BEHAVIORAL RISK FACTOR SURVEILLANCE SYSTEM			
                                (Project Title)

Sec.          											Exh.         
┌──┐Input		┌──┐		┌──┐								Page    1    
└──┘Validity	└──┘Yes	└──┘No        1992           
    					         (Project Number)			Date  3-31-93
┌──┐
└──┘Output

                              1992 FINAL DATA LAYOUT         
TYPE OF FILE	 (File Name)
┌──┐                 ┌──┐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)	
Type	
      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\brfs92\layout92.fin

RECORD SPECIFICATION - CONTINUATION SHEET
FOR BRFS - 1992                                                Page     2     
QUESTIONNAIRE                                                  Date  3-28-91 

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

Type	

        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 - 1992                                                Page     3    
QUESTIONNAIRE                                                  Date  3-31-93

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

Type	

        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 - 1992                                                Page     4    
QUESTIONNAIRE                                                  Date  3-31-93

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

Type	

        Comments	
					
   	   	  **SECTION C:**
     EXERCISE			
					
   1	    38	DID YOU PARTICI-
PATE 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?		Code in Miles and Tenths
(XXX-one Implied Decimal Place)
777=Don't Know/Not Sure
999=Refused	
					
   3	   44-46	HOW OFTEN TAKE PART IN ACTIVITY?		101-199=# Times Per Week
201-299=# Times Per Month
    777=Don't Know/Not Sure
    999=Refused	
					
   3	   47-49	HOW MANY MINUTES OR HOURS TAKE PART
IN ACTIVITY?		Code in Hours and Minutes
777=Don't Know/Not Sure
999=Refused	
					
   1	    50	WAS THERE ANOTHER
EXERCISE OR ACTI-
VITY YOU PARTICI-
PATED IN?		1=Yes
2=No
7=Don't Know/Not Sure
9=Refused	

RECORD SPECIFICATION - CONTINUATION SHEET
FOR BRFS - 1992                                                Page     5    
QUESTIONNAIRE                                                  Date  3-31-93

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

Type	

        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?		Code in Miles and Tenths
(XXX-One Implied Decimal Place)
777=Don't Know/Not Sure
999=Refused	
					
   3	   56-58	HOW OFTEN DID YOU
TAKE PART IN
ACTIVITY?		101-199=# Times per Week
201-299=# 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?		Code 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 - 1992                                                Page     6     
QUESTIONNAIRE                                                  Date  3-31-93 

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

Type	

        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 CIGAR-
ETTES IN LIFE?		1=Yes
2=No
7=Don't Know/Not Sure
9=Refused	
					
   2	   66-67	AGE STARTED SMOKING REGULARLY		Code in Years
77=Don't Know/Not Sure           88=Never smoked regularly
99=Refused	
					
   1	    68	DO YOU SMOKE NOW?		1=Yes
2=No
9=Refused	
					
   2	   69-70	NUMBER OF CIGAR-
ETTES 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 - 1992                                                Page     7    
QUESTIONNAIRE                                                  Date  3-31-93

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

Type	

        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
8=Never smoked regularly
9=Refused	
					
		  **SECTION F:**
     ALCOHOL            CONSUMPTION			
   1	    73	HAVE YOU HAD ANY
ALCOHOLIC BEVER-
AGES 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 DRANK, 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 - 1992                                                Page     8    
QUESTIONNAIRE                                                  Date  3-31-93

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

Type	

        Comments	
					
   	   	  **SECTION G:**
 PREVENTIVE HEALTH
     PRACTICES			
   1	    83	HOW LONG SINCE LAST VISITED DOC-
TOR 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 CHOLEST-
EROL CHECKED?		1=Yes
2=No
7=Don't Know/Not Sure
9=Refused	
					
   1	    85	HOW LONG SINCE 
LAST HAD CHOLEST-
EROL 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 - 1992                                                Page     9    
QUESTIONNAIRE                                                  Date  3-31-93

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

Type	

        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 - 1992                                                Page     10   
QUESTIONNAIRE                                                  Date  3-31-93

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

Type	

        Comments	
   1   	    95   	ARE CHECKUPS OR
PREVENTIVE SER-
VICES 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 - 1992                                                Page     11   
QUESTIONNAIRE                                                  Date  3-31-93

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

Type	

        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 Cert
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 - 1992                                                Page     12   
QUESTIONNAIRE                                                  Date  3-31-93

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

Type	

        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=1 year ago or less
2=More than 1 year ago, but        less than, or equal to,          2 years ago
3=More than 2 years ago, but       less than, or equal to,          3 years ago
4=More than 3 years ago, but       less than, or equal to 5         years ago
5=More than 5 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 - 1992                                                Page     13   
QUESTIONNAIRE                                                  Date  3-31-93

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

Type	

        Comments	
   1	    115   	EVER HAD A CLINICAL BREAST
EXAM? 
		1=Yes
2=No
7=Don't Know/Not Sure
9=Refused	
					
   1	    116	HOW LONG HAS IT BEEN SINCE LAST BREAST EXAM?		1=1 year ago or less
2=More than 1 year ago, but        less than, or equal to, 2        years ago
3=More than 2 years ago, but       less than, or equal to, 3        years ago
4=More than 3 years ago, but       less than, or equal to, 5        years ago
5=More than 5 years ago
7=Don't Know/Not Sure
8=Never
9=Refused 	
					
   1	    117	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	    118	EVER HAD A PAP SMEAR?		1=Yes
2=No
7=Don't Know/Not Sure
9=Refused	

RECORD SPECIFICATION - CONTINUATION SHEET
FOR BRFS - 1992                                                Page     14   
QUESTIONNAIRE                                                  Date  3-31-93

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

Type	

        Comments	
   1	    119   	WHEN WAS LAST PAP
SMEAR?		1=1 year ago or less
2=More than 1 year ago, but        less than, or equal to, 2
  years ago
3=More than 2 years ago, but       less than, or equal to, 3        years ago
4=More than 3 years ago, but       less than, or equal to, 5        years ago
5=More than 5 years ago
7=Don't Know/Not Sure
8=Never
9=Refused 	
   1    	    120 	WAS YOUR LAST PAP SMEAR DONE AS A PART OF A ROUTINE CHECKUP?	
	1=Routine Checkup
2=Check Problem
3=Other
7=Don't Know/Not Sure
9=Refused	
   1	    121	EVER HAD A 
HYSTERECTOMY?		1=Yes
2=No
7=Don't Know/Not Sure
9=Refused	
   1	    122	ARE YOU NOW PREG-
NANT? 		1=Yes
2=No
7=Don't Know/Not Sure
9=Refused	
   2	  123-124 	WHAT MONTH IS YOUR
BABY DUE?		Code Month 01-12
77=Don't Know/Not Sure
99=Refused	
		  **SECTION K:**
       AIDS			
   1	    125	EVER HEARD OF THE
AIDS VIRUS?		1=Yes
2=No
7=Don't Know/Not Sure
9=Refused	
   1	    126	ANY DRUGS AVAIL-
ABLE 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 - 1992                                                Page     15   
QUESTIONNAIRE                                                  Date  3-31-93

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

Type	

        Comments	
   1	    127   	CAN SOMEONE WHO
HAS AIDS LOOK AND
FEEL WELL &
HEALTHY?		1=Yes
2=No
7=Don't Know/Not Sure
9=Refused	
					
   1	    128	CAN YOU GET IN-
FECTED WITH THE
AIDS VIRUS FROM-
A:  GIVING BLOOD?		1=Yes
2=No
7=Don't Know/Not Sure
9=Refused	
					
   1	    129	CAN YOU GET IN-
FECTED 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	    130	CAN A PREGNANT
WOMAN WITH AIDS
GIVE IT TO HER
BABY?		1=Yes
2=No
7=Don't Know/Not Sure
9=Refused	
					
   1	    131	DO YOU HAVE ANY
CHILDREN IN KINDERGARTEN THRU
8TH GRADE?		1=Yes
2=No
7=Don't Know/Not Sure
9=Refused	
					
   1	    132	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 - 1992                                                Page     16   
QUESTIONNAIRE                                                  Date  3-31-93

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

Type	

        Comments	
   2	  133-134 	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	    135	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	    136	WOULD YOU WORK WITH SOMEONE WHO
HAS AIDS VIRUS?		1=Yes
2=No
7=Don't Know/Not Sure
9=Refused	
					
   2	  137-138	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 - 1992                                                Page     17   
QUESTIONNAIRE                                                  Date  3-31-93

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

Type	

        Comments	
   2	  139-140 	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	   141	HOW EFFECTIVE IS 
CONDOM USE IN PRE-
VENTING 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	   142	# OF TELEPHONE
NUMBERS		Total Number of Different Telephone Numbers	
					
   1 	   143   	FILLER  		This column is not used.	
	    **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 - 1992                                                Page     18   
QUESTIONNAIRE                                                  Date  3-31-93

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

Type	

        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 - 1992                                                Page     19   
QUESTIONNAIRE                                                  Date  3-31-93

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

Type	

        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 PROCTO-
SCOPIC 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 PROCTO-
SCOPIC 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 - 1992                                                Page     20   
QUESTIONNAIRE                                                  Date  3-31-93

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

Type	

        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 CON-
TROL 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 - 1992                                                Page     21   
QUESTIONNAIRE                                                  Date  3-31-93

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

Type	

        Comments	
   1	    164   	WHEN RIDING IN A
CAR, HOW OFTEN IS
THE YOUNGEST CHILD
BUCKLED IN A CAR
SAFETY SEAT OR SEATBELT?		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 - 1992                                                Page     22   
QUESTIONNAIRE                                                  Date  3-31-93

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

Type	

        Comments	
   5	  170-174 	CAN ANY OF THE FOLLOWING CONDI-
TIONS 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 FOL-
LOWING DESCRIBES
YOUR RESIDENCE?		1=Single Family Home, Duplex,
  or Townhouse
2=Apt. or 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 - 1992                                                Page     23   
QUESTIONNAIRE                                                  Date  3-31-93

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

Type	

        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
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	  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 - 1992                                                Page     24   
QUESTIONNAIRE                                                  Date  3-31-93

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

Type	

        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 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	  200-202	HOW OFTEN DO YOU
EAT DOUGHNUTS,
COOKIES, CAKE, PA-
STRY, 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	  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 - 1992                                                Page     25   
QUESTIONNAIRE                                                  Date  3-31-93

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

Type	

        Comments	
   3	  206-208 	HOW OFTEN DO YOU ADD BUTTER/MARG-
ARINE 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 - 1992                                                Page     26   
QUESTIONNAIRE                                                  Date  3-31-93

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

Type	

        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 (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	  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 CAR-
ROTS, 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	

RECORD SPECIFICATION - CONTINUATION SHEET
FOR BRFS - 1992                                                Page     27   
QUESTIONNAIRE                                                  Date  3-31-93

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=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)
 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 - 1992                                                Page    28     
QUESTIONNAIRE                                                  Date   3-31-93

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	
				
  13	 431-443	 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 - 1992                                                Page    29     
QUESTIONNAIRE                                                  Date   3-31-93

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 - 1992                                                Page    30     
QUESTIONNAIRE                                                  Date  3-31-93 

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	Physical Activity Level - Frequent Regular
(Year 2000 Objective 1.3)	0=Does not engage in very
  regular and sustained    
  activity
1=Engages in very regular  
  and sustained activity
9=Unknown	
				
   1	  441	AT RISK FOR OBESITY (GREATER THAN 120% OF WEIGHT FOR HEIGHT PERCENT MEDIAN)	0=Not At Risk
1=At Risk
9=Unknown

   1	  442	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	  443	AT RISK FOR SMOKELESS TOBACCO (CURRENT USER)	0=Not At Risk
1=At Risk
9=Unknown

RECORD SPECIFICATION - CONTINUATION SHEET
FOR BRFS - 1992                                                Page     31    
QUESTIONNAIRE                                                  Date  3-31-93 

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

        Comments	
  	   			
   4	 444-447 	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	 448-451 	CLUSTER SIZE ADJUSTMENT (CSA) 
(Expected Cluster Size Divided by the Actual Cluster Size)	####=(2 Implied Decimal            Places)
9999=Unknown	
				
   4	 452-455 	WT1 (Raw * CSA) 
THE PRODUCT OF UNEQUAL SELECTION PROBABILITY WEIGHT AND CLUSTER SIZE ADJUSTMENT	####=(2 Implied Decimal
     Places)
9999=Unknown	
				
   10	 456-465 	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 - 1992                                                Page     32    
QUESTIONNAIRE                                                  Date   3-31-93

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

        Comments	
   	   			
  10	 466-475  	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	   476

	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	   477

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

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

RECORD SPECIFICATION - CONTINUATION SHEET
FOR BRFS - 1992                                                Page     33    
QUESTIONNAIRE                                                  Date  3-31-93 

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

        Comments	
  	   			
   1	   478 	SEX GROUP CODES USED IN
POST-STRATIFICATION	CODES 1-2
   1 = Male
   2 = Female

				
   2	  479-480	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.	
				
  20	  481-500	BLANK		
K:\share\bsb\brfs92\layout92.fin