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California Health Interview Survey (CHIS) 2009 Adult Questionnaire

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.

In: http://www.chis.ucla.edu/pdf/CHIS2009adultquestionnaire.pdfExternal Web Site Policy

Section C - Health Behaviors

Walking for Transportation and Leisure

The next questions are about walking for transportation. I will ask you separately about walking for relaxation or exercise.

QA09_C1 During the past 7 days, did you walk to get some place that took you at least 10 minutes?

1 YES
2 NO [GO TO QA09_C4]
3 UNABLE TO WALK [GO TO QA09_C7]
-7 REFUSED [GO TO QA09_C4]
-8 DON'T KNOW [GO TO QA09_C4]

QA05_C2 In the past 7 days, how many times did you do that? [IF NEEDED, SAY: "Walk for at least 10 minutes to get some place."]

______ TIMES PER WEEK
-7 REFUSED
-8 DON'T KNOW

QA09_C3 {How long did that walk take/On average, how long did those walks take}?

______ MINUTES PER DAY
______ HOURS PER DAY
-7 REFUSED
-8 DON'T KNOW

QA05_C4 Sometimes you may walk for fun, relaxation, exercise, or to walk the dog. During the past 7 days, did you walk for at least 10 minutes for any of these reasons? {Please do not include walking for transportation.}

1 YES
2 NO [GO TO QA09_C7]
-7 REFUSED [GO TO QA09_C7]
-8 DON'T KNOW [GO TO QA09_C7]

QA09_C5 In the past 7 days, how many times did you do that? [IF NEEDED, SAY: "Walk for at least 10 minutes for fun, relaxation, exercise, or to walk the dog."]

______ TIMES PER WEEK [IF 0, GO TO QA09_C7]
-7 REFUSED [GO TO QA09_C7]
-8 DON'T KNOW [GO TO QA09_C7]

QA09_C6 {How long did that walk take/On average, how long did those walks take}?

______ MINUTES PER DAY
______ HOURS PER DAY
-7 REFUSED
-8 DON'T KNOW

QA09_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, dancing, swimming, 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?

1 YES
2 NO [GO TO QA09_C10]
-7 REFUSED [GO TO QA09_C10]
-8 DON'T KNOW [GO TO QA09_C10]

QA09_C8 On how many days did you do this?

______ DAYS PER WEEK [IF 0, GO TO QA09_C10]
-7 REFUSED [GO TO QA09_C10]
-8 DON'T KNOW [GO TO QA09_C10]

QA09_C9 How much time did you {usually} spend on {one of those days/that day} doing moderate physical activities in your free time?

______ HOURS PER DAY
______ MINUTES PER DAY
-7 REFUSED
-8 DON'T KNOW

QA09_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."]

1 YES
2 NO [GO TO QA09_C13]
-7 REFUSED [GO TO QA09_C13]
-8 DON'T KNOW [GO TO QA09_C13]

QA09_C11 On how many days did you do this?

______ DAYS PER WEEK [IF 0, GO TO QA09_C13]
-7 REFUSED [GO TO QA09_C13]
-8 DON'T KNOW [GO TO QA09_C13]

QA09_C12 How much time did you {usually} spend on {one of those days/that day} doing vigorous physical activities in your free time?

______ HOURS PER DAY
______ MINUTES PER DAY
-7 REFUSED
-8 DON'T KNOW

Section D - General Health, Disability, and Sexual Health

QA09_D6 Do you have a condition that substantially limits one or more basic physical activities such as walking, climbing stairs, reaching, lifting, or carrying?

1 YES
2 NO
-7 REFUSED
-8 DON'T KNOW

Last Modified: 11 Apr 2014