BEHAVIORAL RISK FACTOR SURVEILLANCE SYSTEM
                               (Project Title)
    												    Page    1    
						         1991      		
    					         (Project Number)			Date 3-18-92

                              1991 FINAL DATA LAYOUT        
                                   (File Name)
Sec.          											
┌──┐Input		┌──┐		┌──┐								
└──┘Validity	└──┘Yes	└──┘No   		
    					         			
┌──┐
└──┘Output
                     
TYPE OF FILE	
┌──┐                 ┌──┐High or
└──┘Floppy Diskette  └──┘Double density
┌──┐
└──┘Magnetic Tape
┌──┐
└──┘Disk
┌──┐
└──┘ISAM				          	    *FILE SEQUENCE                
┌──┐			 
└──┘Key Tape             Data                    Positions
┌──┐                                                      
└──┘Paper Tape                                            

RECORD DATA                               MISCELLANEOUS DATA

Label                                     Volume               Per          
Record Length                             Source                            
Blocking Factor                           Recipient                         

Field
Size	Columns or
Positions	Field Title (Name)
(Indicate Filler if not used)	
      Comments	
  28	   1-28	IDENTIFICATION INFORMATION		
   2	    1-2	FIPS STATE CODE		
   1	     3	STRATUM CODE		
   5	    4-8	PSU NUMBER		
   1	     9	RECORD NUMBER		
   6	   10-15	DATE OF INTERVIEW		
   2	   16-17	INTERVIEWER IDENTIFICATION		
K:\SHARE\BSB\BRFS91\LAYOUT91.FIN                                  revised 3/92

RECORD SPECIFICATION - CONTINUATION SHEET
FOR BRFS - 1991                                                Page     2     
QUESTIONNAIRE                                                  Date  3-18-92

Field
Size	
Columns or
Positions	Field Title (Name)
(Indicate Filler
if not used)	

        Comments	
   8	   18-25  	TELEPHONE NUMBER	First Eight Digits of Phone#	
				
   2 	   26-27	FINAL DISPOSITION OF TELEPHONE CALL	01=Completed Interview
02=Refused Interview
03=Non-Working Number
04=No Answer
05=Business Telephone
06=No Eligible Respondent at     this number                07=No Eligible Respondent        could be reached during       this time
08=Language barrier              prevented completion of      interview
09=Interview terminated          within questionnaire
10=Line Busy
11=Selected Respondent           unable to respond because     of physical or mental
   impairment	
				
   1	    28	WINDDOWN	Blank=Regular Mode
    9=Wind Down Mode	
				
   2	   29-30	NUMBER OF ADULTS
IN HOUSEHOLD	(18 Years Plus)	
				
   1	    31	NUMBER OF ADULT
MEN IN HOUSEHOLD	
(18 Years Plus)	
				
   1	    32	NUMBER OF ADULT
WOMEN IN HOUSEHOLD	
(18 Years Plus)	

RECORD SPECIFICATION - CONTINUATION SHEET
FOR BRFS - 1991                                                Page     3     
QUESTIONNAIRE                                                  Date  3-18-92

Field
Size	
Columns or
Positions	Field Title (Name)
(Indicate Filler
if not used)	

        Comments	
	          	  **SECTION A:**
    SEATBELTS		
   1	    33   	SEATBELT USE	1=Always
2=Nearly Always
3=Sometimes
4=Seldom
5=Never
7=Don't Know/Not Sure
8=Never Drive or Ride in a     Car
9=Refused	
		  **SECTION B:**
   HYPERTENSION		
   1	    34	HOW LONG SINCE
BLOOD PRESSURE
TAKEN?	1=Within the past 6 months
2=Within the past year     
3=Within the past two years
4=Within the past five years
5=More than 5 years ago
7=Don't Know/Not Sure
8=Never
9=Refused	
				
   1	    35	TOLD YOU HAVE HIGH
BLOOD PRESSURE?	1=No
2=Yes, By a Doctor
3=Yes, By a Nurse
4=Yes, By a Health             Professional
7=Don't Know/Not Sure
9=Refused	
				
   1	    36	TOLD BLOOD PRESSURE HIGH MORE THAN ONCE	1=More Than Once
2=Only Once
7=Don't Know/Not Sure
9=Refused	
				
   1 	    37	MEDICINE PRESCRIBED FOR
HIGH BLOOD PRESSURE	1=Yes
2=No
7=Don't Know/Not Sure
9=Refused	
RECORD SPECIFICATION - CONTINUATION SHEET
FOR BRFS - 1991                                                Page     4     
QUESTIONNAIRE                                                  Date  3-18-92

Field
Size	
Columns or
Positions	Field Title (Name)
(Indicate Filler
if not used)	

        Comments	
				
   	   	  **SECTION C:**
     EXERCISE		
				
   1	    38	DID YOU PARTICIPATE IN ACTIVITIES SUCH AS RUN, WALK, GARDENING, OR GOLF?	1=Yes
2=No
7=Don't Know/Not Sure
9=Refused	
				
   2	  39-40	TYPE OF PHYSICAL ACTIVITY OR EXERCISE	99=Refused
(See Last Page, Coding List A for Activity Code)	
				
   3	   41-43	HOW FAR DID YOU
WALK/RUN/JOG/OR SWIM?	Coded in Miles and Tenths
(###-One Implied Decimal           Place)
777=Don't Know/Not Sure
999=Refused	
				
   3	   44-46	HOW OFTEN TAKE PART IN ACTIVITY?	101-198=# Times Per Week
201-298=# Times Per Month
    777=Don't Know/Not Sure
    999=Refused	
				
   3	   47-49	HOW MANY MINUTES OR HOURS TAKE PART IN ACTIVITY?	Coded in Hours and Minutes
777=Don't Know/Not Sure
999=Refused	
				
   1	    50	WAS THERE ANOTHER EXERCISE OR ACTIVITY YOU PARTICI-
PATED IN?	1=Yes
2=No
7=Don't Know/Not Sure
9=Refused	

RECORD SPECIFICATION - CONTINUATION SHEET
FOR BRFS - 1991                                                Page     5     
QUESTIONNAIRE                                                  Date  3-18-92

Field
Size	
Columns or
Positions	Field Title (Name)
(Indicate Filler
if not used)	

        Comments	
   2 	   51-52  	TYPE OF PHYSICAL ACTIVITY, GIVE NEXT MOST EXERCISE?	99=Refused
(See Last Page, Coding List   A, for Activity Code)	
				
   3	   53-55	HOW FAR DID YOU WALK/RUN/JOG/OR SWIM?	Coded in Miles and Tenths
(###-One Implied Decimal           Place)
777=Don't Know/Not Sure
999=Refused	
				
   3	   56-58	HOW OFTEN DID YOU TAKE PART IN ACTIVITY?	101-198=# Times per Week
201-298=# Times per Month
    777=Don't Know/Not Sure
    999=Refused	
				
   3	   59-61	HOW MANY MINUTES OR HOURS DID YOU TAKE PART IN
ACTIVITY?	Coded in Hours and Minutes
777=Don't Know/Not Sure
999=Refused

		  **SECTION D:**
  WEIGHT CONTROL		
				
   1	    62	TRYING TO LOSE
WEIGHT?	1=Yes
2=No
9=Refused	

				

RECORD SPECIFICATION - CONTINUATION SHEET
FOR BRFS - 1991                                                Page     6     
QUESTIONNAIRE                                                  Date  3-18-92

Field
Size	
Columns or
Positions	Field Title (Name)
(Indicate Filler
if not used)	

        Comments	
   1	    63   	EATING FEWER CALORIES TO LOSE WEIGHT?	1=Yes
2=No
7=Don't Know/Not Sure
9=Refused	
				
   1	    64	INCREASED PHYSICAL ACTIVITY TO LOSE WEIGHT?	1=Yes
2=No
7=Don't Know/Not Sure
9=Refused	
				
		  **SECTION E:**
   TOBACCO USE		
				
   1	    65	SMOKED 100 CIGARETTES IN LIFE?	1=Yes
2=No
7=Don't Know/Not Sure
9=Refused	
				
   2	   66-67	AGE STARTED SMOKING
REGULARLY?	Coded in Years
77=Don't Know/Not Sure
99=Refused	
				
   1	    68	DO YOU SMOKE NOW?	1=Yes
2=No
9=Refused	
				
   2	   69-70	NUMBER OF CIGARETTES SMOKE A DAY?	01-87=# of Cigarettes
   88=Don't Smoke Regularly
   99=Refused	
				
   1	    71	QUIT SMOKING A DAY OR LONGER IN PAST
YEAR?	1=Yes
2=No
7=Don't Know/Not Sure
9=Refused	

RECORD SPECIFICATION - CONTINUATION SHEET
FOR BRFS - 1991                                                Page     7     
QUESTIONNAIRE                                                  Date  3-18-92

Field
Size	
Columns or
Positions	Field Title (Name)
(Indicate Filler
if not used)	

        Comments	
   1	    72    	HOW LONG SINCE YOU SMOKED REGULARLY?	1=Less than 1 month
2=1 month to less than 3        months
3=3 months to less than 6 
  months
4=6 months to less than 1       year
5=1 year to less than 5         years
6=5 or more years
7=Don't Know/Not Sure
9=Refused	
		  **SECTION F:**
     ALCOHOL            CONSUMPTION		
   1	    73	HAVE YOU HAD ANY ALCOHOLIC BEVERAGES IN PAST MONTH	1=Yes
2=No
9=Refused	
   3	  74-76	IN PAST MONTH, HOW OFTEN DID YOU DRINK ALCOHOLIC
BEVERAGES?  (DAYS PER WEEK/MONTH)	101-107=# Days per Week
201-231=# Days per Month
    777=Don't Know/Not Sure
    999=Refused	
				
   2	   77-78	ON THE DAYS WHEN YOU DRINK, ABOUT HOW MANY DRINKS?	01-76=# of Drinks
   77=Don't Know/Not Sure
   99=Refused	
				
   2	   79-80	HOW MANY TIMES DURING THE PAST MONTH DID YOU HAVE
5 OR MORE DRINKS ON AN OCCASION?	01-76=# Times
   88=None
   77=Don't Know/Not Sure
   99=Refused	
				
   2	   81-82	# TIMES DRIVEN WHEN YOU'VE HAD TOO MUCH TO DRINK	01-76=# Times
   88=None
   77=Don't Know/Not Sure
   99=Refused	

RECORD SPECIFICATION - CONTINUATION SHEET
FOR BRFS - 1991                                                Page     8     
QUESTIONNAIRE                                                  Date  3-18-92

Field
Size	
Columns or
Positions	Field Title (Name)
(Indicate Filler
if not used)	

        Comments	
				
   	   	  **SECTION G:**
 PREVENTIVE HEALTH
     PRACTICES		
   1	    83	HOW LONG SINCE LAST VISITED DOCTOR FOR ROUTINE CHECKUP	1=Within Past Year
2=Within Past Two Years
3=Within Past Five Years
4=More than Five Years Ago
7=Don't Know/Not Sure
8=Never
9=Refused	
				
   1	    84	EVER HAD CHOLESTEROL CHECKED?	1=Yes
2=No
7=Don't Know/Not Sure
9=Refused	
				
   1	    85	HOW LONG SINCE LAST HAD CHOLESTEROL CHECKED?	1=Within Past Year
2=Within Past Two Years
3=Within Past Five Years
4=More than Five Years Ago
7=Don't Know/Not Sure
8=Never
9=Refused	
				
   1	    86	TOLD CHOLESTEROL LEVEL IN NUMBERS	1=Yes
2=No
7=Don't Know/Not Sure
9=Refused	
				
   3	   87-89	WHAT IS YOUR CHOLESTEROL LEVEL?	Record the Number
777=Don't Know/Not Sure
999=Refused	

RECORD SPECIFICATION - CONTINUATION SHEET
FOR BRFS - 1991                                                Page     9     
QUESTIONNAIRE                                                  Date  3-18-92

Field
Size	
Columns or
Positions	Field Title (Name)
(Indicate Filler
if not used)	

        Comments	
   1	    90   	EVER BEEN TOLD BY DR. OR OTHER HLTH. PROFESSIONAL THAT BLOOD CHOLESTEROL
IS HIGH?	1=Yes
2=No
7=Don't Know/Not Sure
9=Refused	
				
   1	    91	EVER BEEN TOLD BY  A DOCTOR THAT YOU HAVE DIABETES?	1=Yes
2=No
7=Don't Know/Not Sure
9=Refused	
				
    		   **SECTION H:**
  HEALTH INSURANCE		
				
   1	    92	HAVE ANY KIND OF HEALTH CARE PLAN?	1=Yes
2=No
7=Don't Know/Not Sure
9=Refused	
				
   1	    93	ARE HOSPITAL BILLS COVERED BY HEALTH PLAN?	1=All
2=Most
3=Some
4=None
7=Don't Know/Not Sure
9=Refused	
				
   1	    94	ARE DOCTOR VISITS COVERED BY HEALTH PLAN?	1=All
2=Most
3=Some
4=None
7=Don't Know/Not Sure
9=Refused	

RECORD SPECIFICATION - CONTINUATION SHEET
FOR BRFS - 1991                                                Page     10    
QUESTIONNAIRE                                                  Date  3-18-92

Field
Size	
Columns or
Positions	Field Title (Name)
(Indicate Filler
if not used)	

        Comments	
   1   	    95   	ARE CHECKUPS OR PREVENTIVE SERVICES COVERED BY
HEALTH PLAN?	1=All
2=Most
3=Some
4=None
7=Don't Know/Not Sure
9=Refused	
				
   1	    96	IN LAST YEAR, TIME WHEN YOU COULDN'T AFFORD TO SEE DOCTOR?	1=Yes
2=No
7=Don't Know/Not Sure
9=Refused	
				
		  **SECTION I:**
   DEMOGRAPHICS		
				
   2	   97-98	HOW OLD WERE YOU ON YOUR LAST BIRTHDAY?	18-99=All Ages*
   07=Don't Know/Not Sure
   09=Refused             
*(99 is also coded for ages
greater than 99)	
				
   1	    99	RACE	1=White
2=Black
3=Asian or Pacific Islander
4=Aleutian, Eskimo, or 
  American Indian
5=Other
7=Don't Know/Not Sure
9=Refused	
				
   1	    100	HISPANIC ORIGIN	1=Yes
2=No
7=Don't Know/Not Sure
9=Refused	

RECORD SPECIFICATION - CONTINUATION SHEET
FOR BRFS - 1991                                                Page     11    
QUESTIONNAIRE                                                  Date  3-18-92

Field
Size	
Columns or
Positions	Field Title (Name)
(Indicate Filler
if not used)	

        Comments	
   1	    101   	HIGHEST GRADE OR YEAR OF SCHOOL COMPLETED	1=Eighth Grade or Less
2=Some High School
3=High School Grad or GED       Certificate
4=Some Technical School
5=Technical School Graduate
6=Some College
7=College Graduate
8=Post Grad or Professional
  Degree
9=Refused	
				
   1	    102	EMPLOYMENT STATUS	1=Employed for Wages
2=Self Employed
3=Out of Work for More Than
  One Year
4=Out of Work for Less Than
  One Year
5=Homemaker
6=Student
7=Retired
9=Refused 	
				
   1	    103	MARITAL STATUS	1=Married
2=Divorced
3=Widowed
4=Separated
5=Never Been Married
6=Member of Unmarried Couple
9=Refused	
				
   1	    104	TOTAL HOUSEHOLD
INCOME	1=Less than $10,000
2=$10 to less than $15,000
3=$15 to less than $20,000
4=$20 to less than $25,000
5=$25 to less than $35,000
6=$35 to $50,000
7=Over $50,000
8=Don't Know/Not Sure
9=Refused	

RECORD SPECIFICATION - CONTINUATION SHEET
FOR BRFS - 1991                                                Page     12    
QUESTIONNAIRE                                                  Date  3-18-92

Field
Size	
Columns or
Positions	Field Title (Name)
(Indicate Filler
if not used)	

        Comments	
   3	  105-107 	WEIGHT WITHOUT SHOES	Coded in Pounds
777=Don't Know/Not Sure
999=Refused	
				
   3	  108-110	HEIGHT WITHOUT SHOES	Coded in Feet and Inches
777=Don't Know/Not Sure
999=Refused	
				
   1	    111	SEX	1=Male
2=Female	
				
		  **SECTION J:**
  WOMEN'S HEALTH		
				
   1	    112	HAVE YOU EVER HAD A MAMMOGRAM?	1=Yes
2=No
7=Don't Know/Not Sure
9=Refused	
				
   1	    113	HOW LONG SINCE LAST MAMMOGRAM?	1=Within Past Year
2=Within Past Two Years
3=Within Past Five Years
4=More than Five Years Ago
7=Don't Know/Not Sure
8=Never
9=Refused	
				
   1	    114	LAST MAMMOGRAM DONE AS PART OF A ROUTINE CHECKUP?	1=Routine Checkup
2=Breast Problem
3=Had Breast Cancer
7=Don't Know/Not Sure
9=Refused	

RECORD SPECIFICATION - CONTINUATION SHEET
FOR BRFS - 1991                                                Page     13    
QUESTIONNAIRE                                                  Date  3-18-92

Field
Size	
Columns or
Positions	Field Title (Name)
(Indicate Filler
if not used)	

        Comments	
   1	    115   	WHOSE IDEA WAS IT FOR YOU TO HAVE THIS LAST MAMMO-
GRAM?	1=Respondent's Idea
2=Doctor's Idea
3=Someone Else's Idea
7=Don't Know/Not Sure
9=Refused	
				
   1	    116	EVER HAD A BREAST PHYSICAL EXAM BY DR. OR MEDICAL
ASSISTANT?	1=Yes
2=No
7=Don't Know/Not Sure
9=Refused	
				
   1	    117	HOW LONG HAS IT BEEN SINCE LAST BREAST EXAM?	1=Within the Past Year
2=Within the Past 2 Years
3=Within the Past 5 Years
4=More than 5 Years Ago
7=Don't Know/Not Sure
8=Never
9=Refused	
				
   1	    118	WAS YOUR LAST BREAST EXAM DONE AS A PART OF A ROUTINE CHECKUP?	1=Routine Checkup
2=Breast Problem
3=Had Breast Cancer
7=Don't Know/Not Sure
9=Refused	
				
   1	    119	EVER HEARD OF A PAP SMEAR?	1=Yes
2=No
7=Don't Know/Not Sure
9=Refused	
				
   1	    120	EVER HAD A PAP SMEAR?	1=Yes
2=No
7=Don't Know/Not Sure
9=Refused	

RECORD SPECIFICATION - CONTINUATION SHEET
FOR BRFS - 1991                                                Page     14    
QUESTIONNAIRE                                                  Date  3-18-92

Field
Size	
Columns or
Positions	Field Title (Name)
(Indicate Filler
if not used)	

        Comments	
   1	    121   	WHEN WAS LAST PAP SMEAR?	1=Within Past Year
2=Within Past Two Years
3=Within Past Five Years
4=More Than 5 Years Ago
7=Don't Know/Not Sure
9=Refused	
				
   1	    122	EVER HAD A HYSTERECTOMY?	1=Yes
2=No
7=Don't Know/Not Sure
9=Refused	
				
   1	    123	ARE YOU NOW PREGNANT? (ASK ONLY FEMALES 18-45 
YEARS OF AGE)	1=Yes
2=No
7=Don't Know/Not Sure
9=Refused	
				
   2	  124-125 	WHAT MONTH IS YOUR BABY DUE?	Code Month 01-12
77=Don't Know/Not Sure
99=Refused	
				
		  **SECTION K:**
       AIDS		
				
   1	    126	EVER HEARD OF THE AIDS VIRUS?	1=Yes
2=No
7=Don't Know/Not Sure
9=Refused	
				
   1	    127	ANY DRUGS AVAILABLE WHICH CAN LENGTHEN LIFE OF
PERSON WITH AIDS?	1=Yes
2=No
7=Don't Know/Not Sure
9=Refused	

RECORD SPECIFICATION - CONTINUATION SHEET
FOR BRFS - 1991                                                Page     15    
QUESTIONNAIRE                                                  Date  3-18-92

Field
Size	
Columns or
Positions	Field Title (Name)
(Indicate Filler
if not used)	

        Comments	
   1	    128   	CAN SOMEONE WHO HAS AIDS LOOK AND FEEL WELL &
HEALTHY?	1=Yes
2=No
7=Don't Know/Not Sure
9=Refused	
				
   1	    129	CAN YOU GET INFECTED WITH THE AIDS VIRUS FROM
A:  GIVING BLOOD?	1=Yes
2=No
7=Don't Know/Not Sure
9=Refused	
				
   1	    130	CAN YOU GET INFECTED WITH THE AIDS VIRUS FROM
B:  INFECTED NURSE, DOCTOR, OR HEALTH WORKER?	1=Yes
2=No
7=Don't Know/Not Sure
9=Refused	
				
   1	    131	CAN A PREGNANT WOMAN WITH AIDS GIVE IT TO HER
BABY?	1=Yes
2=No
7=Don't Know/Not Sure
9=Refused	
				
   1	    132	DO YOU HAVE ANY CHILDREN IN KINDERGARTEN THRU 8TH GRADE?	1=Yes
2=No
7=Don't Know/Not Sure
9=Refused	
				
   1	    133	WOULD YOU ALLOW YOUR CHILD IN THE SAME CLASSROOM WITH A CHILD WITH AIDS?	1=Yes
2=No
7=Don't Know/Not Sure
9=Refused	

RECORD SPECIFICATION - CONTINUATION SHEET
FOR BRFS - 1991                                                Page     16    
QUESTIONNAIRE                                                  Date  3-18-92

Field
Size	
Columns or
Positions	Field Title (Name)
(Indicate Filler
if not used)	

        Comments	
   2	  134-135 	WHAT GRADE CHILD SHOULD BEGIN AIDS EDUCATION?	Code Grade 01-12, 55(Kinder-
garten)
88=Never
77=Don't Know/Not Sure
99=Refused	
				
   1	    136	WOULD YOU EAT IN A 
RESTAURANT IF THE COOK WAS INFECTED WITH AIDS?	1=Yes
2=No
7=Don't Know/Not Sure
9=Refused	
				
   1	    137	WOULD YOU WORK WITH SOMEONE WHO HAS AIDS VIRUS?	1=Yes
2=No
7=Don't Know/Not Sure
9=Refused	
				
   2	  138-139	WHERE COULD YOU GO TO BE TESTED FOR AIDS?	01=Private Doctor, HMO
02=Blood Bank, Plasma            Center, Red Cross
03=Health Department
04=AIDS Clinic, AIDS Testing
   Site
05=Hospital, Emergency Room
06=Family Planning Clinic
07=STD Clinic
08=Community Health Clinic,
   Primary Care Clinic
09=Company or Industry           Clinic
10=Military Induction or
   Examination
87=Other
88=No Place
77=Don't Know/Not Sure
99=Refused	

				

RECORD SPECIFICATION - CONTINUATION SHEET
FOR BRFS - 1991                                                Page     17    
QUESTIONNAIRE                                                  Date  3-18-92

Field
Size	
Columns or
Positions	Field Title (Name)
(Indicate Filler
if not used)	

        Comments	
   2	  140-141 	WHERE ELSE COULD YOU GO FOR TEST?	01=Private Doctor, HMO
02=Blood Bank, Plasma            Center, Red Cross
03=Health Department
04=AIDS Clinic, AIDS Testing
   Site
05=Hospital, Emergency Room
06=Family Planning Clinic
07=STD Clinic
08=Community Health Clinic,
   Primary Care Clinic
09=Company or Industry           Clinic
10=Military Induction or
   Examination
87=Other
88=No Place
77=Don't Know/Not Sure
99=Refused	
				
   1	   142	HOW EFFECTIVE IS CONDOM USE IN PREVENTING GETTING THE AIDS VIRUS?	1=Very Effective
2=Somewhat Effective
3=Not at all Effective
4=Don't Know How Effective
5=Don't Know Method
9=Refused	
				
   1	    143	# OF TELEPHONE NUMBERS	Total Number of Telephone
Numbers (1-8)
9=Refused	
	    **NOTE	COLUMNS 144-232 CONTAIN MODULES 1-7		
		   **MODULE 1:**
 COUNTY RESIDENCE		
   3	  144-146	WHAT COUNTY DO YOU LIVE IN?	Record County Code
777=Don't Know/Not Sure
999=Refused	

RECORD SPECIFICATION - CONTINUATION SHEET
FOR BRFS - 1991                                                Page     18    
QUESTIONNAIRE                                                  Date  3-18-92

Field
Size	
Columns or
Positions	Field Title (Name)
(Indicate Filler
if not used)	

        Comments	
				
    	      	   **MODULE 2:**
 SMOKELESS TOBACCO
        USE		
   1	    147	HAVE YOU EVER USED OR TRIED ANY SMOKELESS TOBACCO
PRODUCTS, SUCH AS, CHEWING TOBACCO OR SNUFF? 	1=Yes, Chewing Tobacco
2=Yes, Snuff
3=Yes, Both
4=No, Neither
7=Don't Know/Not Sure
9=Refused	
				
   1	    148	DO YOU CURRENTLY USE ANY SMOKELESS TOBACCO PRODUCTS,SUCH AS, CHEWING TOBACCO OR SNUFF?	1=Yes, Chewing Tobacco
2=Yes, Snuff
3=Yes, Both
4=No, Neither
7=Don't Know/Not Sure
9=Refused	
				
		   **MODULE 3:**
 COLORECTAL CANCER
     SCREENING		
   1	    149	HAVE YOU EVER HEARD OF A DIGITAL RECTAL EXAMINATION?	1=Yes
2=No
7=Don't Know/Not Sure
9=Refused	
				
   1	    150	HAVE YOU EVER HAD A DIGITAL RECTAL EXAMINATION?	1=Yes
2=No
7=Don't Know/Not Sure
9=Refused	
				
   1 	    151	WHEN DID YOU HAVE YOUR LAST DIGITAL RECTAL EXAMINATION?	1=Within Past Year
2=Within Past Two Years
3=Within Past Five Years
4=More Than Five Years Ago
7=Don't Know/Not Sure
9=Refused	
RECORD SPECIFICATION - CONTINUATION SHEET
FOR BRFS - 1991                                                Page     19    
QUESTIONNAIRE                                                  Date  3-18-92

Field
Size	
Columns or
Positions	Field Title (Name)
(Indicate Filler
if not used)	

        Comments	
   1	    152   	HAVE YOU EVER HEARD OF A BLOOD STOOL TEST?	1=Yes
2=No
7=Don't Know/Not Sure
9=Refused	
				
   1	    153	HAVE YOU EVER HAD A BLOOD STOOL TEST?	1=Yes
2=No
7=Don't Know/Not Sure
9=Refused	
				
   1	    154	WHEN DID YOU HAVE YOUR LAST BLOOD STOOL TEST?	1=Within Past Year
2=Within Past Two Years
3=Within Past Five Years
4=More Than Five Years Ago
7=Don't Know/Not Sure
9=Refused	
				
   1	    155	HAVE YOU EVER 
HEARD OF A PROCTOSCOPIC EXAMINATION?	1=Yes
2=No
7=Don't Know/Not Sure
9=Refused	
				
   1	    156	HAVE YOU EVER HAD A PROCTOSCOPIC EXAMINATION?	1=Yes
2=No
7=Don't Know/Not Sure
9=Refused	
				
   1	    157	WHEN DID YOU HAVE YOUR LAST PROCTOSCOPIC EXAMINATION?	1=Within Past Year
2=Within Past Two Years
3=Within Past Five Years
4=More Than Five Years Ago
7=Don't Know/Not Sure
9=Refused	

				
RECORD SPECIFICATION - CONTINUATION SHEET
FOR BRFS - 1991                                                Page     20    
QUESTIONNAIRE                                                  Date  3-18-92

Field
Size	
Columns or
Positions	Field Title (Name)
(Indicate Filler
if not used)	

        Comments	
				
   	   	   **MODULE 4:**
INJURY CONTROL AND
   CHILD SAFETY		
				
   1	    158	IS THERE A WORKING SMOKE DETECTOR IN YOUR HOUSEHOLD?	1=Yes
2=No
7=Don't Know/Not Sure
9=Refused	
				
   1	    159	IN THE PAST 12 MONTHS HAVE YOU USED A THERMOMETER TO TEST THE TEMPERATURE OF THE HOT WATER?	1=Yes
2=No
7=Don't Know/Not Sure
9=Refused	
				
   2	  160-161	WHAT IS THE AGE OF THE YOUNGEST CHILD IN YOUR HOUSEHOLD?	01-17=Child's Age in Years
   89=Age is Less Than One          Year
   88=No Children in                Household
   77=Don't Know/Not Sure
   99=Refused	
				
   1	    162	DO YOU HAVE THE TELEPHONE NUMBER FOR A POISON CONTROL CENTER IN YOUR AREA?	1=Yes
2=No
7=Don't Know/Not Sure
9=Refused

   1	    163	DO YOU HAVE ANY IPECAC SYRUP IN YOUR HOUSEHOLD?	1=Yes
2=No
7=Don't Know/Not Sure
9=Refused	

RECORD SPECIFICATION - CONTINUATION SHEET
FOR BRFS - 1991                                                Page     21    
QUESTIONNAIRE                                                  Date  3-18-92

Field
Size	
Columns or
Positions	Field Title (Name)
(Indicate Filler
if not used)	

        Comments	
   1	    164   	WHEN RIDING IN A
CAR, HOW OFTEN IS
THE YOUNGEST CHILD BUCKLED IN A CAR SAFETY SEAT OR SEAT BELT?	1=All the Time
2=Most of the Time
3=Sometimes
4=Rarely
5=Never
7=Don't Know/Not Sure
9=Refused	
				
		   **MODULE 5:**
   RADON TESTING		
				
   1	    165	HAVE YOU HEARD OF RADON?	1=Yes
2=No
7=Don't Know/Not Sure
9=Refused	
				
   1	    166	HAS YOUR HOUSEHOLD AIR BEEN TESTED FOR RADON GAS?	1=Yes
2=No
7=Don't Know/Not Sure
9=Refused	
				
   1	    167	DO YOU KNOW HOW TO TEST YOUR HOME FOR RADON?	1=Yes
2=No
7=Don't Know/Not Sure
9=Refused	
				
   1	    168	DOES ANYONE IN YOUR HOME PLAN TO HAVE YOUR HOME
TESTED FOR RADON?	1=Yes
2=No
7=Don't Know/Not Sure
9=Refused	
				
   1	    169	PROLONGED EXPOSURE TO RADON GAS CAN BE HARMFUL TO YOUR
HEALTH?	1=Agree
2=Disagree
7=Don't Know/Not Sure
9=Refused	
				
RECORD SPECIFICATION - CONTINUATION SHEET
FOR BRFS - 1991                                                Page     22    
QUESTIONNAIRE                                                  Date  3-18-92

Field
Size	
Columns or
Positions	Field Title (Name)
(Indicate Filler
if not used)	

        Comments	
   5	  170-174 	CAN ANY OF THE FOLLOWING CONDITIONS BE CAUSED BY
PROLONGED RADON EXPOSURE?	1=Yes
2=No
7=Don't Know/Not Sure
9=Refused	
   1	    170	HEADACHE		
   1	    171	ASTHMA		
   1	    172	ARTHRITIS		
   1	    173	LUNG CANCER		
   1	    174	OTHER CANCERS		
				
   1	    175	WHICH OF THE FOLLOWING DESCRIBES YOUR RESIDENCE?	1=Family Home, Duplex, Town-
  house
2=Apt., Condo at Basement       Level
  or on 1st or 2nd Floor
3=Apt. or Condo Above 2nd       Floor
4=Trailer or Mobile Home
5=Other
7=Don't Know/Not Sure
9=Refused	
				
		   **MODULE 6:**
    DIETARY FAT		
				
   3	  176-178   	HOW OFTEN DO YOU EAT HOT DOGS, LUNCH MEATS, OR
OTHER COLD CUTS?	101-199=Per Day
201-299=Per Week
301-399=Per Month
401-499=Per Year
    555=Never
    777=Don't Know/Not Sure
    999=Refused	

RECORD SPECIFICATION - CONTINUATION SHEET
FOR BRFS - 1991                                                Page     23    
QUESTIONNAIRE                                                  Date  3-18-92

Field
Size	
Columns or
Positions	Field Title (Name)
(Indicate Filler
if not used)	

        Comments	
   3	  179-181 	HOW OFTEN DO YOU EAT BACON OR SAUSAGE?	101-199=Per Day
201-299=Per Week
301-399=Per Month
401-499=Per Year
    555=Never
    777=Don't Know/Not Sure
    999=Refused	
				
   3	  182-184	HOW OFTEN DO YOU EAT PORK EXCEPT HAM, BACON, OR
SAUSAGE?	101-199=Per Day
201-299=Per Week
301-399=Per Month
401-499=Per Year 
    555=Never
    777=Don't Know/Not Sure
    999=Refused	
				
   3	  185-187	HOW OFTEN DO YOU EAT HAMBURGERS, CHEESEBURGERS, OR MEATLOAF?	101-199=Per Day
201-299=Per Week
301-399=Per Month
401-499=Per Year
    555=Never
    777=Don't Know/Not Sure
    999=Refused	
				
   3	  188-190	HOW OFTEN DO YOU EAT BEEF EXCEPT HAMBURGER, CHEESEBURGER, OR MEATLOAF?	101-199=Per Day
201-299=Per Week
301-399=Per Month
401-499=Per Year
    555=Never 
    777=Don't Know/Not Sure
    999=Refused	
				
   3	  191-193	HOW OFTEN DO YOU EAT FRIED CHICKEN?	101-199=Per Day
201-299=Per Week
301-399=Per Month
401-499=Per Year 
    555=Never
    777=Don't Know/Not Sure 
    999=Refused	
RECORD SPECIFICATION - CONTINUATION SHEET
FOR BRFS - 1991                                                Page     24    
QUESTIONNAIRE                                                  Date  3-18-92

Field
Size	
Columns or
Positions	Field Title (Name)
(Indicate Filler
if not used)	

        Comments	
   3	  194-196 	HOW OFTEN DO YOU EAT FRENCH FRIES OR FRIED POTATOES?	101-199=Per Day
201-299=Per Week
301-399=Per Month
401-499=Per Year
    555=Never
    777=Don't Know/Not Sure
    999=Refused	
				
   3	  197-199	HOW OFTEN DO YOU EAT CHEESE PRODUCTS?	101-199=Per Day
201-299=Per Week
301-399=Per Month
401-499=Per Year
    555=Never
    777=Don't Know/Not Sure
    999=Refused	
				
   3	  200-202	HOW OFTEN DO YOU EAT DOUGHNUTS, COOKIES, CAKE, PASTRY, AND PIES?	101-199=Per Day
201-299=Per Week
301-399=Per Month
401-499=Per Year
    555=Never
    777=Don't Know/Not Sure
    999=Refused	
				
   3	  203-205	HOW OFTEN DO YOU EAT SNACKS LIKE CHIPS OR POPCORN?	101-199=Per Day
201-299=Per Week
301-399=Per Month
401-499=Per Year
    555=Never
    777=Don't Know/Not Sure
    999=Refused	

				

				
RECORD SPECIFICATION - CONTINUATION SHEET
FOR BRFS - 1991                                                Page     25    
QUESTIONNAIRE                                                  Date  3-18-92

Field
Size	
Columns or
Positions	Field Title (Name)
(Indicate Filler
if not used)	

        Comments	
   3	  206-208 	HOW OFTEN DO YOU ADD BUTTER/MARGARINE TO BREAD,
ROLLS, OR VEGETABLES?	101-199=Per Day
201-299=Per Week
301-399=Per Month
401-499=Per Year
    555=Never
    777=Don't Know/Not Sure
    999=Refused	
				
   3	  209-211	HOW MANY EGGS DO YOU USUALLY EAT?	101-199=Per Day
201-299=Per Week
301-399=Per Month
401-499=Per Year
    555=Never
    777=Don't Know/Not Sure
    999=Refused	
				
   3	  212-214	HOW MANY GLASSES OF WHOLE MILK DO YOU DRINK?	101-199=Per Day
201-299=Per Week
301-399=Per Month
401-499=Per Year
    555=Never
    777=Don't Know/Not Sure
    999=Refused	
				
		   **MODULE 7:**
 FRUITS AND VEGETABLES		
				
   3	  215-217	HOW OFTEN DO YOU DRINK FRUIT JUICES (ORANGE, TOMATO, OR GRAPEFRUIT)?	101-199=Per Day
201-299=Per Week
301-399=Per Month
401-499=Per Year
    555=Never
    777=Don't Know/Not Sure
    999=Refused	

RECORD SPECIFICATION - CONTINUATION SHEET
FOR BRFS - 1991                                                Page     26    
QUESTIONNAIRE                                                  Date  3-18-92

Field
Size	
Columns or
Positions	Field Title (Name)
(Indicate Filler
if not used)	

        Comments	
   3	  218-220 	NOT COUNTING JUICE HOW OFTEN DO YOU EAT FRUIT?	101-199=Per Day
201-299=Per Week
301-399=Per Month
401-499=Per Year
    555=Never
    777=Don't Know/Not Sure
    999=Refused	
				
   3	  221-223	HOW OFTEN DO YOU EAT GREEN SALAD?	101-199=Per Day
201-299=Per Week
301-399=Per Month
401-499=Per Year
    555=Never
    777=Don't Know/Not Sure
    999=Refused	
				
   3	  224-226	HOW OFTEN DO YOU EAT POTATOES?	101-199=Per Day
201-299=Per Week
301-399=Per Month
401-499=Per Year
    555=Never
    777=Don't Know/Not Sure
    999=Refused	
				
   3	  227-229	HOW OFTEN DO YOU EAT CARROTS?	101-199=Per Day
201-299=Per Week
301-399=Per Month
401-499=Per Year
    555=Never
    777=Don't Know/Not Sure
    999=Refused	
				
   3	  230-232	NOT COUNTING CARROTS, POTATOES, OR SALAD, HOW MANY VEGETABLES DO YOU
USUALLY EAT?	101-199=Per Day
201-299=Per Week
301-399=Per Month
401-499=Per Year
    555=Never
    777=Don't Know/Not Sure
    999=Refused	

RECORD SPECIFICATION - CONTINUATION SHEET
FOR BRFS - 1991                                                Page    27     
QUESTIONNAIRE                                                  Date   3-18-92

Field
Size	
Columns or
Positions	Field Title (Name)
(Indicate Filler
if not used)	

        Comments	
   27	 233-259	FILLER		
  141	 260-400   	STATE SPECIFIC
INFORMATION		
   2 	 401-402	NEW RACE CODE	01=White, Non-Hispanic
02=Black, Non-Hispanic
03=Hispanic, White
04=Hispanic, Black
05=Other Hispanic
06=Asian or Pacific Islander
07=Aleutian, Eskimo, or          Am.Ind. 
08=Other
99=Unknown/Refused 	
   1 	   403	COMPUTED SMOKING STATUS	1=Current Smoker
2=Former Smoker
3=Never Smoked
4=Not Regular Smoker
9=Refused	
   4	 404-407	TOTAL NUMBER DRINKS A MONTH	0001-1000=# of Drinks
8888=Did Not Drink in the         Past Month
9999=Refused 	
   5	 408-412	WEIGHT FOR HEIGHT PERCENT OF MEDIAN	#####-(2 Implied Decimal            Places)
99999=Unknown	
   3	 413-415	BODY MASS INDEX	###-(1 Implied Decimal            Place)
999=Unknown	
   1	   416	PHYSICAL ACTIVITY LEVEL	   1=Sedentary
   2=Irregular Activity
   3=Regular Activity
   4=1990 Objective
 0,9=Unknown	
   1	   417 	COMPUTED SMOKELESS STATUS	1=Current User
2=Former User
3=Never Used
9=Unknown

RECORD SPECIFICATION - CONTINUATION SHEET
FOR BRFS - 1991                                                Page    28     
QUESTIONNAIRE                                                  Date   3-18-92

Field
Size	
Columns or
Positions	Field Title (Name)
(Indicate Filler
if not used)	

        Comments	
				
   6	 418-423	TOTAL GRAMS OF FAT CONSUMED PER DAY	######-(2 Implied Decimal            Places)
999999=Unknown	
				
   1   	   424   	SUMMARY INDEX FOR DIETARY FAT	1=Less Than or Equal to 25th
  Pecentile
2=25th-75th Pecentile
3=Greater Than 75th             Percentile
9=Unknown	
				
   5 	 425-429	TOTAL NUMBER OF SERVINGS OF FRUITS AND VEGETABLES CONSUMED PER DAY.	#####-(2 Implied Decimal
        Places
99999=Unknown 	
				
   1 	   430	SUMMARY INDEX FOR FRUITS AND VEGETABLES
	1=Less than Once Per Day or
  Never
2=Once But Less Than 3 Times
  Per Day
3=3 But Less Than 5 Times       Per Day
4=5 or More Times Per Day
9=Unknown	
				
   12	 431-442	 RISK FACTORS	0=Not At Risk
1=At Risk
9=Unknown
	
    1   	 431    	AT RISK FOR SEATBELT USE(1) (SELDOM OR NEVER)	0=Not at risk
1=At risk
9=Unknown

RECORD SPECIFICATION - CONTINUATION SHEET
FOR BRFS - 1991                                                Page    29     
QUESTIONNAIRE                                                  Date   3-18-92

Field
Size	
Columns or
Positions	Field Title (Name)
(Indicate Filler
if not used)	

        Comments	
				
   1	    432   	AT RISK FOR SEATBELT USE(2) (SOMETIMES, SELDOM OR NEVER)	0=Not At Risk
1=At Risk
9=Unknown	
				
   1	    433	AT RISK FOR SEATBELT USE(3) (NEARLY ALWAYS, SOMETIMES, SELDOM, OR NEVER)	0=Not At Risk
1=At Risk
9=Unknown	
				
   1	    434 	AT RISK FOR HYPERTENSION(2) (TOLD BLOOD PRESSURE HIGH)	0=Not At Risk
1=At Risk
9=Unknown

   1	    435	AT RISK FOR SMOKING
(CURRENT REGULAR SMOKERS)	0=Not At Risk
1=At Risk
9=Unknown

    1

	    436   	AT RISK FOR ACUTE DRINKING 
(REPORTED HAVING 5+ DRINKS AT LEAST ONCE ON AN OCCASION)
	0=Not At Risk
1=At Risk
9=Unknown

RECORD SPECIFICATION - CONTINUATION SHEET
FOR BRFS - 1991                                                Page    30     
QUESTIONNAIRE                                                  Date  3-18-92 

Field
Size	
Columns or
Positions	Field Title (Name)
(Indicate Filler
if not used)	

        Comments	
				
   1
  	  437	AT RISK FOR DRINKING AND DRIVING (REPORTED HAVING DRIVEN AT LEAST ONCE WHEN PERHAPS HAD TOO MUCH TO DRINK)	0=Not At Risk
1=At Risk
9=Unknown	
				
   1	  438	AT RISK FOR CHRONIC DRINKING (HAVING 60+ DRINKS A MONTH)	0=Not At Risk
1=At Risk
9=Unknown

   1	  439	AT RISK FOR SEDENTARY LIFESTYLE (SEDENTARY OR IRREGULAR PHYSICAL ACTIVITY PROFILE)	0=Not At Risk
1=At Risk
9=Unknown

   1	  440	AT RISK FOR OBESITY (GREATER THAN 120% OF WEIGHT FOR HEIGHT PERCENT MEDIAN)	0=Not At Risk
1=At Risk
9=Unknown

   1	  441	AT RISK FOR OVERWEIGHT BASED ON BMI (AT RISK DEFINED AS 
>27.8 For Males and 
>27.3 For Females)
	0=Not At Risk
1=At Risk
9=Unknown	
				
   1	  442	AT RISK FOR SMOKELESS TOBACCO (CURRENT USER)	0=Not At Risk
1=At Risk
9=Unknown

RECORD SPECIFICATION - CONTINUATION SHEET
FOR BRFS - 1991                                                Page     31    
QUESTIONNAIRE                                                  Date  3-18-92 

Field
Size	
Columns or
Positions	Field Title (Name)
(Indicate Filler
if not used)	

        Comments	
  	   			
   4	 443-446 	RAW WEIGHTING FACTOR 
UNEQUAL SELECTION PROBABILITY WEIGHT 
(Number of Adults in Household /the Number of Phone # Reaching House)	####-(2 Implied Decimal                Places)
9999=Unknown	
				
   4	 447-450 	CLUSTER SIZE ADJUSTMENT (CSA) 
(Expected Cluster Size Divided by the Actual Cluster Size)	####-(2 Implied Decimal             Places)
9999=Unknown	
				
   4	 451-454 	WT1 (Raw * CSA) 
THE PRODUCT OF UNEQUAL SELECTION PROBABILITY WEIGHT AND CLUSTER SIZE ADJUSTMENT	####-(2 Implied Decimal
       Places)
9999=Unknown	
				
   10	 455-464 	POST STRATIFICATION (FREQUENCY BY AGE/RACE/SEX DISTRIBUTION FROM 1990 CENSUS DIVIDED BY THE WEIGHTED SAMPLE FREQUENCY BY AGE/RACE/SEX)	##########-(2 Implied                    Decimal Places)
9999999999=Unknown	

RECORD SPECIFICATION - CONTINUATION SHEET
FOR BRFS - 1991                                                Page     32    
QUESTIONNAIRE                                                  Date   3-18-92

Field
Size	
Columns or
Positions	Field Title (Name)
(Indicate Filler
if not used)	

        Comments	
   	   			
  10	 465-474  	FINAL WEIGHT: POST STRATIFICATION MULTIPLIED BY THE PRODUCT OF STRATUM ADJUSTMENT AND THE PRODUCT OF UNEQUAL SELECTION PROBABILITY WEIGHT AND CLUSTER SIZE ADJUSTMENT	##########-(2 Implied                     Decimal Places)
9999999999=Unknown	
				
   1	   475

	AGE GROUP CODES USED IN POST-STRATIFICATION	CODES 1-6
   1 = 18 - 24
   2 = 25 - 34 
   3 = 35 - 44
   4 = 45 - 54
   5 = 55 - 64
   6 = 65 + 

Note: If cell sizes are too small, age categories may have been collapsed.	
   1	   476

	RACE GROUP CODES USED IN POST-STRATIFICATION	CODES 1-2
   1 = White 
   2 = Non-white 

Note: If cell sizes are too small, race categories may have been collapsed.	

RECORD SPECIFICATION - CONTINUATION SHEET
FOR BRFS - 1991                                                Page     33    
QUESTIONNAIRE                                                  Date  3-18-92 

Field
Size	
Columns or
Positions	Field Title (Name)
(Indicate Filler
if not used)	

        Comments	
  	   			
   1	   477 	SEX GROUP CODES USED IN
POST-STRATIFICATION	CODES 1-2
   1 = Male
   2 = Female

				
   2	  478-479	AGE VALUE USED TO DETERMINE AGE GROUPS	18-99= Reported or Imputed           Ages*  
    
*This value is the reported age or an imputed age, if the respondent refused to give an age.   

The imputed age value is only used to estimate the age group used to compute the final weight.  It will not be recorded as the respondent's age.  

The value of the imputed age will be an average age computed from the sample if the respondent refused to give an age.	
				
  21	  480-500	BLANK		
	
K:\SHARE\BSB\BRFS91\LAYOUT91.FIN