BEHAVIORAL RISK FACTOR SURVEILLANCE SYSTEM			
                               (Project Title)

                           1993 - Final Data Layout			Page   1                    		      (Project Year)          	     Date 3-18-94

Field
Size

Columns

Question

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 |
8 | 18-25 | Telephone Number | First Eight Digits of Telephone Number

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
    time period
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

K:\share\bsb\brfs93\layout93.fin 
CDC 0.648a
REV 3/94

Field
Size

Columns

Questions

Comments

1

28

Winddown

Blank= Regular Mode
    9= Winddown Mode

2

29-30

Number of Adults in Household

01-18= Number of adults, 18
       years plus in       
       household

1

31

Number of Adult Men in Household

0-9= Number of adult men,
     18 years plus in
     household

1

32

Number of Adult Women in Household

0-9= Number of adult women,
     18 Years Plus in
     household

| | SECTION A:  HEALTH STATUS |

1

33

Q1:  Would you say that in general your health is:

1= Excellent
2= Very good
3= Good
4= Fair
5= Poor
7= Don't know/Not sure
9= Refused

2

34-35

Q2:  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?

01-30= Number of days
   88= None
   77= Don't know/Not sure
   99= Refused

2

36-37

Q3:  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?

01-30= Number of days
   88= None
   77= Don't know/Not sure
   99= Refused

2

38-39

Q4:  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?

01-30= Number of days
   88= None
   77= Don't know/Not sure
   99= Refused

SECTION B:  HEALTH CARE    
             ACCESS

1

40

Q5:  Do you have any kind of health care coverage, including health insurance, prepaid plans such as HMOs, or government plans such as Medicare?

1= Yes
2= No
7= Don't know/Not sure
9= Refused

1

41

Q6:  About how long has it been since you had health care coverage?

1= Within the past 6 months     (1 to 6 months ago)
2= Within the past year (7      to 12 months ago)
3= Within the past 2 years      (1 to 2 years ago)
4= Within the past 5 years      (2 to 5 years ago)
5= 5 or more years ago
7= Don't know/Not sure
8= Never
9= Refused

1

42

Q7:  Was there a time during the last 12 months when you needed to see a doctor, but could not because of the cost?

1= Yes
2= No
7= Don't know/Not sure
9= Refused

1

43

Q8:  Is there one particular clinic, health center, doctor's office, or other place that you usually go to if you are sick or need advice about your health?

1= Yes, one particular          place
2= Yes, more than one           particular place
3= No
7= Don't know/Not sure
9= Refused

1

44

Q9:  About how long has it been since you last visited a doctor for a routine checkup?

1= Within the past year (1      to 12 months ago)
2= Within the past 2 years      (1 to 2 years ago)
3= Within the past 5 years      (2 to 5 years ago)
4= 5 or more years ago
7= Don't know/Not sure
8= Never
9= Refused

SECTION C:  HYPERTENSION
             AWARENESS

1

45

Q10:  About how long has it been since you last had your blood pressure taken by a doctor, nurse, or other health professional?

1= Within the past 6 months     (1 to 6 months ago)
2= Within the past year (7      to 12 months ago)
3= Within the past 2 years      (1 to 2 years ago)
4= Within the past 5 years      (2 to 5 years ago)
5= 5 or more years ago
7= Don't know/Not sure
8= Never
9= Refused

1

46

Q11:  Have you ever been told by a doctor, nurse, or other health professional that you have high blood pressure?

1= Yes
2= No
7= Don't know/Not sure
9= Refused

1

47

Q12:  Have you been told on more than one occasion that your blood pressure was high, or have you been told this only once?

1= More than once
2= Only once
7= Don't know/Not sure
9= Refused

| | SECTION D:  CHOLESTEROL                   AWARENESS |

1

48

Q13:  Have you ever had your blood cholesterol checked?

1= Yes
2= No
7= Don't know/Not sure
9= Refused

1

49

Q14:  About how long has it been since you last had your blood cholesterol checked?

1= Within the past year (1      to 12 months ago)
2= Within the past 2 years      (1 to 2 years ago)
3= Within the past 5 years      (2 to 5 years ago)
4= 5 or more years ago
7= Don't know/Not sure
9= Refused

1

50

Q15:  Have you ever been told by a doctor or other health professional that your blood cholesterol is high?

1= Yes
2= No
7= Don't know/Not sure
9= Refused

| | SECTION E:  DIABETES |

1

51

Q16:  Have you ever been told by a doctor that you have diabetes?

1= Yes
2= No
7= Don't know/Not sure
9= Refused

| | SECTION F:  INJURY CONTROL |

1

52

Q17:  How often do you use seatbelts when you drive or ride in a car?

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

2

53-54

Q18:  How many children less than 18 years of age live in your household?

01-25= Number of children
   88= None
   99= Refused

2

55-56

Q19:  What is the age of the oldest child in your household under the age of 15?

01-14= Age in years 
   88= No children under
       age 15
   77= Don't know/Not sure
   99= Refused

1

57

Q20:  How often does the oldest child (of children under age 15) in your household use a car safety seat (child under 5) seatbelt (child 5 or older) when they ride in a car?

1= Always
2= Nearly always
3= Sometimes
4= Seldom
5= Never
7= Don't know/Not sure
8= Never rides in a car
9= Refused

1

58

Q21:  Can you swim or tread water for 5 minutes in water that is over your head?

1= Yes
2= No
7= Don't know/Not sure
9= Refused

1

59

Q22:  Do you have a specific plan for how you would escape from your house or apartment in case of fire?

1= Yes
2= No
7= Don't know/Not sure
9= Refused

| | SECTION G:  TOBACCO USE |

1

60

Q23:  Have you smoked at least 100 cigarettes in your entire life?

1= Yes
2= No
7= Don't know/Not sure
9= Refused

1

61

Q24:  Do you smoke cigarettes now?

1= Yes
2= No
9= Refused

2

62-63

Q25:  On the average, about how many cigarettes a day do you now smoke?

01-87= Number of cigarettes         (1 pack = 20                 cigarettes)
   88= Don't smoke
       regularly
   99= Refused

1

64

Q26:  During the past 12 months, have you quit smoking for 1 day or longer?

1= Yes
2= No
7= Don't know/Not sure
9= Refused

1

65

Q27:  Would you like to stop smoking?

1= Yes
2= No
7= Don't know/Not sure
9= Refused

1

66

Q28:  About how long has it been since you last smoked cigarettes regularly (that is, daily)?

1= Within the past month (0     to 1 month ago)
2= Within the past 3 months     (1 to 3 months ago)
3= Within the past 6 months     (3 to 6 months ago)
4= Within the past year (6      months to 1 year ago)
5= Within the past 5 years      (1 year to 5 years ago) 
6= 5 years or more
7= Don't know/Not sure
8= Never smoked regularly
9= Refused

| | SECTION H:  ALCOHOL                        CONSUMPTION |

1

67

Q29:  During the past month, have you had at least one drink of any alcoholic beverage such as beer, wine, wine coolers, or liquor?

1= Yes
2= No
7= Don't know/Not sure
9= Refused

3

68-70

Q30:  During the past month, how many days per week or per month did you drink any alcoholic beverages, on the average?

101-107= Number days per  
         week
201-231= Number days per
         month
    777= Don't know/Not
         sure
    999= Refused

2

71-72

Q31:  On the days when you drank, about how many drinks did you drink on the average?

01-76= Number of drinks
   77= Don't know/Not sure
   99= Refused

2

73-74

Q32:  Considering all types of alcoholic beverages, how many times during the past month did you have 5 or more drinks on an occasion?

01-76= Number of times
   88= None
   77= Don't know/Not sure
   99= Refused

2

75-76

Q33:  During the past month, how many times have you driven when you've had perhaps too much to drink?

01-76= Number of times
   88= None
   77= Don't know/Not sure
   99= Refused

2

77-78

Q34:  During the past month, how many times have you ridden with a driver who has had perhaps too much to drink?

01-76= Number of times
   88= None
   77= Don't know/Not sure
   99= Refused

| | SECTION I:  DEMOGRAPHICS |

2

79-80

Q35:  What is your age?

18-99= Age of respondent
   07= Don't know/Not sure
   09= Refused

1

81

Q36:  What is your race?

1= White
2= Black
3= Asian, Pacific Islander
4= American Indian, Alaska      Native
5= Other
7= Don't know/Not sure
9= Refused

1

82

Q37:  Are you of Spanish/ Hispanic origin?

1= Yes
2= No
7= Don't know/Not sure
9= Refused

1

83

Q38:  Are you:

1= Married
2= Divorced
3= Widowed
4= Separated
5= Never been married
6= A member of an unmarried     couple
9= Refused

1

84

Q39:  What is the highest grade or year of school you completed?

1= Never attended school or     kindergarten only
2= Grades 1 through 8           (Elementary)
3= Grades 9 through 11          (Some high school)
4= Grade 12 or GED (High        school graduate)
5= College 1 year to 3          years (Some college or       technical school)
6= College 4 years or more      (College graduate)
9= Refused

1

85

Q40:  Are you currently:

1= Employed for wages
2= Self-employed
3= Out of work for more         than 1 year
4= Out of work for less         than 1 year
5= Homemaker
6= Student
7= Retired
8= Unable to work
9= Refused

1

86

Q41:  Which of the following categories best describes your annual household income from all sources?

1= Less than $10,000
2= $10,000 to less than         $15,000
3= $15,000 to less than         $20,000
4= $20,000 to less than         $25,000
5= $25,000 to less than         $35,000
6= $35,000 to $50,000
7= Over $50,000
8= Don't know/Not sure
9= Refused

3

87-89

Q42:  About how much do you weigh without shoes?

050-776= Code in pounds
    777= Don't know/Not
         sure
    999= Refused

3

90-92

Q43:  About how tall are you without shoes?

200-805= Code in feet and             inches
    777= Don't know/Not
         sure
    999= Refused

3

93-95

Q44:  What county do you live in?

XXX= Code County code
777= Don't know/Not sure
999= Refused

1

96

Q45:  Do you have more than one telephone number in your household?

1= Yes
2= No
9= Refused

1

97

Q46:  How many residential telephone numbers do you have?

1-8= Total residential 
     telephone numbers
  9= Refused

1

98

Q47:  Indicate sex of respondent.

1= Male
2= Female

| | SECTION J:  WOMEN'S HEALTH |

1

99

Q48:  Have you ever had a mammogram?

1= Yes
2= No
7= Don't know/Not sure
9= Refused

1

100

Q49:  How long has it been since you had your last mammogram?

1= Within the past year (1      to 12 months ago)
2= Within the past 2 years      (1 to 2 years ago)
3= Within the past 3 years      (2 to 3 years ago)
4= Within the past 5 years      (3 to 5 years ago)
5= 5 or more years ago
7= Don't know/Not sure
9= Refused

1

101

Q50:  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?

1= Routine checkup
2= Breast problem other         than cancer
3= Had breast cancer
7= Don't know/Not sure
9= Refused

1

102

Q51:   Have you ever had a clinical breast exam?

1= Yes
2= No
7= Don't know/Not sure
9= Refused

1

103

Q52:  How long has it been since your last breast exam?

1= Within the past year (1      to 12 months ago)
2= Within the past 2 years      (1 to 2 years ago)
3= Within the past 3 years      (2 to 3 years ago)
4= Within the past 5 years      (3 to 5 years ago)
5= 5 or more years ago
7= Don't know/Not sure
9= Refused

1

104

Q53:  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?

1= Routine checkup
2= Breast problem other         than cancer
3= Had breast cancer
7= Don't know/Not sure
9= Refused

1

105

Q54:  Have you ever had a Pap smear?

1= Yes
2= No
7= Don't know/Not sure
9= Refused

1

106

Q55:  How long has it been since you had your last Pap smear?

1= Within the past year (1      to 12 months ago)
2= Within the past 2 years      (1 to 2 years ago)
3= Within the past 3 years      (2 to 3 years ago)
4= Within the past 5 years      (3 to 5 years ago)
5= 5 or more years ago
7= Don't know/Not sure
9= Refused

1

107

Q56:  Was your last Pap smear done as part of a routine exam, or to check a current or previous problem?

1= Routine exam
2= Check current or             previous problem
3= Other
7= Don't know/Not sure
9= Refused

1

108

Q57:  Have you had a hysterectomy?

1= Yes
2= No
7= Don't know/Not sure
9= Refused

1

109

Q58:  To your knowledge, are you now pregnant?

1= Yes
2= No
7= Don't know/Not sure
9= Refused

| | SECTION K:  IMMUNIZATION |

1

110

Q59:  During the past 12 months, have you had a flu shot?

1= Yes
2= No
7= Don't know/Not sure
9= Refused

1

111

Q60:  Have you ever had a pneumonia vaccination?

1= Yes
2= No
7= Don't know/Not sure
9= Refused

SECTION L:  COLORECTAL
             CANCER SCREENING

1

112

Q61:  A digital rectal exam is when a doctor or other health professional inserts a finger in the rectum to check for cancer and other health problems.  Have you ever had this exam?

1= Yes
2= No
7= Don't know/Not sure
9= Refused

1

113

Q62:  When did you have your last digital rectal exam?

1= Within the past year (1      to 12 months ago)
2= Within the past 2 years      (1 to 2 years ago)
3= Within the past 5 years      (2 to 5 years ago)
4= 5 or more years ago
7= Don't know/Not sure
9= Refused

1

114

Q63:  A proctoscopic exam is when a tube is inserted in the rectum to check for cancer and other health problems.  Have you ever had this exam?

1= Yes
2= No
7= Don't know/Not sure
9= Refused

1

115

Q64:  When did you have your last proctoscopic exam?

1= Within the past year (1      to 12 months ago)
2= Within the past 2 years      (1 to 2 years ago)
3= Within the past 5 years      (2 to 5 years ago)
4= 5 or more years ago
7= Don't know/Not sure
9= Refused

SECTION M:  AIDS KNOWLEDGE
             AND TESTING

1

116

Q65:  Can you tell by looking at a person if he or she has the AIDS virus?

1= Yes
2= No
7= Don't know/Not sure
9= Refused

1

117

Q66:  Would you be willing to work next to or near a person who you know is infected with the AIDS virus?

1= Yes
2= No
7= Don't know/Not sure
9= Refused

1

118

Q67:  If you had a child in school, would you allow him or her to be in the same classroom with another child who is infected with the AIDS virus?

1= Yes
2= No
3= Don't have children
7= Don't know/Not sure
9= Refused

1

119

Q68:  If you had a teenager who was sexually active, would you encourage him or her to use a condom?

1= Yes
2= No
7= Don't know/Not sure
9= Refused

1

120

Q69:  Some people use condoms to keep from getting the AIDS virus through sexual activity.  How effective do you think a properly used condom is for this purpose?

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

121

Q70:  To your knowledge is there medical treatment available that may help a person who is infected with the AIDS virus live longer?

1= Yes
2= No
7= Don't know/Not sure
9= Refused

1

122

Q71:  What are your chances of getting the AIDS virus?

1= High
2= Medium
3= Low
4= None
7= Don't know/Not sure
9= Refused

1

123

Q72:  In the past five years (that is, since 1988), have your chances of getting the AIDS virus increased, decreased, or stayed the same?

1= Increased
2= Decreased
3= Stayed the same
7= Don't know/Not sure
9= Refused

1

124

Q73:  Except for donating or giving blood, have you ever had your blood tested for the AIDS virus infection?

1= Yes
2= No
7= Don't know/Not sure
9= Refused

4

125-128

Q74:  When was your last test?

0180-1293= Code month and
           year of last
           test
     7777= Don't know/Not
           sure
     9999= Refused

2

129-130

Q75:  What was the main reason you had your last AIDS blood test?

01= For hospitalization or       surgical procedure
02= To apply for health          insurance
03= To apply for life            insurance
04= For employment
05= To apply for a marriage      license
06= For military induction       or military service
07= For immigration
08= Just to find out if you      were infected
09= Because of referral by       a doctor
10= Because of referral by       the Health Department
11= Referred by your sex         partner
12= Because it was part of       a blood donation             process
13= For routine checkup
14= Because of occupational      exposure
15= Because of illness
87= Other
77= Don't know/Not sure
99= Refused

2

131-132

Q76:  Where did you have your last blood test for the AIDS virus?

01= Private Doctor, HMO
02= Blood Bank, Plasma           Center, Red Cross
03= Health Department
04= AIDS Clinic,
    Counseling, Testing
    Site
05= Hospital, Emergency          Room, Outpatient Clinic
06= Family Planning Clinic
07= Prenatal Clinic
08= Tuberculosis Clinic
09= STD Clinic
10= Community Health             Clinic
11= Clinic Run By                Employer
12= Insurance Company            Clinic
13= Other Public Clinic
14= Drug Treatment Facility
15= Military Induction or
    Military Service Site 
16= Immigration Site
17= At Home, Home Visit By
    Nurse Or Health Worker
87= Other
77= Don't Know/Not Sure
99= Refused

1

133

Q77:  If you received the results of your last test, did you receive counseling or talk with a health care professional about how to lower your chances of becoming infected with the AIDS virus or how to avoid passing it on to another person?

1= Yes (received results        and was counseled)
2= No (received results and     was not counseled)
3= Did not get results
7= Don't know/Not sure
9= Refused

MODULE 1:  SMOKELESS TOBACCO
            USE

1

134

Q1:  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

135

Q2:  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 2:  RADON TESTING |

1

136

Q1:  Have you heard of radon, which is a radioactive gas that occurs in nature?

1= Yes
2= No
7= Don't know/Not sure
9= Refused

1

137

Q2:  Has your household air been tested for the presence of radon gas?

1= Yes
2= No
7= Don't know/Not sure
9= Refused

1

138

Q3:  Do you know how to test your home for the presence of radon?

1= Yes
2= No
7= Don't know/Not sure
9= Refused

1

139

Q4:  Do you, or does anyone in your home plan to have your household air tested for radon within the next year?

1= Yes
2= No
7= Don't know/Not sure
9= Refused

1

140

Q5:  Prolonged exposure to radon gas can be harmful to your health.  Do you agree or disagree?

1= Agree
2= Disagree
7= Don't know/Not sure
9= Refused

1

141

Q6:  Which, if any, of the following conditions do you think can be caused by prolonged radon exposure?
A.  Headache?

1= Yes
2= No
7= Don't know/Not sure
9= Refused

1

142

B.  Asthma?

1= Yes
2= No
7= Don't know/Not sure
9= Refused

1

143

C.  Arthritis?

1= Yes
2= No
7= Don't know/Not sure
9= Refused

1

144

D.  Lung Cancer?

1= Yes
2= No
7= Don't know/Not sure
9= Refused

1

145

E.  Other cancers besides lung?

1= Yes
2= No
7= Don't know/Not sure
9= Refused

1

146

Q7:  Which of the following best describes your residence?

1= Single family home,          duplex, or townhouse
2= Apartment or condominium     at basement level, or on     1st or 2nd floor
3= Apartment or condominium     above 2nd floor
4= Trailer or mobile home  
5= Other
7= Don't know/Not sure
9= Refused

| | MODULE 3:  DIETARY FAT |

3

147-149

Q1:  How often do you eat hot dogs or lunch meats such as ham 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

3

150-152

Q2:  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

153-155

Q3:  How often do you eat pork other than 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

156-158

Q4:  How often do you eat hamburgers, cheeseburgers, or meat loaf?

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

159-161

Q5:  How often do you eat beef other than hamburgers, cheeseburgers, or meat loaf?

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

162-164

Q6:  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

3

165-167

Q7:  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

168-170

Q8:  How often do you eat cheese or cheese spreads, not including cottage cheese?

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

171-173

Q9:  How often do you eat doughnuts, cookies, cake, pastry, or 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

174-176

Q10:  How often do you usually eat snacks, such as 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

3

177-179

Q11:  How often do you  usually add butter or 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

180-182

Q12:  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

183-185

Q13:  How many glasses (8 oz.) of whole milk do you usually drink?  Remember to include drinks made with whole milk or milk on cereal.  Do not include low-fat milk, such as skim milk or 2% milk.

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 4:  FRUITS AND
            VEGETABLES

3

186-188

Q1:  How often do you drink fruit juices such as orange, grapefruit, or tomato?

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

189-191

Q2:  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

192-194

Q3:  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

195-197

Q4:  How often do you eat potatoes (not including french fries, fried potatoes, or potato chips?)

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

198-200

Q5:  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

201-203

Q6:  Not counting carrots, potatoes, or salad, how many servings of 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

| | MODULE 5:  DIABETES |

2

204-205

Q1:  How old were you when you were told you have diabetes?

01-76= Code age in years
   77= Don't know/Not sure
   99= Refused

1

206

Q2:  Are you now taking insulin?

1= Yes
2= No
9= Refused

1

207

Q3:  In general, how would you rate your vision when wearing glasses or contacts if needed?

1= Excellent
2= Very good
3= Good
4= Fair
5= Poor
7= Don't know/Not sure
9= Refused

1

208

Q4:  How often do you have trouble telling the difference between a one dollar bill and a five dollar bill?  (This means when wearing glasses or contacts if needed.)

1= All of the time
2= Most of the time
3= Some of the time
4= A little bit of the time  5= None of the time
7= Don't know/Not sure
9= Refused

1

209

Q5:  While stopped in a vehicle at a traffic light, how often do you have trouble reading the license plate on the car in front of you?  (This means when wearing glasses or contacts if needed.)

1= All of the time
2= Most of the time
3= Some of the time
4= A little bit of the time  5= None of the time
7= Don't know/Not sure
9= Refused

| | MODULE 6:  EXERCISE |

1

210

Q1:  During the past month, did you participate in any physical activities or exercises such as running, calisthenics, golf, gardening, or walking for exercise?

1= Yes
2= No
7= Don't know/Not sure
9= Refused

2

211-212

Q2:  What type of physical activity or exercise did you spend the most time doing during the past month?

XX= See Last Page, Coding
    List A for Activity
    Code
99= Refused

3

213-215

Q3:  How far did you usually walk/run/jog/swim?

001-150= Code Miles and 
         Tenths (One
         Implied Decimal
         Place)
    777= Don't know/Not
         sure
    999= Refused

3

216-218

Q4:  How many times per week or per month did you take part in this activity during the past month?

101-199= Code Times Per
         Week
201-299= Code Times Per
         Month
    777= Don't know/Not
         sure
    999= Refused

3

219-221

Q5:  And when you took part in this activity, for how many minutes or hours did you usually keep at it?

001-959= Code Hours and               Minutes
    777= Don't know/Not
         sure
    999= Refused

1

222

Q6:  Was there another physical activity or exercise that you participated in during the last month?

1= Yes
2= No
7= Don't know/Not sure
9= Refused

2

223-224

Q7:  What other type of physical activity gave you the next most exercise during the past month?

XX= See Last Page, Coding
    List A for Activity
    Code
99= Refused

3

225-227

Q8:  How far did you usually walk/run/jog/swim?

001-150= Code Miles and 
         Tenths (One
         Implied Decimal
         Place)
    777= Don't know/Not
         sure
    999= Refused

3

228-230

Q9:  How many times per week or per month did you take part in this activity?

101-199= Code Times Per
         Week
201-299= Code Times Per
         Month
    777= Don't know/Not
         sure
    999= Refused

3

231-233

Q10:  And when you took part in this activity, for how many minutes or hours did you usually keep at it?

001-959= Code in Hours and            Minutes
    777= Don't Know/Not
         sure
    999= Refused

| | MODULE 7:  WEIGHT CONTROL |

1

234

Q1:  Are you now trying to lose weight?

1= Yes
2= No
9= Refused

1

235

Q2:  Are you eating fewer calories to lose weight?

1= Yes
2= No
7= Don't know/Not sure
9= Refused

1

236

Q3:  Have you increased your physical activity to lose weight?

1= Yes
2= No
7= Don't know/Not sure
9= Refused

MODULE 8:  ACTIVITY
            LIMITATIONS

1

237

Q1:  What were you doing MOST of the past 12 months?

1= Working at a job or          business
2= Keeping house
3= Going to school
4= Something else
7= Don't know/Not sure
9= Refused

1

238

Q2:  Does any impairment or health problem NOW keep you from working at a job or business?

1= Yes
2= No
7= Don't know/Not sure
9= Refused

1

239

Q3:  Are you limited in the kind or amount of work you can do because of any impairment or health problem?

1= Yes
2= No
7= Don't know/Not sure
9= Refused

1

240

Q4:  Does any impairment or health problem NOW keep you from doing any housework at all?

1= Yes
2= No
7= Don't know/Not sure
9= Refused

1

241

Q5:  Are you limited in the kind or amount of housework you can do because of any impairment or health problem?

1= Yes
2= No
7= Don't know/Not sure
9= Refused

1

242

Q6:  Does any impairment or health problem keep you from working at a job or business?

1= Yes
2= No
7= Don't know/Not sure
9= Refused

1

243

Q7:  Are you limited in the kind or amount of work you could do because of any impairment or health problem?

1= Yes
2= No
7= Don't know/Not sure
9= Refused

1

244

Q8:  Are you limited in any way in any activities because of any impairment or health problem?

1= Yes
2= No
7= Don't know/Not sure
9= Refused

1

245

Q9:  Because of any impairment or health problem, do you need the help of other persons with your PERSONAL CARE needs, such as eating, bathing, dressing, or getting around the house?

1= Yes
2= No
7= Don't know/Not sure
9= Refused

1

246

Q10:  Because of any impairment or health problem, do you need the help of other persons in handling your ROUTINE needs, such as everyday household chores, doing necessary business, shopping, or getting around for other purposes?

1= Yes
2= No
7= Don't know/Not sure
9= Refused

1

247

Q11:  Because of any impairment or health problem, do you need the help of other persons with your PERSONAL CARE needs, such as eating, bathing, dressing, or getting around the house?

1= Yes
2= No
7= Don't know/Not sure
9= Refused

1

248

Q12:  Because of any impairment or health problem, do you need the help of other persons in handling your ROUTINE needs, such as everyday household chores, doing necessary business, shopping, or getting around for other purposes?

1= Yes
2= No
7= Don't know/Not sure
9= Refused

1

249

Q13:  Are you limited in any way in any activities because of any impairment or health problem?

1= Yes
2= No
7= Don't know/Not sure
9= Refused

10 | 250-259 | BLANK |
141 | 260-400 | State added questions |

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
    American Indian
08= Other
99= Unknown/Refused

1

403

Computed smoking status

1= Current smoker
2= Former smoker
3= Never smoked
4= Irregular 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= Physically inactive 
   (Yr. 2000 Obj. 1.5)
2= Irregular and/or not
   sustained activity
3= Regular and not
   intensive
4= Regular and intensive
   (Yr. 2000 Obj. 1.4)

Note: Prior to 1992, code 4 represented a measure of a 1990 Objective for physical activity.

1

417

Computed smokeless status

1= Current user
2= Former user
3= Never used
9= Unknown

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 percentile
2= 25th-75th Percentile
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

15

431-445

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

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 
only )

0= Not at risk
1= At risk
9= Unknown

1

436

At risk for smoking (2)
(current regular and irregular smokers)

0= Not at risk
1= At risk
9= Unknown

1

437

At risk for acute drinking (reported having 5+ drinks at least once on an occasion)

0= Not at risk
1= At risk
9= Unknown

1

438

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

439

At risk for riding with a drunk driver (reported having ridden at least once with a driver who perhaps had too much to drink)

0= Not at risk
1= At risk
9= Unknown

1

440

At risk for chronic drinking (having 60+ drinks a month)

0= Not at risk
1= At risk
9= Unknown

1

441

At risk for sedentary lifestyle (sedentary or irregular physical activity profile)

0= Not at risk
1= At risk
9= Unknown

1

442

Physical activity level - Frequent Regular
(Yr. 2000 Obj. 1.3)

0= Does not engage in very
   regular and sustained
   activity
1= Engages in very regular
   and sustained activity
9= Unknown

1

443

At risk for obesity (greater than 120% of weight for height percent median)

0= Not at risk
1= At risk
9= Unknown

1

444

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

445

At risk for smokeless tobacco (current user)

0= Not at risk
1= At risk
9= Unknown

4

446-449

Raw weighting factor unequal selection probability weight (number of adults in household/the number of phone # reaching houshold)

####= (2 implied decimal
      places)
9999= Unknown

4

450-453

Cluster size adjustment (CSA) (Expected cluster size divided by the actual cluster size)

####= (2 implied decimal
      places)
9999= Unknown

4

454-457

WT1 (Raw * CSA)
The product of unequal selection probability weight and cluster size adjustment

####= (2 implied decimal
      places)
9999= Unknown

10

458-467

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

10

468-477

Final weight:  Post stratifi-cation 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

478

Age group codes used in post-stratification

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

479

Race group codes used in post-stratification

1= White
2= Other than white

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

1

480

Sex group codes used in post-stratification

CODES 1-2
1= Male
2= Female

2

481-482

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.

18 | 483-500 | Blank |
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