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CDC OPTIONAL MODULES: Back to topics
STATE ADDED QUESTIONS:
Back to topics
RISK FACTORS AND DERIVED
VARIABLES (Located within the corresponding section)
CDC
CORE SECTIONS:
HEALTH STATUS
 Would you say in general that your
health is excellent, very good, good, fair or poor?
RISK FACTORS / CREATED VARIABLES
Risk factor for fair and poor
health
HEALTHY DAYS Back to topics
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?
HEALTH CARE ACCESS Back to topics
Do you have any kind
of health care coverage, including health insurance, prepaid plans
such as HMOS, or government plans such as Medicare?
Do you have one person
you think of as your personal doctor or health care provider?
Was there a time in the
past 12 months when you needed to see a doctor but could not because
of cost?
About how long has it been since you last visited a doctor for a routine checkup? EXERCISE
Back to topics
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?
RISK FACTORS / CREATED VARIABLES
Adults that report doing physical activity or exercise during the past 30 days other than their regular job.
HYPERTENSION AWARENESS
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Have you ever been told by a doctor, nurse or other health professional that you have high blood pressure?
Are you currently taking medicine for your high blood pressure?
RISK FACTORS / CREATED VARIABLES
Adults who have been told they have high blood pressure by a doctor, nurse or other health professional.
CHOLESTEROL AWARENESS
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Blood cholesterol is a fatty substance found in the blood. Have you ever had your blood cholesterol checked?
About how long has it been since you last had your blood cholesterol checked?
Have you ever been told by a doctor, nurse or other health professional that your blood cholesterol is high?
RISK FACTORS / CREATED VARIABLES
Cholesterol check within the past five years
Adults who have had their cholesterol checked and have been told by a doctor, nurse or other health professional that it was high.
TOBACCO USE Back to topics
Have you smoked at least
100 cigarettes in your entire life?
Do you now smoke cigarettes
every day, some days or not at all?
During the past 12 months,
have you stopped smoking for one day or longer because you were
trying to quit smoking?
RISK FACTORS / CREATED VARIABLES
Four level computed smoking
status
Risk factor for smoking
ALCOHOL CONSUMPTION Back to topics
During the past 30 days, have you had at least one drink of any alcoholic beverage such as beer, wine, a malt beverage or liquor?
During the past 30 days,
how many days per week or per month did you have at least one drink
of any alcoholic beverage?
On days when you drank,
about how many drinks did you drink on the average?
Considering all types
of alcoholic beverages, how many times during the past 30 days did
you have 5 or more drinks on an occasion?
During the past 30 days,
what is the largest number of drinks you had on any occasion?
RISK FACTORS / CREATED VARIABLES
At risk for binge drinking.
At risk for heavy alcohol consumption
Heavy Drinking Among Men
ASTHMA Back to topics
Have you ever been told
by a doctor, nurse or other health professional that you had asthma?
Do you still have asthma?
RISK FACTORS / CREATED VARIABLES
Adults who have been told they have asthma (lifetime risk)
Asthma status
Adults who have been told they currently have asthma
DIABETES Back to topics
Have you ever been told
by a doctor that you have diabetes?
FRUITS AND VEGETABLES Back to topics
How often do you drink fruit juices such as orange, grapefruit of tomato?
Not counting juice, how often do you eat fruit?
How often do you eat green salad?
How often do you eat potatoes not including French fries, fried potatoes or potato chips?
How often do you eat carrots?
Not counting carrots, potatoes or salad, how many servings of vegetables do you usually eat?
RISK FACTORS / CREATED VARIABLES
Summary index for fruits and vegetables
Consumed five or more servings of fruits and vegetables per day
IMMUNIZATION
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During the past 12 months,
have you had a flu shot?
During the past 12 months,
have you had a flu vaccine that was sprayed into your nose?
Have you ever had a pneumonia
shot? This shot is usually given only once or twice in a person’s
lifetime and is different from the flu shot. It is also called the
pneumocoocal vaccine.
RISK FACTORS / CREATED VARIABLES
Risk factor for respondents
aged 65 or older that did not have a flu shot within the past 12
months.
Risk factor for respondents
aged 65 or older that have never had a pneumonia shot.
VETERAN STATUS
Back to topics
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?
ARTHRITIS BURDEN Back to topics
The next questions refer to your joints. Please do not include the back or neck. During the past 30 days, have you had any symptoms of pain, aching or stiffness in or around a joint?
Did your joint symptoms first begin more than 3 months ago?
Have you ever seen a doctor or other health professional for these joint symptoms?
Have you ever been told by a doctor or other health professional that you have some form of arthritis, rheumatoid arthritis, gout, lupus or fibromyalgia?
Are you limited in any way in any of your usual activities because of arthritis or joint symptoms?
CARDIOVASCULAR DISEASE PREVALENCE Back to topics
Has a doctor, nurse or other health professional ever told you that you have had a heart attack, also called a myocardial infarction?
Has a doctor, nurse or other health professional ever told you that you have angina or coronary heart disease?
Has a doctor, nurse or other health professional ever told you that you have had a stroke?
PHYSICAL ACTIVITY Back to topics
When you are at work, which of the following best describes what you do?
Now thinking about moderate physical activities you do in a usual week, do you do moderate activities for at least 10 minutes at a time, such as brisk walking, bicycling, vacuuming, gardening, or anything else that causes some increase in breathing or heart rate?
How many days of the week do you do these moderate activities for at least 10 minutes at a time?
On days when you do moderate activities for at least 10 minutes at a time, how much total time per day do you spend doing these activities?
Now, thinking about the vigorous physical activities you do in a usual week, do you do vigorous activities for at least 10 minutes at a times, such as running, aerobics, heavy yard work, or anything else that causes large increases in breathing or heart rate?
How many days per week do you do these vigorous activities for at least 10 minutes at a time?
On days when you do vigorous activities for at least 10 minutes at a time, how much total time per day do you spend doing these activities?
RISK FACTORS / CREATED VARIABLES
3 level moderate physical activity category
Moderate Physical Activity Risk Factor
3 level vigorous physical activity category
Vigorous Physical Activity Risk Factor
5 level physical activity category
Physical Activity Recommendation
Status
Adults that have reported participating in physical activity or exercise
EMOTIONAL SUPPORT AND LIFE SATISFACTION Back to topics
How often do you get the soical and emotional support you need? Would you say....
In general, how satisfied are you with your life? Would you say...
DISABILITY Back to topics
Are you limited in any
way in any activities because of physical, mental, or emotional
problems?
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? Include occasional
use or use in certain circumstances
HIV/AIDS
Back to topics
Have you ever been tested
for HIV? Do not count tests you may have had as part of a blood
donation.
Not including blood donations,
in what month and year was your last HIV test? Include saliva tests.
Where did you have your
last HIV test- at a private doctor or HMO office, at a counseling
and testing site, at a hospital, at a clinic, in a jail or prison,
at home or somewhere else?
I am going to read you
a list. When I am done, please tell me if any of the situations
apply to you.: You have used intravenous drugs in the past year.
You have been treated for a sexually transmitted or venereal disease
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. Do any of these situations apply to you?
RISK FACTORS / CREATED VARIABLES
Adults aged 18-64 that have ever been tested for HIV
Adults aged 18-64 tht have ever participated in high-risk behavior
RISK FACTOR / CREATED VARIABLES
FOR OBESITY
Back to topics
Four categories of Body Mass
Index
Risk factor for overweight
or obese
CDC OPTIONAL MODULES
Back to topics
DIABETES
How old were you when
you were told you have diabetes?
Are you now taking insulin?
Are you now taking diabetes
pills?
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.
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.
Have you ever had any
sores or irritations on your feet that took more than four weeks
to heal?
About how many times
in the past 12 months have you seen a doctor, nurse, or other health
professional for your diabetes?
A test for "A one
C" measures the average level of blood sugar over the past
three months. About how many times in the past 12 months has a doctor,
nurse, or other health professional checked you for hemoglobin "A
one C"?
About how many times in
the past 12 months has a health professional checked your feet for
any sores or irritations?
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.
Has a doctor ever told
you that diabetes has affected your eyes or that you had retinopathy?
Have you ever taken a
course or class in how to manage your diabetes yourself
SECONDHAND SMOKE POLICY Back to topics
Which statement best describes the rules about smoking inside your home?
While working at your job, are you indoors most of the time?
Which of the following best describes your place of work's official policy for indoor public or common areas, such as lobbies, rest rooms and lunch rooms?
Which of the following best describes your place of work's official somking policy for work areas?
CARDIOVASCULAR DISEASE Back to topics
After you left the hospital
following your heart attack did you go to any kind of
outpatient rehabilitation? This is sometimes called “Rehab.”
After you left the hospital following your stroke did you go to any kind of outpatient rehabilitation? This is sometimes called "Rehab".
Do you take aspirin daily
or every other day?
Do you have a health
problem or condition that makes taking aspirin unsafe for you?
SMOKING CESSATION Back to topics
About how long has it
been since you last smoked cigarettes?
In the last 12 months,
how many times have you seen a doctor, nurse or other health professional
to get any kind of care for yourself?
In the last 12 months,
on how many visits were you advised to quit smoking by a doctor
or other health provider?
On how many visits did your
doctor, nurse or other health professional recommend to discuss
medication to assist you with quitting smoking, such as nicotine
gum, patch, nasal spray, inhaler, lozenge, or prescription medication
such as Wellbutrin/ Zyban/ Bupropion?
On how many visits did your
doctor or health provider recommend or discuss methods and strategies
other than medication to assist you with quitting smoking?
INFLUENZA Back to topics
Where did you go to get your most recent flu shot/vaccination?
ARTHRITIS MANAGEMENT Back to topics
Thinking about your arthritis
or joint symptoms, which of the following best describes you today?
Has a doctor or other
health professional ever suggested losing weight to help with your
arthritis or joint symptoms?
Has a doctor or other
health professional ever suggested physical activity or exercise
to help your arthritis or joint symptoms?
Have you ever taken an
educational course or class to teach you how to manage problems
related to your arthritis or joint symptoms?
WEIGHT CONTROL Back to topics
Are you now trying to lose weight?
Are you trying to maintain your current weight, that is, to keep from gaining weight?
Are you eating either fewer calories or less fat to lose weight or keep from gaining weight?
Are you using physical activity or exercise to lose weight or keep from gaining weight?
In the past 12 months, has a doctor, nurse or other health professional given you advice about your weight?
SEXUAL VIOLENCE Back to topics
In the past 12 months, has anyone exposed you to unwanted sexual situations that did not involve physical touching?
In the past 12 months, has anyone touched sexual parts of your body after you said or showed that you didn't want them to or without your consent?
In the past 12 months, has anyone attempted to have sex with you after you said or showed that you didn't want to or without your consent, but sex did not occur?
In the past 12 months, has anyone had sex with you after you said or showed that you didn't want to or without your consent?
At the time of the most recent incident, what was your relationship to the person who had sex or attempted to have sex with you after you said or showed that you didn't want to or without your consent?
Was the person who did this male or female?
Has anyone ever attempted to have sex with you after you said or showed that you didn't want to or without your consent, but sex did not occur?
Has anyone ever had sex with you after you said or showed that you didn't want them to or without your consent?
STATE ADDED QUESTIONS
Back to topics
EPILEPSY AND SEIZURE Back to topics
Have you ever been told
by a doctor that you have a seizure disorder or epilepsy?
Are you currently taking
any medicine to control your seizure disorder or epilepsy?
How many seizures have
you had in the last three months?
In the past year, have
you seen a neurologist or epilepsy specialist for your epilepsy
or seizure disorder?
During the past 30 days,
to what extent has epilepsy or its treatment interfered with your
normal activities like working, school, or socializing with family
or friends?
SKIN CANCER Back to topics
When you go outside on a sunny summer day for more than one hour, how often do you use sunscreen or sunblock?
What is the Sun Protection Factor or SPF of the sunscreen you use the most?
When you go outside on a sunny summer day for more than one hour, how often do you stay in the shade?
When you go outside on a sunny summer day for more than one hour, how often do you wear a wide-brimmed hat or any other hat that shades your face, ears and neck from the sun?
When you go outside on a sunny summer day for more than one hour, how often do you wear longsleeved shirts?
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