Sections
 

1.  Health Status

2.  Physical Activity
 

Individual
Community
Workplace

3.  Nutrition
 
Individual
Community
Workplace
 
4.  Weight Control

5.  Tobacco

Individual
Community
Workplace

6.  Hypertension Awareness

7.  Stroke Awareness

• Would you say that in general your health is:?
All responses
Fair/Poor vs. Good/Very Good/Excellent

• Individual

• During the past month, did you participate in any physical activities or exercises such as running, calisthenics, golf, gardening, or walking for exercise?

 
• Regular and sustained physical activity (derived).

 
• Thinking about and planning to increase physical activity

 
• Physical Activities people engaged in include :
Walking
Indoor Conditioning Activity
Recreational Activity
Home Maintenance Activity
Jogging
Team Sports
Water Activities
Racquet Sports
Bicycling for Pleasure
 
• The six most common places where physical activity is done are:
Home
Streets
Private gym/recreational facility
Work Facilities
Public Park
Public gym/recreational facility
 
• When you are at work, which of the following best describes what you do?
All responses
Sitting/Standing vs. Walking/Heavy Labor
 
• In the past week, how much time did you spend walking or bicycling for transportation, such as to and from work or shopping?
Any amount of time vs. None
>=1 hr vs. <1 hr vs. None
 
• How often do you climb the stairs instead of taking the elevator?
All responses
Sometimes/Never vs. Usually/Often
 
• How often do you walk or bike instead of driving a short distance?
All responses
Sometimes/Never vs. Usually/Often
 
• What is the main personal reason you are not more physically active during your leisure time?

 
• Because of any impairment or health problem, are you limited in your ability to get 30 minutes of physical activity a day?

• Community

• Do you have access to places to be physically active?
All responses
No vs. Yes
 
• Do you have sidewalks in your neighborhood?

 
• Do you have walking, jogging, or biking trails in your neighborhood?

 
• Do you have heavy traffic in your neighborhood?

 
• Do you have street lights in your neighborhood?

 
• Do you have unattended dogs in your neighborhood?

 
• How safe from crime do you consider your neighborhood to be?
All responses
Not at all or slightly safe vs. extremely or quite safe
 
• In your neighborhood or community, what environmental reasons keep you from being more active?
Reported any environmental reason vs. no environmental reason

• Do you think local government regulations should require sidewalks or other walkways for new housing developments in your community?

 
• Do you think local government funds should be spent to build and maintain sidewalks?

 
• Do you think local government funds should be spent to build and maintain public walking, jogging, or biking trails?

 
• Do you think local government funds should be spent to build and maintain public swimming pools?

 
• Do you think local government funds should be spent to build and maintain public parks or recreation centers?

 
• Do you think local schools should require physical education for all students?

 
• What structural or environmental change could be made in your neighborhood or community that would help you be more physically active? Among people with disabilities who reported wanting a change, the six most common were:
Construct/Repair Sidewalks
Trails/Greenways
Unspecified Walkways/Walking Paths
Park/Playground
Street Lights
Traffic Calming
 

• Workplace

• Do you have lunch breaks or other regular breaks during most workdays?

 
• In a usual week, do you use your lunch or other regular work breaks to do physical activity or exercise, such as walking aerobics, or jogging, for at least 10 minutes at a time?

 
• What is the main reason you are not more physically active during your break time?

 
• Not counting lunch or break time, does your workplace allow actual paid work time to be used for physical activity that is not work-related?

 
• Does your workplace have a written flex-time policy?

 
• Does your workplace have facilities or equipment for employees to use for physical activity?

 
• Does your workplace offer regular physical activity programs or exercise classes?

 
• Safe place to walk, jog, or bike outdoors at work (derived)?

 
• Does your workplace subsidize off-site health club memberships or off-site exercise classes for its employees?

 
• Does your workplace have safe and clean stairways that employees can use instead of the elevator?

• Individual

• Fruit and Vegetable Consumption per day (derived).

 
• Thinking about and planning to increase fruit and vegetable consumption

 
• Dietary Fat Intake (derived).

 
• During the past 3 months, when you drank milk or had milk on cereal, how often was it 1% or less, nonfat, or skim milk?
All responses
Sometimes/Never vs. Usually/Often

• Community

• How often do you usually eat meals from a restaurant, fast food shop, or food stand, including take-out or delivery meals?

 
• When you eat meals from a restaurant, fast food shop, or food stand, how often do you order lower-fat items?
Sometimes/Never vs. Usually/Often
 
• Would you like to see more lower-fat options in restaurants, fast food shops, and food stands?

 
• How often do you usually purchase food items, not including beverages, from a vending machine?

 
• When you purchase items from a vending machine, how often do you choose lower-fat items?
Sometimes/Never vs. Usually/Often
 
• Would you like to see more lower-fat items provided in vending machines?

 
• Thinking of the store where you do most of your grocery shopping, how would you rate the quality of their fresh fruits and vegetables?
All responses
Fair/Poor vs. Excellent/Good
 
• Thinking of the store where you do most of your grocery shopping, how would you rate the variety of their fresh fruits and vegetables?
All responses
Fair/Poor vs. Excellent/Good
 
• Thinking of the store where you do most of your grocery shopping, how would you rate the affordability of their fresh fruits and vegetables?

 
• Do you think your local public school system should require that all sources of food and drinks at school include healthy choices?

 
• Would you support using state or local taxes to improve healthy food options for public school students?

 

• Workplace

• Does your workplace have a cafeteria for employees?

 
• In your opinion, does your workplace cafeteria offer an adequate choice of healthy food and meal options, such as fresh fruits and vegetables, or low-fat meals?

 
• Does your workplace have a place where employees can refrigerate meals and snacks brought from home?

 
• Does your workplace offer any nutrition education programs for employees?

 

• Body Mass Index (BMI) Grouping-Underweight, Recommended Range, Overweight and Obese.

• Are you now trying to lose weight?

 

• Individual

• Current smoker (derived).

 
• During the past 12 months, have you quit smoking for 1 day or longer?

• Community

• In the past 30 days has anyone, including yourself, smoked cigarettes, cigars or pipes anywhere inside your home?

 
• Which statement best describes the rules about smoking inside your home?

 
• In the following locations, do you think that smoking should be allowed in all areas, some areas, or not allowed at all: Restaurants?

 
• In the following locations, do you think that smoking should be allowed in all areas, some areas, or not allowed at all: Schools?

• Workplace

• In the following locations, do you think that smoking should be allowed in all areas, some areas, or not allowed at all: Indoor work areas?

 
• Which of the following best describes your place of work’s official smoking policy for indoor public or common areas, such as lobbies, rest rooms and lunch rooms?

 
• Which of the following best describes your place of work’s official smoking policy for work areas?

 
• Workplace prohibits smoking in indoor public areas and indoor work areas (derived)?

 
• Is there a cigarette vending machine, cafeteria, or other place at your workplace where employees can buy cigarettes?

• About how long has it been since you last had your blood pressure taken by a doctor, nurse, or other health professional?

 
• Have you ever been told by a doctor, nurse, or other health professional that you have high blood pressure?

• Number of stroke symptoms correct
All correct vs. less than 5 correct
 
• Do you think the following is a symptom that someone may be having a stroke: Sudden numbness or weakness of face, arm, or leg, especially on one side?

 
• Do you think the following is a symptom that someone may be having a stroke: Sudden confusion or trouble speaking?

 
• Do you think the following is a symptom that someone may be having a stroke: Sudden trouble seeing in one or both eyes?

 
• Do you think the following is a symptom that someone may be having a stroke: Sudden trouble walking, dizziness, or loss of balance?

 
• Do you think the following is a symptom that someone may be having a stroke: Severe headache with no known cause?

 
• If you thought someone was having a stroke, what would you do?