Table 3.
Item | Response Options | Item source | |
---|---|---|---|
What is your age? | ____ Years old (18–130) | HINTS | |
Are you male or female? | • Male • Female |
HINTS | |
What is your race? One or more categories may be selected. Mark all that apply. | • White • Black or African American • American Indian or Alaska Native • Asian Indian • Chinese • Filipino • Japanese |
• Korean • Vietnamese • Other Asian • Native Hawaiian • Guamanian or Chamorro • Samoan • Other Pacific Islander |
HINTS |
Are you Hispanic, Latino/a, or Spanish origin? Mark all that apply. | • Mexican, Mexican American, Chicano/a • Puerto Rican • Cuban • Another Hispanic, Latino/a, or Spanish origin • None of these |
BRFSS | |
Thinking about members of your family living in this household, what is your combined annual income, meaning the total pre-tax income from all sources earned in the past year? | • $0 to $9,999 • $10,000 to $14,999 • $15,000 to $19,999 • $20,000 to $34,999 • $35,000 to $49,999 • $50,000 to $74,999 • $75,000 to $99,999 • $100,000 to $199,999 • $200,000 or more |
HINTS | |
Do you currently rent or own your home? | • Own • Rent • Occupied without paying monetary rent |
HINTS | |
Which one of these comes closest to your own feelings about your household’s income these days? | • Living comfortably on present income. • Getting by on present income. • Finding it difficult on present income. • Finding it very difficult on present income |
Gallup | |
Do you have any kind of health care coverage, including health insurance, prepaid plans such as HMOs, or government plans such as Medicare, or Indian Health Service? | • Yes • No |
BRFSS | |
What is the primary source of your health care coverage? | • A plan purchased through an employer or union (including plans purchased through another person’s employer) • A plan that you or another family member buys on your own • Medicare |
• Medicaid or other state program • TRICARE (formerly CHAMPUS), VA, or Military • Alaska Native, Indian Health Service, Tribal Health Services • Some other source |
BRFSS |
What is the highest grade or level of schooling you completed? | • Less than 8 years • 8 through 11 years • 12 years or completed high school • Post high school training other than college (vocational or technical) • Some college • College graduate • Postgraduate |
HINTS | |
What is your marital status? Mark only one. | • Married • Living as married • Divorced |
• Widowed • Separated • Single, never been married |
HINTS |
What is your current occupational status? Mark only one. | • Employed • Unemployed • Homemaker • Student |
• Retired • Disabled • Other (Specify)_______ |
HINTS |
Were you born in the United States? | • Yes • No |
HINTS |
Note: Question wording was provided for both self-administered and interviewer-administered surveys. The question wording was adapted for mode without fundamental or consequential changes to the stem or response options.