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Standardized Questionnaires of Walking & Bicycling Database:
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About This Database
You are browsing a database of standardized
questionnaires that ask about respondents' walking and bicycling habits. 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.
Health Insurance Plan of New York City Activity Questionnaire
In:
Pereira MA, FitzGerald SJ, Gregg EW, Joswiak ML, Ryan WJ, Suminski RR, Utter AC, Zmuda JM.
A collection of Physical Activity Questionnaires for health-related research.
Med Sci Sports Exerc 1997 Jun;29(6 Suppl):S1-205.
The individual is asked to complete six occupational activity and five leisure time activity questions. The questions may be administered by an interviewer.
Calculations: each possible response on the questionnaire is assigned a weight. Occupational-related scores are obtained by summing the weights of the different categories and determining the class in which the total score falls. A similar system is used for leisure activities.
Physical Activity Connected with Job:
| Question |
Answer |
Assigned weight |
| Time on job spent walking |
Almost none |
0 |
| Less than ½ |
1 |
| About ½ |
2 |
| More than ½ |
3 |
| Practically all |
4 |
| Walking to get to and from work |
None or less than 1 block |
0 |
| 1 or 2 blocks |
1 |
| 3 or 4 blocks |
2 |
| 5 to 9 blocks |
3 |
| 10 to 19 blocks |
4 |
| 20 to 39 blocks |
5 |
| 40+ blocks (2+ miles) |
6 |
| Hours on job |
Less than 25 |
1 |
| 25-34 |
2 |
| 35-40 |
3 |
| 41-50 |
4 |
| 50+ |
5 |
Physical Activity Off the Job
:
| Item |
Frequently |
Sometimes |
Very
infrequently or never |
| Takes walks in good weather |
2 |
1 |
0 |
| Walks around house or
apartment |
2 |
1 |
0 |
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