View in Courier 12 pt. with .25" left and right margins 1996 Behavioral Risk Factor Questionnaire HELLO, I'm calling for the . We're doing a study of the health practices of residents. Your phone number has been chosen randomly by the to be included in the study, and we'd like to ask some questions about things people do which may affect their health. Is this ? No Thank you very much, but I seem to have dialed the wrong number, It's possible that your number may be called at a later time. Stop Is this a private residence? No Thank you very much, but we are only interviewing private residences. Stop Our study requires that we randomly select one adult who lives in your household to be interviewed. How many members of your household, including yourself, are 18 years of age or older? If "1" Are you the adult? If "yes" Then you are the person I need to speak with. Go to page 3 If "no" May I speak with him or her? Go to "correct respondent" at bottom of page How many of these adults are men and how many are women? Who is the oldest man who presently lives in this household? Who is the next oldest man who presently lives in this household? Etc. Who is the oldest woman who presently lives in this household? Who is the next oldest woman who presently lives in this household? Etc. The person in your household that I need to speak with is . If "you," go to page 3 To correct respondent Hello, I'm calling for the I'm a member of a special research team. We're doing a study of residents regarding their health practices and day-to-day living habits. You have been randomly chosen to be included in the study from among the adult members of your household. The interview will only take a short time, and all the information obtained in this study will be confidential. Section 1: Health Status 1. Would you say that in general your health is: (33) Please Read a. Excellent 1 b. Very good 2 c. Good 3 d. Fair 4 or e. Poor 5 Do not Don't know/Not Sure 7 read these responses Refused 9 2. 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? (34-35) a. Number of days __ __ b. None 8 8 Don't know/Not sure 7 7 Refused 9 9 3. 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? (36-37) a. Number of days __ __ b. None If Q. 2 also "None," go to Q. 5 (p. 5) 8 8 Don't know/Not sure 7 7 Refused 9 9 4. 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? (38-39) a. Number of days __ __ b. None 8 8 Don't know/Not sure 7 7 Refused 9 9 Section 2: Health Care Access 5. Do you have any kind of health care coverage, including health insurance, prepaid plans such as HMOs, or government plans such as Medicare? (40) a. Yes 1 b. No Go to Q. 7b (p. 7) 2 Don't know/Not sure Go to Q. 12 (p. 9) 7 Refused Go to Q. 12 (p. 9) 9 6. Do you have Medicare? (41) Medicare is a a. Yes Go to Q. 8 (p. 7) 1 coverage plan for people 65 b. No 2 or over and for certain Don't know/not sure 7 disabled people Refused 9 7a. What type of health care coverage do you use to pay for most of your medical care? (42-43) Is it coverage through: Please Read a. Your employer Go to Q. 8 (p. 7) 0 1 b. Someone else's employer Go to Q. 8 (p. 7) 0 2 c. A plan that you or someone else buys on your own Go to Q. 8 (p. 7) 0 3 d. Medicare Go to Q. 8 (p. 7) 0 4 e. Medicaid or Medical Assistance [or substitute state program name] Go to Q. 8 (p. 7) 0 5 f. The military, CHAMPUS, or the VA [or CHAMP-VA] Go to Q. 8 (p. 7) 0 6 g. The Indian Health Service [or the Alaska Native Health Service] Go to Q. 8 (p. 7) 0 7 or h. Some other source Go to Q. 8 (p. 7) 0 8 Do not None Go to Q. 11 (p. 9) 8 8 read these responses Don't know/Not sure Go to Q. 8 (p. 7) 7 7 Refused Go to Q. 8 (p. 7) 9 9 7b. There are some types of coverage you may not have considered. Please tell me if you have any of the following: (44-45) Coverage through: Please Read If more than a. Your employer 0 1 one, ask "Which type b. Someone else's employer 0 2 do you use to pay for most c. A plan that you or someone else buys on of your your own 0 3 medical care?" d. Medicare 0 4 e. Medicaid or Medical Assistance [or substitute state program name] 0 5 f. The military, CHAMPUS, or the VA [or CHAMP-VA] 0 6 g. The Indian Health Service [or the Alaska Native Health Service] 0 7 or h. Some other source 0 8 Do not None Go to Q. 11 (p. 9) 8 8 read these responses Don't know/Not sure Go to Q. 12 (p. 9) 7 7 Refused Go to Q. 12 (p. 9) 9 9 8. About how long have you had [fill in type (Medicare/Medicaid/this particular health care coverage) from Q. 6, Q. 7a, or Q. 7b]? (46) Read only if necessary If necessary, a. For less than 12 months (1 to 12 months) 1 say "The coverage you b. For less than 2 years (1 to 2 years) 2 use currently to pay for c. For less than 3 years (2 to 3 years) 3 most of your medical care" d. For less than 5 years (3 to 5 years) 4 e. For 5 or more years 5 Don't know/Not sure 7 Refused 9 9. Is there a book or list of doctors associated with your [fill in type (Medicare/Medicaid/health coverage) from Q. 6, Q. 7a, or Q. 7b] plan? (47) If necessary, say "The coverage you use currently to pay for most of your medical care" a. Yes 1 If "no" or b. No 2 "Dk/Ns," probe "Is there a Don't know/Not sure 7 certain number you are supposed Refused 9 to call to find a doctor to go to?" 10. Does your [fill in type (Medicare/Medicaid/health coverage) from Q. 6, Q. 7a, or Q. 7b] plan require you to select a certain doctor or clinic for all of your routine care? (48) If necessary, say "The coverage you use currently to pay for most of your medical care" a. Yes Go to Q. 12 (p. 9) 1 Do not include emergency care b. No Go to Q. 12 (p. 9) 2 or referral to a specialist Don't know/Not sure Go to Q. 12 (p. 9) 7 Refused Go to Q. 12 (p. 9) 9 11. About how long has it been since you had health care coverage? (49) Read Only if Necessary a. Within the past 6 months (1 to 6 months ago) 1 b. Within the past year (6 to 12 months ago) 2 c. Within the past 2 years (1 to 2 years ago) 3 d. Within the past 5 years (2 to 5 years ago) 4 e. 5 or more years ago 5 Don't know/Not sure 7 Never 8 Refused 9 12. Was there a time during the last 12 months when you needed to see a doctor, but could not because of the cost? (50) a. Yes 1 b. No 2 Don't know/Not sure 7 Refused 9 13. About how long has it been since you last visited a doctor for a routine checkup? (51) Read Only if Necessary a. Within the past year (1 to 12 months ago) 1 b. Within the past 2 years (1 to 2 years ago) 2 c. Within the past 5 years (2 to 5 years ago) 3 d. 5 or more years ago 4 Don't know/Not sure 7 Never 8 Refused 9 Section 3: Diabetes 14. Have you ever been told by a doctor that you have diabetes? (52) If "Yes" and female, ask a. Yes 1 "Was this only when b. Yes, but female told only during pregnancy 2 you were pregnant?" c. No 3 Don't know/Not sure 7 Refused 9 Section 4: Exercise The next few questions are about exercise, recreation, or physical activities other than your regular job duties. 15. During the past month, did you participate in any physical activities or exercises such as running, calisthenics, golf, gardening, or walking for exercise? (53) a. Yes 1 b. No Go to Q. 25 (p. 14) 2 Don't know/Not sure Go to Q. 25 (p. 14) 7 Refused Go to Q. 25 (p. 14) 9 16. What type of physical activity or exercise did you spend the most time doing during the past month? (54-55) Activity (specify): _________________________ __ __ See coding list A Refused Go to Q. 20 (p. 12) 9 9 Ask Q. 17 only if answer to Q. 16 is running, jogging, walking, or swimming. All others, go to Q. 18. 17. How far did you usually walk/run/jog/swim? (56-58) See coding Miles and tenths __ __.__ list B if response is Don't know/Not sure 7 7 7 not in miles and tenths Refused 9 9 9 18. How many times per week or per month did you take part in this activity during the past month? (59-61) a. Times per week 1 __ __ b. Times per month 2 __ __ Don't know/Not sure 7 7 7 Refused 9 9 9 19. And when you took part in this activity, for how many minutes or hours did you usually keep at it? (62-64) Hours and minutes __ :__ __ Don't know/Not sure 7 7 7 Refused 9 9 9 20. Was there another physical activity or exercise that you participated in during the last month? (65) a. Yes 1 b. No Go to Q. 25 (p. 14) 2 Don't know/Not sure Go to Q. 25 (p. 14) 7 Refused Go to Q. 25 (p. 14) 9 21. What other type of physical activity gave you the next most exercise during the past month? (66-67) Activity (specify): __________________________ __ __ See coding list A Refused Go to Q. 25 (p. 14) 9 9 Ask Q. 22 only if answer to Q. 21 is running, jogging, walking, or swimming. All others go to Q. 23 (p. 13). 22. How far did you usually walk/run/jog/swim? (68-70) See coding list B if Miles and tenths __ __.__ response is not in Don't know/Not sure 7 7 7 miles and tenths Refused 9 9 9 23. How many times per week or per month did you take part in this activity? (71-73) a. Times per week 1 __ __ b. Times per month 2 __ __ Don't know/Not sure 7 7 7 Refused 9 9 9 24. And when you took part in this activity, for how many minutes or hours did you usually keep at it? (74-76) Hours and minutes __ : __ __ Don't know/Not sure 7 7 7 Refused 9 9 9 Section 5: Tobacco Use 25. Have you smoked at least 100 cigarettes in your entire life? (77) 5 packs = 100 a. Yes 1 ciga- rettes b. No Go to Section 6: Nutrition (p. 16) 2 Don't know/Not sure Go to Section 6: Nutrition (p. 16) 7 Refused Go to Section 6: Nutrition (p. 16) 9 26. Do you now smoke cigarettes everyday, some days, or not at all? (78) a. Everyday 1 b. Some days Go to Q. 27a 2 c. Not at all Go to Q. 29 (p. 15) 3 Refused Go to Section 6: Nutrition (p. 16) 9 27. On the average, about how many cigarettes a day do you now smoke? (79-80) 1 pack = 20 Number of cigarettes Go to Q. 28 (p. 15) __ __ ciga- rettes Don't know/Not sure Go to Q. 28 (p. 15) 7 7 Refused Go to Q. 28 (p. 15) 9 9 27a. On the average, when you smoked during the past 30 days, about how many cigarettes did you smoke a day? (81-82) 1 pack = 20 Number of cigarettes Go to Section 6: Nutrition (p. 16)__ __ ciga- rettes Don't know/Not sure Go to Section 6: Nutrition (p. 16) 7 7 Refused Go to Section 6: Nutrition (p. 16) 9 9 28. During the past 12 months, have you quit smoking for 1 day or longer? (83) a. Yes Go to Section 6: Nutrition (p. 16) 1 b. No Go to Section 6: Nutrition (p. 16) 2 Don't know/Not sure Go to Section 6: Nutrition (p. 16) 7 Refused Go to Section 6: Nutrition (p. 16) 9 29. About how long has it been since you last smoked cigarettes regularly, that is, daily? (84-85) Read Only if Necessary a. Within the past month (0 to 1 month ago) 0 1 b. Within the past 3 months (1 to 3 months ago) 0 2 c. Within the past 6 months (3 to 6 months ago) 0 3 d. Within the past year (6 to 12 months ago) 0 4 e. Within the past 5 years (1 to 5 years ago) 0 5 f. Within the past 15 years (5 to 15 years ago) 0 6 g. 15 or more years ago 0 7 Don't know/Not sure 7 7 Never smoked regularly 8 8 Refused 9 9 Section 6: Nutrition These next questions are about the foods you usually eat or drink. Please tell me how often you eat or drink each one, for example, twice a week, three times a month, and so forth. Remember, I am only interested in the foods you eat. Include all foods you eat, both at home and away from home. 30. How often do you drink fruit juices such as orange, grapefruit, or tomato? (86-88) a. Per day 1 __ __ b. Per week 2 __ __ c. Per month 3 __ __ d. Per year 4 __ __ e. Never 5 5 5 Don't know/Not sure 7 7 7 Refused 9 9 9 31. Not counting juice, how often do you eat fruit? (89-91) a. Per day 1 __ __ b. Per week 2 __ __ c. Per month 3 __ __ d. Per year 4 __ __ e. Never 5 5 5 Don't know/Not sure 7 7 7 Refused 9 9 9 32. How often do you eat green salad? (92-94) a. Per day 1 __ __ b. Per week 2 __ __ c. Per month 3 __ __ d. Per year 4 __ __ e. Never 5 5 5 Don't know/Not sure 7 7 7 Refused 9 9 9 33. How often do you eat potatoes not including french fries, fried potatoes, or potato chips? (95-97) a. Per day 1 __ __ b. Per week 2 __ __ c. Per month 3 __ __ d. Per year 4 __ __ e. Never 5 5 5 Don't know/Not sure 7 7 7 Refused 9 9 9 34. How often do you eat carrots? (98-100) a. Per day 1 __ __ b. Per week 2 __ __ c. Per month 3 __ __ d. Per year 4 __ __ e. Never 5 5 5 Don't know/Not sure 7 7 7 Refused 9 9 9 35. Not counting carrots, potatoes, or salad, how many servings of vegetables do you usually eat? (101-103) Example: a. Per day 1 __ __ A serving of vegetables at b. Per week 2 __ __ both lunch and dinner c. Per month 3 __ __ would be two servings d. Per year 4 __ __ e. Never 5 5 5 Don't know/Not sure 7 7 7 Refused 9 9 9 Section 7: Weight Control 36. Are you now trying to lose weight? (104) a. Yes Go to Q. 38 1 b. No 2 Don't know/Not sure 7 Refused 9 37. Are you now trying to maintain your current weight, that is to keep from gaining weight? (105) a. Yes 1 b. No Go to Q. 40 (p. 20) 2 Don't know/Not sure Go to Q. 40 (p. 20) 7 Refused Go to Q. 40 (p. 20) 9 38. Are you eating either fewer calories or less fat to... lose weight? [if "Yes" on Q. 36] keep from gaining weight? [if "Yes" on Q. 37] (106) Probe a. Yes, fewer calories 1 for which b. Yes, less fat 2 c. Yes, fewer calories and less fat 3 d. No 4 Don't know/Not sure 7 Refused 9 39. Are you using physical activity or exercise to... lose weight? [if "Yes" on Q. 36] keep from gaining weight? [if "Yes" on Q. 37] (107) a. Yes 1 b. No 2 Don't know/Not sure 7 Refused 9 40. In the past 12 months, has a doctor, nurse, or other health professional given you advice about your weight? (108) Probe a. Yes, lose weight 1 for which b. Yes, gain weight 2 c. Yes, maintain current weight 3 d. No 4 Don't know/Not sure 7 Refused 9 Section 8: Demographics 41. What is your age? (109-110) Code age in years __ __ Don't know/Not sure 0 7 Refused 0 9 42. What is your race? (111) Would you say: Please Read a. White 1 b. Black 2 c. Asian, Pacific Islander 3 d. American Indian, Alaska Native 4 or e. Other: (specify) 5 Do not Don't know/Not sure 7 read these responses Refused 9 43. Are you of Spanish or Hispanic origin? (112) a. Yes 1 b. No 2 Don't know/Not sure 7 Refused 9 44. Are you: (113) Please Read a. Married 1 b. Divorced 2 c. Widowed 3 d. Separated 4 e. Never been married 5 or f. A member of an unmarried couple 6 Refused 9 45. How many children live in your household who are... Please Read Code 1-9 a. less than 5 years old? __ (114) 7 = 7 or more 8 = None b. 5 through 12 years old? __ (115) 9 = Refused c. 13 through 17 years old? __ (116) 46. What is the highest grade or year of school you completed? (117) Read Only if Necessary a. Never attended school or only attended kindergarten 1 b. Grades 1 through 8 (Elementary) 2 c. Grades 9 through 11 (Some high school) 3 d. Grade 12 or GED (High school graduate) 4 e. College 1 year to 3 years (Some college or technical school) 5 f. College 4 years or more (College graduate) 6 Refused 9 47. Are you currently: (118) Please Read a. Employed for wages 1 b. Self-employed 2 c. Out of work for more than 1 year 3 d. Out of work for less than 1 year 4 e. Homemaker 5 f. Student 6 g. Retired 7 or h. Unable to work 8 Refused 9 48. Is your annual household income from all sources: (119-120) Read as Appropriate a. Less than $25,000 If "no," ask e; if "yes," ask b If res- ($20,000 to less than $25,000) 0 4 pondent refuses b. Less than $20,000 If "no," code a; if "yes," ask c at any ($15,000 to less than $20,000) 0 3 income level, c. Less than $15,000 If "no," code b; if "yes," ask d code ($10,000 to less than $15,000) 0 2 refused d. Less than $10,000 If "no," code c 0 1 e. Less than $35,000 If "no," ask f ($25,000 to less than $35,000) 0 5 f. Less than $50,000 If "no," ask g ($35,000 to less than $50,000) 0 6 g. Less than $75,000 If "no," code h ($50,000 to less than $75,000) 0 7 h. $75,000 or more 0 8 Do not Don't know/Not sure 7 7 read these responses Refused 9 9 49. About how much do you weigh without shoes? (121-123) Round Weight __ __ __ fractions pounds up Don't know/Not sure 7 7 7 Refused 9 9 9 50. How much would you like to weigh? (124-126) Weight __ __ __ pounds Don't know/Not sure 7 7 7 Refused 9 9 9 51. About how tall are you without shoes? (127-129) Round Height __ /__ __ fractions ft/inches down Don't know/Not sure 7 7 7 Refused 9 9 9 52. What county do you live in? (130-132) FIPS county code __ __ __ Don't know/not sure 7 7 7 Refused 9 9 9 53. Do you have more than one telephone number in your household? (133) a. Yes 1 b. No Go to Q. 55 (p. 25) 2 Refused Go to Q. 55 (p. 25) 9 54. How many residential telephone numbers do you have? (134) Total telephone numbers [8=8 or more] __ Refused 9 55. Indicate sex of respondent. Ask Only if Necessary (135) Male Go to Section 10: HIV/AIDS (p. 30) 1 Female 2 Now I have some questions about other health services you may have received. Section 9: Women's Health 56. A mammogram is an x-ray of each breast to look for breast cancer. Have you ever had a mammogram? (136) a. Yes 1 b. No Go to Q. 59 (p. 27) 2 Don't know/Not sure Go to Q. 59 (p. 27) 7 Refused Go to Q. 59 (p. 27) 9 57. How long has it been since you had your last mammogram? (137) Read only if Necessary a. Within the past year (1 to 12 months ago) 1 b. Within the past 2 years (1 to 2 years ago) 2 c. Within the past 3 years (2 to 3 years ago) 3 d. Within the past 5 years (3 to 5 years ago) 4 e. 5 or more years ago 5 Don't know/Not sure 7 Refused 9 58. Was your last mammogram done as part of a routine checkup, because of a breast problem other than cancer, or because you've already had breast cancer? (138) a. Routine checkup 1 b. Breast problem other than cancer 2 c. Had breast cancer 3 Don't know/Not sure 7 Refused 9 59. A clinical breast exam is when a doctor, nurse, or other health professional feels the breast for lumps. Have you ever had a clinical breast exam? (139) a. Yes 1 b. No Go to Q. 62 (p. 28) 2 Don't know/Not sure Go to Q. 62 (p. 28) 7 Refused Go to Q. 62 (p. 28) 9 60. How long has it been since your last breast exam? (140) Read Only if Necessary a. Within the past year (1 to 12 months ago) 1 b. Within the past 2 years (1 to 2 years ago) 2 c. Within the past 3 years (2 to 3 years ago) 3 d. Within the past 5 years (3 to 5 years ago) 4 e. 5 or more years ago 5 Don't know/Not sure 7 Refused 9 61. Was your last breast exam done as part of a routine checkup, because of a breast problem other than cancer, or because you've already had breast cancer? (141) a. Routine Checkup 1 b. Breast problem other than cancer 2 c. Had breast cancer 3 Don't know/Not sure 7 Refused 9 62. A Pap smear is a test for cancer of the cervix. Have you ever had a Pap smear? (142) a. Yes 1 b. No Go to Q. 65 (p. 29) 2 Don't know/Not sure Go to Q. 65 (p. 29) 7 Refused Go to Q. 65 (p. 29) 9 63. How long has it been since you had your last Pap smear? (143) Read Only if Necessary a. Within the past year (1 to 12 months ago) 1 b. Within the past 2 years (1 to 2 years ago) 2 c. Within the past 3 years (2 to 3 years ago) 3 d. Within the past 5 years (3 to 5 years ago) 4 e. 5 or more years ago 5 Don't know/Not sure 7 Refused 9 64. Was your last Pap smear done as part of a routine exam, or to check a current or previous problem? (144) a. Routine exam 1 b. Check current or previous problem 2 Other 3 Don't know/Not sure 7 Refused 9 65. Have you had a hysterectomy? (145) a. Yes Go to Section 10: HIV/AIDS (p. 30) 1 A hysterec- tomy is an b. No 2 operation to remove the Don't know/Not sure 7 uterus (womb) Refused 9 If respondent 45 years old or older, go to Section 10: HIV/AIDS (p. 30). 66. To your knowledge, are you now pregnant? (146) a. Yes 1 b. No 2 Don't know/Not sure 7 Refused 9 Section 10: HIV/AIDS If respondent is 65 years old or older, go to Closing Statement. The next few questions are about the national health problem of HIV, the virus that causes AIDS. Please remember that your answers are strictly confidential and that you don't have to answer every question if you don't want to. 67. If you had a child in school, at what grade do you think he or she should begin receiving education in school about HIV infection and AIDS? (147-148) Code 01 a. Grade __ __ thru 12 b. Kindergarten 5 5 c. Never 8 8 Don't know/Not sure 7 7 Refused 9 9 68. If you had a teenager who was sexually active, would you encourage him or her to use a condom? (149) a. Yes 1 b. No 2 Would give other advice 3 Don't know/Not sure 7 Refused 9 69. What are your chances of getting infected with HIV, the virus that causes AIDS? (150) Would you say: Please Read a. High 1 b. Medium 2 c. Low 3 or d. None 4 Not applicable Go to Q. 71 (p. 32) 5 Do not read these Don't know/Not sure 7 responses Refused 9 70. Have you ever had your blood tested for HIV? (151) a. Yes Go to Q. 71 (p. 32) 1 b. No 2 Don't know/Not sure 7 Refused 9 71a. Have you donated blood since March 1985? (152) a. Yes 1 b. No Go to Q. 76 (p. 34) 2 Don"t know/Not sure Go to Q. 76 (p. 34) 7 Refused Go to Q. 76 (p. 34) 9 72a. When did you last donate blood? (153-156) Code month and year Go to Q. 76 (p. 34) __ __ /__ __ Don't know/Not sure Go to Q. 76 (p. 34) 7 7 7 7 Refused Go to Q. 76 (p. 34) 9 9 9 9 71. When was your last blood test for HIV? (157-160) Code month and year __ __ /__ __ Don't know/Not sure 7 7 7 7 Refused 9 9 9 9 72. What was the main reason you had your last blood test for HIV? (161-162) Reason code __ __ Read only if necessary a. For hospitalization or surgical procedure 0 1 b. To apply for health insurance 0 2 c. To apply for life insurance 0 3 d. For employment 0 4 e. To apply for a marriage license 0 5 f. For military induction or military service 0 6 g. For immigration 0 7 h. Just to find out if you were infected 0 8 i. Because of referral by a doctor 0 9 j. Because of pregnancy 1 0 k. Referred by your sex partner 1 1 l. Because it was part of a blood donation process Go to Q. 76 (p. 34) 1 2 m. For routine check-up 1 3 n. Because of occupational exposure 1 4 o. Because of illness 1 5 p. Because I am at risk for HIV 1 6 q. Other 8 7 Don't know/Not sure 7 7 Refused 9 9 73. Where did you have your last blood test for HIV? (163-164) Facility Code __ __ Read only if necessary a. Private doctor, HMO 0 1 b. Blood bank, plasma center, Red Cross 0 2 c. Health department 0 3 d. AIDS clinic, counseling, testing site 0 4 e. Hospital, emergency room, outpatient clinic 0 5 f. Family planning clinic 0 6 g. Prenatal clinic, obstetrician's office 0 7 h. Tuberculosis clinic 0 8 i. STD clinic 0 9 j. Community health clinic 1 0 k. Clinic run by employer 1 1 l. Insurance company clinic 1 2 m. Other public clinic 1 3 n. Drug treatment facility 1 4 o. Military induction or military service site 1 5 p. Immigration site 1 6 q. At home, home visit by nurse or health worker 1 7 r. At home using self-sampling kit 1 8 s. In jail or prison 1 9 t. Other 8 7 Don't know/Not sure 7 7 Refused 9 9 74. Did you receive the results of your last test? (165) a. Yes 1 b. No Go to Q. 76 2 Don't know/Not sure Go to Q. 76 7 Refused Go to Q. 76 9 75. Did you receive counseling or talk with a health care professional about the results of your test? (166) a. Yes 1 b. No 2 Don't know/Not sure 7 Refused 9 76. Some people use condoms to keep from getting infected with HIV through sexual activity. How effective do you think a properly used condom is for this purpose? (167) Would you say: Please read a. Very effective 1 b. Somewhat effective 2 or c. Not at all effective 3 Don't know how effective 4 Do not read these Don't know method 5 responses Refused 9 These next few questions are about your personal sexual behavior, and I want to remind you that your answers are confidential. 77. Due to what you know about HIV, have you changed your sexual behavior in the last 12 months? (168) a. Yes 1 b. No Go to Closing Statement 2 Don't know/Not sure Go to Closing Statement 7 Refused Go to Closing Statement 9 78. Have you: Please Read Yes No Dk/Ns Ref a. Had sexual intercourse with only one partner? 1 2 7 9 (169) b. Used condoms for protection? 1 2 7 9 (170) c. Been more careful in selecting sexual partners? 1 2 7 9 (171) Closing Statement That's my last question. Everyone's answers will be combined to give us information about the health practices of people in this state. Thank you very much for your time and cooperation. OR Transition to Modules and/or State-added Questions Finally, I have just a few questions left about some other health topics. Activity List for Common Leisure Activities Coding List A Code Description 01. Aerobics class 02. Backpacking 03. Badminton 04. Basketball 05. Bicycling for pleasure 06. Boating (canoeing, rowing, sailing for pleasure or camping) 07. Bowling 08. Boxing 09. Calisthenics 10. Canoeing/rowing - in competition 11. Carpentry 12. Dancing-aerobics/ballet 13. Fishing from river bank or boat 14. Gardening (spading, weeding, digging, filling) 15. Golf 16. Handball 17. Health club exercise 18. Hiking - cross-country 19. Home exercise 20. Horseback riding 21. Hunting large game - deer, elk 22. Jogging 23. Judo/karate 24. Mountain climbing 25. Mowing lawn 26. Paddleball 27. Painting/papering house 28. Racketball 29. Raking lawn 30. Running 31. Rope skipping 32. Scuba diving 33. Skating - ice or roller 34. Sledding, tobogganing 35. Snorkeling 36. Snowshoeing 37. Snow shoveling by hand 38. Snow blowing 39. Snow skiing 40. Soccer 41. Softball 42. Squash 43. Stair climbing 44. Stream fishing in waders 45. Surfing 46. Swimming laps 47. Table tennis 48. Tennis 49. Touch football 50. Volleyball 51. Walking 52. Waterskiing 53. Weight lifting 54. Other______________ 55. Bicycling machine exercise 56. Rowing machine exercise Coding List B Lap Swimming Size pool/Laps 50 ft. pool: 10 laps = .1 mile 100 ft. pool: 5 laps = .1 mile 50 meter pool: 3 laps = .1 mile Running/Jogging/Walking 1/2 mile = .5 mile 1/4 mile = .3 mile 1/8 mile = .1 mile 1 block = .1 mile