Behavioral Risk
Factor Surveillance System
Indiana Statewide Survey
Data, 2011
Table of
Contents
Preface
Introduction:
Tables:
Core 01: Health Status
C01.01 Would you say that in general your health is:
Core 02: Healthy Days—Health-Related Quality of Life
C02.01
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?
C02.02
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?
C02.03
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?
Core 03: Health Care Access
C03.01
Do you have any kind of health care coverage, including health insurance,
prepaid plans such as HMOs, or government plans such as Medicare?
C03.02
Do you have one person you think of as your personal doctor or health care
provider?
C03.03
Was there a time in the past 12 months when you needed to see a doctor but could
not because of cost?
C03.04
About how long has it been since you last visited a doctor for a routine
checkup? [A routine checkup is a general physical exam, not an exam for a
specific injury, illness, or condition.]
Core 04: Hypertension Awareness
C04.01
Have you EVER been told by a doctor, nurse, or other health professional that
you have high blood pressure?
C04.02 Are you currently taking
medicine for your high blood pressure?
Module 10: Actions to Control High Blood Pressure
M10.01 Are you now doing changing your eating habits
to help lower or control your high blood pressure?
M10.02 Are you cutting down on salt (to help
lower or control your high blood pressure)?
M10.03 Are you reducing alcohol use (to help
lower or control your high blood pressure)?
M10.04 Are you exercising (to help lower or
control your high blood pressure)?
M10.05 Has a doctor or other
health
professional ever advised you to change your eating habits to help lower or
control your high blood pressure?
M10.06 Has a doctor or other health
professional ever advised you to cut down on salt (to help lower or control your
high blood pressure)?
M10.07 Has a doctor or other health
professional ever advised you to reduce alcohol use (to help lower or control
your high blood pressure)?
M10.08 Has a doctor or other health
professional ever advised you to exercise (to help lower or control your high
blood pressure)?
M10.09 Has a doctor or other health
professional ever advised you to take medication (to help lower or control your
high blood pressure)?
M10.10 Were you told on two or more visits by
a doctor or other health professional that you had high blood pressure?
Core 05:
Cholesterol Awareness
C05.01
Have you EVER had
your blood cholesterol checked?
C05.02 About how long has it been since
you last had your blood cholesterol checked?
C05.03 Have you EVER been told by a
doctor, nurse or other health professional that your blood cholesterol is high?
Core 06: Chronic Health Conditions
C06.01
Ever told you that you had a heart attack also called a myocardial infarction?
C06.02 Ever told you had angina or
coronary heart disease?
C06.03 Ever told you had a stroke?
C06.04 Ever told you had asthma?
C06.05 Do you still have asthma?
C06.06 Ever told you had skin cancer?
C06.07 Ever told you had other types of
cancer?
C06.08 Ever told you have chronic
obstructive pulmonary disease (COPD), emphysema or chronic bronchitis?
C06.09 Ever told you have some form of
arthritis, rheumatoid arthritis, gout, lupus, or fibromyalgia?
C06.10 Ever told you have a depressive
order (including depression, major depression, dysthymia, or minor depression)?
C06.11 Ever told you have kidney
disease? Do NOT include kidney stones, bladder infection or incontinence.
C06.12 Ever told you have vision impairment in one or both
eyes, even when wearing glasses?
C06.13 Ever told you have diabetes?
Module 01: Pre-Diabetes
M01.01 Have you had a test for high
blood sugar or diabetes within the past three years?
M01.02 Have you ever been told by a
doctor or other health professional that you have pre-diabetes or borderline
diabetes?
Module 02: Diabetes
M02.01
How old were you when you were told you have diabetes?
M02.02
Are you now taking insulin?
M02.03
About how often do you check your blood for glucose or sugar? Include times when
checked by a family member or friend, but do NOT include times when checked by a
health professional.
M02.04
About how often do you check your feet for any sores or irritations? Include
times when checked by a family member or friend, but do NOT include times when
checked by a health professional.
M02.05
About how many times in the past 12 months have you seen a doctor, nurse, or
other health professional for your diabetes?
M02.06
About how many times in the past 12 months has a health
professional checked you for 'A one C'?
M02.07
About how many times in the past 12 months has a health professional checked
your feet for any sores or irritations?
M02.08
When was the last time you had an eye exam in which the pupils were dilated?
This would have made you temporarily sensitive to bright light.
M02.09
Has a doctor ever told you that diabetes has affected your eyes or that you had
retinopathy?
M02.10
Have you ever taken a course or class in how to manage your diabetes yourself?
Core 07: Tobacco Use
C07.01
Have you smoked at least 100 cigarettes in your entire life?
C07.02
Do you now smoke cigarettes every day, some days, or not at all?
C07.03
During the past 12 months, have you stopped smoking for one day or longer
because you were trying to quit smoking?
C07.04 How long has it been since you last smoked a
cigarette, even one or two puffs?
C07.05
Do you currently use chewing tobacco, snuff, or snus every day, some days, or
not at all? (Snus (Swedish for snuff) is a moist smokeless tobacco)
Core 8: Demographics
C08.05 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? Active duty does not include
training for the Reserves or National Guard, but DOES include activation, for
example, for the Persian Gulf War.
C08.13 What county do you live in?
Core 9: Fruits and Vegetables
C09.01 During the past month, how many
times per day, week or month did you drink 100% PURE fruit juices? Do not
include fruit-flavored drinks with added sugar or fruit juice you made at home
and added sugar to. Only include 100% juice.
C09.02 During the past month, not
counting juice, how many times per day, week, or month did you eat fruit? Count
fresh, frozen, or canned fruit.
C09.03 During the past month, how
many times per day, week, or month did you eat cooked or canned beans, such as
refried, baked, black, garbanzo beans, beans in soup, soybeans, edamame, tofu or
lentils? Do NOT include long green beans.
C09.04 During the past month, how many
times per day, week, or month did you eat dark green vegetables; for example,
broccoli or dark leafy greens including romaine, chard, collard greens or
spinach?
C09.05 During the past month, how many
times per day, week, or month did you eat orange-colored vegetables such as
sweet potatoes, pumpkin, winter squash, or carrots?
C09.06 Not counting what you just told
me about, during the past month, about how many times per day, week, or month
did you eat OTHER vegetables? Examples of other vegetables include tomatoes,
tomato juice or V-8 juice, corn, eggplant, peas, lettuce, cabbage, and white
potatoes that are not fried such as baked or mashed potatoes.
Core 10: Exercise (Physical Activity)
C10.01 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?
Core 11: Disability
C11.01 Are you limited in any way in
any activities because of physical, mental, or emotional problems?
C11.02 Do you now have any health
problem that requires you to use special equipment, such as a cane, a wheelchair,
a special bed, or a special telephone?
Core 12: Arthritis Burden
C12.01 Are you now limited in any way
in any of your usual activities because of arthritis or join symptoms?
C12.02 Do arthritis or joint symptoms now affect whether you
work, the type of work you do, or the amount of work you do?
C12.03
During the past
30 days, to what extent has your arthritis or joint symptoms interfered with
your normal social activities, such as going shopping, to the movies, or to
religious or social gatherings?
C12.04 During the past 30 days, how bad was your joint pain
ON AVERAGE?
Core 13: Seatbelt Use
C13.01
How often do you use seat belts when you drive or ride in a car?
Core 14: Immunization
C14.01 During the past 12 months, have you had
either a seasonal flu shot or a seasonal flu vaccine that was sprayed in your
nose?
C14.03 At what kind of place did you get your
last flu shot/vaccine?
C14.04 Have you ever had a pneumonia shot?
Core 15: Alcohol Consumption
C15.01
During the past 30 days, how many days per week or per month did you have at
least one drink of any alcoholic beverage?
C15.02
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?
C15.03
Considering all types of alcoholic beverages, how many times during the past 30
days did you have 5 or more drinks for men or 4 or more drinks for women on an
occasion?
C15.04 During the past 30 days, what is the
largest number of drinks you had on any occasion?
Core 16: HIV/AIDS
C16.01
Have you ever been tested for HIV? Do not count tests you may have had as part
of a blood donation. Include testing fluid from your mouth.
C16.03
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. [Risk factors for
HIV.]
Calculated Variables and Risk Factors:
CLV01.01 Adults with good or better health
CLV03.01 Respondents aged 18-64 that have any form of health care coverage
CLV04.01 Adults who have been told they have high blood
pressure by a doctor, nurse, or other health care professional
CLV05.01
Cholesterol check
within past five years
CLV05.02 Adults who have had their cholesterol checked
and have been told by a doctor, nurse, or other health professional that it was
high
CLV06.01 Adults who have ever been told they have asthma
CLV06.02 Adults who have been told they currently have
asthma
CLV06.03 Computed asthma status
CLV06.04 Respondents that have had a doctor diagnose them
as having some form of arthritis
CLV07.01 Four-level smoker status: Everyday smoker,
Someday smoker, Former smoker, Non-smoker
CLV07.02 Adults who are current smokers
CLV08.18 Four-categories of Body Mass Index (BMI)
CLV08.19 Adults who have a body mass index greater than
25.00 (Overweight or Obese)
CLV10.01 Adults that report doing physical activity or
exercise during the past 30 days other than their regular job
CLV10.23 Physical Activity Index
CLV10.24 Adults that participated in 150 minutes (or
vigorous equivalent minutes) of physical activity per week
CLV10.25 Adults that participated in 300 minutes (or
vigorous equivalent minutes) of physical activity per week
CLV10.27 Adults that participated in 300 minutes (or
vigorous equivalent minutes) of physical activity per week
CLV10.28 Adults that participated in 300 minutes (or
vigorous equivalent minutes) of physical activity per week
CLV13.01 Always or nearly always wear seat belts
calculated variable
CLV13.02 Always wear seat belts calculated variable
CLV14.01 Adults aged 65+ who have had a flu shot within the past year
CLV14.02 Adults aged 65+ who have ever had a pneumonia vaccination
CLV15.03 Binge drinkers (males having five or more drinks on one occasion,
females having four or more drinks on one occasion)
CLV15.04 Calculated total number of alcoholic beverages consumed per day
CLV15.06 Heavy drinkers (adult men having more than two drinks per day and adult
women having more than one drink per day)
CLV15.07 Adult Men that are Heavy drinkers (having more than two drinks per day)
CLV15.08 Adult Women that are Heavy drinkers (having more than one drink per
day)
Module 05: Preconception Health / Family Planning
M05.01 Has a doctor, nurse, or other health
care worker ever talked with you about ways to prepare for a healthy pregnancy
and baby?
M05.02 Have you ever been pregnant?
M05.03 Did you or your husband/partner do
anything the LAST TIME YOU HAD SEX to keep from getting pregnant?
M05.04 What did you or your husband/partner do
the LAST TIME YOU HAD SEX to keep you from getting pregnant?
M05.05 What was your main reason for not doing
anything the LAST TIME YOU HAD SEX to keep you from getting pregnant?
M05.06 How do you feel about having a child
now or something in the future?
M05.07 How many times a week do you currently
take a multivitamin, a prenatal vitamin, or a folic acid vitamin?
Module 09: Cardiovascular Health
M09.01
Following your heart attack, did you go to any
kind of outpatient rehabilitation (rehab)?
M09.02 Following your stroke, did you go to
any kind of outpatient rehabilitation (rehab)?
M09.03 Do you take aspirin daily or every
other day?
M09.04 Do you have a health problem or
condition that makes taking aspirin unsafe for you?
Module 16: Secondhand Smoke
M16.01
On how many days did you breathe the
smoke at your workplace from SOMEONE OTHER THAN YOU who was smoking tobacco?
M16.02 On how many days did SOMEONE OTHER THAN
YOU smoke tobacco inside your home while you were at home?
M16.03 On how many days did you ride in a
vehicle where SOMEONE OTHER THAN YOU was smoking tobacco?
M16.04 On how many days did you breathe the
smoke from SOMEONE ELSE who was smoking in an indoor public place?
M16.05 Not counting desks, porches, or
garages, inside your home, is smoking...?
M16.06 Not counting motorcycles, in the
vehicles that you or family members who live with you own or lease, is
smoking...?
M16.07 At workplaces, do you think smoking
indoors should be...?
Module 33: Childhood Asthma Prevalence
M33.01
Has a doctor, nurse or other health professional EVER said that your child has
asthma?
M33.02
Does the child still have asthma?
Appendices:
Appendix A
- Healthy
People 2020 in Indiana
Appendix B - 2011 Behavioral Risk Factor Surveillance Survey Questionnaire
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