Alcohol and Tobacco for Adults (BRFSS)
Behavioral Risk Factor Surveillance System
Centers for Disease Control and Prevention (CDC)
T1. Have you smoked at least 100 cigarettes in your life? [NOTE: 5 packs = 100 cigarettes]
1. Yes2. No [Skip to T5]7. Don’t know/not sure [Skip to T5]9. Refused [Skip to T5]
T2. At present‚ do you smoke cigarettes every day‚ some days‚ or never?
1. Every day2. Some days3. Never [Skip to T4]7. Don’t know/not sure [Skip to T5]9. Refused [Skip to T5]
T3. During the past 12 months‚ have you stopped smoking for a day or more because you were tryingto quit smoking?
1. Yes [Skip to T5]2. No [Skip to T5]7. Don’t know/not sure [Skip to T5]9. Refused [Skip to T5]
T4. When did you stop smoking cigarettes regularly?
1. Within the past month (less than 1 month ago)2. Within the past 3 months (at least 1 month but less than 3 months ago)3. Within the past 6 months (at least 3 months but less than 6 months ago)4. Within the past year (at least 6 months but less than 1 year ago)5. Within the past 5 years (at least 1 year but less than 5 years ago)6. Within the past 10 years (at least 5 years but less than 10 years ago)7. 10 years ago or more77. Don’t know/not sure99. Refused
T5. A t present‚ do you use chewing tobacco‚ snuff‚ or “snus” every day‚ some days‚ or never? [NOTE:“Snus” (or Swedish snuff) is moist tobacco that is not smoked. It is usually sold in small bags thatare placed under the lip‚ pressing against the gum.]
1. Every day2. Some days3. Never7. Don’t know/not sure9. Refused
Alcohol consumption (A)
A1. During the past 30 days‚ how many days per week or per month did you consume at least onedrink of any alcoholic beverage such as beer‚ malt beverage‚ or liquor?
__ Days per week __ Days in the past 30 days
88 No drinks at all in the past 30 days [Finish the questions on alcohol]77 Don’t know/not sure [Finish the questions on alcohol]99 Refused [Finish the questions on alcohol]
A2. A “drink” is defined as a beer of 12 ounces (350 cl)‚ a glass of wine of 5 ounces (150 cl)‚ or a shot ofliquor. During the past 30 days‚ on the days when you drank‚ approximately how many drinks didyou consume on average? [NOTE: A beer of 40 ounces would be equivalent to three drinks; a cocktailwith two shots of alcohol would be equivalent to two drinks.]
__ Number of drinks77 Don’t know/not sure99 Refused
A3. Taking into account all types of alcoholic beverages‚ how many times during the past 30 days didyou consume X drinks or more [X = 5 for men‚ X = 4 for women] on one occasion?
__ Time(s)88 Never77 Don’t know/not sure99 Refused
A4. During the past 30 days‚ what was the maximum number of drinks that you consumed on oneoccasion?
__ Number of drinks77 Don’t know/not sure99 Refused
Nelson DE‚ Holtzman D‚ Bolen J‚ Stanwyck CA‚ Mack KA. Reliability and validity of measures from the Behavioral Risk Factor Surveillance System (BRFSS).Social and Preventive Medicine‚ 2001; 46‚ Suppl 1:S03-S42.
· Alcohol
· Behavioral Risk Factor
This instrument can be found on pages 130-132 of Latino Families and Youth: A Compendium of Assessment Tools‚ available online at: http://www.paho.org/hq/index.php?option=com_docman&task=doc_view&gid=23171&Itemid=
Centers for Disease Control and Prevention (CDC). Behavioral Risk Factor Surveillance System Survey Questionnaire. Atlanta‚Georgia: U.S. Department of Health and Human Services‚
Centers for Disease Control and Prevention‚ 2011.http://www.cdc.gov/brfss/index.htm.