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BRFSS SURVEY QUESTIONS 2004-2005Section 1: Health StatusWould you say that in general your health is excellent, very good, good, fair, or poor?Section 2: Health Care AccessDo you have any kind of health care coverage, including health insurance, prepaid plans such as HMOs, or government plans such as Medicare?What type of health care coverage do you use to pay for most of your medical care? Section 3: ExerciseDuring 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?Section 4: Tobacco RelatedHave 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? Which statement best describes the rules about smoking in your home? Are you personally in favor, opposed to, or indifferent to the recently enacted New York State law prohibiting smoking in all public and workplaces, including bars and restaurants? In the past 12 months, have you seen a doctor, nurse, or other health professional to get any kind of care for yourself? In the past 12 months, did any doctor, nurse, or other health professional ask if you smoke? In the past 12 months, has a doctor, nurse, or other health professional advised you to quit smoking? Section 5: AsthmaHave you ever been told by a doctor, nurse or other health professional that you had asthma?Do you still have asthma? During the past 12 months, have you had an episode of asthma or an asthma attack? During the past 12 months, how many times did you visit an emergency room or urgent care center because of your asthma? During the past 12 months, how many times did you see a doctor, nurse or other health professional for urgent treatment of worsening asthma symptoms? During the past 12 months, how many days were you unable to work or carry out your usual activities because of your asthma? Symptoms of asthma include cough, wheezing, shortness of breath, chest tightness and phlegm production when you don’t have a cold or respiratory infection. During the past 30 days, how often did you have any symptoms of asthma? Section 6: DiabetesHave you ever been told by a doctor that you have diabetes?About how often do you check your blood for glucose or sugar? About how often do you check your feet for any sores or irritations? About how many times in the past 12 months has a doctor, nurse, or other health professional checked you for "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? Have you ever taken a course or class in how to manage your diabetes yourself? Section 7: DisabilityAre 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? Section 8: Fruits and VegetablesHow often do you drink fruit juices such as orange, grapefruit, or 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? Section 9: Milk ConsumptionWhat TYPE of milk do you usually drink or put on your cereal?Section 10: Weight ControlAre you now trying to lose weight?Are you now 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? Section 11: WalkingIn a usual week, do you walk for at least 10 minutes at a time for recreation, exercise, to get to and from places, or for any other reason?How many days per week do you walk for at least 10 minutes at a time? On days when you walk for at least 10 minutes at a time, how much total time per day do you spend walking? Section 12: Physical ActivityWhen you are at work, which of the following best describes what 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 small increase in breathing or heart rate? How many days per 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? In a usual week, do you do vigorous activities for at least 10 minutes at a time, 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? Section 13: DemographicsAbout how much do you weight without shoes?About how tall are you without shoes? Marital statusHow many children less than 18 years of age live in your household?What is the highest grade or year of school you completed? Employment statusIs your annual household income from all sources?During the past 12 months, has your household been without telephone service for 1 week or more? GenderTo your knowledge, are you now pregnant?Section 14: County AddedHave you heard about Steps to a Healthier New York?Have you heard about BC Walks? How many people in your household participated in BC Walks? Have you heard about the Give Me Five Campaign? How many people in your household participated in Give Me Five? Have you heard about the North Country Steps Forward Walking Program? How many people in your household pledged to walk or wheelchair for the North Country Steps Forward Program? Have you heard about Move4Life? How many people in your household participated in Move4Life? Calculated Variables**Age group [ BRFSS Home | Steps Home Page ] |
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