2005 BRFSS Questions

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Center for Health Statistics - Adult Survey (BRFSS)

Department
- Human Services Department
- Divisions

ACUTE RESPIRATORY INFECTION

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In the past 14 days, have you had a fever over 100 degrees Fahrenheit?
In the past 14 days, did you have a sore throat?
In the past 14 days, did you have a cough?
In the past 14 days, did you have sputum or phlegm production?
In the past 14 days, did you miss work or school?
In the past 14 days, did you seek medical care?

ALCOHOL CONSUMPTION

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All Respondents who reported drinking any alcohol in the past 30 days.
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 month did you have 5 or more drinks on an occasion?
Binge drinking: (At risk for chronic disease and other acute health problems): All respondents who reported having had five or more alcoholic drinks on one or more occasions in the past 30 days.
Heavy drinking, Men: (At risk for chronic disease and other acute health problems): Male Respondents who reported drinking more than two alcoholic drinks per day on average in the past 30 days.
Heavy drinking, Women: (At risk for chronic disease and other acute health problems): Female Respondents who reported drinking more than one alcoholic drink per day on average in the past 30 days.

ANTIBIOTICS

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In the past 4 weeks, have you taken any antibiotic medicine?
Agree or disagree: I will be sick for a longer time if I don't receive an antibiotic for cough, cold, or flu symptoms.
Agree or disagree: By the time I am sick enough to talk to or visit a doctor because of a cold, I usually expect a prescription for antibiotics.
How often do you think antibiotics are needed for a sore throat that lasts less than a week?
How often do you think antibiotics are needed for a cold that lasts less than a week?
How often do you think antibiotics are needed for a cough without fever that lasts less than a week?
How often do you think antibiotics are needed for a runny nose with yellow or green mucous that lasts less than a week?
Are you aware of any health dangers to yourself or other people associated with taking antibiotics?
What kind of health dangers to yourself or other people do you think are associated with taking antibiotics?

ARTHRITIS

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During the past 30 days, have you had pain, aching, stiffness or swelling in or around a joint?
Did your joint symptoms first begin 3 months ago?
Have you 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?
Are you now limited in any way in any activities because of arthritis or joint symptoms?

ASTHMA

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Have you ever been told by a doctor, nurse or other health care professional that you had asthma?
Do you still have asthma? (Current asthma prevalence)

CARDIOVASCULAR DISEASE

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Has a doctor ever told you that you had a heart attack or myocardial infarction?
Has a doctor ever told you that you had angina or coronary heart disease?
Has a doctor ever told you that you had a stroke?

Heart Attack Symptoms

Do you think pain or discomfort in the jaw, neck, or back are symptoms of a heart attack?
Do you think feeling weak, lightheaded, or faint are symptoms of a heart attack?
Do you think chest pain or discomfort are symptoms of a heart attack?
Do you think sudden trouble seeing in one or both eyes is a symptom of a heart attack?
Do you think pain or discomfort in the arms or shoulder are symptoms of a heart attack?
Do you think shortness of breath is a symptom of a heart attack?

Stroke Symptoms

Do you think sudden confusion or trouble speaking are symptoms of a stroke?
Do you think sudden numbness or weakness of face, arm, leg, especially on one side, are symptoms of a stroke?
Do you think sudden trouble seeing in one or both eyes is a symptom of a stroke?
Do you think sudden chest pain or discomfort are symptoms of a stroke?
Do you think sudden trouble walking, dizziness, or loss of balance are symptoms 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 stroke, what is the first thing you would do?

CHOLESTEROL AWARENESS

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Have you ever had your blood cholesterol checked?
About how long has it been since you had your blood cholesterol checked?
Have you ever been told by a doctor, nurse, or other health professional that your blood cholesterol is high?

DEMOGRAPHICS

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What county do you live in?
Are you Hispanic or Latino?
What is your race? (Mark all that apply)
What is your race? (Mutually Exclusive)
Are you married, divorced, widowed, separated, never been married, a member of an unmarried couple?
How many children live in your household who are less than 18 years old?
What is the highest grade or year of school you completed?
Are you currently employed for wages, self-employed, out of work for more than one year, out of work for less than 1 year, homemaker, student, retired, unable to work?
What is your annual household income from all sources?
Do you have more than one telephone number in your household?
Sexual orientation. Do you consider yourself to be:
Overweight and obesity prevalence among adults?
At risk for chronic disease based on Body Mass Index (BMI) being 25.0 or higher?

DEPRESSION

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Major depression among Oregon Residents.
In the last two weeks, have you had little interest or pleasure in doing things?
In the last two weeks, have you noticed feeling down, depressed, or hopeless?
In the last two weeks, have you noticed trouble falling asleep, staying asleep, or sleeping too much?
In the last two weeks, have you noticed feeling tired or having little energy?
In the last two weeks, have you noticed having a poor appetite or overeating?
In the last two weeks, have you noticed feeling bad about yourself - or feeling that you are a failure or have let yourself or your family down?
In the last two weeks, have you noticed having trouble concentrating on things, such as reading the newspaper or watching television?
In the last two weeks, have you noticed moving or speaking so slowly that other people could have noticed?
In the last two weeks, have you had thoughts that you would be better off dead or hurting yourself in some way?
How difficult have these problems made it for you to do your work, take care of things at home or get along with other people?
In the past two years, have you felt depressed or sad most days, even if you felt ok sometimes?
In the last 12 months, have you been told be a doctor or other health professional that you have depression?
Have you ever received treatment for depression from a counselor, therapist, or doctor for depression?
When did you begin to receive treatment for your most recent episode of depression?
Are you still receiving treatment from a counselor, therapist, or doctor for depression?
Are you currently taking medication prescribed by a doctor or health provider for your depression?

DIABETES

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Have you ever been told by a doctor that you have diabetes?
How old were you when you were told you have diabetes?
Are you now taking insulin?
Are you now taking pills to treat your diabetes? These are pills that help lower blood sugar.

Services and Management

About how often do you check your blood for glucose or sugar? (Includes times when checked by a family member or friend, but does not include times when checked by a health professional.)
About how often do you check your feet for any sores or irritations? (Includes times when checked by a family member or friend, but not times when checked by a health professional.)
Have you ever had any sore 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?
About how many times in the past 12 months has a doctor, nurse, or other health professional tested you for glycosylated hemoglobin or hemoglobin "A one C"?
Do you know the results of your last glycosylated hemoglobin test?
During the past 12 months, did a doctor, nurse, or other health professional test the feeling in your feet or legs by touching you with something and asking if you could feel it?
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 attended any formal diabetes education programs, such as a classes or one-on-one training with a diabetes educator?
When was the last time you had this formal diabetes session?
Was there a time during the past 12 months when cost kept you from seeing your doctor for your diabetes or to get your medicine and supplies?
Are you taking aspirin daily or every other day?
Do you have a health problem or condition that makes taking aspirin unsafe for you?

Health Provider Information

Has a doctor, nurse, or other health professional explained or shown you how to care for your feet?
Has a doctor, nurse, or other health professional explained or shown you how and when to test your blood glucose?
Has a doctor, nurse, or other health professional explained or shown you how to adjust your food choices to help you manage your blood glucose level?
Has a doctor, nurse, or other health professional explained or shown you how to get appropriate physical activity?
Has a doctor, nurse, or other health professional explained or shown you how to take your medications?
Has a doctor, nurse, or other health professional explained to you about the long-term consequences of diabetes, for example eye problems, foot ulcers, or heart attack?
Has a doctor, nurse, or other health professional helped you set clear, specific goals for managing your diabetes?

ENVIRONMENTAL ISSUES

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Outdoor Air Quality

During the last 12 months, how many times did you reduce or change your outdoor activity level because you thought the air quality was bad or was affecting how well you felt? Please do not include times when you made changes because of high pollen levels.
Have you ever heard or read about the air quality index or air quality alerts where you live? Please do not include times when you may have heard or read about high pollen counts.
During the last 12 months, how many times did you reduce or change your outdoor activity level based on the air quality index or air quality alerts? Please do not include times when you may have heard or read about high pollen counts.
Has a doctor, nurse, or other health professional ever told you to reduce your outdoor activity level when the air quality is bad?

EPILEPSY

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Have you ever been told by a doctor that you have seizure disorder or epilepsy?
Are you currently taking any medicine to control your seizure disorder or epilepsy?
How many seizures of any type have you had in the last three months?
In the past year, have you seen a neurologist or epilepsy specialist for your epilepsy or seizure disorder?
During the past month, to what extent has epilepsy or its treatment interfered with your normal activities like working, school, or socializing with family or friends?

EXERCISE AND PHYSICAL ACTIVITY

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During the past 30 days, other than your regular job, did you participate in any physical activities or exercise such as running, calisthenics, golf, gardening, or walking for exercise?
Adults at risk for no leisure time activity.
When you are at work, which of the following best describes what you do? Would you say?

FAMILY PLANNING

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Are you/your spouse/partner doing anything now to keep from getting pregnant?
What are you/your spouse/partner doing now to keep from getting pregnant?
When you have intercourse, how often do you/your spouse/partner use a method to prevent pregnancy?
What is your/your spouse's/partner's main reason for not doing anything to keep you/her from getting pregnant?
During the last 12 months, have you/your partner used emergency birth control pills?
How do you feel about having a child now or sometime in the future?
How soon would you want to have a child?

FOLIC ACID AND VITAMIN/SUPPLEMENTS

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Current use of a multivitamin or other supplement containing folic acid: women under the age of 45.
Weekly folic acid intake: women under the age of 45.
Folic acid is recommended by health experts for which of the following reasons?

GENETICS

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Has a doctor, nurse, or other health care provider asked you about your family history of illnesses or health problems?
Has a health care provider ever asked you about your family history of diabetes?
Has a doctor, nurse, or other health care provider ever discussed the chance of you getting diabetes?
Has a health care provider ever recommended changes in diet or exercise to reduce your chances of getting diabetes or other illnesses like heart disease, stroke, or cancer?
Do you have a parent, brother or sister, or child related by blood, who has been diagnosed with diabetes by a health care provider? [Does not include female relatives who only had diabetes during pregnancy.]
Other than during pregnancy, how many of your relatives were diagnosed before the age of 20?
Other than during pregnancy, how many of your relatives were diagnosed between the ages of 20-44?
Other than during pregnancy, how of your relatives many were diagnosed at age 45 and older?
How worried are you that you will get diabetes in the future?
Have you made changes in your diet or exercise, to reduce your chances of getting diabetes or other diseases like heart disease, stroke, or cancer?

HEALTH CARE COVERAGE & SOURCE

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Do you have any kind of health care coverage?
Do you have one person who you think of as your personal doctor or health care provider?
Was there a time in the past 12 months when you needed to see a doctor but could not because of the cost?
About how long has it been since you last visited a doctor for a routine checkup (general physical exam)?
In the past 12 months, have you been enrolled in the Oregon Health Plan, which is the State's Medicaid program?
Are you currently enrolled in the Oregon Health Plan, which is the State's Medicaid program?
During the past twelve months, was there a time that you did not have any health insurance or coverage?
During the past twelve months, about how many months would you say you have been without health insurance or coverage?
Was there a time during the last twelve months when you needed to see a dentist, but could not because of the cost?

HEALTH STATUS

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How is your general health?
For how many days during the past 30 days was your physical health not good?
For how many days during the past 30 days was your mental health not good?
During the past 30 days, how many days did poor physical or mental health keep you from doing your usual activities, such as self-care, work, or recreation?
Adults at risk for fair or poor health.

HIV/AIDS

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Have you ever been tested for HIV?
Where did you have your last blood test for HIV?
In the past year, have any of these situations applied to you?: Used intravenous drugs, been treated for sexually transmitted diseases or venereal disease, given or received money or drugs in exchange for sex, or had anal sex without a condom?

HUNGER

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"The food that we bought just didn't last, and we didn't have money to get more." Was this statement often, sometimes, or never true for you in the last 12 months?
"We couldn't afford balanced meals." Was this statement often, sometimes, or never true for you in the last 12 months?
In the last 12 months, did you or other adults in your household ever cut the size or your meals or skip meals because there wasn't enough money for food?
In the last 12 months, how often did you cut the size or your meals or skip meals because there wasn't enough money for food?
In the last 12 months, did you ever eat less than you felt you should because there wasn't enough money to buy food?
In the last 12 months, were you ever hungry but didn't eat because you couldn't afford enough food?
Oregon adults living in food insecure households.
Oregon adults living in households that experienced hunger at times.

HYPERTENSION AWARENESS

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Have you ever been told by a health professional that you had high blood pressure?
Are you currently taking any medicine for your high blood pressure?

IMMUNIZATION

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During the past 12 months, have you had a flu shot?
During the past 12 months, have you had a flu vaccine sprayed in your nose?
Where did you go to get your most recent flu shot/vaccine that was sprayed in your nose/vaccination?
What is the MAIN reason you have NOT received a flu vaccination for this current flu season?
Did you get a flu vaccination during the last flu season of September 2003 through March 2004?
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.
Has a doctor, nurse, or other health professional ever said that you have any of the following health problems: Asthma; Lung problems, other than asthma; Hearth problems; Diabetes; Kidney problems; Weakened immune systems caused by a chronic illness, such as cancer or HIV/AIDS, or medicines, such as steroids; or sickle cell anemia or other anemia?
Do you still have (this/any of these) problem(s)?
Do you currently work in a health care facility, such as a medical clinic, hospital, or nursing home?
Do you have direct face-to-face or hands-on contact with patients as a part of your routine work?

INTERPERSONAL VIOLENCE

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Has an intimate partner ever threatened you with physical violence?
Has an intimate partner ever hit, slapped, pushed, kicked, or physically hurt you in any way?
Has an intimate partner ever attempted physical violence against you?
Have you ever experienced any unwanted sex by a current or former intimate partner?
In the past 12 months, have you experienced any physical violence or had unwanted sex with an intimate partner?
In the past 12 months, have you had any injuries, such as bruises, cuts, scrapes, black eyes, vaginal or anal tears, or broken bones, as a result of this physical violence or unwanted sex?
At the time of the most recent incident, what was your relationship to the intimate partner who was physically violent or had unwanted sex with you?
Has anyone ever had sex with you against your will or without your consent?
Has anyone ever tried to have sex with you against your will or without your consent, but intercourse or penetration did not occur?
Did this incident/any of these incidents occur in the past year?
Have you ever had any injuries (such as bruises, cuts, a black eye, broken bones, etc.) as a result of being hit, slapped, punched, shoved, kicked, or otherwise physically hurt by an intimate partner?
Did this incident/any of these incidents occur in the past year?

NUTRITION

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Respondents who consume 5 or more servings of fruits and vegetables each day. (Current recommendation is to eat five or more servings per day, to reduce the risk of chronic disease, including some types of cancer, heart disease, and stroke.)

ORAL HEALTH

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How many of your permanent teeth have been removed because of tooth decay or gum disease?
How would you describe the health of your teeth and gums? [Includes those with no teeth.]
Do you have any kind of dental care coverage, including dental insurance, prepaid plans such as HMOs, or government plans such as Medicare?
In the past year, did you have a toothache or pain when chewing or biting?
How long has it been since you last visited a dentist for any reason?
How long has it been since you had your teeth cleaned by a dentist or dental hygienist?
Does your oldest child under age 18 who is still living with you have any kind of dental care coverage, including dental insurance, prepaid plans such as HMOs, or government plans such as Medicare?
How long has it been since this child visited a dentist or a dental clinic for any reason?
Does the tap water in your home contain fluoride?
At risk for not having visited a dentist, dental hygienist, or dental clinic within the past year.
Respondents who have had no permanent teeth removed.

QUALITY OF LIFE

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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?
Because of any impairment or health problem, do you have any trouble learning, remembering, or concentrating?
Disability and Limitations among Oregon residents.
What is the nature of this health condition?
In general, how satisfied are you with your life?
How often do you get the social and emotional support you need?

SMOKE EXPOSURE

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In a typical week, how many hours are you in the same room where others are smoking?
On how many of the past 30 days has someone, including yourself, smoked cigarettes, cigars, or pipes anywhere inside your home?
What are the rules about smoking in your family's cars?
In a typical week, about how many hours would you say you are exposed to second hand smoke at work?
Do you agree or disagree with the following statement: People should be protected from secondhand smoke?
Do you agree or disagree with the following statement: Smoking should not be allowed in indoor work areas?
Do you agree with the following statement: Smoking should not be allowed in restaurants?
Do you agree or disagree with the following statement: Smoking should not be allowed in bars?
Do you agree or disagree with the following statement: Tobacco use by adults should not be allowed on school grounds or at any school events?

SMOKELESS TOBACCO USE

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Do you currently use any smokeless tobacco products such as chewing tobacco and snuff?
Are you seriously considering stopping the use of smokeless tobacco within the next 30 days?
Have you smoked a cigar in the last month?

TOBACCO USE

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Current Cigarette Consumption

Do you now smoke every day, some days, or not at all?
On the average, about how many cigarettes a day do you now smoke? (Every day smokers)
On the average, when you smoked during the past 30 days, about how many cigarettes did you smoke a day? (Some day smokers)
At what age did you start smoking regularly?

Current Smoker Quit Patterns

The last time you tried to quit smoking, did you use the nicotine patch, nicotine gum, or any other medication to help you quit?
The last time you tried to quit smoking, did you use any other assistance such as classes or counseling? (Includes hypnosis and acupuncture).
Do you agree or disagree with the following statement: People close to me are upset at my smoking?

Current Smokers Cessation and Health Insurance Coverage

If you were trying to quit smoking, how helpful do you think it would be to have assistance such as a nicotine patch or gum, or a smoking cessation program?
Are you seriously considering stopping smoking within the next 6 months?
Does your health insurance coverage pay for the cost of any smoking cessation assistance, such as nicotine replacement or a smoking cessation program?

Former Smoker Quit Patterns

When you quit smoking the last time, did you use the nicotine patch, nicotine gum, nasal spray, or any other medication to help you quit?
When you quit smoking, did you use any other assistance such as classes or counseling?

Health Advice and Tobacco Cessation

At your last visit to your health care provider, did someone ask you if you smoked, either by questionnaire or by person?
At your last visit to your health care provider, were you advised to quit smoking?
Has a doctor or other health care professional ever advised you to quit smoking?
At your last visit to your health care provider, were you offered recommendations or assistance on how to quit smoking?

Purchase of cigarettes

In what type of store do you usually buy cigarettes?
In the past year, have you bought cigarettes over the Internet, or using a mail-order source?

VETERANS STATUS

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Have you ever served on active duty in the United States Armed Forces?

WEIGHT CONTROL

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Are you now trying to lose weight?
In the past 12 months, has a doctor, nurse or other health professional given you advice about your weight?
Overweight and obesity prevalence among adults.
At risk for chronic disease based on Body Mass Index (BMI) being 25.0 or higher.

WEST NILE VIRUS

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In the past 6 months, where did you get information on the West Nile Virus?
In the past 6 months, have you heard about or seen any materials on "Fight the Bite Oregon," a West Nile Virus prevention education campaign?
In the past 6 months, have you visited the website for West Nile Virus information?
How useful was the information on the website?
Were you aware of the toll-free Oregon West Nile Virus hotline?
During the past summer, how often did you use mosquito repellents when outdoors?
What was the main reason you did not use repellents?
To protect against West Nile Virus, when is it recommended that you use mosquito repellents containing DEET?
In the past 6 months, were there any animals or humans infected with West Nile Virus in your area?
Some communities in Oregon have mosquito control programs. Would you support having a mosquito control program in your community if it had to be paid for with tax money?
If there were lots of West Nile infected mosquitoes in your community, would you support spraying to reduce the number of mosquitoes?
What is the main reason you would not support mosquito spraying in your community?

WOMEN'S HEALTH

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To your knowledge, are you now pregnant?
A mammogram is an x-ray of each breast to look for breast cancer. Have you EVER had a mammogram?
How long has it been since you had your last mammogram?
At risk: Women ages 40 and older who have not had a mammogram in the past 2 years.
A clinical breast exam is when a doctor, nurse, or other health professional feels the breast for lumps. Have you ever had a clinical breast exam?
How long has it been since your last breast exam?
A Pap smear is a test for cancer of the cervix. Have you ever had a Pap test?
How long has it been since you had your last Pap test?
Have you had a hysterectomy? A hysterectomy is an operation to remove the uterus.
At risk: Women ages 18 and older, with an intact cervix, who have not had a Pap smear within the past 3 years.

WORKSITE

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In the past 12 months, has your employer offered health promotion or wellness programs, services, or classes? Examples might include a walking program, access to a fitness center, or cholesterol screening, etc.
Does your employer encourage nutritious foods to be available at meetings, in a cafeteria, or through vending machines?
Which one of these categories would you say best represents your occupation?
Does your employer offer classes to help you recognize and know what to do when a person is having a heart attack or stroke?

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