Breast Cancer -
[Top] |
| [BC-01] |
A mammogram is an x-ray of each breast to look for breast cancer. Have you ever had a mammogram? |
| [BC-02] |
When did you have your most recent mammogram to check for breast cancer? |
Cancer Communication -
[Top] |
| [CA-01] |
Have you ever been told by a doctor that you had cancer? |
| [CA-02] |
What type of cancer was it, or in what part of the body did the cancer start? |
| [CA-02t] |
Cancer Classification |
| [CA-03] |
At what age or in what year were you first told that you had cancer? |
| [CA-03t] |
At what age were you diagnosed with cancer? |
| [CA-03t] |
Time since diagnosed with cancer |
| [CA-04] |
Did you undergo treatment for your cancer? |
| [CA-05] |
How long ago did you finish your treatment? |
| [CA-06] |
Have any of your family members ever had cancer? |
| [CA-07] |
What type of cancer was it? |
| [CA-08] |
Have you ever looked for information about cancer from any source? |
| [CA-09] |
Not including your doctor or other health care provider, has someone else ever looked for information about cancer for you? |
| [CA-09t] |
Did you look for information by yourself, by proxy, both or neither? |
| [CA-10] |
Who was that? |
| [CA-10] |
Who was that? [that looked for information about cancer for you] |
| [CA-11] |
Think about the most recent time you looked for cancer-related information from any source. About how long ago was that? |
| [CA-11t] |
How many days since you looked for cancer info? |
| [CA-11t] |
Time since last sought cancer information |
| [CA-12] |
The most recent time you wanted information on cancer, where did you go first? |
| [CA-13] |
What type of information were you looking for in your most recent search? |
| [CA-14a] |
Based on the results of your search for information on cancer from all sources, how much do you agree or disagree with the following statements? It took a lot of effort to get the information you needed. |
| [CA-14b] |
...You felt frustrated during your search for the information. Would you say you strongly agree, somewhat agree, somewhat disagree, or strongly disagree? |
| [CA-14c] |
...You were concerned about the quality of the information. |
| [CA-14d] |
...The information you found was too hard to understand. |
| [CA-15] |
Have you ever visited an Internet web site to learn specifically about cancer? |
| [CA-16] |
How useful was the cancer-related information you got from the Internet? |
| [CA-17] |
Overall, how confident are you that you could get advice or information about cancer if you needed it? |
| [CA-18] |
Imagine that you had a strong need to get information about cancer. Where would you go first? |
| [CA-21c] |
Before being contacted for this study, had you ever heard of the National Cancer Institute? |
| [CA-21d] |
Before being contacted for this study, had you ever heard of the National Cancer Institute's Cancer Information Service? |
| [CA-21e] |
Before being contacted for this study, had you ever heard of the 1-800-4-Cancer information number? |
| [CA-21h] |
Before being contacted for this study, had you ever heard of the 1-800-ACS-2345 cancer information number? |
| [CA-21i] |
Before being contacted for this study, had you ever heard of Cancer Control of America? |
| [CA-22] |
Have you ever contacted it for information? |
| [CA-23] |
Is there a particular reason that you didn't contact it? |
Cancer Representations -
[Top] |
| [MM-05a] |
Would you say you agree or disagree with the following statements? There's not much you can do to lower your chances of getting colon cancer. |
| [MM-05a] |
... There's not much you can do to lower your chances of getting lung cancer. |
| [MM-05a] |
... There's not much you can do to lower your chances of getting skin cancer. |
| [MM-05b] |
... There are so many different recommendations about preventing colon cancer that it's hard to know which ones to follow. |
| [MM-05b] |
... There are so many different recommendations about preventing lung cancer that it's hard to know which ones to follow. |
| [MM-05b] |
... There are so many different recommendations about preventing skin cancer that it's hard to know which ones to follow. |
| [MM-05c] |
... Colon cancer develops over a period of several years. |
| [MM-05c] |
... Lung cancer develops over a period of several years. |
| [MM-05c] |
... Skin cancer develops over a period of several years. |
| [MM-05d] |
... There are ways to slow down or disrupt the development of colon cancer. |
| [MM-05d] |
... There are ways to slow down or disrupt the development of lung cancer. |
| [MM-05d] |
... There are ways to slow down or disrupt the development of skin cancer. |
| [MM-05e] |
... Colon cancer is most often caused by a person's behavior or lifestyle. |
| [MM-05e] |
... Lung cancer is most often caused by a person's behavior or lifestyle. |
| [MM-05e] |
... Skin cancer is most often caused by a person's behavior or lifestyle. |
| [MM-05f] |
... It seems like almost everything causes colon cancer. |
| [MM-05f] |
... It seems like almost everything causes lung cancer. |
| [MM-05f] |
... It seems like almost everything causes skin cancer. |
| [MM-05h] |
... You are reluctant to get checked for colon cancer because you fear you may have it. |
| [MM-05h] |
... You are reluctant to get checked for lung cancer because you fear you may have it. |
| [MM-05h] |
... You are reluctant to get checked for skin cancer because you fear you may have it. |
| [MM-05i] |
... Getting checked regularly for colon cancer increases the chances of finding cancer when it's easy to treat. |
| [MM-05i] |
... Getting checked regularly for skin cancer increases the chances of finding cancer when it's easy to treat. |
| [MM-05l] |
... People with colon cancer would have pain or other symptoms prior to being diagnosed. |
| [MM-05l] |
... People with lung cancer would have pain or other symptoms prior to being diagnosed. |
| [MM-05l] |
... People with skin cancer would have pain or other symptoms prior to being diagnosed. |
| [MM-06] |
What are the common symptoms of colon cancer? |
| [MM-06] |
What are the common symptoms of lung cancer? |
| [MM-06] |
What are the common symptoms of skin cancer? |
| [MM-06] |
What are the common symptoms of colon cancer? |
| [MM-06] |
... colon cancer? |
| [MM-06] |
... lung cancer? |
| [MM-06] |
... skin cancer? |
| [MM-06] |
What are the common symptoms of lung cancer? |
| [MM-06] |
... lung cancer? |
| [MM-07] |
Overall, how many people who develop colon cancer do you think survive at least 5 years? |
| [MM-07] |
Overall, how many people who develop lung cancer do you think survive at least 5 years? |
| [MM-07] |
Overall, how many people who develop skin cancer do you think survive at least 5 years? |
Colon Cancer -
[Top] |
| [CC-01] |
Can you think of any tests that detect colon cancer? |
| [CC-01] |
Can you think of any tests that detect colon cancer? Anything else? |
| [CC-04] |
Has a doctor, nurse or other health professional ever advised you to get a test to check for colon cancer? |
| [CC-05] |
A stool blood test, also known as a Fecal Occult Blood Test, is a test done to check for colon cancer. It is done at home using a set of 3 cards to determine whether the stool contains blood. Have you ever done this test using a home kit? |
| [CC-06] |
When did you do your most recent stool blood test using a home kit to check for colon cancer? |
| [CC-06t] |
When was your last Home Stool Blood Test? |
| [CC-07] |
A sigmoidoscopy and a colonoscopy are both tests that examine the bowel by inserting a tube in the rectum. Have you ever had either a colonoscopy or a sigmoidoscopy? |
| [CC-08] |
When did you have your most recent sigmoidoscopy or colonoscopy to check for colon cancer? |
| [CC-08t] |
When was your last Endoscopy? |
Cervical Cancer -
[Top] |
| [CV-01] |
Have you ever had a Pap smear? |
| [CV-02] |
When did you have your most recent Pap smear? |
| [CV-02t] |
When was your last Pap Screen? |
| [CV-03] |
What was the main reason that you had this Pap smear? |
| [CV-04] |
How long before that Pap smear was the previous one? |
| [CV-05] |
Have you had a hysterectomy? |
| [CV-06] |
When do you expect to have your next Pap smear? |
| [CV-07] |
How often do you think a woman your age should have a Pap smear? |
| [CV-08] |
Most medical organizations now recommend a Pap smear every three years for healthy adult women. Have you heard about this change in guidelines? |
| [CV-09] |
Would you agree to have Pap smears every three years if your health care provider recommended it? |
| [CV-10] |
Have you ever been treated for venereal warts or condyloma? |
| [CV-11] |
Have you ever heard of HPV? HPV stands for Human Papillomavirus. |
| [CV-12] |
Have you ever been told by a health care provider that you had HPV infection? |
| [CV-13a] |
Do you think that HPV causes cervical cancer? |
| [CV-13b] |
Do you think that HPV is a sexually transmitted disease? |
| [CV-13c] |
Do you think that HPV infection is rare? |
| [CV-13d] |
Do you think that HPV will often go away on its own without treatment? |
| [CV-13e] |
Do you think HPV can cause abnormal Pap smears? |
| [CV-13f] |
Do you think that HPV can affect a woman's ability to get pregnant? |
Demographics -
[Top] |
| [DM-01] |
Are you currently employed for wages, self-employed, out of work for more than one year, out of work for less than one year, a homemaker, a student, retired, or unable to work? |
| [DM-02] |
Are you married, divorced, widowed, separated, never been married, or living with a partner? |
| [DM-03] |
What is the highest level of school you completed? |
| [DM-03a] |
What is the highest level of school you completed? (Grouped A) |
| [DM-03b] |
What is the highest level of school you completed? (Grouped B) |
| [DM-04] |
Are you Hispanic or Latino? |
| [DM-05] |
Which one or more of the following would you say is your race? Are you American Indian or Alaska Native, Asian, Black or African American, Native Hawaiian or other Pacific Islander, or White? |
| [DM-05t] |
Race/ethnicity |
| [DM-06] |
Were you born in the United States? |
| [DM-07] |
In what year did you come to live in the United States? |
| [DM-08] |
How comfortable do you feel speaking English? |
| [DM-09] |
Do you currently rent or own your home? |
| [DM-11] |
Including yourself, how many people live in your household? |
| [DM-12] |
How many people in your household are related to you by blood, marriage, or adoption? |
| [DM-13] |
How many of these family members are under the age of 18? |
| [DM-14] |
What is your combined annual income, meaning the total pre-tax income from all sources earned in the past year? |
| [DM-14a] |
Is your annual household income from all sources less than $25,000? |
| [DM-14b] |
Is your annual household income from all sources less than $20,000? |
| [DM-14c] |
Is your annual household income from all sources less than $15,000? |
| [DM-14d] |
Is your annual household income from all sources less than $10,000? |
| [DM-14e] |
Is your annual household income from all sources less than $35,000? |
| [DM-14f] |
Is your annual household income from all sources less than $50,000? |
| [DM-14g] |
Is your annual household income from all sources less than $75,000? |
| [DM-14h] |
Is your annual household income from all sources less than $100,000? |
| [DM-14i] |
Is your annual household income from all sources less than 200,000? |
| [DM-14j] |
Is your annual household income from all sources $200,000 or more? |
| [DM-14ta] |
What is your {combined} annual household income? |
| [DM-15] |
At the end of the month, how much money are you able to put aside? |
Energy Balance -
[Top] |
| [EB-01] |
During the past 30 days, how often did you drink 100% fruit juice? |
| [EB-01t] |
How often do you drink fruit juice per day? |
| [EB-02] |
During the past 30 days, how often did you eat fruit? |
| [EB-02t] |
How often do you eat fruit per day? |
| [EB-03] |
During the past 30 days, how often did you eat potatoes? |
| [EB-03t] |
How often do you eat potatoes per day? |
| [EB-04] |
During the past 30 days, how often did you eat vegetables other than potatoes? |
| [EB-04t] |
How often do you eat vegetables per day? (excluding potatoes)? |
| [EB-05] |
How many servings of fruits and vegetables do you think a person should eat each day for good health? |
| [EB-06] |
In a typical week, how many days do you do any moderate-intensity physical activity or exercise comparable to walking as if you were in a hurry? |
| [EB-07] |
On the days that you do any moderate physical activity or exercise, how long are you typically doing these activities? |
| [EB-08] |
How many days a week of physical activity or exercise are recommended for the average adult to stay healthy? |
| [EB-09] |
On those days, how long should the average adult be physically active to stay healthy? |
| [EB-10] |
As far as you know, does physical activity or exercise increase the chances of getting some types of cancer, decrease the chances of getting some types of cancer, or does it not make much difference? |
| [EB-11] |
Have you tried to lose any weight in the past year? |
| [EB-12] |
Are you aware of low carbohydrate, high protein diets such as the Atkins Diet, the Zone, Sugar Busters, or the South Beach Diet? |
| [EB-13] |
Have you tried a low carbohydrate, high protein diet in the past 12 months? |
| [EB-15] |
Do you think a low carbohydrate, high protein diet is a healthy way to lose weight? |
| [EB-16] |
When you hear or read a new recommendation about nutrition, are you more likely to pay attention to it or to ignore it? |
| [EB-16] |
When you hear or read a new recommendation about physical activity or exercise, are you more likely to pay attention to it or to ignore it? |
| [EB-17] |
Think about the last time you heard a new recommendation about nutrition. Which of the following things did you do in response to the new recommendation? I changed what I do; I did not change what I do; or
I waited to get more information. |
| [EB-17] |
Think about the last time you heard a new recommendation about physical activity or exercise. Which of the following things did you do in response to the new recommendation? I changed what I do; I did not change what I do; or
I waited to get more information. |
| [EB-18] |
How much do you agree or disagree with the following statement? There are so many different recommendations about nutrition that it's hard to know which ones to follow. Would you say you strongly agree, somewhat agree, somewhat disagree, or strongly disagree? |
| [EB-18] |
How much do you agree or disagree with the following statement? There are so many different recommendations about physical activity or exercise that it's hard to know which ones to follow. Would you say you strongly agree, somewhat agree, somewhat disagree, or strongly disagree? |
| [EB-19] |
People who are overweight can lose a significant amount of weight by doing 30 minutes of moderate activities such as brisk walking on most days of the week. Would you say you strongly agree, somewhat agree, somewhat disagree, or strongly disagree? |
| [EB-20] |
Within the past 12 months, have you seen, heard, or read anything about nutrition and cancer? |
| [EB-20] |
Within the past 12 months, have you seen, heard, or read anything about exercise or physical activity and cancer? |
| [EB-21a] |
Within the past 12 months, how much have you heard about nutrition and cancer on television? |
| [EB-21a] |
Within the past 12 months, how much have you heard about physical activity or exercise and cancer on television? |
| [EB-21b] |
Within the past 12 months, how much have you heard about nutrition and cancer in newspapers? |
| [EB-21b] |
Within the past 12 months, how much have you heard about physical activity or exercise and cancer in newspapers? |
| [EB-21c] |
Within the past 12 months, how much have you heard about nutrition and cancer in magazines? |
| [EB-21c] |
Within the past 12 months, how much have you heard about physical activity or exercise and cancer in magazines? |
| [EB-21d] |
Within the past 12 months, how much have you heard about nutrition and cancer on the Internet? |
| [EB-21d] |
Within the past 12 months, how much have you heard about physical activity or exercise and cancer on the Internet? |
| [EB-21e] |
Within the past 12 months, how much have you heard about nutrition and cancer from a doctor or other health care professional? |
| [EB-21e] |
Within the past 12 months, how much have you heard about physical activity or exercise and cancer from a doctor or other health care professional? |
| [EB-22] |
About how tall are you without shoes? |
| [EB-23] |
About how much do you weigh without shoes? |
| [EB-23t] |
Body Mass Index (BMI) |
Group Assignment -
[Top] |
| [GA-0A] |
[AUTOFILL. ASK ONLY IF NECESSARY: First, may I please have your age?] |
| [GA-0B] |
Are you less than 18 years old, between 18 and 34, 35 to 39, 40 to 44, or 45 or older? |
| [GA-0C] |
Are you male or female? |
| [GA-0D] |
WHICH LANGUAGE IS THIS INTERVIEW GOING TO BE CONDUCTED IN? |
| [GA-0ta] |
What is your age? (Grouped A) |
| [GA-0tb] |
What is your age? (Grouped B) |
| [GA-1] |
Do you ever go on-line to use the Internet or World Wide Web, or to send and receive e-mail? |
| [GA-2] |
Where do you go on-line from to use the Internet? |
| [GA-2] |
Where do you go on-line from to use the Internet? |
| [GA-2] |
Where do you go on-line from to use the Internet? [PROBE: Anywhere else?] |
| [GA-3] |
Where do you use the Internet from most often? |
| [GA-4A] |
When you use the Internet at home, do you mainly access it through a telephone modem, a cable or satellite modem, a DSL modem, a wireless device such as a PDA, or some other way? (SPECIFY) |
| [GA-4B] |
When you use the Internet, do you mainly access it through a telephone modem or some other way? (SPECIFY) |
| [GA-5] |
To make participation in this study as convenient as possible for you, you have the choice of completing the rest of the questions over the telephone or on the Internet. Which would you prefer? |
Health Communication -
[Top] |
| [HC-01a] |
On a typical weekday, about how many hours do you watch television? |
| [HC-01b] |
On a typical weekday, about how many hours do you listen to the radio? |
| [HC-01c] |
On a typical weekday, about how many hours do you use the Internet for personal reasons? |
| [HC-02a] |
During a typical weekend, about how many hours do you watch television? |
| [HC-02b] |
During a typical weekend, about how many hours do you listen to the radio? |
| [HC-02c] |
During a typical weekend, about how many hours do you use the Internet for personal reasons? |
| [HC-03a] |
In the past seven days, how many days did you read a newspaper? |
| [HC-03b] |
In the past seven days, how many days did you watch the national news on television? |
| [HC-03c] |
In the past seven days, how many days did you watch the local news on television? |
| [HC-04] |
In the past 12 months, have you read health sections of the newspaper or of a general magazine? |
| [HC-05] |
About how often have you read such health sections in the past 12 months? Would you say once or more per week, or
less than once per week? |
| [HC-08] |
Some local television news programs include special segments of their newscasts that focus on health issues. In the past 12 months, have you watched health segments on the local news? |
| [HC-09] |
How often have you watched health segments on local news in the past 12 months? |
| [HC-10] |
Have you read such health information on the Internet in the past 12 months? |
| [HC-11] |
About how often have you read this sort of information in the past 12 months? |
| [HC-13a] |
How much would you trust information about health or medical topics from a doctor or other health care professional ? |
| [HC-13b] |
... from family or friends? |
| [HC-13c] |
... in newspapers? |
| [HC-13d] |
... in magazines? |
| [HC-13e] |
... on the radio? |
| [HC-13f] |
... on the Internet? |
| [HC-13g] |
... on television? |
| [HC-14a] |
In the past 12 months, have you done the following things while using the Internet? Looked for health or medical information for yourself? |
| [HC-14b] |
... Looked for health or medical information for someone else? |
| [HC-14c] |
... Bought medicine or vitamins on-line? |
| [HC-14d] |
... Participated in an on-line support group for people with a similar health or medical issue? |
| [HC-14e] |
... Used e-mail or the Internet to communicate with a doctor or a doctor's office? |
| [HC-14f] |
... Looked for information about physical activity or exercise? |
| [HC-14g] |
... Looked for information about diet or nutrition? |
| [HC-14h] |
... Looked for information about protecting yourself from the sun? |
| [HC-14i] |
... Looked for information about quitting smoking? |
| [HC-14k] |
... Done anything else health-related on the Internet? (SPECIFY) |
| [HC-15] |
Have you ever talked to a doctor, nurse, or other health care provider about any kind of health information you have gotten from the Internet? |
| [HC-16] |
When you talked with a health care provider, how interested were they in hearing about the information you found on-line? |
Health Status -
[Top] |
| [HS-01] |
In general, would you say your health is excellent, very good, good, fair, or poor? |
| [HS-02a] |
During the past 30 days, how often did you feel so sad that nothing could cheer you up? |
| [HS-02b] |
During the past 30 days, how often did you feel nervous? |
| [HS-02c] |
During the past 30 days, how often did you feel restless or fidgety? |
| [HS-02d] |
During the past 30 days, how often did you feel hopeless? |
| [HS-02e] |
During the past 30 days, how often did you feel that everything was an effort? |
| [HS-02f] |
During the past 30 days, how often did you feel worthless? |
| [HS-02s] |
Psychological Distress Composite Score |
| [HS-02t] |
Serious Psychological Distress |
| [HS-03] |
The last few questions were about a number of feelings you had during the past 30 days. Altogether, how much did these feelings interfere with your life or activities? |
| [HS-04] |
Do you have any kind of health care coverage, including health insurance, prepaid plans such as HMOs, or government plans such as Medicare? |
| [HS-05] |
During the past 12 months, not counting times you went to an emergency room, how many times did you go to a doctor, nurse or other health care provider to get care for yourself? |
Prostate Cancer -
[Top] |
| [PC-01] |
Have you ever heard of a PSA or prostate-specific antigen test? |
| [PC-02] |
Have you ever had a PSA test? |
| [PC-03] |
When did you have your most recent PSA test? |
| [PC-04] |
Has a health care provider such as a doctor or nurse ever talked to you about a PSA test? |
| [PC-05] |
Thinking about the last time a health care provider talked to you about a PSA test, which of the following statements best describes your health care provider's recommendation about PSA tests? That you should have a PSA test. That you should NOT have a PSA test. Your health care provider did not make a recommendation. |
| [PC-06] |
Thinking about the last time a health care provider talked to you about a PSA test, did your health care provider encourage you to ask questions or express any concerns you had about PSA testing? Would you say yes, definitely; yes, somewhat; or no, not at all? |
Risk Perceptions -
[Top] |
| [MM-01] |
How likely do you think it is that you will develop colon cancer in the future? |
| [MM-01] |
How likely do you think it is that you will develop lung cancer in the future? |
| [MM-01] |
How likely do you think it is that you will develop skin cancer in the future? |
| [MM-02] |
Compared to the average person your age, would you say that you are more likely to get colon cancer, less likely, or about as likely? |
| [MM-02] |
Compared to the average person your age, would you say that you are more likely to get lung cancer, less likely, or about as likely? |
| [MM-02] |
Compared to the average person your age, would you say that you are more likely to get skin cancer, less likely, or about as likely? |
| [MM-03] |
How often do you worry about getting colon cancer? |
| [MM-03] |
How often do you worry about getting lung cancer? |
| [MM-03] |
How often do you worry about getting skin cancer? |
| [MM-04] |
What are some things that people can do to reduce their chances of getting colon cancer? |
| [MM-04] |
... colon cancer? |
| [MM-04] |
... lung cancer? |
| [MM-04] |
... skin cancer? |
| [MM-04] |
What are some things that people can do to reduce their chances of getting colon cancer? |
| [MM-04] |
... colon cancer? |
| [MM-04] |
... lung cancer? |
| [MM-04] |
... skin cancer? |
Social Networks -
[Top] |
| [SN-01] |
How many community organizations are you currently a member of? |
| [SN-02] |
{Does this/Do any of these} community organization{s} provide you with information on health? |
| [SN-03] |
Do you have friends or family members that you talk to about your health? |
| [SN-04] |
How frequently do you talk to these friends or family members about health? Would you say very frequently, somewhat frequently, or not very frequently? |
| [SN-05] |
How many people live near you who you can rely on in case you need a ride to visit your health care provider? |
| [SN-06] |
Not including funerals and weddings, how often do you attend religious services? |
Skin Protection -
[Top] |
| [SP-01a] |
When you go outside for more than 1 hour on a warm, sunny day, how often do you wear sunscreen? |
| [SP-01b] |
... stay in the shade? |
| [SP-01c] |
... wear a hat that shades your face, ears and neck? |
| [SP-01d] |
... wear a long-sleeve shirt? |
| [SP-01e] |
... wear long pants? |
| [SP-02] |
How many times in the past 12 months have you used indoor tanning devices such as a sun lamp, a sun bed, or a tanning booth? |
| [SP-03] |
How many times in the past 12 months have you used sunless tanning products? These are products that you either have sprayed on or which you apply to darken the color of your skin. |
Tobacco Use -
[Top] |
| [TU-01] |
Have you smoked at least 100 cigarettes in your entire life? |
| [TU-02] |
Do you now smoke cigarettes every day, some days, or not at all? |
| [TU-03] |
On the average, how many cigarettes do you now smoke a day? |
| [TU-04] |
On how many of the past 30 days did you smoke cigarettes? |
| [TU-05] |
On the average, about how many cigarettes did you usually smoke each day? |
| [TU-06] |
During the past 12 months, have you tried to quit smoking completely? |
| [TU-07] |
Have you ever stopped smoking for one day or longer because you were trying to quit smoking? |
| [TU-08] |
How many times during the past 12 months have you stopped smoking for one day or longer because you were trying to quit smoking? |
