CDC OPTIONAL MODULES:                                           Back to topics

DIABETES				ORAL HEALTH
INFLUENZA				CHILDHOOD ASTHMA
HEART ATTACK OR STROKE				CARDIOVASCULAR DISEASE
FOLIC ACID				ARTHRITIS
PROSTATE CANCER SCREENING				COLORECTAL CANCER SCREENING

STATE ADDED QUESTIONS:                                    Back to topics

IMMUNIZATION				TOBACCO INDICATORS
RACE RELATED ISSUES				SEXUAL AND PHYSICAL VIOLENCE
EPILPSEY AND SEIZURE

RISK FACTORS AND DERIVED VARIABLES (Located within the corresponding section)

CDC CORE SECTIONS:

HEALTH STATUS
Would you say that in general your health is excellent,very good,good fair or poor?
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?
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?
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?
     RISK FACTORS / CREATED VARIABLES
      Fair or Poor General Health

HEALTH CARE ACCESS                                                          Back to topics
Do you have any kind of health care coverage, including health insurance, prepaid plans such as HMOs, or government plans such as Medicare?
Do you have one person you think of as your personal doctor or health care provider?

EXERCISE                                                                                   Back to topics
During the past month, other than your regular job, did you participate in any physical activities or exercises such as running, calisthenics, golf, gardening, or walking for exercise?
     RISK FACTORS / CREATED VARIABLES
      Leisure Time Physical Activity or Exercise in the past 30 days

DIABETES                                                                                   Back to topics
Have you ever been told by a doctor that you have diabetes?

HYPERTENSION AWARENESS                                              Back to topics
Have you ever been told by a doctor, nurse, or other health professional that you have high blood pressure?
Are you currently taking medicine for your high blood pressure?
     RISK FACTORS / CREATED VARIABLES
      Risk Factor for having been told by a doctor, nurse, or other health professional that they have high blood pressure

CHOLESTEROL AWARENESS                                                Back to topics
Blood cholesterol is a fatty substance found in the blood. Have you ever had your blood cholesterol checked?
About how long has it been since you last had your blood cholesterol checked?
Have you ever been told by a doctor, nurse, or other health professional that your blood cholesterol is high?
     RISK FACTORS / CREATED VARIABLES
      Cholesterol check within the past years
      High Cholesterol Risk Factor

FRUIT AND VEGETABLES                                                      Back to topics
How often do you drink fruit juices such as orange, grapefruit, or tomato?
Not counting juice, how often do you eat fruit?
How Often Do You Eat Green Salad?
How often do you eat potatoes not including French fries, fried potatoes, or potato chips?
How often do you eat carrots?
Not counting carrots, potatoes, or salad, how many servings of vegetables do you usually eat?
Fruit and Vegetable Consumption per day
     RISK FACTORS / CREATED VARIABLES
      Fruit and Vegetable Consumption per day
      Five Fruit and Vegetable Servings per day

WEIGHT CONTROL                                                                    Back to topics
Are you now trying to lose weight?
Are you now trying to maintain your current weight, that is, to keep from gaining weight?
Are you eating either fewer calories or less fat ...to lose weight?
Are you using physical activity or exercise to...lose weight?
In the past 12 months, has a doctor, nurse or other health professional given you advice about your weight?
     RISK FACTORS / CREATED VARIABLES
      Overweight or Obese
      Risk Factor for being Overweight or Obese

ASTHMA                                                                                        Back to topics
Did a doctor ever tell you that you had asthma?
Do you still have asthma?
     RISK FACTORS / CREATED VARIABLES
      Asthma Status

IMMUNIZATION                                                                          Back to topics
During the past 12 months, have you had a flu shot?
Have you ever had a pneumonia shot? This shot is usually given only once or twice in a person's lifetime and is different from the flu shot. It is also called the pneumococcal vaccine?
     RISK FACTORS / CREATED VARIABLES
      Risk factor for respondents’ aged 65+ that had flu shot in the past 12 months
      Risk factor for respondents aged 65 or older that have ever had a pneumonia shot

TOBACCO USE                                                                              Back to topics
Have you smoked at least 100 cigarettes in your entire life?
Do you now smoke cigarettes everyday, some days, or not at all?
During the past 12 months, have you stopped smoking for one day or longer because you were trying to quit smoking?
     RISK FACTORS / CREATED VARIABLES
      Smoking Status
      Current Smoker

ALCOHOL CONSUMPTION                                                        Back to topics
A drink of alcohol is 1 can or bottle of beer, 1 glass of wine, 1 can or bottle of wine cooler, 1 cocktail, or 1 shot of liquor. During the past 30 days, how often have you had at least one drink of any alcoholic beverage?
On the days when you drank, about how many drinks did you drink on the average?
Considering all types of alcoholic beverages, how many times during the past 30 days did you have 5 or more drinks on an occasion?
     RISK FACTORS / CREATED VARIABLES
      Risk factor for respondents having had at least one drink of alcohol in the past 30 days
      Binge Drinking
      Heavy Drinking
      Heavy Drinking Among Men
      Heavy Drinking Among Women

EXCESS SUN EXPOSURE                                                              Back to topics
The next question is about sunburns, including any time that even a small part of your skin was red for more than 12 hours. Have you had a sunburn within the past 12 months?
Including times when even a small part of your skin was red for more than 12 hours, how many sunburns have you had within the past 12 months?

ARTHRITIS                                                                                       Back to topics
During the past 30 days, have you had pain, aching, stiffness or swelling in or around a joint?
Did your joint symptoms first begin more than 3 months ago?
Are you now limited in any way in any activities because of joint symptoms?
Have you ever seen a doctor, nurse, or other health professional for these joint symptoms?
Have you ever been told by a doctor or other health professional that you have some form of arthritis, rheumatoid arthritis, gout, lupus, or fibromyalgia?
Do arthritis or joint symptoms now affect whether you work, the type of work you do or the amount of work you do?

FALLS                                                                                                 Back to topics
In the past 3 months, have you had a fall?
Were you injured?

DISABILITY                                                                                      Back to topics
Are you limited in any way in any activities because of physical, mental, or emotional problems?
Do you now have any health problem that requires you to use special equipment, such as a cane, a wheelchair, a special bed, or a special telephone?

PHYSICAL ACTIVITY                                                                      Back to topics
When you are at work, which of the following best describes what you do? Would you say…?
Now, thinking about the moderate physical activities you do when you are not working (if employed or self-employed) in a usual week, do you do moderate activities for at least 10 minutes at a time, such as brisk walking, bicycling, vacuuming, gardening, or anything else that causes small increases in breathing or heart rate?
How many days per week do you do these moderate activities for at least 10 minutes at a time?
On days when you do moderate activities for at least 10 minutes at a time, how much total time per day do you spend doing these activities?
Now thinking about the vigorous physical activities you do (when you are not working, if employed or self-employed) in a usual week, do you do vigorous activities for at least 10 minutes at a time, such as running, aerobics, heavy yard work, or anything else that causes large increases in breathing or heart rate?
How many days per week do you do these vigorous activities for at least 10 minutes at a time?
On days when you do vigorous activities for at least 10 minutes at a time, how much total time per day do you spend doing these activities?
     RISK FACTORS / CREATED VARIABLES
      Moderate Physical Activity
      Vigorous Physical Activity
      Leisure Time Physical Activity
      Physical Activity Recommendation Status

VETERAN STATUS                                                                              Back to topics
Have you ever served on active duty in the United States Armed Forces, either in the regular military or in a National Guard or military reserve unit?
Which of the following best describes your service in the United States military?

HIV/AIDS                                                                                                Back to topics
I'm going to read two statements about HIV, the virus that causes AIDS. After I read each one, please tell me whether you think it is true or false, or if you don't know. A pregnant woman with HIV can get treatment to help reduce the chances that she will pass the virus on to her baby.
I'm going to read two statements about HIV, the virus that causes AIDS. After I read each one, please tell me whether you think it is true or false, or if you don't know. There are medical treatments available that are intended to help a person who is infected with HIV to live longer.
How important do you think it is for people to know their HIV status by getting tested? Would you say …
As far as you know, have you ever been tested for HIV? Do not count tests you may have had as part of a blood donation.
Not including blood donations, in what year was your last HIV test - Include saliva tests?
What was the main reason you had your test for HIV?
Where did you have the HIV test?
I'm going to read you a list... please tell me if any of the situations apply to you, Have you used intravenous drugs in the past year, been treated for a sexually transmitted or venereal disease in the past year, given or received money or drugs in exchange for sex in the past year,or had anal sex without a condom in the past year?
In the past 12 months has a doctor, nurse, or other health professional talked to you about preventing sexually transmitted diseases through condom use?
     RISK FACTORS / CREATED VARIABLES
      Risk Factor for Persons Aged Less Than 65 Years Having Ever Been Tested for HIV
      Risk Factor for Persons Aged Less Than 65 Years Ever Participating in High-Risk Behavior
      Risk Factor for Persons Aged Less Than 65 Years Who Have Ever Been Counseled by a Doctor, Nurse, or Other Health          Professional Within the Past 12 Months on the Prevention of Sexually Transmitted Diseases Through Condom Use

CDC OPTIONAL MODULES                                 Back to topics

DIABETES
How old were you when you were told you have diabetes?
Are you now taking insulin?
Are you now taking diabetes pills?
About how often do you check your blood for glucose or sugar? Include times when checked by a family member or friend, but do not include times when checked by a health professional.
About how often do you check your feet for any sores or irritations? Include times when checked by a family member or friend, but do not include times when checked by a health professional.
Have you ever had any sores or irritations on your feet that took more than four weeks to heal?
About how many times in the last year have you seen a doctor, nurse, or other health professional for your diabetes?
A test for hemoglobin 'A one C' measures the average level of blood sugar over the past three months. About how many times in the past 12 months has a doctor, nurse, or other health professional checked you for hemoglobin 'A one C'?
About how many times in the last year has a health professional checked your feet for any sores or irritations?
When was the last time you had an eye exam in which the pupils were dilated? This would have made you temporarily sensitive to bright light.
Has a doctor ever told you that diabetes has affected your eyes or that you had retinopathy?
Have you ever taken a course or class in how to manage your diabetes yourself?

ORAL HEALTH                                                                                    Back to topics
How long has it been since you last visited a dentist or a dental clinic for any reason?
How many of your permanent teeth have been removed because of tooth decay or gum disease? Do not include teeth lost for other reasons, such as injury or orthodontics.
How long has it been since you had your teeth cleaned by a dentist or dental hygienist?

INFLUENZA                                                                                         Back to topics
At what kind of place did you get your last flu shot?

CHILDHOOD ASTHMA                                                                      Back to topics
Earlier you said there were children age 17 or younger living in your household. How many of these children have ever been diagnosed with asthma?
How many of these children still have asthma?

HEART ATTACK OR STROKE                                                          Back to topics
Which of the following do you think is a symptom of a heart attack. For each, tell me yes, no, or you're not sure. Do you think pain or discomfort in the jaw, neck, or back are symptoms of a heart attack?
Which of the following do you think is a symptom of a heart attack. For each, tell me yes, no, or you're not sure. Do you think feeling weak, lightheaded, or faint is a symptom of a heart attack?
Which of the following do you think is a symptom of a heart attack. For each, tell me yes, no, or you're not sure. Do you think chest pain or discomfort are symptoms of a heart attack?
Which of the following do you think is a symptom of a heart attack. For each, tell me yes, no, or you're not sure. Do you think sudden trouble seeing in one or both eyes is a symptom of a heart attack?
Which of the following do you think is a symptom of a heart attack. For each, tell me yes, no, or you're not sure. Do you think pain or discomfort in the arms or shoulders are symptoms of a heart attack?
Which of the following do you think is a symptom of a heart attack. For each, tell me yes, no, or you're not sure. Do you think shortness of breath is a symptom of a heart attack?
Which of the following do you think is a symptom of a stroke. For each, tell me yes, no, or you're not sure. Do you think sudden confusion or trouble speaking are symptoms of a stroke?
Which of the following do you think is a symptom of a stroke. For each, tell me yes, no, or you’re not sure. Do you think sudden numbness or weakness of face, arm, or leg, especially on one side, are symptoms of a stroke?
Which of the following do you think is a symptom of a stroke. For each, tell me yes, no, or you’re not sure. Do you think sudden trouble seeing in one or both eyes is a symptom of a stroke?
Which of the following do you think is a symptom of a stroke. For each, tell me yes, no, or you’re not sure. Do you think sudden chest pain or discomfort are symptoms of a stroke?
Which of the following do you think is a symptom of a stroke. For each, tell me yes, no, or you’re not sure. Do you think sudden trouble walking, dizziness, or loss of balance is a symptom of a stroke?
Which of the following do you think is a symptom of a stroke. Do you think severe headache with no known cause is a symptom of a stroke?
If you thought someone was having a heart attack or a stroke, what is the first thing you would do?

CARDIOVASCULAR DISEASE                                                          Back to topics
To lower your risk of developing heart disease or stroke, are you...Eating fewer high fat or high cholesterol foods?
To lower your risk of developing heart disease or stroke, are you...Eating more fruits and vegetables?
To lower your risk of developing heart disease or stroke, are you...More physically active?
Within the past 12 months, has a doctor, nurse, or other health professional told you to...Eating fewer high fat or high cholesterol foods?
Within the past 12 months, has a doctor, nurse, or other health professional told you to...Eating more fruits and vegetables?
Within the past 12 months, has a doctor, nurse, or other health professional told you to...More physically active?
Has a doctor, nurse, or other health professional ever told you that you had any of the following; a heart attack, also called a myocardial infarction?
Has a doctor, nurse, or other health professional ever told you that you had any of the following; Angina or coronary heart disease?
Has a doctor, nurse, or other health professional ever told you that you had any of the following; A stroke?
History of Any Cardiovascular Diseases (heart attack or coronary heart disease or stroke
At what age did you have your first heart attack?
At what age did you have your first stroke?
After you left the hospital following your heart attack or stroke, did you go to any kind of outpatient rehabilitation?
Do you take aspirin daily or every other day?
Do you have a health problem or condition that makes taking aspirin unsafe for you?
Why do you take aspirin...To relieve pain?
Why do you take aspirin...To reduce the chance of a heart attack?
Why do you take aspirin...To reduce the chance of a stroke?

FOLIC ACID                                                                                            Back to topics
Do you currently take any vitamin pills or supplements?
Are any of these a multivitamin?
Do any of the vitamin pills or supplements you take contain folic acid?
How often do you take this vitamin pill or supplement?
Some health experts recommend that women take 400 micrograms of the B vitamin folic acid, for which of the following reasons...
Taking multivitamins or vitamin pills/supplements containing folic acid
Daily taking multivitamins or vitamin pills/supplements containing folic acid
Currently taking multivitamins or vitamin pills/supplements containing folic acid-FEMALES, Age 18-44
Daily consumption of multivitamins or vitamin pills/supplements containing folic acid-FEMALES, Age 18-44

ARTHRITIS                                                                                             Back to topics
Thinking about your arthritis or joint symptoms, which of the following best describes you TODAY?
Has a doctor or other health professional EVER suggested losing weight to help your arthritis or joint symptoms?
Has a doctor or other health professional EVER suggested losing weight to help your arthritis or joint symptoms?
Have you EVER taken an educational course or class to teach you how to manage problems related to your arthritis or joint symptoms?

PROSTATE CANCER SCREENING                                                    Back to topics
A Prostate-Specific Antigen test, also called a PSA test, is a blood test used to check men for prostate cancer. Have you ever had a PSA test?
How long has it been since you had your last PSA test?
A digital rectal exam is an exam in which a doctor, nurse, or other health professional places a gloved finger into the rectum to feel the size, shape, and hardness of the prostate gland. Have you ever had a digital rectal exam?
How long has it been since you had your last Digital Rectal Exam?
Have you ever been told by a doctor, nurse, or other health professional that you had prostate cancer?

COLORECTAL CANCER SCREENING                                             Back to topics
A blood stool test is a test that may use a special kit at home to determine whether the stool contains blood. Have you ever had this test using a home kit?
How long has it been since you had your last blood stool test using a home kit?
Sigmoidoscopy and colonoscopy are exams in which a tube is inserted in the rectum to view the bowel for signs of cancer or other health problems. Have you ever had either of these exams?
How long has it been since you had your last sigmoidoscopy or colonoscopy?

STATE ADDED QUESTIONS                                     Back to topics

IMMUNIZATION                                                                                   Back to topics
What was the main reason you did not get a flu shot?
Have you ever had chicken pox?

TOBACCO INDICATORS                                                                      Back to topics
In the past 12 months, have you seen a doctor, nurse or other health care professional to get any kind of care for yourself?
In the past 12 months, has a doctor, nurse or other health care professional advised you to quit smoking?
Which statment best describes the rules about smoking inside your home?
In the following locations, do you think that smoking should be allowed in all areas, or not allowed at all?

RACE RELATED ISSUES                                                                       Back to topics
How do other people usually classify you in this country?
How often do you think about your race?
Within the past 12 months at work, do you feel you were treated worse than, the same as, or better than people of other races?
Within the past 12 months when seeking health care, do you feel your experiences were worse than, the same as, or better than people of other races?
Within the past 30 days, have you felt emotionally upset, e.g. angry, sad, or frustrated, as a result of how you were treated based on your race?
Within the past 30 days, have you experienced any physical symptoms, e.g. headache, upset stomach, tensing of your muscles, or a pounding heart, as result of how you were treated based on your race?

SEXUAL AND PHYSICAL VIOLENCE                                                  Back to topics
Within the past 12 months, on any occasion were you hit, slapped, kicked, raped or otherwise physically hurt by a spouse, partner, ex-spouse or partner, boyfriend, girlfriend or date?
Has anyone ever had sex with you against your will or without your consent?
This would include situations where verbal threats, coercion, physical force, or a weapon was used or you were not able to give consent for some reason;
Has anyone ever attempted to have sex with you against your will or without your consent, but intercourse/penetration did not occur? Again, this would include situations where verbal threats, coercion, physical force, or a weapon was used, or you were not able to give consent for some reason
In the past 12 months,has anyone had or attempted to have sex with you against your will or consent?

EPILEPSY AND SEIZURE                                                                          Back to topics
Have you ever been told by a doctor that you have a seizure disorder or epilepsy?