Form 0920-1061 2022 Field Test Questionnaire

[NCCDPHP] Behavioral Risk Factor Surveillance System (BRFSS)

2022 Field Test for 2023 BRFSS Questionnaire_20220830_clean

2022 Field Test Questionnaire

OMB: 0920-1061

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2022 BRFSS Field Test for 2023 Questionnaire

DRAFT











OMB Header and Introductory Text


Read if necessary

Read

Interviewer instructions

(not read)

Public reporting burden of this collection of information is estimated to average 13 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Reports Clearance Officer; 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (0920-1061).


Form Approved

OMB No. 0920-1061

Exp. Date 12/31/2024


Interviewers do not need to read any part of the burden estimate nor provide the OMB number unless asked by the respondent for specific information. If a respondent asks for the length of time of the interview provide the most accurate information based on the version of the questionnaire that will be administered to that respondent. If the interviewer is not sure, provide the average time as indicated in the burden statement. If data collectors have questions concerning the BRFSS OMB process, please contact Carol Pierannunzi at [email protected].


HELLO, I am calling for the [STATE OF xxx] Department of Health. My name is (name). We are gathering information about the health of US residents. This project is conducted by the health department with assistance from the Centers for Disease Control and Prevention. Your telephone number has been chosen randomly, and I would like to ask some questions about health and health practices.

States may opt not to mention the state name to avoid refusals by out of state residents in the cell phone sample.


If cell phone respondent objects to being contacted by state where they have never lived, say:

“This survey is conducted by all states and your information will be forwarded to the correct state of residence”




Landline Introduction


Question Number

Question text

Variable names

Responses

(DO NOT READ UNLESS OTHERWISE NOTED)

SKIP INFO/ CATI Note

Interviewer Note (s)

Column(s)

Landline screening section removed from field test since sample consists of only cell phone sample.
















Cell Phone Introduction


Question Number

Question text

Variable names

Responses

(DO NOT READ UNLESS OTHERWISE NOTED)

SKIP INFO/ CATI Note

Interviewer Note (s)

Column(s)








CP01.


Is this a safe time to talk with you?

SAFETIME


1 Yes

Go to CP02



2 No

([set appointment if possible]) TERMINATE]

Thank you very much. We will call you back at a more convenient time.

CP02.


Is this [PHONE NUMBER]?

CTELNUM1


1 Yes

Go to CP03



2 No

TERMINATE


CP03.


Is this a cell phone?

CELLFON5


1 Yes

Go to CADULT1



2 No

TERMINATE

If "no”: thank you very much, but we are only interviewing persons on cellular telephones at this time

CP04.


Are you 18 years of age or older?

CADULT1


1 Yes





2 No

TERMINATE

Read: Thank you very much but we are only interviewing persons aged 18 or older at this time.

CP05a.

Are you ?


***NEW***

Please read:

1 Male

2 Female

3 Unspecified or another gender identity

Do not read:

7 Don’t know/Not sure

9 Refused

Go to CP06.


New

question tested with half the field test sample from Collecting SOGI Data: Principles and Practices presentation; May 17, 2022 by Bob Sivinski,

FCSM SOGI Interest Group

CP05b.

Are you male or female?



***NEW***

1 Male

2 Female

7 Don’t know/Not sure

9 Refused

Read if necessary:

“What sex were you assigned at birth on your original birth certificate?”




Go to CP06.


Sex question from 2022 NHIS to be tested with other half of the field test sample.

CP06.


Do you live in a private residence?

PVTRESD3


1 Yes

Go to CP08

Read if necessary: By private residence we mean someplace like a house or apartment

Do not read: Private residence includes any home where the respondent spends at least 30 days including vacation homes, RVs or other locations in which the respondent lives for portions of the year.


2 No

Go to CP07


CP07.


Do you live in college housing?

CCLGHOUS


1 Yes

Go to CP08

Read if necessary: By college housing we mean dormitory, graduate student or visiting faculty housing, or other housing arrangement provided by a college or university.


2 No

TERMINATE

Read: Thank you very much, but we are only interviewing persons who live in private residences or college housing at this time.

CP08.


Do you currently live in___(state)____?

CSTATE1


1 Yes

Go to CP10



2 No

Go to CP09


CP09.


In what state do you currently live?

RSPSTAT1


1 Alabama

2 Alaska

4 Arizona

5 Arkansas

6 California

8 Colorado

9 Connecticut

10 Delaware

11 District of Columbia

12 Florida

13 Georgia

15 Hawaii

16 Idaho

17 Illinois

18 Indiana

19 Iowa

20 Kansas

21 Kentucky

22 Louisiana

23 Maine

24 Maryland

25 Massachusetts

26 Michigan

27 Minnesota

28 Mississippi

29 Missouri

30 Montana

31 Nebraska

32 Nevada

33 New Hampshire

34 New Jersey

35 New Mexico

36 New York

37 North Carolina

38 North Dakota

39 Ohio

40 Oklahoma

41 Oregon

42 Pennsylvania

44 Rhode Island

45 South Carolina

46 South Dakota

47 Tennessee

48 Texas

49 Utah

50 Vermont

51 Virginia

53 Washington

54 West Virginia

55 Wisconsin

56 Wyoming

66 Guam

72 Puerto Rico

78 Virgin Islands




77 Live outside US and participating territories

99 Refused

TERMINATE

Read: Thank you very much, but we are only interviewing persons who live in the US.

CP10.


Do you also have a landline telephone in your home that is used to make and receive calls?

LANDLINE


1 Yes

2 No

7 Don’t know/ Not sure

9 Refused


Read if necessary: By landline telephone, we mean a regular telephone in your home that is used for making or receiving calls. Please include landline phones used for both business and personal use.


CP11.

How many members of your household, including yourself, are 18 years of age or older?

HHADULT

_ _ Number

77 Don’t know/ Not sure

99 Refused

If CP07 = yes then number of adults is automatically set to 1



Transition to section 1.



I will not ask for your last name, address, or other personal information that can identify you. You do not have to answer any question you do not want to, and you can end the interview at any time. Any information you give me will not be connected to any personal information. If you have any questions about the survey, please call (give appropriate state telephone number).





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)

Comments

CHCA.01


Do you have any kind of health care coverage, including health insurance, prepaid plans such as HMOs, or government plans such as Medicare, or Indian Health Service?

HLTHPLN1


1 Yes

2 No

7 Don’t know/Not Sure

9 Refused



Question included for field test

CHCA.01


What is the current primary source of your health insurance?


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.

This question was taken from an optional module used in BRFSS from 2014 through 2020. The question was used to replace the previous health care coverage question in the 2021 BRFSS core and continues in use for 2022. The phrase “health care coverage” was changed to “health Insurance” to improve understanding of the term by respondents.


CHCA.02

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


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?


NOTE: if the respondent had multiple doctor groups then it would be more than one—but if they had more than one doctor in the same group it would be one.


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?


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 (Physical Activity)



Question Number

Question text

Variable names

Responses

(DO NOT READ UNLESS OTHERWISE NOTED)

SKIP INFO/ CATI Note

Interviewer Note (s)

Column(s)

CEXP.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


If respondent does not have a regular job or is retired, they may count the physical activity or exercise they spend the most time doing in a regular month.


2 No

7 Don’t know/Not Sure

9 Refused

Go to C 11.08

CEXP.02

What type of physical activity or exercise did you spend the most time doing during the past month?

EXRACT11

__ __ Specify from Physical Activity Coding List


See Physical Activity Coding List.

If the respondent’s activity is not included in the physical activity coding list, choose the option listed as “other”.



77 Don’t know/ Not Sure

99 Refused

Go to C11.08

CEXP.03

How many times per week or per month did you take part in this activity during the past month?

EXEROFT1

1_ _ Times per week

2_ _ Times per month

777 Don’t know / Not sure

999 Refused




CEXP.04

And when you took part in this activity, for how many minutes or hours did you usually keep at it?

EXERHMM1

_:_ _ Hours and minutes

777 Don’t know / Not sure

999 Refused




CEXP.05

What other type of physical activity gave you the next most exercise during the past month?

EXRACT21

__ __ Specify from Physical Activity List


See Physical Activity Coding List.



If the respondent’s activity is not included in the physical activity coding list, choose the option listed as “other”.



88 No other activity

77 Don’t know/ Not Sure

99 Refused

Go to CEXP.08

CEXP.06

How many times per week or per month did you take part in this activity during the past month?

EXEROFT2

1_ _ Times per week

2_ _ Times per month

777 Don’t know / Not sure

999 Refused




CEXP.07

And when you took part in this activity, for how many minutes or hours did you usually keep at it?

EXERHMM2

_:_ _ Hours and minutes

777 Don’t know / Not sure

999 Refused




CEXP.08

During the past month, how many times per week or per month did you do physical activities or exercises to strengthen your muscles?

STRENGTH

1_ _ Times per week

2_ _Times per month

888 Never

777 Don’t know / Not sure

999 Refused


Do not count aerobic activities like walking, running, or bicycling. Count activities using your own body weight like yoga, sit-ups or push-ups and those using weight machines, free weights, or elastic bands.






Core Section 5: Demographics






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 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 respondent indicates that they are Hispanic for race, please read the race choices.






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

















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 landline 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 landline 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 your 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.

Do not include cell phones that are used exclusively by other members of your household.

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—

INCOME2


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 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


Emerging Core: Long-term COVID Effects


Question Number

Question text

Variable names

Responses

(DO NOT READ UNLESS OTHERWISE NOTED)

SKIP INFO/ CATI Note

Interviewer Note (s)

Column(s)

COVID.01

Have you ever tested positive for COVID-19 (using a rapid point-of-care test, self-test, or laboratory test) or been told by a doctor or other health care provider that you have or had COVID-19?”

***REPLACE***

1 Yes



This question is the one used in the Census Bureau’s Household Pulse Survey fielded in June, 2022

2 No

7 Don’t know / Not sure

9 Refused

Skip to next section

COVID.02

Do you currently have symptoms lasting 3 months or longer that you did not have prior to having coronavirus or COVID-19?


***REPLACE***

1 Yes


Read if necessary:

- Tiredness or fatigue

- Difficulty thinking or concentrating or forgetfulness/

memory problems (sometimes referred to as “brain fog”)

- Difficulty breathing or shortness of breath

- Joint or muscle pain

- Fast-beating or pounding heart (also known as heart palpitations) or chest pain

- Dizziness on standing

-menstrual changes

- Symptoms that get worse after physical or mental activities

--Loss of taste or smell

The 2022 question assessed period prevalence (from start of pandemic to survey date). Point prevalence will be more useful in 2023 for assessing health care needs because it will more closely reflect ongoing the burden of long-term symptoms as transmission wanes.

2 No

7 Don’t know / Not sure

9 Refused

Skip to next section

COVID.03

Do these long-term symptoms reduce your ability to carry out day-to-day activities compared with the time before you had COVID-19?”

***NEW***

1 Yes, a lot

2 Yes, a little

3 Not at all

7 Don’t know / Not sure

9 Refused



Assessment of functional impairment is necessary to describe the impact of long-term COVID effects and inform and inform the public health response. In 2023, assessing the impact of symptoms on daily activity is now a higher priority (has more information value), as frequencies of various symptoms following COVID will have been well-studied by then.





Closing Statement/ Transition to Modules


Read if necessary

Read

CATI instructions

(not read)

That was my last question. Everyone’s answers will be combined to help us provide information about the health practices of people in this state. Thank you very much for your time and cooperation.


Read if no optional modules follow, otherwise continue to optional modules.



Optional Modules


Module 1: COVID Vaccination


Question Number

Question text

Variable names

Responses

(DO NOT READ UNLESS OTHERWISE NOTED)

SKIP INFO/ CATI Note

Interviewer Note (s)

Comments








MCOV.01

Have you received at least one dose of a COVID-19 vaccination?

COVIDVA1

1 Yes


Go to MCOV.03 (COVIDNUM)



2 No


Go to MCOV.02

(COVACGET)

7 Don’t know / Not sure

9 Refused

GOTO Next module

MCOV.02

Would you say you will definitely get a vaccine, will probably get a vaccine, will probably not get a vaccine, will definitely not get a vaccine, or are you not sure?

COVACGET

1 = Will definitely get a vaccine

2 = Will probably get a vaccine

3 = Will probably not get a vaccine

4 = Will definitely not get a vaccine

7 = Don’t know/Not sure

9 = Refused

Go to next section



MCOV.03

How many COVID-19 vaccinations have you received?


***RESPONSE CHANGED***

1 One

2 Two

3 Three

4 Four

5 Five or more

7 Don’t know / Not sure

9 Refused



With new recommendations for additional and booster doses possible by 2023, some respondents could have received as many as 5 recommended doses

MCOV.04

Which of the following best describes your intent to take COVID vaccinations?


***REPLACE***

1 = Already received all recommended doses, including boosters

2 = Plan to receive all recommended doses

3 = Do not plan to receive all recommended doses

7 = Don’t know/Not sure

9 = Refused



Since the creation of this optional module, CDC has changed the definition of “up to date” for COVID-19 vaccination to include booster doses, so adding clarifying language to the question to explain that it includes booster doses and not just the initial COVID-19 vaccine series. Will cognitively test to see if anchoring categories to “recommendations is informative and will compare answers with MCOV.03 to see if both questions are needed..



Module 2: Cognitive Decline


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 45 years of age or older continue, else go to next module.



M13.01


The next few questions ask about difficulties in thinking or memory that can make a big difference in everyday activities. We want to know how these difficulties may have impacted you.


During the past 12 months, have you experienced difficulties with thinking or memory that are happening more often or are getting worse?

***REPLACE***


1 Yes





The introduction was shortened to: Reduce time needed to administer.

Remove mention of specific activities from the current introduction (i.e. “forgetting how to do things you’ve always done”). These activities were removed to avoid priming respondents to answer one way or another.

The question was changed, Removed “confusion.” Current research on subjective cognitive decline (SCD) does not suggest confusion is a major component of SCD.

“Difficulties with thinking or memory” was a specific suggestion for phrasing by the individuals living with early-stage dementia and reflected how they would have first described their subjective symptoms with cognition.

2 No

7 Don’t know/ not sure

9 Refused

Go to next module


M13.02

Are you worried about these difficulties with thinking or memory?

***NEW***

1 Yes

2 No

7 Don’t know/ not sure

9 Refused



This is a new question.


Current research on subjective cognitive decline (SCD) suggests a strong correlation between those who express worry about their difficulties with thinking or memory and future risk of developing dementia. This data will further identify population burden of cognitive impairment.

M13.03

Have you or anyone else discussed your difficulties with thinking or memory with a health care provider?


***REPLACE***


1 Yes

2 No

7 Don’t know/ not sure

9 Refused



The change to “provider” is to align with other questions on the BRFSS. The proposed change of order — to move the question to third rather than last — is to improve the flow of questions and place similar/cascading questions next to one another.

M13.04

During the past 12 months, have your difficulties with thinking or memory interfered with day-to-day activities, such as managing medications, paying bills, or keeping track of appointments?

***REPLACE***

1 Yes

2 No

7 Don’t know/ not sure

9 Refused



Based on current research on subjective cognitive decline (SCD), the proposed activities listed align well with difficulties first noted by those experiencing SCD. Clinical researchers on the advisory group noted that the cognitive effort required for “paying bills” was different than the effort required to “clean.”


Further, the input from those living with early-stage dementia cited “managing medications” and “paying bills” as two of the activities when they first noticed cognitive issues in themselves.

“keeping track of appointments” was added as another example that required similar cognitive load.


The decision to change “given up” to “interfered with” was to resolve the ambiguity around what “given up” meant. The advisory group noted that “interfered with” would be easier for respondents to answer.

M13.05

During the past 12 months, have your difficulties with thinking or memory interfered with your ability to work or volunteer?

***REPLACE***

1 Yes

2 No

7 Don’t know/ not sure

9 Refused



This question was simplified to ascertain additional burden among those experiencing subjective cognitive decline (SCD). “engage in social activities” was removed due to mild confusion over what the phrase meant. “outside the home” was removed since respondents may work or volunteer from home.









Closing Statement


Read

That was my last question. Everyone’s answers will be combined to help us provide information about the health practices of people in this state. Thank you very much for your time and cooperation.












Activity List for Common Leisure Activities

(To be used for Section 4: Exercise/Physical Activity)


Code Description (Physical Activity, Questions CEXP.2 and CEXP.5 above)



01. Walking

02. Running or jogging

03. Gardening or yard work

04. Bicycling or bicycling machine exercise

05. Aerobics video or class

06. Calisthenics

07. Elliptical/EFX machine exercise

08. Household activities

09. Weight lifting

10. Yoga, Pilates, or Tai Chi

11. Other


• Proposed reducing from 75 activities to 10 activities

• Derived using most frequently reported activities

• Combined some activities based on intensity and using NHIS as guide

16

2 September 2023

File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorPierannunzi, Carol (CDC/ONDIEH/NCCDPHP)
File Modified0000-00-00
File Created2023-09-02

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