3A: Behavior Risk Factor Survey Questions
Please place the last four digits of your social security number as a confidential identification:_________
| 7. | Are you currently: | |||
| [Please read] | ||||
| a. | Employed for wages, full-time | (go to question 8) |
1 |
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| b. | Employed for wages, part-time | (go to question 8) |
2 |
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| c. | Self-employed | (go to question 8) |
3 |
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| d. | Out of work for less than 1 year | (go to question 9) |
4 |
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| e. | Out of work for more than 1 year | (go to question 9) |
5 |
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| f. | Homemaker | (go to question 8) | 6 |
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| g. | Student | (go to question 9) | 7 |
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| h. | Retired | (go to question 9) | 8 |
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| i. | Disabled and unable to work | (go to question 9) | 9 |
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| [Do not read] | ||||
| Don't know/not sure | 777 |
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| Refused | 999 |
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| Ask only of those who are employed; if not employed, skip to question 9. | ||||
| 8. | When you are at work, which of the following best describes what you do? Would you say: | |||
| a. | Mostly sitting or standing | 1 |
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| b. | Mostly walking | 2 |
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| c. | Mostly heavy labor or physically demanding work | 3 |
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| [Do not read] |
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| Don't know/not sure | 77 |
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| Refused | 9 |
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| If respondent has multiple jobs, include all jobs |
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| 9. | In a usual week, do you walk for at least 10 munites at a time [if employed, insert: while at work.] for recreation, exercise, to get to and from places, or for any other reason? |
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| a. | Yes | 1 |
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| b. | No | (go to question 14) | 2 |
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| [Do not read] |
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| Don't know/not sure | (go to question 14) | 77 |
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| Refused | (go to question 14) | 99 |
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| 10. | How many days per week do you walk for at least 10 minutes at a time? |
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| Days per week | ______ |
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[Do not read] |
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| Don't know/not sure | 77 |
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| Refused | 99 |
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| 11. | On days when you walk for at least 10 minutes at a time, how much total time per day do you spend walking? |
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| Hours and minutes per day | _:____ |
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[Do not read] |
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| Don't know/not sure | 777 |
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| Refused | 999 |
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| 12. | In a usual week, do you do any activities designed to increase muscle strength or tone, such as lifting weights, pull-ups, or sit-ups? |
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| a. | Yes | 1 |
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| b. | No | (go to question 14) | 2 |
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[Do not read] |
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| Don't know/not sure | (go to question 14) | 7 |
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| Refused | (go to question 14) | 9 |
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| 13. | How many days per week do you do these activities? |
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| Days per week | _____ |
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[Do not read] |
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| Don't know/not sure | 77 |
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| Refused | 99 |
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| We are interested in two types of physical activity - vigorous and moderate. Please answer even if you have included these activities in previous questions. Vigorous activities cause large increases in breathing or heart rate while moderate activities cause small increases in breathing or heart rate. | ||||
| Now, thinkin gabout the moderate activities you do [if employed, insert: when you are not working,]... | ||||
| 14. | 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? | |||
| a. | Yes | 1 |
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| b. | No | (go to question 17) | 2 |
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[Do not read] |
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| Don't know/not sure | (go to question 17) | 77 |
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| Refused | (go to question 17) | 99 |
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| 15. | How many days per week do you do these moderate activities for at least 10 minutes at a time? | |||
| Days per week | _____ |
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[Do not read] |
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| Don't know/not sure | 77 |
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| Refused | 99 |
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| 16. | 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? | |||
| Hours and minutes per day | _:____ |
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[Do not read] |
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| Don't know/not sure | 777 |
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| Refused | 999 |
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| Now, thinking about the vigorous activities you do [if employed, insert: when you are not working,]... | ||||
| 17. | 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? | |||
| a. | Yes | 1 |
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| b. | No | (go to question 20) | 2 |
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[Do not read] |
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| Don't know/not sure | (go to question 20) | 77 |
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| Refused | (go to question 20) | 99 |
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| 18. | Howmany days per week do you do these vigorous activities for at least 10 minutes at a time? | |||
| Days per week | _____ |
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[Do not read] |
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| Don't know/not sure | 77 |
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| Refused | 99 |
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| 19. | 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? | |||
| Hours and minutes per day | _:____ |
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|
[Do not read] |
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| Don't know/not sure | 777 |
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| Refused | 999 |
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