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NHANES Physical Activity and Physical Fitness PAQ-SP 12-15 Version 12/9/98

Questionnaires:

About This Database

You are browsing a database of standardized questionnaires that ask about respondents' walking and bicycling habits.

The survey on this page is presented for informational purposes only, and is not intended to be filled out by visitors to this Web site.

The Applied Research Program maintains this database, but, except where noted, did not create and does not maintain the questionnaires themselves. For more information about a specific questionnaire, please contact its author(s). When possible, we cite the source of each questionnaire near the top of the page.

http://www.cdc.gov/nchs/data/nhanes/cpaq.pdf

PAQ.040

The next series of questions are about physical activities that {you/SP} {have/has} done over the past 30 days. First I will ask about activities that are related to transportation. Then I'll ask about physical activities that {you/he/she} {do/does} at school or in {your/his/her} leisure time.

Over the past 30 days, {have/has} {you/SP} walked or bicycled as part of getting to and from work, or school, or to do errands?

CODE 'UNABLE TO DO' ONLY IF RESPONDENT VOLUNTEERS.

YES . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . 2 (PAQ.200) UNABLE TO DO ACTIVITY . . . . 3 (PAQ.200) REFUSED . . . . . . . . . . . 7 (PAQ.200) DON'T KNOW . . . . . . . . . 9 (PAQ.200)

PAQ.050

[Over the past 30 days], how often did {you/SP} do this? [Walk or bicycle as part of getting to and from work, or school, or to do errands.]

PROBE: How many times per day, per week, or per month did {you/s/he} do these activities?

|___|___|___| ENTER NUMBER (OF DAYS, WEEKS OR MONTHS) REFUSED . . . . . 777 (PAQ.200) DON'T KNOW . . . . 999 (PAQ.200) ENTER UNIT DAY . . . . . . . 1 WEEK . . . . . . . 2 MONTH . . . . . . 3 REFUSED . . . . . 7 (PAQ.200) DON'T KNOW . . . . 9 (PAQ.200)

PAQ.080

On those days when {you/SP} walked or bicycled, about how long did {you/s/he} spend altogether doing this?

|___|___|___| ENTER NUMBER (OF MINUTES OR HOURS) REFUSED . . . . . 777 DON'T KNOW . . . . 999 ENTER UNIT MINUTES . . . . . 1 HOURS . . . . . . 2 REFUSED . . . . . 7 DON'T KNOW . . . . 9

PAQ.200

The next questions are about physical activities including exercise, sports, and physically active hobbies that {you/SP} may have done in {your/his/her} leisure time or at school over the past 30 days. (Information statement): First I will ask you about vigorous activities that cause heavy sweating or large increases in breathing or heart rate. Then I will ask you about moderate activities that cause only light sweating or a slight to moderate increase in breathing or heart rate.

Over the past 30 days, did {you/SP} do any vigorous activities for at least 10 minutes that caused heavy sweating, or large increases in breathing or heart rate? Some examples are running, lap swimming, aerobics classes, or fast bicycling.

CODE 'UNABLE TO DO' ONLY IF RESPONDENT VOLUNTEERS

YES . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . 2 (PAQ.320) UNABLE TO DO ACTIVITY . . . . 3 (PAQ.320) REFUSED . . . . . . . . . . . 7 (PAQ.320) DON'T KNOW . . . . . . . . . 9 (PAQ.320)

PAQ.220

[Over the past 30 days], what vigorous activities did {you/SP} do?

CODE ALL THAT APPLY

BICYCLING . . . . . 13 WALKING . . . . . . 42 REFUSED . . . . . . 77 DON'T KNOW . . . . 99

BOX 1

LOOP 1:
ASK PAQ.280 AND PAQ.300 FOR EACH ACTIVITY ENTERED IN PAQ.220.

PAQ.280

[Over the past 30 days], how often did {you/SP} {ACTIVITY}?

PROBE: How many times per day, per week, or per month?

CAPI INSTRUCTION: FILLS FOR ACTIVITY SHOULD BE AS FOLLOWS: 13. bicycle, 42. walk, 47. DISPLAY ACTIVITY IN 'OTHER SPECIFY'.

|___|___|___| ENTER NUMBER (OF DAYS, WEEKS OR MONTHS) REFUSED . . . . . 777 DON'T KNOW . . . . 999 ENTER UNIT DAY . . . . . . . 1 WEEK . . . . . . . 2 MONTH . . . . . . 3 REFUSED . . . . . 7 DON'T KNOW . . . . 9

PAQ.300

[Over the past 30 days], on average about how long did {you/SP} {ACTIVITY} each time?

|___|___|___| ENTER NUMBER (OF MINUTES OR HOURS) REFUSED . . . . . 777 DON'T KNOW . . . . 999 ENTER UNIT MINUTES . . . . . 1 HOURS . . . . . . 2 REFUSED . . . . . 7 DON'T KNOW . . . . 9

BOX 2

END LOOP 1:
ASK PAQ.280 AND PAQ.300 FOR NEXT ACTIVITY.
IF NO NEXT ACTIVITY, CONTINUE WITH PAQ.320.

PAQ.320

Information Statement: [Over the past 30 days], did {you/SP} do moderate activities for at least 10 minutes that cause only light sweating or a slight to moderate increase in breathing or heart rate? Some examples are brisk walking, bicycling for pleasure, golf, or dancing.

CODE 'UNABLE TO DO' ONLY IF RESPONDENT VOLUNTEERS

YES . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . 2 (PAQ.440) UNABLE TO DO ACTIVITY . . . . 3 (PAQ.440) REFUSED . . . . . . . . . . . 7 (PAQ.440) DON'T KNOW . . . . . . . . . 9 (PAQ.440)

PAQ.340

[Over the past 30 days], what activity or activities did {you/SP} do?

CODE ALL THAT APPLY

BICYCLING . . . . 13 WALKING . . . . . 42 REFUSED . . . . . 77 (PAQ.440) DON'T KNOW . . . . 99 (PAQ.440)

BOX 3

LOOP 2:
ASK PAQ.400 AND PAQ.420 FOR EACH ACTIVITY ENTERED IN PAQ.340.

PAQ.400

[Over the past 30 days], how often did {you/SP} {ACTIVITY}?

PROBE: How many times per day, per week, or per month?

CAPI INSTRUCTION: FILLS FOR ACTIVITY SHOULD BE AS FOLLOWS: 13. bicycle, 42. walk,

|___|___|___| ENTER NUMBER (OF DAYS, WEEKS OR MONTHS) REFUSED . . . . . 777 DON'T KNOW . . . . 999 ENTER UNIT DAY . . . . . . . 1 WEEK . . . . . . . 2 MONTH . . . . . . 3 REFUSED . . . . . 7 DON'T KNOW . . . . 9

PAQ.420

[Over the past 30 days], on average about how long did {you/SP} {ACTIVITY} each time?

|___|___|___| ENTER NUMBER (OF MINUTES OR HOURS) REFUSED . . . . . 777 DON'T KNOW . . . . 999 ENTER UNIT MINUTES . . . . . 1 HOURS . . . . . . 2 REFUSED . . . . . 7 DON'T KNOW . . . . 9

BOX 4

END LOOP 2:
ASK PAQ.400 AND PAQ.420 FOR NEXT ACTIVITY.
IF NO NEXT ACTIVITY, CONTINUE WITH PAQ.440.

Last Modified: 11 Apr 2014