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California Health Interview Survey 2005

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.

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QA05_C1. The next questions are about walking for transportation. Please only include walks that involved an errand or to get some place. I will ask you separately about walking for relaxation or exercise.

During the past seven days, did you walk for at least ten minutes at a time to get some place such as work, school, a store, or restaurant?

YES.............................1
NO...............................2 [GO TO QA05_C4]
UNABLE TO WALK...3 [GO TO QA05_C7]
REFUSED................-7 [GO TO QA05_C4]
DON'T KNOW..........-8 [GO TO QA05_C4]

QA05_C2. On how many days did you do this?

DAYS PER WEEK [IF 0, GO TO QA05_C5]

REFUSED................-7 [GO TO QA05_C4]
DON'T KNOW..........-8 [GO TO QA05_C4]

QA05_C3. How much time did you {usually} spend walking on {one of those days/that day}?

HOURS PER DAY
MINUTES PER DAY

REFUSED................-7
DON'T KNOW..........-8

QA05_C4. Sometimes you may walk for fun, relaxation, exercise, or to walk the dog. During the past seven days did you walk for at least ten minutes at a time for any of these reasons? Please do not include any walking that you already told me about.

YES.............................1
NO...............................2 [GO TO QA05_C7]
REFUSED................-7 [GO TO QA05_C7]
DON'T KNOW..........-8 [GO TO QA05_C7]

QA05_C5. On how many days did you do this?

DAYS PER WEEK [IF 0, GO TO QA05_C7]

REFUSED................-7 [GO TO QA05_C7]
DON'T KNOW..........-8 [GO TO QA05_C7]

QA05_C6. How much time did you (usually) spend walking on (one of those days/on that day)?

[IF NEEDED SAY: "For fun, relaxation, exercise or to walk the dog?"]

HOURS PER DAY
MINUTES PER DAY

REFUSED................-7
DON'T KNOW..........-8

Moderate and Vigorous Physical Activity

QA05_C7. The next questions are about physical activities or exercise you may do in your free time for at least 10 minutes, other than walking. First, think about activities that take moderate physical effort, such as bicycling, swimming, dancing, and gardening.

During the last 7 days, did you do any moderate physical activities in your free time for at least 10 minutes, other than walking?

[IF NEEDED SAY: Moderate physical activities make you breathe somewhat harder than normal.]
[IF NEEDED SAY: "Think about only those physical activities that you did for at least 10 minutes at a time."]

YES.............................1
NO...............................2 [GO TO QA05_C10]
REFUSED................-7 [GO TO QA05_C10]
DON'T KNOW..........-8 [GO TO QA05_C10]

QA05_C8. On how many days did you do this?

DAYS PER WEEK [IF 0, GO TO QA05_C10]

REFUSED................-7 [GO TO QA05_C10]
DON'T KNOW..........-8 [GO TO QA05_C10]

QA05_C9. How much time did you {usually} spend on {one of those days/that day} doing moderate physical activities in your free time?

[IF NEEDED SAY: "Think about only those physical activities that you did for at least 10 minutes at a time."]

HOURS PER DAY
MINUTES PER DAY

REFUSED................-7
DON'T KNOW..........-8

QA05_C10. Now think about vigorous activities you did in your free time that take hard physical effort, such as aerobics, running, soccer, fast bicycling, or fast swimming. Again, do not include walking.

During the last 7 days, did you do any vigorous physical activities in your free time?

[IF NEEDED SAY: "Vigorous activities make you breathe much harder than normal."]
[IF NEEDED SAY: "Think about only those vigorous physical activities that you did for at least 10 minutes at a time."]

YES.............................1
NO...............................2 [GO TO QA05_C13]
REFUSED................-7 [GO TO QA05_C13]
DON'T KNOW..........-8 [GO TO QA05_C13]

QA05_C11. On how many days did you do this?

DAYS PER WEEK [IF 0, GO TO QA05_C13]

REFUSED................-7 [GO TO QA05_C13]
DON'T KNOW..........-8 [GO TO QA05_C13]

QA05_C12. How much time did you {usually} spend on {one of those days/on that day} doing vigorous physical activities in your free time?

[IF NEEDED SAY: "Think about only those physical activities that you did for at least 10 minutes at a time."]

HOURS PER DAY
MINUTES PER DAY

REFUSED................-7
DON'T KNOW..........-8

Last Modified: 11 Apr 2014