Wheeling Walks Training Manual

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Chapter 3:
Appendix

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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

b. Employed for wages, part-time (Go to Question 8).......................... 2

c. Self-employed (Go to Question 8)....................................................... 3

d. Out of work for less than 1 year (Go to Question 9).......................... 4

e. Out of work for more than 1 year (Go to Question 9)........................ 5

f. Homemaker(Go to Question 8)........................................................... 6

g. Student (Go to Question 9).................................................................... 7

h. Retired (Go to Question 9).................................................................... 8

i. Disabled and unable to work (Go to Question 9).............................. 9

[Do not read.]

Don?t know/not sure....................................................................... 777

Refused..................................................................... 999

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

b.

Mostly walking

2

c.

Mostly heavy labor or physically demanding work

3

[Do not read.]
Don't know/Not Sure 77

Refused

9

If respondent has multiple jobs, include all jobs

9.

In a usual week, do you walk for at least 10 minutes at a time [if employed, insert: while at work,] for recreation, exercise, to get to and from places, or for any other reason?

a.

Yes

1

b.

No Go to Q. 14

[Do not read.]

2

Don't know/Not sure Go to Q. 14

77

Refused Go to Q. 14

99

10.

How many days per week do you walk for at least 10 minutes at a time?

Days per week

____

[Do not read.]

Don't know/Not sure 77

Refused

99

11.

On days when you walk for at least 10 minutes at a time, how much total time per day do you spend walking?

Hours and minutes per day

[Do not read.]

____: ____ ____

Don't know/Not sure

777

Refused

999

12.

In a usual week, do you do any activities designed to increase muscle strength or tone, such as lifting weights, pull-ups, push-ups, or sit-ups?

a.

Yes

1

b.

No Go to Q. 14

[Do not read.]

2

Don't know/Not sure Go to Q. 14

7

Refused Go to Q. 14

9

13.

How many days per week do you do these activities?

Days per week

____


[Do not read.]
Don't know/Not sure



77

Refused

99

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, thinking about 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

b.

No Go to Q. 17

2

[Do not read.]

Don't know/Not sure Go to Q. 17 77

Refused Go to Q. 17

99

15.

How many days per week do you do these moderate activities for at least 10 minutes at a time?

Days per week

____

[Do not read.]

Don't know/Not sure

77

Refused

99

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

____: ____ ____

[Do not read.]Don't know/Not sure

777

Refused

999

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

b.

No Go to Q. 20

2

[Do not read.]
Don't know/Not sure Go to Q. 20




77

Refused Go to Q. 20

99

18.

How many days per week do you do these vigorous activities for at least 10 minutes at a time?

Days per week

____


[Do not read.]
Don't know/Not sure



77

Refused

99

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

____: ____ ____


[Do not read.]
Don't know/Not sure



777

Refused

999

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