stones, bladder infection or incontinence, were you ever told you had kidney disease?

CHCKDNY2


1 Yes

2 No

7 Don’t know / Not sure

9 Refused


Read if necessary: Incontinence is not being able to control urine flow.


CCHC.11

(Ever told) (you had) diabetes?

DIABETE4


1 Yes



If yes and respondent is female, ask: was this only when you were pregnant? If respondent says pre-diabetes or borderline diabetes, use response code 4.


2 Yes, but female told only during pregnancy

3 No

4 No, pre-diabetes or borderline diabetes

7 Don’t know / Not sure

9 Refused

Go to Pre-Diabetes Optional Module (if used). Otherwise, go to next section.


CCHC.12

How old were you when you were told you had diabetes?

DIABAGE3

_ _ Code age in years [97 = 97 and older]

98 Don‘t know / Not sure

99 Refused

Go to Diabetes Module if used, otherwise go to next section.



CCHC.13

Has a doctor, nurse or other health professional ever told you that you had some form of arthritis, rheumatoid arthritis, gout, lupus, or fibromyalgia?

HAVARTH5


1 Yes

2 No

7 Don’t know / Not sure

9 Refused








Core Section 8: Demographics



Question Number

Question text

Variable names

Responses

(DO NOT READ UNLESS OTHERWISE NOTED)

SKIP INFO/ CATI Note

Interviewer Note (s)

Column(s)

CDEM.01

What is your age?

AGE


_ _ Code age in years

07 Don’t know / Not sure

09 Refused




CDEM.02

Are you Hispanic, Latino/a, or Spanish origin?

HISPANC3


If yes, read: Are you…

1 Mexican, Mexican American, Chicano/a

2 Puerto Rican

3 Cuban

4 Another Hispanic, Latino/a, or Spanish origin

Do not read:

5 No

7 Don’t know / Not sure

9 Refused


One or more categories may be selected.


CDEM.03

Which one or more of the following would you say is your race?

MRACE1


Please read:

10 White

20 Black or African American

30 American Indian or Alaska Native

40 Asian

41 Asian Indian

42 Chinese

43 Filipino

44 Japanese

45 Korean

46 Vietnamese

47 Other Asian

50 Pacific Islander

51 Native Hawaiian

52 Guamanian or Chamorro

53 Samoan

54 Other Pacific Islander

Do not read:

60 Other

88 No additional choices

77 Don’t know / Not sure

99 Refused

.

If 40 (Asian) or 50 (Pacific Islander) is selected read and code subcategories underneath major heading.

One or more categories may be selected.






If more than one response to CDEM.03; continue. Otherwise, go to CDEM.05



CDEM.04

Which one of these groups would you say best represents your race?

ORACE3


Please read:

10 White

20 Black or African American

30 American Indian or Alaska Native

40 Asian

41 Asian Indian

42 Chinese

43 Filipino

44 Japanese

45 Korean

46 Vietnamese

47 Other Asian

50 Pacific Islander

51 Native Hawaiian

52 Guamanian or Chamorro

53 Samoan

54 Other Pacific Islander

Do not read:

60 Other

77 Don’t know / Not sure

99 Refused


If 40 (Asian) or 50 (Pacific Islander) is selected read and code subcategories underneath major heading.


If respondent has selected multiple races in previous and refuses to select a single race, code refused







If using Sex at Birth Module, insert here

If using SOGI module, insert here.



CDEM.05

Are you…

MARITAL


Please read:

1 Married

2 Divorced

3 Widowed

4 Separated

5 Never married

Or

6 A member of an unmarried couple

Do not read:

9 Refused




CDEM.06

What is the highest grade or year of school you completed?

EDUCA


Read if necessary:

1 Never attended school or only attended kindergarten

2 Grades 1 through 8 (Elementary)

3 Grades 9 through 11 (Some high school)

4 Grade 12 or GED (High school graduate)

5 College 1 year to 3 years (Some college or technical school)

6 College 4 years or more (College graduate)

Do not read:

9 Refused




CDEM.07

Do you own or rent your home?

RENTHOM1


1 Own

2 Rent

3 Other arrangement

7 Don’t know / Not sure

9 Refused


Other arrangement may include group home, staying with friends or family without paying rent. Home is defined as the place where you live most of the time/the majority of the year.

Read if necessary: We ask this question in order to compare health indicators among people with different housing situations.


CDEM.08

In what county do you currently live?

CTYCODE2


_ _ _ANSI County Code

777 Don’t know / Not sure

999 Refused

888 County from another state




CDEM.09

What is the ZIP Code where you currently live?

ZIPCODE1


_ _ _ _ _

77777 Do not know

99999 Refused








If cell interview go to CDEM12




CDEM.10

Not including cell phones or numbers used for computers, fax machines or security systems, do you have more than one telephone number in your household?

NUMHHOL3


1 Yes





2 No

7 Don’t know / Not sure

9 Refused

Go to CDEM.12


CDEM.11

How many of these telephone numbers are residential numbers?

NUMPHON3


__ Enter number (1-5)

6 Six or more

7 Don’t know / Not sure

8 None

9 Refused




CDEM.12

How many cell phones do you have for personal use?

CPDEMO1B


__ Enter number (1-5)

6 Six or more

7 Don’t know / Not sure

8 None

9 Refused

Last question needed for partial complete.

Read if necessary: Include cell phones used for both business and personal use.


CDEM.13

Have you ever served on active duty in the United States Armed Forces, either in the regular military or in a National Guard or military reserve unit?

VETERAN3


1 Yes

2 No

7 Don’t know / Not sure

9 Refused


Read if necessary: Active duty does not include training for the Reserves or National Guard, but DOES include activation, for example, for the Persian Gulf War.


CDEM.14

Are you currently…?

EMPLOY1


Read:

1 Employed for wages

2 Self-employed

3 Out of work for 1 year or more

4 Out of work for less than 1 year

5 A Homemaker

6 A Student

7 Retired

Or

8 Unable to work

Do not read:

9 Refused


If more than one, say “select the category which best describes you”.


CDEM.15

How many children less than 18 years of age live in your household?

CHILDREN


_ _ Number of children

88 None

99 Refused




CDEM.16

Is your annual household income from all sources—

***NEW***


Read if necessary:

01 Less than $10,000?

02 Less than $15,000? ($10,000 to less than $15,000)

03 Less than $20,000? ($15,000 to less than $20,000)

04 Less than $25,000

05 Less than $35,000 If

($25,000 to less than $35,000)

06 Less than $50,000 If

($35,000 to less than $50,000)

07 Less than $75,000? ($50,000 to less than $75,000)

08 Less than $100,000? ($75,000 to less than $100,000)

09 Less than $150,000? ($100,000 to less than $150,000)?

10 Less than $200,000? ($150,000 to less than $200,000)

11 $200,000 or more


Do not read:

77 Don’t know / Not sure

99 Refused

SEE CATI information of order of coding;


Start with category 05 and move up or down categories.

If respondent refuses at ANY income level, code ‘99’ (Refused)







Skip if Male (MSAB.01, BIRTHSEX, is coded 1). If MSAB.01=missing and (CP05=1 or LL12=1; or LL09 = 1 or LL07 =1).

or YEARBORN < 1972 (Age >49)



CDEM.17

To your knowledge, are you now pregnant?

PREGNANT


1 Yes

2 No

7 Don’t know / Not sure

9 Refused




CDEM.18

About how much do you weigh without shoes?

WEIGHT2


_ _ _ _ Weight (pounds/kilograms)

7777 Don’t know / Not sure

9999 Refused


If respondent answers in metrics, put 9 in first column. Round fractions up


CDEM.19

About how tall are you without shoes?

HEIGHT3


_ _ / _ _ Height (ft / inches/meters/centimeters)

77/ 77 Don’t know / Not sure

99/ 99 Refused


If respondent answers in metrics, put 9 in first column. Round fractions down




Core Section 10: Disability


Question Number

Question text

Variable names

Responses

(DO NOT READ UNLESS OTHERWISE NOTED)

SKIP INFO/ CATI Note

Interviewer Note (s)

Column(s)

CDIS.01

Some people who are deaf or have serious difficulty hearing use assistive devices to communicate by phone. Are you deaf or do you have serious difficulty hearing?

DEAF


1 Yes

2 No

7 Don’t know / Not sure

9 Refused




CDIS.02

Are you blind or do you have serious difficulty seeing, even when wearing glasses?

BLIND


1 Yes

2 No

7 Don’t know / Not sure

9 Refused




CDIS.03

Because of a physical, mental, or emotional condition, do you have serious difficulty concentrating, remembering, or making decisions?

DECIDE


1 Yes

2 No

7 Don’t know / Not sure

9 Refused




CDIS.04

Do you have serious difficulty walking or climbing stairs?

DIFFWALK

1 Yes

2 No

7 Don’t know / Not sure

9 Refused




CDIS.05

Do you have difficulty dressing or bathing?

DIFFDRES

1 Yes

2 No

7 Don’t know / Not sure

9 Refused




CDIS.06

Because of a physical, mental, or emotional condition, do you have difficulty doing errands alone such as visiting a doctor’s office or shopping?

DIFFALON

1 Yes

2 No

7 Don’t know / Not sure

9 Refused







Core Section 11: Tobacco Use



Question Number

Question text

Variable names

Responses

(DO NOT READ UNLESS OTHERWISE NOTED)

SKIP INFO/ CATI Note

Interviewer Note (s)

Column(s)

CTOB.01


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

SMOKE100


1 Yes


Do not include: electronic cigarettes (e-cigarettes, njoy, bluetip, JUUL), herbal cigarettes, cigars, cigarillos, little cigars, pipes, bidis, kreteks, water pipes (hookahs) or marijuana.

5 packs = 100 cigarettes.


2 No

7 Don’t know/Not Sure

9 Refused

Go to CTOB.03


CTOB.02

Do you now smoke cigarettes every day, some days, or not at all?

SMOKDAY2


1 Every day

2 Some days

3 Not at all

7 Don’t know / Not sure

9 Refused




CTOB.03

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

USENOW3

1 Every day

2 Some days

3 Not at all

7 Don’t know / Not sure

9 Refused


Read if necessary: Snus (Swedish for snuff) is a moist smokeless tobacco, usually sold in small pouches that are placed under the lip against the gum.


CTOB.04

Do you now use e-cigarettes or other electronic vaping products every day, some days or not at all?

***NEW***

1 Every day

2 Some days

3 Not at all

4 Never used e-cigs

7 Don’t know / Not sure

9 Refused


Electronic cigarettes (e-cigarettes) and other electronic vaping products include electronic hookahs (e-hookahs), vape pens, e-cigars, and others. These products are battery-powered and usually contain nicotine and flavors such as fruit, mint, or candy. Brands you may have heard of are JUUL, NJOY, or blu.

Interviewer note: These questions concern electronic vaping products for nicotine use. The use of electronic vaping products for marijuana use is not included in these questions.





Core Section 12: Alcohol Consumption


Question Number

Question text

Variable names

Responses

(DO NOT READ UNLESS OTHERWISE NOTED)

SKIP INFO/ CATI Note

Interviewer Note (s)

Column(s)

CALC.01


During the past 30 days, how many days per week or per month did you have at least one drink of any alcoholic beverage such as beer, wine, a malt beverage or liquor?

ALCDAY5


1 _ _ Days per week

2 _ _ Days in past 30 days


Read if necessary: A 40-ounce beer would count as 3 drinks, or a cocktail drink with 2 shots would count as 2 drinks.


888 No drinks in past 30 days

777 Don’t know / Not sure

999 Refused

Go to next section

CALC.02

One drink is equivalent to a 12-ounce beer, a 5-ounce glass of wine, or a drink with one shot of liquor. During the past 30 days, on the days when you drank, about how many drinks did you drink on the average?

AVEDRNK3


_ _ Number of drinks

88 None

77 Don’t know / Not sure

99 Refused


Read if necessary: A 40-ounce beer would count as 3 drinks, or a cocktail drink with 2 shots would count as 2 drinks.


CALC.03

Considering all types of alcoholic beverages, how many times during the past 30 days did you have X [CATI X = 5 for men, X = 4 for women] or more drinks on an occasion?

DRNK3GE5


_ _ Number of times

77 Don’t know / Not sure

88 no days

99 Refused

CATI X = 5 for men, X = 4 for women (states may use sex at birth to determine sex if module is adopted)



CALC.04

During the past 30 days, what is the largest number of drinks you had on any occasion?

MAXDRNKS

_ _ Number of drinks

77 Don’t know / Not sure

99 Refused






Core Section 13: Immunization


Question Number

Question text

Variable names

Responses

(DO NOT READ UNLESS OTHERWISE NOTED)

SKIP INFO/ CATI Note

Interviewer Note (s)

Column(s)

CIMM.01


During the past 12 months, have you had either a flu vaccine that was sprayed in your nose or a flu shot injected into your arm?

FLUSHOT7

1 Yes


Read if necessary: A new flu shot came out in 2011 that injects vaccine into the skin with a very small needle. It is called Fluzone Intradermal vaccine. This is also considered a flu shot.


2 No

7 Don’t know / Not sure

9 Refused

Go to CIMM.04

CIMM.02

During what month and year did you receive your most recent flu vaccine that was sprayed in your nose or flu shot injected into your arm?

FLSHTMY3

_ _ / _ _ _ _ Month / Year

77 / 7777 Don’t know / Not sure

09 / 9999 Refused




CIMM.03

Have you ever had a pneumonia shot also known as a pneumococcal vaccine?

PNEUVAC4

1 Yes

2 No

7 Don’t know / Not sure

9 Refused


Read if necessary: There are two types of pneumonia shots: polysaccharide, also known as Pneumovax, and conjugate, also known as Prevnar.











Core Section 14: H.I.V./AIDS


Question Number

Question text

Variable names

Responses

(DO NOT READ UNLESS OTHERWISE NOTED)

SKIP INFO/ CATI Note

Interviewer Note (s)

Column(s)

CHIV.01


Including fluid testing from your mouth, but not including tests you may have had for blood donation, have you ever been tested for H.I.V?

HIVTST7


1 Yes


Please remember that your answers are strictly confidential and that you don’t have to answer every question if you do not want to. Although we will ask you about testing, we will not ask you about the results of any test you may have had.



2 No

7 Don’t know/ not sure

9 Refused

Go to Next section

CHIV.02

Not including blood donations, in what month and year was your last H.I.V. test?

HIVTSTD3


_ _ /_ _ _ _ Code month and year

77/ 7777 Don’t know / Not sure 99/ 9999 Refused

If response is before January 1985, code "777777".

INTERVIEWER NOTE: If the respondent remembers the year but cannot remember the month, code the first two digits 77 and the last four digits for the year.




Rotating Core Sections By Year


Rotating Core Section 1: Place of Flu Vaccination (2024)


Question Number


Question text

Variable names

Responses

(DO NOT READ UNLESS OTHERWISE NOTED)

SKIP INFO/ CATI Note

Interviewer Note (s)

Column(s)






Ask if CIMM= 1

This question may be inserted in core after CIMM.02



MFP.01


At what kind of place did you get your last flu shot or vaccine?

IMFVPLA1


Read if necessary:

01 A doctor’s office or health maintenance organization (HMO)

02 A health department

03 Another type of clinic or health center (a community health center)

04 A senior, recreation, or community center

05 A store (supermarket, drug store)

06 A hospital (inpatient or outpatient)

07 An emergency room

08 Workplace

09 Some other kind of place

11 A school

Do not read:

10 Received vaccination in Canada/Mexico

77 Don’t know / Not sure

99 Refused

Read if necessary: How would you describe the place where you went to get your most recent flu vaccine?

348-349


Rotating Core Section 2: Hypertension Awareness (2023)


Question Number

Question text

Variable names

Responses

(DO NOT READ UNLESS OTHERWISE NOTED)

SKIP INFO/ CATI Note

Interviewer Note (s)

Column(s)

C05.01


Have you ever been told by a doctor, nurse, or other health professional that you have high blood pressure?


1 Yes


If “Yes” and respondent is female, ask: “Was this only when you were pregnant?”



By other health professional we mean nurse practitioner, a physician assistant, or some other licensed health professional.


2 Yes, but female told only during pregnancy

3 No

4 Told borderline high or pre-hypertensive or elevated blood pressure

7 Don’t know / Not sure

9 Refused

Go to next section

C05.02

Are you currently taking prescription medicine for your high blood pressure?

BPMEDS

1 Yes

2 No

7 Don’t know / Not sure

9 Refused






Rotating Core Section 3: Cholesterol Awareness (2023)


Question Number

Question text

Variable names

Responses

(DO NOT READ UNLESS OTHERWISE NOTED)

SKIP INFO/ CATI Note

Interviewer Note (s)

Column(s)

C06.01


Cholesterol is a fatty substance found in the blood. About how long has it been since you last had your cholesterol checked?


1 Never

Go to next section.


2 Within the past year (anytime less than one year ago)

3 Within the past 2 years (1 year but less than 2 years ago)

4 Within the past 3 years (2 years but less than 3 years ago)

5 Within the past 4 years (3 years but less than 4 years ago)

6 Within the past 5 years (4 years but less than 5 years ago)

8 5 or more years ago


7 Don’t know/ Not sure

9 Refused

Go to next section

C06.02

Have you ever been told by a doctor, nurse or other health professional that your cholesterol is high?


1 Yes



By other health professional we mean nurse practitioner, a physician assistant, or some other licensed health professional.


2 No

7 Don’t know / Not sure

9 Refused


C06.03


Are you currently taking medicine prescribed by your doctor or other health professional for your cholesterol?

CHOLMED2

1 Yes

2 No

7 Don’t know / Not sure

9 Refused


Doctors might prescribe statin for those without high cholesterol but with high atherosclerotic cardiovascular disease risk



Rotating Core Section 4: Inadequate Sleep (2022)



Question Number

Question text

Variable names

Responses

(DO NOT READ UNLESS OTHERWISE NOTED)

SKIP INFO/ CATI Note

Interviewer Note (s)

Column(s)

CIS.01


On average, how many hours of sleep do you get in a 24-hour period?

SLEPTIM1

_ _ Number of hours [01-24]

77 Don’t know / Not sure

99 Refused


Do not read: Enter hours of sleep in whole numbers, rounding 30 minutes (1/2 hour) or more up to the next whole hour and dropping 29 or fewer minutes.

113-114



Rotating Core Section 5: Oral Health (2022, 2024)



Question Number

Question text

Variable names

Responses

(DO NOT READ UNLESS OTHERWISE NOTED)

SKIP INFO/ CATI Note

Interviewer Note (s)

Column(s)

COH.01


Including all types of dentists, such as orthodontists, oral surgeons, and all other dental specialists, as well as dental hygienists, how long has it been since you last visited a dentist or a dental clinic for any reason?

LASTDEN4


Read if necessary:

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 5 years (2 years but less than 5 years ago)

4 5 or more years ago

Do not read:

7 Don’t know / Not sure

8 Never

9 Refused



129

COH.02

Not including teeth lost for injury or orthodontics, how many of your permanent teeth have been removed because of tooth decay or gum disease?

RMVTETH4

Read if necessary:

1 1 to 5

2 6 or more but not all

3 All

8 None

Do not read:

7 Don’t know / Not sure

9 Refused


Read if necessary: If wisdom teeth are removed because of tooth decay or gum disease, they should be included in the count for lost teeth.

130




Rotating Core Section 6: Falls (2023)


Question Number

Question text

Variable names

Responses

(DO NOT READ UNLESS OTHERWISE NOTED)

SKIP INFO/ CATI Note

Interviewer Note (s)

Column(s)





Skip Section if AGE, coded 18-44



CFAL.01


In the past 12 months, how many times have you fallen?

FALL12MN


_ _ Number of times


Read if necessary: By a fall, we mean when a person unintentionally comes to rest on the ground or another lower level.

226-227

88 None

77 Don’t know / Not sure

99 Refused

Go to Next Section

CFAL.02

How many of these falls caused an injury that limited your regular activities for at least a day or caused you to go to see a doctor?

FALLINJ4

_ _ Number of falls [76 = 76 or more]

88 None

77 Don’t know / Not sure

99 Refused


Read if necessary: By an injury, we mean the fall caused you to limit your regular activities for at least a day or to go see a doctor.

228-229





Rotating Core Section 7: Seat Belt Use and Drinking and Driving (2023)



Question Number

Question text

Variable names

Responses

(DO NOT READ UNLESS OTHERWISE NOTED)

SKIP INFO/ CATI Note

Interviewer Note (s)

Column(s)

CSBD.01


How often do you use seat belts when you drive or ride in a car? Would you say—

SEATBELT

Read:

1 Always

2 Nearly always

3 Sometimes

4 Seldom

5 Never

Do not read:

7 Don’t know / Not sure



230

8 Never drive or ride in a car

Go to next section

9 Refused






If CALC.01 = 888 (No drinks in the past 30 days); go to next section.



CSBD.02

During the past 30 days, how many times have you driven when you’ve had perhaps too much to drink?

DRNKDRI2

_ _ Number of times

88 None

77 Don’t know / Not sure

99 Refused



231-232




Rotating Core Section 8: Breast and Cervical Cancer Screening (2022, 2024)



Question Number

Question text

Variable names

Responses

(DO NOT READ UNLESS OTHERWISE NOTED)

SKIP INFO/ CATI Note

Interviewer Note (s)

Column(s)





Skip if Male (MSAB.01, BIRTHSEX, is coded 1). If MSAB.01=missing and (CP05=1 or LL12=1; or LL09 = 1 or LL07 =1).




CBCC.01


The next questions are about breast and cervical cancer. Have you ever had a mammogram?

HADMAM


1 Yes


A mammogram is an x-ray of each breast to look for breast cancer.

233

2 No

7 Don’t know/ not sure

9 Refused

Go to CBCC.03

Go to CBCC.03

CBCC.02

How long has it been since you had your last mammogram?

HOWLONG


Read if necessary:

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



234

CBCC.03

Have you ever had a Pap test?

HADPAP2


1 Yes


A Pap test is a test for cancer of the cervix.

235

2 No

7 Don’t know / Not sure

9 Refused

Go to CBCC.05

CBCC.04

How long has it been since you had your last Pap test?

LASTPAP2


Read if necessary:

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



236

CBCC.05

An H.P.V. test is sometimes given with the Pap test for cervical cancer screening. Have you ever had an H.P.V. test?

HPVTEST


1 Yes


Human papillomarvirus (pap-uh-loh-muh virus)

237

2 No

7 Don’t know / Not sure

9 Refused

Go to CBCC.07

CBCC.06

How long has it been since you had your last H.P.V. test?

HPLSTTST

Read if necessary:

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



238

CBCC.07

Have you had a hysterectomy?

HADHYST2

1 Yes

2 No

7 Don’t know / Not sure

9 Refused

If response to Core CDEM.17 = 1 (is pregnant); then go to next section.

Read if necessary: A hysterectomy is an operation to remove the uterus (womb).

239




Rotating Core Section 9: Prostate Cancer Screening (2022,2024)


Question Number

Question text

Variable names

Responses

(DO NOT READ UNLESS OTHERWISE NOTED)

SKIP INFO/ CATI Note

Interviewer Note (s)

Column(s)





If respondent is ≤39 years of age, or Skip if female (MSAB.01, BIRTHSEX, is coded 2). If MSAB.01=missing and (CP05=2 or LL12=2; or LL09 = 2 or LL07 =2)., go to next section.



CPCS.01


Has a doctor, nurse, or other health professional ever talked with you about the advantages of the Prostate-Specific Antigen or P.S.A. test?

PCPSAAD3


1 Yes

2 No

7 Don’t know/ not sure

9 Refused


Read if necessary: A prostate-specific antigen test, also called a P.S.A. test, is a blood test used to check men for prostate cancer.

240

CPCS.02

Has a doctor, nurse, or other health professional ever talked with you about the disadvantages of the P.S.A. test?

PCPSADI1


1 Yes

2 No

7 Don’t know/ not sure

9 Refused



241

CPCS.03

Has a doctor, nurse, or other health professional ever recommended that you have a P.S.A. test?

PCPSARE1


1 Yes

2 No

7 Don’t know / Not sure

9 Refused



242

CPCS.04

Have you ever had a P.S.A. test?

PSATEST1


1 Yes



243

2 No

7 Don’t know / Not sure

9 Refused

Go to next section

CPCS.05

How long has it been since you had your last P.S.A. test?

PSATIME

Read if necessary:

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

Do not read:

7 Don’t know / Not sure

9 Refused



244

CPCS.06

What was the main reason you had this P.S.A. test – was it …?

PCPSARS1

Read:

1 Part of a routine exam

2 Because of a prostate problem

3 Because of a family history of prostate cancer

4 Because you were told you had prostate cancer

5 Some other reason

Do not read:

7 Don’t know / Not sure

9 Refused



245





Rotating Core Section 10: Colorectal Cancer Screening (2022, 2024)


Question Number

Question text

Variable names

Responses

(DO NOT READ UNLESS OTHERWISE NOTED)

SKIP INFO/ CATI Note

Interviewer Note (s)

Column(s)





CATI note: If respondent is < 45 years of age, go to next section.



Prologue

The next questions are about the five different types of tests for colorectal cancer screening.






CRC.01

A colonoscopy checks the entire colon. 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?

COLNSCPY

1 Yes




Do not include a virtual colonoscopy, where your colon is filled with air and you are moved through a donut shaped X-ray machine as you lie on your back and then on your stomach.

246


2 No

7 Don't know / Not sure

9 Refused

Go to CRC.03



CRC.02

How long has it been since you had this test?

COLNTEST

Read if necessary:

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 5 years (2 years but less than 5 years ago)

4 Within the past 10 years (5 years but less than 10 years ago)

5 10 or more years ago

Do not read:

7 Don't know / Not sure

9 Refused



247

CRC.03

A sigmoidoscopy checks part of the colon and you are fully awake. Have you ever had a sigmoidoscopy?

SIGMSCPY

1 Yes




248


2 No

7 Don't know / Not sure

9 Refused

Go to CRC.05



CRC.04

How long has it been since you had this test?

SIGMTEST

Read if necessary:

1 Within the past year (anytime less than 12 s ago)

2 Within the past 2 years (1 year but less than 2 years ago)

3 Within the past 5 years (2 years but less than 5 years ago)

4 Within the past 10 years (5 years but less than 10 years ago)

5 10 or more years ago

Do not read:

7 Don't know / Not sure

9 Refused




249

CRC.05


Another test uses a special kit to obtain a small amount of stool at home to determine whether the stool contains blood and returns the kit to the doctor or the lab. Have you ever had this test using a home kit?

BLDSTOL1

1 Yes


This is also called a fecal immunochemical test or F.I.T. or a guaiac-based fecal occult blood test also known as gFOBT. The FIT test uses antibodies to detect blood in the stool. The gFOBT uses a chemical called guaiac to detect blood in the stool.


250

2 No

7 Don't know / Not sure

9 Refused


Go to CRC.07


CRC.06

How long has it been since you had this test?


LSTBLDS4

Read if necessary:

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

Do not read:

7 Don't know / Not sure

9 Refused




251

CRC.07

Another test uses a special kit to obtain an entire bowel movement at home and returns the kit to a lab. Have you ever had this test?



STOOLDNA

1 Yes



This is also called a FIT-DNA test, a stool DNA test, or a Cologuard test. This test combined the FIT with a test that detects altered DNA in the stool.

252


2 No

7 Don't know / Not sure

9 Refused

Go to CRC.09


CRC.08

How long has it been since you had this test?


SDNATEST


Read if necessary:

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

Do not read:

7 Don't know / Not sure

9 Refused



253

CRC.09

For a virtual colonoscopy, your colon is filled with air and you are moved through a donut shaped X-ray machine as you lie on your back and then on your stomach. Have you ever had a virtual colonoscopy?

VIRCOLON

1 Yes




Unlike a regular colonoscopy, you do not need medication to make you sleepy during the test.

254


2 No

7 Don't know / Not sure

9 Refused

Go to next section


CRC.10

How long has it been since you had this test?

VCLNTEST

Read if necessary:

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

Do not read:

7 Don't know / Not sure

9 Refused



255







Rotating Core Section 11: HIV Risk (2022, 2024)


Question Number

Question text

Variable names

Responses

(DO NOT READ UNLESS OTHERWISE NOTED)

SKIP INFO/ CATI Note

Interviewer Note (s)

Column(s)

C14.03

I am going to read you a list. When I am done, please tell me if any of the situations apply to you. You do not need to tell me which one.


You have injected any drug other than those prescribed for you in the past year. 

You have been treated for a sexually transmitted disease or STD in the past year.

You have given or received money or drugs in exchange for sex in the past year.

You had anal sex without a condom in the past year.

You had four or more sex partners in the past year. 

Do any of these situations apply to you?


Do any of these situations apply to you?

HIVRISK5

1 Yes

2 No

7 Don’t know / Not sure

9 Refused



277




Rotating Core Section 12: Shingles Vaccination (2023)


Question Number

Question text

Variable names

Responses

(DO NOT READ UNLESS OTHERWISE NOTED)

SKIP INFO/ CATI Note

Interviewer Note (s)

Column(s)





If age <50 GOTO CIMM.04.



CIMM.03

Have you ever had the shingles or zoster vaccine?

SHINGLE2

1 Yes

2 No

7 Don’t know / Not sure

9 Refused



Shingles is an illness that results in a rash or blisters on the skin, and is usually painful. There are two vaccines now available for shingles: Zostavax, which requires 1 shot and Shingrix which requires 2 shots.

224




Rotating Core Section 13: TDAP Vaccination (2022)


Question Number

Question text

Variable names

Responses

(DO NOT READ UNLESS OTHERWISE NOTED)

SKIP INFO/ CATI Note

Interviewer Note (s)

Column(s)

C13.03


Have you received a tetanus shot in the past 10 years?

TETANUS1

1 Yes, received Tdap

2 Yes, received tetanus shot, but not Tdap

3 Yes, received tetanus shot but not sure what type

4 No, did not receive any tetanus shot in the past 10 years

7 Don’t know/Not sure

9 Refused


If yes, ask: Was this Tdap, the tetanus shot that also has pertussis or whooping cough vaccine?

268



26

19 September 2022

File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorPierannunzi, Carol (CDC/ONDIEH/NCCDPHP)
File Modified0000-00-00
File Created2022-09-19

© 2024 OMB.report | Privacy Policy