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State-Designed Questions
Used in the New Jersey Behavioral Risk Factor Survey
Through 2005

Activities of Daily Living (1999)
Asthma (2003 - 2005)
Bone Density Scan (2000)
Breastfeeding (1999)
Calcium Intake (1991-2001)
Cholesterol Awareness (2002)
Colorectal Cancer Screening (2004-2005)
Demographics (2003 - 2005)
Diabetes (1991-1993, 2003)
Drug/Alcohol Use (1999)
Falls (2005)
Food Handling/Safety (1996, 2001)
Fracture History (1992-2001)
Health Care Access (1994)
Health Insurance (1996)
HIV/AIDS Knowledge (2005)
HIV Testing (2005)
Hypertension Awareness (2002, 2004)
Immunization (1998-2005)
Language of Interview (2003 - 2005)
Lyme Disease (1994, 1998)
Medication (2004)
Oral or Mouth Cancer Awareness (2004)
Physical Activity (2002-2004)
Prostate Cancer Screening (1999)
Stay Healthy (2003)
Sunburn (2002)
Tobacco Use (1991-2000)
Women's Health (1992-2001)
5-A-Day Post Test (2004)  

View the subject matter of CDC-designed required and optional modules.  

Activities of Daily Living (1999)  

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

What is the major impairment or health problem that limits your activities?

For how long have your activities been limited because of your major impairment or health problem?

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?

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?

 

Asthma

Have you ever held a job outside the home? (2003, 2005)

Were you ever told by a doctor or other medical person that your asthma was related to any job you ever had? (2004 - 2005)

Did you ever tell a doctor or other medical person that your asthma was related to any job you ever had? (2004 - 2005)

 

Bone Density Scan (2000)

Have you ever been tested for osteoporosis by having a bone density scan, a test that scans and measures your bones,similar to an x-ray?

 

Breastfeeding (1999)

Based on your knowledge and feelings today, if you were about to have a baby, would you breastfeed or support your partner's decision to breastfeed?

 

Calcium Intake

How many 8 oz. glasses of milk or drinks made with milk do you usually drink? (1991-1999)

How often do you eat yogurt (8 oz.)? (1993-1999)

Do you take any pills that have calcium in them? (1992-2000)

During the past month, did you take any products to supplement your calcium intake, such as Tums, Oscal or calcium fortified orange juice? (2001)

 

Cholesterol Awareness (2002)

Questions identical to 2001 core section 5 but asked only of diabetics.

Colorectal Cancer Screening (2004-2005)

Which of two tests that screen for colon cancer and other health problems have you had? (Sigmoidoscopy or colonoscopy)
[Question asked only of those 40-49]

 

Demographics (2003 - 2005)

What city or town do you live in?

Where were you born?

When did you come to live in the United States?

 

Diabetes

Are you following a written diet ordered by a doctor to help control your diabetes? (1991 1993)

Are you taking diabetes pills to help control your diabetes? (1991 1993)

Are you taking insulin injections to help control your diabetes? (1991 1993)

If you are taking insulin injections, have you taken insulin injections ever since you knew you had diabetes? (1991 1993)

How serious is diabetes? By serious I mean decreasing the quality of life, leading to death, costs of caring for diabetes, leading to other medical problems, etc. (2003)

In the past year, do you remember seeing, reading or hearing any messages about diabetes? (2003)

Please tell me where you saw, read, or heard about diabetes in the past year. (2003)

What, if anything, did you do as a result of these diabetes messages? For example, call a phone number for more information, get checked for diabetes at a screening, or change your eating or exercise habits? (2003)

 

Drug/Alcohol Use (1999)

Has a doctor or other health professional ever talked to you about drug abuse?

Has a doctor or other health professional ever talked to you about alcohol abuse?

 

Falls (2005)

In the past three months, did you report a fall to your medical doctor? By report we mean call or tell your physician/health provider or go to the emergency room at the hospital. [Question asked only of those 45 and over]

If you did report a fall or go to the emergency room, did any health provider tell you the reason or underlying cause of your fall?

 

Food Handling/Safety

After handling raw meat or chicken in the kitchen, do you continue cooking; rinse and/or wipe your hands, then continue cooking; or, wash your hands with soap and water, then continue cooking? (1996, 2001)

After you have used a cutting board, counter top, or other surface for cutting raw meat or chicken, do you continue using the surface as is; rinse and/or wipe the surface, then continue cooking; or wash the surface with soap or bleach and water, then continue cooking? (1996, 2001)

In the past 12 months, how often did you eat vegetables that you or someone else canned at home, such as asparagus, corn, or tomato sauces? (1996)

In the past 12 months, how often did you eat hamburger, both at home and away from home? (1996)

In the past 12 months, how often did you eat hamburgers that were still pink or red on the inside, both at home and away from home? (1996, 2001)

In the past 12 months, how often did you eat eggs which were soft-boiled, soft-poached, loosely scrambled, or lightly fried with a runny yolk, both at home and away from home? (1996, 2001)

In the past 12 months, how often did you eat raw oysters, at home and away from home? (1996, 2001)

In the past 12 months, did you drink any unpasteurized milk, also know as "raw milk"? (1996)

Since the spring of 1994, packages of uncooked meat and poultry at grocery stores have had new labeling information. Have you seen this information? (1996)

Do you remember reading anything in the new labeling about safe handling of raw meat and poultry? (1996)

Has the new labeling information on raw meat and poultry changed the way you prepare these products? (1996)

In the past month, were you ill with diarrhea lasting at least two days with at least three loose stools on one of these days? (1996, 2001)

Do you think there is a health problem with eating hamburgers that are sill pink or red on the inside? (2001)

What type of health problem do you associate with eating hamburgers that are sill pink or red on the inside? (2001)

 

Fracture History

Since the age of 35, have you broken your wrist, hip or backbone? (1992-2001)

Under what circumstances did the break occur? (1993-1996)

At what age did the break occur? (1993-1996)

At what time in relation to the injury where you broke your wrist, hip, or backbone did you first begin regularly taking daily calcium supplements or eating and drinking more dairy products? (1994-1996)

 

Health Care Access (1994)

Where do you usually go when you visit a medical doctor, nurse or doctor's (physician's) assistant?

 

Health Insurance (1996)

Do you have any children under the age of 18 living in your household?

Is this child/are these children covered by health insurance?

What type of health care coverage do you use to pay for most of this child's (these children's) medical care?

 

HIV/AIDS Knowledge (2005)

Please tell me whether you think the following sentence 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.

 

HIV Testing (2005)

In the past 12 months, how many times have you been tested for HIV, including times when you did not get your results?

 

Hypertension Awareness (2002)

Questions identical to 2003 core section 5 but asked only of diabetics. (2002)

Questions identical to 2003 core section 5 but asked only of 50% of respondents. (2004)

 

Immunization

Why didn't you get a flu shot? (1998-2002, 2005)
[From 2004-2005 asked only of three high risk-groups: over 65, diabetic, or asthmatic]

Where did you get your last flu shot? (1998-2002, 2004-2005)
[From 1998-2002 asked only of those over 65]
[From 2004-2005 asked only of three high-risk groups: over 65, diabetic, or asthmatic]

At what kind of place did you get the pneumonia shot? (1998-2002, 2004-2005)
[From 2004-2005 asked only of three high-risk groups]

Why didn't you get a pneumonia shot? (1998-2003, 2004-2005)
[From 2004-2005 asked only of three high-risk groups]

 

Language of Interview (2003)

In what language was this interview completed?

 

Lyme Disease (1994, 1998)

How much would you say you know about Lyme disease?

Do you believe that Lyme disease in New Jersey is extremely common, fairly common or rare?

How would you rate your own chances of getting Lyme disease in the coming year?

Have you personally known anyone who has Lyme disease?

Do you think that wearing long pants in the woods or grassy areas will protect you from getting Lyme disease?

Do you think that looking for ticks on yourself and removing them after walking in the woods or grassy areas will protect you from getting Lyme disease?

Do you think that using insect repellent on your skin or clothes will protect you from getting Lyme disease?

Do you think that avoiding wooded areas will protect you from getting Lyme disease?

Do you think that using a tick collar or repellent on your dog or cat will protect you from getting Lyme disease?

In the past year, have you taken any specific steps to protect yourself from getting Lyme disease?

 

Medication (2004)

How many, if any, different prescription medications are you currently taking?

How many times in the past month have you taken an over-the-counter (non-prescription) medication?

In the past year, have you encountered any of the following problems regarding your prescription or over-the-counter medications?

You were confused or unsure about the benefit or safety of the medication.
You had difficulty remembering when to take the medication or what dosage to take. You had side effects that caused you to stop taking the medication and/or seek medical attention.
You unintentionally took the wrong medication or the wrong amount/dosage.

 

Oral or Mouth Cancer Awareness (2004)

Have you ever heard about oral or mouth cancer?

What is one early sign of mouth cancer?

Do you think excessive exposure to sunlight increases your chances of getting oral or mouth cancer?

Do you think tobacco use in any form increases your chances?

Do you think regular alcohol drinking increases your chances?

Do you think frequently biting the cheek or lip increases your chances?

Have you ever had a check-up or an exam in which the dentist pulls out your tongue, sometimes with gauze wrapped around it, and feels under the tongue and inside the cheeks, or feels your neck?

How long ago was this?


 

Physical Activity

Questions identical to 2001 core section 15 but asked only of diabetics. (2002)

Within the past 12 months, has a doctor, nurse or other health professional told you to be more physically active? (2002-2003) [In 2002 asked only of diabetics]

 

Prostate Cancer Screening (1999)

Has a doctor or other health professional ever talked with you about having any kind of screening test or exam to check for prostate cancer?

Have you ever had a digital rectal exam?

When did you have your last digital rectal exam?

Have you ever had a Prostate Specific Antigen (PSA) test?


When did you have your last PSA test?

 

Staying Healthy (2003)

What are the most important things people like you should do to stay healthy?

 

Sunburn (2002)

Same as 1999 core section 7.

 

Tobacco Use

Has a doctor or other health professional ever advised you to quit smoking? (1996-1999)

What helped you most in your attempt to stop smoking? (1991-1993)

Do you think you are addicted to cigarettes? (1994)

How many of the other people living in your household are smokers? (1994)

How many times have/did you seriously tried to quit smoking? (1994)

In the last twelve months, have you cut down on the number of cigarettes you usually smoke? (1994)

In the last twelve months, have you switched to a lower tar or nicotine brand of cigarettes? (1994)

In the last twelve months, have you cut down smoking around others who don't smoke? (1994)

The last time you quit smoking for one day or more did Nicotine replacement therapy like the Nicotine patch, Nicotine gum, or Nicotrol help you quit? (2000)

The last time you quit smoking for one day or more did a prescription from your doctor for medication like Zyban or Wellbutrin help you quit? (2000)

The last time you quit smoking for one day or more did an organized program such as SmokeEnders help you quit? (2000)

The last time you quit smoking for one day or more did alternative medicine such as hypnosis or acupuncture help you quit? (2000)

The last time you quit smoking for one day or more did you not use outside help to help you quit? (2000)

Do you want to quit smoking cigarettes? (2000)

Are you seriously considering stopping smoking within the next 6 months? (2000)

Are you planning to stop within the next 30 days? (2000)

How many smokers at your work site break the no smoking rules? (2000)

During the past 30 days, about how often have you seen commercials on TV about the dangers of smoking? (2000)

During the past 30 days, about how often have you seen messages on billboards or outdoor signs about the dangers of smoking? (2000)

Please tell me whether you agree with this statement: Inhaling smoke from someone else's cigarette can harm your health. (2000)

 

Women's Health

Have you had surgery where both of your ovaries were removed? (1992-2001)

Except for the times when you've taken birth control pills, have you ever taken female hormones or estrogen replacement therapy? (1992-2001)

Are you currently taking female hormones or estrogen replacement therapy with the exception of birth control pills? (1996-2001)

Have you ever been counseled by your doctor, a nurse or other health professional about the benefits and risks of using estrogen replacement therapy for the prevention of osteoporosis? (1994-2001)

Have you gone through the change of life or menopause? (1992-2001)

 

5-a-day post-test (2004)

According to your understanding, what does ‘5-a-day’ refer to?

Have you watched ‘ER’ within the past two months?

 

 
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