2020 BRFSS Questionnaire

1 2020 BRFSS . Questionnaire 1. 12 July 2021. Table of Contents OMB Header and Introductory Text ..4. Landline Cell Phone Introduction .. 10. Core Section 1: health Status .. 15. Core Section 2: Healthy Days .. 16. Core Section 3: health Care Access .. 18. Core Section 4: Exercise .. 20. Core Section 5: Inadequate Sleep .. 21. Core Section 6: Chronic health Conditions .. 22. Core Section 7: Oral 25. Core Section 8: Demographics .. 26. Core Section 9: Disability .. 32. Core Section 10: Tobacco Use .. 34. Core Section 11: Alcohol 36. Core Section 12: Immunization .. 38. Core Section 13: Falls .. 40. Core Section 14: Seat Belt Use and Drinking and Driving .. 41. Core Section 15: Breast and Cervical Cancer 42. Core Section 16: Prostate Cancer Screening .. 45. Core Section 17: Colorectal Cancer Screening .. 48.

2 Core Section 18: .. 53. Closing Statement/ Transition to Modules .. 55. Optional Modules .. 56. Module 1: 56. Module 2: 57. Module 3: ME/CFS .. 60. Module 4: Hepatitis Treatment .. 61. Module 5: health Care Access .. 63. Module 6: Cognitive Decline .. 64. Module 7: Caregiver .. 67. Module 8: E-Cigarettes .. 71. 2. 12 July 2021. Module 9: Marijuana Use .. 72. Module 10: Lung Cancer Screening .. 74. Module 11: Cancer Survivorship: Type of Cancer .. 76. Module 12: Cancer Survivorship: Course of Treatment .. 80. Module 13: Cancer Survivorship: Pain Management .. 83. Module 14: Prostate Cancer Screening Decision Making .. 84. Module 15: Adult Human Papillomavirus (HPV) - 86. Module 16: Tetanus Diphtheria (Tdap) (Adults) .. 88. Module 17: Place of Flu Vaccination .. 89. Module 18: Industry and Occupation.

3 91. Module 19: Sex at Birth .. 93. Module 20: Sexual Orientation and Gender Identity (SOGI) .. 94. Module 21: Adverse Childhood Experiences .. 98. Module 22: Random Child Selection .. 101. Module 23: Childhood Asthma Prevalence .. 106. Asthma Call-Back Permission Script .. 107. Closing Statement .. 109. 3. 12 July 2021. OMB Header and Introductory Text Read if necessary Read Interviewer instructions (not read). Public reporting burden of this Form Approved collection of information is OMB No. estimated to average 27 minutes Exp. Date 3/31/2021. per response, including the time for reviewing instructions, Interviewers do not need to searching existing data sources, read any part of the burden gathering and maintaining the estimate nor provide the data needed, and completing and OMB number unless asked reviewing the collection of by the respondent for information.

4 An agency may not specific information. If a conduct or sponsor, and a person respondent asks for the length of time of the is not required to respond to a interview provide the most collection of information unless it accurate information based displays a currently valid OMB on the version of the control number. Send comments Questionnaire that will be regarding this burden estimate or administered to that any other aspect of this collection respondent. If the of information, including interviewer is not sure, suggestions for reducing this provide the average time as burden to CDC/ATSDR Reports indicated in the burden Clearance Officer; 1600 Clifton statement. If data collectors Road NE, MS D-74, Atlanta, have questions concerning Georgia 30333; ATTN: PRA (0920- the BRFSS OMB process, 1061). please contact Carol Pierannunzi at HELLO, I am calling for the [STATE.]

5 OF xxx] department of health . My name is (name). We are gathering information about the health of US residents. This project is conducted by the health department with assistance from the Centers for Disease Control and Prevention. Your telephone number has been chosen randomly, and I would like to ask some questions about health and health practices. 4. 12 July 2021. Landline Introduction Question Question text Variable Responses SKIP INFO/ Interviewer Column(s). Number names (DO NOT CATI Note Note(s). READ. UNLESS. OTHERWISE. NOTED). LL01. Is this [PHONE CTELENM1 1 Yes Go to LL02 63. NUMBER]? 2 No TERMINATE Thank you very much, but I seem to have dialed the wrong number. It's possible that your number may be called at a later time. LL02. Is this a private PVTRESD1 1 Yes Go to LL04 Read if necessary: 64.

6 Residence? By private residence we mean someplace like a house or apartment. Do not read: Private residence includes any home where the respondent spends at least 30. days including vacation homes, RVs or other locations in which the respondent lives for portions of the year. 2 No Go to LL03 If no, business phone only: thank you very much but we are only interviewing persons on residential phones lines at this time. NOTE: Business numbers which are also used for personal 5. 12 July 2021. communication are eligible. 3 No, this is Read: Thank you a business very much but we are only interviewing persons on residential phones at this time. TERMINATE. LL03. Do you live in COLGHOUS 1 Yes Go to LL04 Read if necessary: 65. college housing? By college housing we mean dormitory, graduate student or visiting faculty housing, or other housing arrangement provided by a college or university.

7 2 No TERMINATE Read: Thank you very much, but we are only interviewing persons who live in private residences or college housing at this time. LL04. Do you currently STATERE1 1 Yes Go to LL05 66. live 2 No TERMINATE Thank you very in__(state)____? much but we are only interviewing persons who live in [STATE] at this time. LL05. Is this a cell CELPHONE 1 Yes, it is a TERMINATE Read: Thank you 67. phone? cell phone very much but we are only interviewing by landline telephones in private residences or college housing at this time. 6. 12 July 2021. 2 Not a cell Go to LL06 Read if necessary: phone By cell phone we mean a telephone that is mobile and usable outside your neighborhood. Do not read: Telephone service over the internet counts as landline service (includes Vonage, Magic Jack and other home-based phone services).

8 LL06. Are you 18 years LADULT1 1 Yes IF COLLEGE 68. of age or older? HOUSING =. YES, . CONTINUE;. OTHERWISE. GO TO ADULT. RANDOM. SELECTION]. 2 No IF COLLEGE Read: Thank you HOUSING = very much but we YES, are only Terminate; interviewing OTHERWISE persons aged 18. GO TO ADULT or older at this RANDOM time. SELECTION]. LL07. Are you male or COLGSEX 1 Male ONLY for 69. female? 2 Female respondents who are LL. and COLGHOUS=. 1. 7 Don't TERMINATE Thank you for know/Not your time, your sure number may be 9 Refused selected for another survey in the future. LL08. I need to NUMADULT 1 Go to LL09 Read: Are you 70-71. randomly select that adult? one adult who If yes: Then you lives in your are the person I. 7. 12 July 2021. household to be need to speak interviewed. with. Excluding adults If no: May I speak living away from with the adult in home, such as the household?

9 Students away at 2-6 or more Go to LL10. college, how many members of your household, including yourself, are 18 years of age or older? LL09. Are you male or LANDSEX 1 Male GO to 72. female? 2 Female Transition Section 1. 7 Don't TERMINATE Thank you for know/Not your time, your sure number may be 9 Refused selected for another survey in the future. LL10. How many of NUMMEN _ _ Number 73-74. these adults are 77 Don't men? know/ Not sure 99 Refused LL11. So the number of NUMWOMEN Do not read: 75-76. women in the Confirm the household is [X]. number of adult Is that correct? women or clarify the total number of adults in the household. Read: The persons in your household that I need to speak with is [Oldest/Youngest/. Middle//Male /Female]. LL12 The person in RESPSLCT 1 Male If person 77. your household 2 Female indicates that that I need to they are not speak with is the selected [Oldest/Youngest/ respondent, Middle//Male ask for /Female].

10 Are you correct the respondent [Oldest/Youngest/ and re-ask Middle//Male LL12. (See 8. 12 July 2021. /Female] in this CATI. household? programming). 7 Don't TERMINATE Thank you for know/Not your time, your sure number may be 9 Refused selected for another survey in the future. Transition I will not ask Do not read: to Section for your last Introductory text 1. name, may be reread address, or when selected other respondent is personal reached. information that can Do not read: The identify you. sentence Any You do not information you have to give me will not answer any be connected to question any personal you do not information may want to, be replaced by and you can Any personal end the information that interview at you provide will any time. not be used to Any identify you. If information the state you give me coordinator will not be approves the connected change.