0990-Appendix A AHA surey article Twelve-Year Follow-up Cardio Risk

Twelve-Year Follow-Up of American Women's Awareness of Cardiovascular
Disease Risk and Barriers to Heart Health
Lori Mosca, Heidi Mochari-Greenberger, Rowena J. Dolor, L. Kristin Newby and
Karen J. Robb
Circ Cardiovasc Qual Outcomes published online Feb 10, 2010;
DOI: 10.1161/CIRCOUTCOMES.109.915538
Circulation: Cardiovascular Quality and Outcomes is published by the American Heart Association.
7272 Greenville Avenue, Dallas, TX 72514
Copyright © 2010 American Heart Association. All rights reserved. Print ISSN: 1941-7705. Online
ISSN: 1941-7713

The online version of this article, along with updated information and services, is
located on the World Wide Web at:
http://circoutcomes.ahajournals.org
Data Supplement (unedited) at:
http://circoutcomes.ahajournals.org/cgi/content/full/CIRCOUTCOMES.109.915538/D
C1

Subscriptions: Information about subscribing to Circulation: Cardiovascular Quality and Outcomes
is online at
http://circoutcomes.ahajournals.org/subscriptions/
Permissions: Permissions & Rights Desk, Lippincott Williams & Wilkins, a division of Wolters
Kluwer Health, 351 West Camden Street, Baltimore, MD 21202-2436. Phone: 410-528-4050. Fax:
410-528-8550. E-mail:
journalpermissions@lww.com
Reprints: Information about reprints can be found online at
http://www.lww.com/reprints

Downloaded from circoutcomes.ahajournals.org at NIH Library on March 5, 2010

Twelve-Year Follow-Up of American Women’s Awareness of
Cardiovascular Disease Risk and Barriers to Heart Health
Lori Mosca, MD, MPH, PhD; Heidi Mochari-Greenberger, MPH, RD; Rowena J. Dolor, MD, MHS;
L. Kristin Newby, MD, MHS; Karen J. Robb, MBA
Background—Awareness of cardiovascular disease (CVD) risk has been linked to taking preventive action in women. The
purpose of this study was to assess contemporary awareness of CVD risk and barriers to prevention in a nationally
representative sample of women and to evaluate trends since 1997 from similar triennial surveys.
Methods and Results—A standardized survey about awareness of CVD risk was completed in 2009 by 1142 women ⱖ25
years of age, contacted through random digit dialing oversampled for racial/ethnic minorities, and by 1158 women
contacted online. There was a significant increase in the proportion of women aware that CVD is the leading cause of
death since 1997 (P for trend⫽⬍0.0001). Awareness among telephone participants was greater in 2009 compared with
1997 (54% versus 30%, P⬍0.0001) but not different from 2006 (57%). In multivariate analysis, African American and
Hispanic women were significantly less aware than white women, although the gap has narrowed since 1997. Only 53%
of women said they would call 9-1-1 if they thought they were having symptoms of a heart attack. The majority of women
cited therapies to prevent CVD that are not evidence-based. Common barriers to prevention were family/caretaking
responsibilities (51%) and confusion in the media (42%). Community-level changes women thought would be helpful were
access to healthy foods (91%), public recreation facilities (80%), and nutrition information in restaurants (79%).
Conclusions—Awareness of CVD as the leading cause of death among women has nearly doubled since 1997 but is
stabilizing and continues to lag in racial/ethnic minorities. Numerous misperceptions and barriers to prevention persist
and women strongly favored environmental approaches to facilitate preventive action. (Circ Cardiovasc Qual
Outcomes. 2010;3:00-00.)
Key Words: cardiovascular disease 䡲 prevention 䡲 women

A

merican women continue to die of heart disease and
stroke at a rate unparalleled by other diseases.1 The last
decade has witnessed intensive public efforts to educate
women about their risk of heart disease, and a recent national
survey documented that awareness of heart disease among
women nearly doubled in 10 years.2 Despite the progress,
there remains a persistent racial and ethnic minority gap in
awareness.2 Recent research has demonstrated a positive
correlation between awareness that cardiovascular disease
(CVD) is the leading cause of death in women and recent
action(s) taken to reduce CVD risk.3 These data suggest that
continued educational campaigns, particularly those targeted
to the highest-risk subgroups, could be important in reducing
the burden of CVD among women.
Beginning in 1997, the American Heart Association
(AHA) has conducted triennial surveys in random samples of
women to track their awareness, knowledge, and perceptions
related to heart disease and stroke according to race/ethnicity
and age. The purpose of the present study was to assess the
current level of awareness, knowledge, and perceptions in a
nationally representative sample including an oversampling

of black, Hispanic, and Asian women and to examine trends
over time. An additional goal was to explore barriers to
women taking preventive action.

Methods
Study Population and Survey Administration
We conducted a cross-sectional survey of 2300 women in the United
States who were at least 25 years of age to assess their awareness,
knowledge, and perceptions of CVD risk and prevention. The study
was designed to result in a margin of error of approximately 2.0%.
Survey data were compared with results from similar surveys
conducted in 1997, 2000, 2003, and 20062,4 – 6 to examine trends in
these parameters. In addition, characteristics of women surveyed by
random digital dialing were compared with those of women surveyed
online to develop a comparative framework for future online studies.
Potential participants were identified through 2 independent
mechanisms: random-digit dialing (n⫽1142) similar to our previous
surveys2,4 – 6 and a new online survey approach (n⫽1158). All
surveys were conducted between July 1, 2009, and August 21, 2009,
by representatives of Harris Interactive, New York, NY (telephone
interviews) or via an online survey conducted through Harris Poll
Online, a multimillion member panel of cooperative online respondents maintained by Harris Interactive. Both the telephone and

Received October 9, 2009; accepted December 16, 2009.
From Columbia University Medical Center (L.M., H.M.-G.), New York, NY; Duke Clinical Research Institute (R.J.D., L.K.N.), Durham, NC; and the
American Heart Association (K.J.R.), Dallas, Tex.
The online-only Data Supplement is available with this article at http://circoutcomes.ahajournals.org/cgi/content/full/CIRCOUTCOMES.109.915538/DC1.
Correspondence to Lori Mosca, MD, New York-Presbyterian Hospital/Columbia University Medical Center, 601 W 168th St, Suite 43, New York, NY
10032. E-mail ljm10@columbia.edu (copy lmr2@columbia.edu)
© 2010 American Heart Association, Inc.
Circ Cardiovasc Qual Outcomes is available at http://circoutcomes.ahajournals.org

DOI: 10.1161/CIRCOUTCOMES.109.915538

1
Downloaded from circoutcomes.ahajournals.org
at NIH Library on March 5, 2010

2

Circ Cardiovasc Qual Outcomes

March 2010

online surveys consisted of the same 21 unique questions; 11
additional questions about health behaviors and changes were asked
on the online survey. Both telephone and online surveys were
administered in English and took approximately 18 minutes to
complete.

WHAT IS KNOWN
●

●

●

●

Awareness of heart disease as the leading cause of
death among women is suboptimal and a gap in
awareness exists between whites and racial/ethnic
minorities.
It is well established that delay in seeking emergency
services is associated with greater cardiac mortality
rates.
Clinical trials have demonstrated that some interventions (eg, antioxidant vitamin supplementation) do
not prevent heart disease.
Environmental factors (such as limited availability of
fresh fruits and vegetables, have been cited as
barriers to heart-healthy living.

WHAT THE STUDY ADDS
●

●

●

●

Although levels of heart disease awareness have
improved since 1997, almost half of women remain
unaware that coronary heart disease is the leading
cause of death among women, and the gap in
awareness among minorities is closing.
The present study documents that only about one
half of women would call 9-1-1 if they thought they
were having symptoms of a heart attack.
A substantial percentage of women perceive that
unproven preventive therapies will reduce their risk
of heart disease.
Women support environmental approaches such as
increased access to healthy foods, recreational facilities, and enhanced nutrition labeling to lower risk.

Data were weighted based on age, race, education, income, and
region to reflect the composition of the US population of women age
25 and older who speak English based on information from the US
Census Bureau’s March 2008 Current Population Survey overall and
within ethnic strata. Propensity weighting was used for the online
survey to adjust for the respondents’ propensity to be online.
Using random-digit dialing, a total of 161 902 numbers were
called. Of these, 48 625 (30%) were nonworking or government
numbers, 5320 (3%) were unable to be completed due to privacy
management equipment, and an additional 68 949 (43%) calls were
unresolved due to the inability to talk directly with a person. Of the
39 008 calls successfully connected, a total of 19 464 were answered
by individuals who declined to speak to an interviewer (50% refusal
rate). An additional 3688 calls (9%) were not completed because of
language barriers, and 6473 (17%) asked to be called back for an
interview (5% of whom scheduled a specific call-back time).
Screening interviews were completed in 9383 calls, with 4177 (45%
of screened individuals) not eligible to participate either because of
no woman ⱖ25 years of age in the household or refusal to allow
contact with a woman ⱖ25 years of age in the household. Of the
5206 women who met criteria for participation, 1142 (22%) completed the survey.
An e-mail invitation was sent to 22 426 women members of Harris
Poll Online. Harris Poll Online includes several million members
invited from multiple sources to ensure a representative sample.

Diverse methods are used to recruit panelists including: targeted
e-mail and postal mail invitations, TV advertisements, and telephone
recruitment.
Of these, 3660 (16%) were undeliverable, and, of the 1622 who
opened the survey link, 222 did not complete the screening section
and 79 (5%) did not meet eligibility criteria. Of the 1158 women who
were qualified, all 1158 (100%) completed the survey. The complete
survey is available in the online-only Data Supplement. All telephone and online participants were asked about demographic information followed by open-ended questions regarding leading cause of
death in women and the single greatest health problem facing
women. These questions replicated methods and sampling in previous AHA surveys of women’s awareness.2,4 – 6 In 2009, new questions on caregiving responsibilities and the burden and impact on
their health were added. Only the online respondents were given
questions about reasons for improving their own health, preventive
actions they have taken in the past year, and barriers to incorporating
healthy lifestyle behaviors. If someone refused or did not know an
answer, the response was coded as “not sure” or “decline to answer,”
and these percentages are not excluded from the analysis. In the
online survey, respondents were not able to move to the next
question before providing an answer to the current question.

Statistical Methods
Descriptive statistics generated for baseline characteristics and survey responses are presented as proportions. Univariate relationships
of responses between each racial/ethnic and age group as well as
online versus telephone surveys were analyzed using t tests with
software designed for marketing research (Quantum, SPSS, Chicago,
Ill). A trend analysis was conducted using linear regression to
evaluate women’s awareness across all survey years. Statistical
significance was declared for P⬍0.05. No adjustments were made
for multiple comparisons.

Results
Characteristics of Respondents
The demographic and clinical characteristics of telephone
respondents (n⫽1142) are listed in Table 1, overall and by
race/ethnicity. Characteristics including education level did
not differ from those of respondents who completed the first
survey in 1997, except that 2009 participants were less likely
to be 25 to 44 years of age (37% versus 47%), more likely to
be married/cohabitating (64% versus 59%), and more likely
to have a household income ⱖ100 000 (18% versus 5%).
Survey results for demographic and clinical characteristics of
online respondents (n⫽1158) are also included in Table 1 and
do not materially differ from telephone results except that
online responders were less likely to be in the 45- to 55-year
age range or have less than a high school education. Unless
otherwise noted, the results that follow are from telephone
respondents only, to allow comparison to results from previous survey years with similar methodology.

Awareness of and Perceptions Related to
Heart Disease
The Figure illustrates trends in awareness of the leading cause
of death among women surveyed from 1997 to 2009. In 2009,
54% of respondents correctly identified heart disease/heart
attack as the leading cause of death among women. This was
significantly higher than 1997 (30%; P for trend⫽⬍.0001)
but not significantly different from the proportion aware in
the survey administered in 2006 (57%; P⫽0.28). A majority
of women surveyed online (65%) also correctly identified
heart disease/heart attack as the leading cause of death.

Downloaded from circoutcomes.ahajournals.org at NIH Library on March 5, 2010

Mosca et al
Table 1.

CVD Awareness in Women

3

Demographic Characteristics of Respondents in the 2009 AHA Women’s Health Survey
All

Race/Ethnic Group Telephone Respondents*
White
(n⫽660)
关a兴

Black
(n⫽128)
关b兴

Hispanic
(n⫽200)
关c兴

Asian
(n⫽125)
关d兴

Other
(n⫽29)
关e兴

On-Line
(n⫽1158)

Telephone†
(n⫽1142)

25–34

16

18

16

16

25a

20

26

35–44

23

19

18

24

20

27a

16

45–54

19

24†

24

19

28

21

33

55–64

20

18

18

19

15

18

19

ⱖ65

21

21

24c,d

21

13

14

5

15

12

7

29a,c

16a

17a

41

b

b

47

Characteristic
Age, y

Marital status
Single, never married

b,c

Married/cohabitating

67

64

71

35

55

Separated/divorced

12

12

12

17

15

9

8

6

11

10

16d

13d

4

3

7

16a,d

14a,d

Widowed

67

Education
ⱕSome high school

5

5

18

High school graduate

38

33

33d

32d

39d

12

38

Some college

17

19

18

22

17

16

18

9

9

10

5

7

7

2

2-Year college graduate

9†

a,b,c

18
5

4-Year college graduate

19

19

20

13

14

34

Postgraduate study

12

12

11

12

10

26a,b,c

⬍25 000

17

18

14

30a,d

23a,d

11

⬍25 000 to 49 999

20

18

18

23

22

14

6

⬍50 000 to 99 999

27

25

25

23

24

26

28

ⱖ100 000

18

18

20b,c

10

12

25b,c

18

Refused

17

21

23

14

20

24

11

10

14

12

21a,d

18d

6

9

Heart attack

4

4

3

5

3

3

3

Stroke

2

5†

5

5

4

2

2

Household income, $
37

Personal history of disease
Diabetes

*Telephone results are presented for comparability with previously published survey results.
All values are weighted percentages. †Significant differences between online and telephone survey responses. Superscript letters
denote significant differences at P⬍0.05 between racial/ethnic groups.

Awareness that heart disease/heart attack is the leading
cause of death has approximately doubled among white and
Hispanic women and tripled among black women between
the first survey in 1997 and the current 2009 survey. However
a racial/ethnic disparity remains in the proportion aware by
race/ethnic group (Table 2). In multivariate analysis adjusting
for age and education level, African American, Hispanic, and
Asian women were significantly less likely to be aware that
heart disease/heart attack is the leading cause of death,
compared with white women.
There were no differences in awareness of the leading
cause of death in women by age group (Table 3). This differs
from results from all previous survey years including 1997 in
which younger women were significantly less aware compared with women in older age groups that heart disease/heart
attack is the leading cause of death in women.4 Women 25 to

34 years of age were more likely than women ⱖ65 years of
age to cite breast cancer as the greatest health problem facing
women today (34% versus 22%; P⬍0.05).

Knowledge of Heart Disease
Forty-five percent of women surveyed in 2009 considered
themselves to be very well or well informed about heart
disease in women compared with 34% in 1997. Knowledge of
heart attack warning signs did not appreciably differ from
1997.4 Fifty-six percent of women cited chest pain and neck,
shoulder, and arm pain, 29% identified shortness of breath,
and 17%, 15%, and 7% recognized chest tightness, nausea,
and fatigue, respectively, as heart attack warning signs. When
asked what they would do if they thought they were having
signs of a heart attack, 53% of women reported that they
would call 9-1-1 and 23% reported they would take an
aspirin.

Downloaded from circoutcomes.ahajournals.org at NIH Library on March 5, 2010

4

Circ Cardiovasc Qual Outcomes

March 2010

Figure. Overall trends in awareness that coronary heart disease is the leading cause of death in women.

Perceived Heart Disease Risk Factors and
Prevention Strategies
As in previous years, most participants recognized that
lifestyle behaviors can prevent or reduce the risk of getting
heart disease. Routine use of fish oil/omega-3 fatty acids
(82%) and aspirin (78%) were also listed as top prevention
strategies (Table 4). The proportion citing hormone replacement therapy as a prevention strategy was significantly less
than in 1997 (19% versus 47%).4

symbol were more aware that heart disease is the leading
cause of death in women compared with those who were
not familiar with the “red dress” symbol (68% versus 43%;
P⬍0.0001).
In 2009, more women reported television as their source of
information about heart disease (45%) compared with magazines (32%), the newspaper (18%), or the Internet (14%).
Additionally, 48% of women reported discussing heart disease with their doctor, an increase from 30% in 1997.

Sources of Information About Heart Disease

Caregiving and Preventive Action

More than 85% of women reported that they had seen, heard,
or read about women and heart disease in the past 12 months.
These women were more likely to be aware that heart disease
is the leading cause of death in women compared with their
counterparts (58% versus 25%; P⬍0.0001). Women who
had seen, heard, or read anything about the “red dress”

Current caregiving (ie, providing care to an adult family
member or friend) was reported by 29% of telephone respondents and 24% of women who completed the online survey.
Among current caregivers, more than half reported spending
6 or more hours per week caregiving. When current caregivers were asked how they felt caregiving responsibilities have

Table 2. Awareness of Leading Cause of Death for Women and Perceived Greatest Health Problem Facing
Women by Ethnic Group in 2009 Versus 1997
Race/Ethnic Group*

Response (Unaided)

Overall
2009

White
关a兴
2009

1997

Black
关b兴
P†

2009

1997

Hispanic
关c兴
P†

2009

1997

P†

Asian
关d兴
2009

Leading cause of death
Breast cancer

11

10

14

0.08

16

18

0.73

14

17

0.56

7

Cancer (general)

23

20

33

⬍0.001

32a

41

0.22

25

43a

0.009

38

Heart disease/heart attack

54

60b,c,d

33b,c

44

20

⬍0.001

34

9

0.61

12a,b

⬍0.001

43

15

⬍0.001

Other

4

3

8

0.002

3

12

0.02

Don’t know/no answer

8

7

12

0.01

6

14

0.08

10

11

0.82

18a,b

Breast cancer

28

25

34

0.005

32

38

0.41

31

34

0.66

25

Cancer (general)

18

18

27

0.002

19

28

0.16

24

25

0.87

17

8

⬍0.001

12

6

0.17

8

9

0.80

19c

7a

Greatest health problem

Heart disease/heart attack
Obesity
Other
Don’t know/no answer

16

c

19

8

8

...

7

n/a

...

10

...

...

12

20

20

16

...

0.14

20

15

0.39

18

16

0.71

13

9

8

15

0.002

9

13

0.40

10

16

0.22

14

*Telephone results are presented for comparability between 1997 and 2009 surveys.
†P values for tests of proportion between 1997 and 2009 telephone survey results. Ellipses indicate response not surveyed in 1997.
All values are weighted percentages. Superscript letters denote significant differences at P⬍0.05 between racial/ethnic groups.

Downloaded from circoutcomes.ahajournals.org at NIH Library on March 5, 2010

Mosca et al

CVD Awareness in Women

5

Table 3. 2009 Awareness of Leading Cause of Death for Women and Perceived Greatest Health Problem Facing Women by Age
Among Telephone Respondents
Age 25–34 y关a兴

Response (Unaided)

2009
(n⫽127)

Age 35– 44 y关b兴

1997
(n⫽188)

P

2009
(n⫽159)

1997
(n⫽294)

Age 45– 64 y关c兴

P

2009
(n⫽517)

1997
(n⫽308)

Age ⱖ65 y关d兴
P

2009
(n⫽338)

1997
(n⫽195)

P

Leading cause of death
Breast cancer

14

19c,d

0.37

10

17d

0.10

12

12

0.99

7

9

0.47

Cancer (general)

27

38

0.12

18

33

0.006

24

36

0.004

24

34

0.03

Heart disease/heart attack

50

16

⬍0.001

59

28a

⬍0.001

53

38a,b

0.001

54

34a

⬍0.001

Other

2

12

0.009

6

10

0.24

4

7

0.14

5

9

0.12

Don’t know/no answer

7

15c

0.09

7

12c

0.17

8

7

0.68

11

14c

0.38

34d

41d

0.34

29

40d

0.06

28

34d

0.15

22

20

0.64

Greatest health problem
Breast cancer
Cancer (general)
Heart disease/heart attack
Obesity
Other
Don’t know/no answer

a

9

19

0.05

15

26

0.03

21

26

0.19

26

12

4

0.05

20

5

⬍0.001

17

11a,b

0.06

15

9

...

29c,d
7

...

a,b

a,b,c

37

0.02

8

0.04

...

7

...

...

8

...

8

13

0.01

21

16

0.29

18

19

0.78

15

17

...

0.60

...

23b,c

0.003

9

13

0.30

7

10

0.23

14c

18c

0.29

Telephone results are presented for comparability between 1997 and 2009 surveys.
All values are weighted percentages. Superscript letters denote significant differences at P⬍0.05 between age groups. P values are for tests of proportion between
1997 and 2009. Ellipses indicate response not surveyed in 1997.

affected their heath, 22% of telephone respondents and 31%
of online respondents reported a negative health impact.
Among those reporting a negative impact, the primary ways
caregiving negatively affected their health were (1) increased
stress, (2) more exhaustion, (3) less time for one’s self, (4)
trouble sleeping, and (5) not enough time to spend with other
friends/family members.

Preventive Actions Taken in the Past Year
Preventive actions taken in the past year are presented in
Table 5. Checking blood pressure (84%), trying to better
Table 4. Perception of Select Heart Disease
Prevention Strategies
All Subjects*

manage stress (74%), and going to see a doctor or other health
care professional (73%) were the top 3 preventive actions
reported. Women 50 years of age and older were significantly
more likely to take these preventive actions as well as to
decrease consumption of unhealthy foods, have blood cholesterol levels checked, start taking vitamins or dietary
supplements, quit using tobacco, or get a diagnostic test for
heart disease compared with women under 50 years of age
(P⬍0.001 for all comparisons). When asked what prompted
them to take preventive actions, a majority of women responded that they wanted to improve their health and feel
better (Table 5). Compared with younger women, those ⱖ50
years of age were more likely to be prompted to take action
because they wanted to live longer, because they read, saw, or
heard information related to heart disease, or because they
had symptoms related to heart disease. Hispanic women were
more likely than African American, Asian, or white women
to report that they took preventive actions for their family
(38% versus 19%, 19%, and 20%, respectively; P⬍0.05).

2009
(n⫽1142)

1997
(n⫽1000)

P Value
2009 vs 1997

Getting adequate sleep

94

…

…

Fish oil/omega-3 fatty acids

82

…

…

Take aspirin regularly

78

…

…

Barriers to Preventive Action

Fiber

75

…

…

Top barriers to taking preventive action included family/
caregiving responsibilities (51%) and too much confusion
in the media about what to do (42%) (Table 6). There were
no differences in barriers to preventive action reported by
race/ethnic group except that white women and Asian
women were more likely than African American and
Hispanic women to report that there is too much confusion
in the media. African American women were more likely
than Asian, Hispanic, or white women to agree that God or
some higher power ultimately determines their health.
Online respondents were given a list of environmental/
community level changes and asked whether they thought
each one would be helpful or not helpful in leading them to

Response (Aided)

Praying or meditating

74

…

…

Preventing gum disease

74

…

…

Antioxidants

70

…

…

Multivitamin

69

50

⬍0.001

Special vitamins (eg, A, C, E)

58

59

0.72

Aromatherapy

29

22

0.005

Plant stanols and sterols

24

…

…

Hormone therapy

19

47

⬍0.001

*All values are weighted percentages of telephone respondents who believe
each activity can prevent or reduce the risk of getting heart disease. Ellipses
indicate response not surveyed in 1997.

Downloaded from circoutcomes.ahajournals.org at NIH Library on March 5, 2010

6

Circ Cardiovasc Qual Outcomes

Table 5.

March 2010

Preventive Actions Taken in the Past Year According to Race/Ethnicity and Age Group
Overall
(n⫽1158)

White
(n⫽634)

Nonwhite

P*

Age ⬍50 y
(n⫽683)

Age ⬎50 y
(n⫽475)

P*

Had blood pressure checked

84

85

82

0.32

72

97

⬍0.001

Tried to better manage stress

74

74

73

0.78

67

82

⬍0.001

Went to see a doctor or other health care professional

73

74

71

0.41

60

87

⬍0.001

Decreased consumption of unhealthy foods

71

74

65

0.02

64

79

⬍0.001

Had cholesterol checked

66

68

63

0.20

47

87

⬍0.001

Increased physical activity

63

63

63

0.99

61

65

0.33

Started taking vitamins or dietary supplements

56

58

53

0.22

46

68

⬍0.001

Lost weight

51

51

53

0.63

50

53

0.48

Preventive Action (Aided)

Quit smoking/using tobacco products

29

25

38

⬍0.001

16

44

⬍0.001

Got a diagnostic test for heart disease such as
a stress test or heart scan

26

26

26

0.99

12

42

⬍0.001

Prompt to take preventive action (aided)
I wanted to improve my health

71

70

75

0.18

71

72

0.79

I wanted to feel better

63

62

64

0.61

64

61

0.46

I wanted to live longer

53

54

51

0.46

44

62

⬍0.001

I wanted to avoid taking medications

29

27

33

0.11

26

31

0.19

My healthcare provider encouraged me to

28

30

23

0.06

17

38

⬍0.001

I did it for my family

22

20

27

0.04

23

21

0.57

A family member/relative developed heart
disease, got sick, or died

17

16

18

0.51

18

16

0.53

Saw/heard/read information related to
heart disease

17

17

17

0.99

10

24

⬍0.001

I experienced symptoms related to heart disease

0.02

15

15

16

0.74

12

19

A family member encouraged me to

7

7

8

0.64

8

7

0.65

A friend developed heart disease, got sick, or died

2

2

2

0.99

1

3

0.09

A friend encouraged me to

2

2

3

0.42

4

1

0.02

Values represent the weighed percent of women surveyed online who reported taking each preventive action to improve her health in the past year.
*P value for difference in proportion by race/ethnic group or by age group.

follow a more heart-healthy lifestyle. A response of “helpful”
was given by 91% of participants for access to better fruits,
vegetables, and other healthy foods, 80% for greater access to
indoor and outdoor public recreation facilities, 79% for
requiring all restaurants to post nutrition information for
menu items, 75% for smoking bans, 74% for stricter regulations on pollution, 73% for bans on trans fats in restaurants,
and 62% for increased public safety in public recreation
areas.

Discussion
Current data suggest that the level of awareness of heart
disease as a leading cause of death among women has nearly
doubled since 1997 and has remained steady for 3 years.
Awareness among racial and ethnic minorities has significantly increased (though remains lower compared with
whites), whereas the awareness gap among younger versus
older women has narrowed. These data support the success of
national educational programs to raise awareness of heart
disease risk among women and highlight the need to sustain
efforts to raise awareness, particularly among racial/ethnic
minorities and young women, in whom the majority of
women are unaware. In addition, programs to assist women in
taking action steps to lower their risk may be prudent, given

the substantial increased awareness that appears to have
reached a plateau.
The finding that awareness among racial and ethnic minorities lags behind white women is consistent with several other
studies that showed demographics and acculturation status
was significantly associated with awareness and knowledge
of CVD.7–11 African American women have a significantly
higher rate of CVD compared with Caucasian women, yet
their rate of awareness was substantially lower. This may
impede risk reduction efforts because awareness of CVD has
been linked to preventive action.6 In the current study, Asian
women had the lowest rate of awareness of CVD risk;
however, the sample size within subpopulations was small, so
definitive conclusion cannot be drawn. Heart disease is now
the leading cause of death in Chinese women, and rates of
awareness are low.10 A recent study showed that ChineseCanadians were less likely to receive heart disease education
compared with other ethnic groups.12 In addition, less acculturated minorities have health beliefs that might impede
prevention; these findings suggest that providers and public
campaigns should be more aggressive in reaching out to
racial and ethnic minorities.11
Of concern was the finding that only 53% of women stated
they would call 9-1-1 if they thought they were having

Downloaded from circoutcomes.ahajournals.org at NIH Library on March 5, 2010

Mosca et al
Table 6.

CVD Awareness in Women

7

Barriers to Living a Heart-Healthy Lifestyle by Race/Ethnicity and Age Group
Overall
(n⫽1158)

White
(n⫽634)

Nonwhite
(n⫽524)

P*

Age ⬍50 y
(n⫽683)

Age ⬎50 y
(n⫽475)

P*

I have family obligations and other people to take care of

51

53

45

0.05

51

50

0.81

There is too much confusion in the media about what to do

42

44

36

0.048

43

41

0.63

God or some higher power ultimately determines my health

37

35

44

0.02

33

42

0.03

I am not confident that I can successfully change my behavior

33

33

34

0.80

36

30

0.13

I do not have the money or insurance coverage to do what
needs to be done

32

31

35

0.30

35

29

0.13

I do not perceive myself to be at risk for heart disease

32

33

30

0.43

36

28

0.04

Barriers (Aided)

I am to stressed to do the things that need to be done

28

28

27

0.79

33

21

0.002

I do not want to change my lifestyle

28

30

25

0.18

32

24

0.04

My health care professional does not think I need to worry
about heart disease

27

26

28

0.58

29

24

0.18

I do not have time to take care of myself

25

24

27

0.40

33

15

⬍0.001

I do not know what I should do

25

24

27

0.40

30

20

0.007

I am fearful of change

22

22

20

0.55

25

18

0.04

I am confused by what I am supposed to do to change
my lifestyle

21

22

18

0.23

24

17

0.04

I feel the changes required are too complicated

20

20

22

0.55

23

17

0.08

My health care professional does not explain clearly what
I should do

19

18

21

0.35

21

17

0.23

My friends/family have told me that I do not need to change

16

17

15

0.51

18

15

0.34

I do not think changing my behavior will reduce my risk
of developing heart disease

13

14

10

0.15

12

14

0.48

I am too ill/old to make changes

8

8

8

0.99

6

10

0.08

My health care professional does not speak my language

8

8

9

0.66

9

8

0.67

Values represent the weighted percent of women surveyed online who strongly or somewhat agreed that they experienced each barrier to living a heart healthy
lifestyle.
*P value for difference in proportion by race/ethnic group or by age group.

symptoms of a heart attack, and awareness of atypical
symptoms of heart disease was low. There has been an
emphasis on raising awareness of the range of symptoms of
heart disease in women over the past decade.13 Women have
been shown to have a significant time delay in receiving
diagnostic and interventional procedures, which may contribute to a worse 30-day mortality rate compared with men.14,15
Educating women about early symptom recognition and
calling 9-1-1 sooner may be an important strategy to reduce
disparities in outcomes.
Notable in the current survey was the finding that a
majority of women perceived that several unproven methods
would reduce risk of heart disease, including use of multivitamins, antioxidants, and special vitamins (eg, vitamin C).
This is a concern because recent randomized clinical trials
showed no benefit of antioxidant vitamins in women.16 The
AHA 2007 Evidence-Based Guidelines for the Prevention of
Cardiovascular Disease in Women recommend against the
use of aspirin in young women as a strategy to lower heart
disease risk, yet the majority of women in this survey
perceived it would benefit their heart.17
Several barriers to prevention were noted including caregiving responsibilities. Caregiving has been linked to an
increased risk of CVD in women, possibly through suboptimal lifestyle habits and psychosocial risk factors.18,19 Future

research should evaluate the influence of programs to educate
and support caregivers on reducing their CVD risk.
There was an overwhelming response from women surveyed that environmental approaches such as increasing
access to healthy foods, recreational facilities and nutrition
labeling would be helpful for women to lower CVD risk.
Health promotion approaches that focus on improving the
environment have shown the potential to improve health
behavior among those living in underserved areas.20 The
WISEWOMEN project also showed that an intervention to
increase use of community resources could help to overcome
environmental barriers to a healthy lifestyle in low-income,
underinsured women in midlife.21 Policymakers should take
into consideration these findings in current national efforts to
reduce the burden and costs associated with CVD.
This study was a cross-sectional sample of Englishspeaking women who were willing to complete a telephone
interview or online survey and were relatively well-educated,
so the results may not be generalizable to all women and may
represent a best-case scenario. Trends observed are not likely
caused by artifact because similar selection bias applied to
prior surveys. Data in subpopulations, although oversampled,
may not have been sufficient to draw definitive conclusions.
We did not adjust for multiple comparisons, and some of the
significant findings could be due to chance.

Downloaded from circoutcomes.ahajournals.org at NIH Library on March 5, 2010

8

Circ Cardiovasc Qual Outcomes

March 2010

In conclusion, awareness of the leading cause of death
among women has not significantly increased since 2006, but
there has been a significant trend for improvement since
1997. Overall knowledge of this fact has doubled in white
women since 1997 and tripled in black women, suggesting
that the gap is beginning to close but still persists. The survey
responses suggest that sustained educational efforts are
needed to raise awareness, particularly among vulnerable
populations. More emphasis should be placed on raising
awareness of the symptoms of heart disease and informing
women of the importance of calling 9-1-1. Many misperceptions remain about how to lower CVD risk; programs are
needed to help women take action and should incorporate
evidence-based prevention education.

Acknowledgments
We thank Harris Interactive for their assistance with survey design
and data analysis and Lisa Rehm, MPA, for assisting with the
preparation of the manuscript.

Sources of Funding
The survey was funded by the American Heart Association through
a grant from Macy’s Go Red For Women Multicultural Fund. Dr
Mosca was supported in part by an NIH Research Career Award
(K24 HL076346).

Disclosures
K.J. Robb is an employee of the American Heart Association.
Relationships with industry for Dr Newby are publically available at:
http://www.dcri.duke.edu/research/coi.jsp.

References
1. American Heart Association. Heart Disease and Stroke Statistics: 2009
Update. Dallas, Tex: American Heart Association; 2009.
2. Christian AH, Rosamond W, White AR, Mosca L. Nine-year trends and
racial and ethnic disparities in women’s awareness of heart disease and
stroke: an American Heart Association national study. J Womens Health.
2007;16:68 – 81.
3. Mosca L, Mochari H, AH, Berra K, Taubert K, Mills T, Burdick KA,
Simpson SL. National study of women’s awareness, action, and barriers
to cardiovascular health. Circulation. 2006;113:525.
4. Mosca L, Jones WK, King KB, Ouyang P, Redberg RF, Hill MN, for the
American Heart Association’s Women’s Heart Disease and Stroke
Campaign Task Force. Awareness, perception, and knowledge of heart
disease risk and prevention among women. Arch Fam Med. 2000;9:
506 –515.
5. Robertson RM. Women and cardiovascular disease. the risks of misperception and the need for action. Circulation. 2001;103:2318 –2320.
6. Mosca L, Ferris A, Fabunmi R, Robertson RM, for the American Heart
Association. Tracking women’s awareness of heart disease: an American
Heart Association national study. Circulation. 2004;109:573–579.

7. Williams RA. Cardiovascular disease in African American women: a
health care disparities issue. J Natl Med Assoc. 2009;101:536 –540.
8. Homko CJ, Santamore WP, Zamora L, Shirk G, Gaughan J, Cross R,
Kashem A, Petersen S, Bove AA. Cardiovascular disease knowledge and
risk perception among underserved individuals at increased risk of cardiovascular disease. J Cardiovasc Nurs. 2008;23:332–337.
9. Hamner J, Wilder B. Knowledge and risk of cardiovascular disease in
rural Alabama women. J Am Acad Nurse Pract. 2008;20:333–338.
10. Cao Y, DiGiacomo M, Du HY, Ollerton E, Davidson P. Cardiovascular
disease in Chinese women: an emerging high-risk population and implications for nursing practice. J Cardiovasc Nurs. 2008;23:386 –394.
11. Edelman D, Christian A, Mosca L. Association of acculturation status
with beliefs, barriers, and perceptions related to cardiovascular disease
prevention among racial and ethnic minorities. J Transcult Nurs. 2009;
20:278 –285.
12. Grunau GL, Ratner PA, Gaidas PM, Hossain S. Ethnic and gender
differences in patient education about heart disease risk and prevention.
Patient Educ Couns. 2009;76:181–188.
13. Zbierajewski-Eischeid SJ, Loeb SJ. Myocardial infarction in women:
promoting symptom recognition, early diagnosis, and risk assessment.
Dimens Crit Care Nurs. 2009;28:1– 6.
14. Berger JS, Elliott L, Gallup D, Roe M, Granger CB, Armstron PW, Simes
RJ, White HD, Van de Werf F, Topol EJ, Hochman JS, Newby LK,
Harrington RA, Califf RM, Becker RC, Douglas PS. Sex differences in
mortality following acute coronary syndromes. JAMA. 2009;302:
874 – 882.
15. Nichol G, Thomas E, Callaway CW, Hedges J, Powell JL, Aufderheide
TP, Rea T, Lowe R, Brown T, Dreyer J, Davis D, Idris A, Stiell I,
Resuscitation Outcomes Consortium Investigators. Regional variation in
out-of-hospital cardiac arrest incidence and outcome. JAMA. 2008;300:
1423–1431.
16. Cook NR, Albert CM, Gaziano M, Zaharris E, MacFadyen J, Danielson
E, Buring JE, Manson JE. A randomized factorial trial of vitamins C and
E and beta carotene in the secondary prevention of cardiovascular events
in women: results from the Women’s Antioxidant Cardiovascular Study.
Arch Intern Med. 2007;167:1610 –1618.
17. Mosca L, Banka CL, Benjamin EJ, Berr K, Bushnell C, Ganiats T, Gomes
AS, Gornick H, Gracia C, Gulati M, Haan CK, Judelson DR, Keenan N,
Kelepouris E, Michos E, Oparil S, Ouyang P, Oz MC, Petitti D, Pinn VW,
Redberg R, Scott R, Sherif K, Smith S Jr, Sopko G, Steinhorn R, Stone
NJ, Taubert K, Todd BA, Urbina E, Wenger N. 2007 Update: American
Heart Association Evidence-Based Guidelines for Cardiovascular Disease
Prevention in Women. Circulation. 2007;115:1481–1501.
18. Lee S, Colditz GA, Berkman LF, Kawachi I. Caregiving and risk of
coronary heart disease in US women: a prospective study. Am J Prev
Med. 2009;24:113–119.
19. Aggarwal B, Liao M, Christian A, Mosca L. Influence of caregiving on
lifestyle and psychosocial risk factors among family members of patients
hospitalized with cardiovascular disease. J Gen Intern Med. 2009;24:
93–98.
20. Amuzu A, Carson C, Watt HC, Lawlor DA, Ebrahim S Influence of area
and individual lifecourse deprivation on health behaviours: findings from
the British Women’s Heart and Health Study. Eur J Cardiovasc Prev
Rehabil. 16:169 –173.
21. Jilcott SB, Keyserling TC, Samuel-Hodge CD, Rosamond W, Garcia B,
Will JC, Farris RP, Ammerman AS. Linking clinical care to community
resources for cardiovascular disease prevention: the North Carolina
Enhanced WISEWOMAN Project. J Women’s Health. 2006;15:569 –583.

Downloaded from circoutcomes.ahajournals.org at NIH Library on March 5, 2010

HARRIS INTERACTIVE
th
161 Avenue of the Americas, 6 Floor
New York, NY 10013
July 16, 2009
American Heart Association
Women & Heart Disease 2009
Title for landing page:

Women’s Health Study

Demographics Template:

PRELOAD AND CUSTOM

1

Downloaded from circoutcomes.ahajournals.org at NIH Library on March 5, 2010

SECTION 200: SCREENING
NOTE TO PROGRAMMER: THROUGHOUT SURVEY DISPLAY INTERVIEWER NOTES: [INT], (VOL)
FOR PHONE ONLY (Q149/2).

BASE: ALL PHONE RESPONDENTS (Q149/2)
Q600 (Q200)
Hello, my name is ________________________ from Harris Interactive, a nationally
known research company. We are talking to women about healthcare issues facing women today. We are
not selling anything. The information will be used to develop important health communications for women,
and all responses will be kept strictly confidential.
(INTERVIEWER: IF MALE ANSWERS PHONE, ASK “May I please speak with a woman in your household
who is 25 years of age or older?” IF YES, REPEAT INTRO ABOVE AND THEN ASK AGE QUESTION
BELOW.)
(INTERVIEWER: IF SPEAKING WITH FEMALE, ASK “Are you 25 years of age or older?”)
1
2
3
4
5

Yes, speaking (25+)
Not available, call back
No female in household, or no female 25+
Not sure (v)
Refused (v)

THANK AND TERMINATE
THANK AND TERMINATE
THANK AND TERMINATE

[PN: BANK Q605, Q268, Q270 ON ONE SCREEN]
BASE: ALL WEB RESPONDENTS (Q149/1)
Q605
INSERT The progress bar below indicates approximately what portion
of the survey you have completed.]
Thank you for participating in this survey about women’s health. Our first few questions are for classification
purposes and they enable us to select the questions to ask you later in the survey. They will also help us
properly analyze responses to this survey.
BASE: WEB RESPONDENTS (Q149/1)
Q268 Are you…?
1
2

Male
Female

BASE: WEB RESPONDENTS (Q149/1)
Q270
In what year were you born? Please enter your response as a four-digit number (for example, 1977).
[RANGE: 1900 TO CURRENT YEAR-6]
BASE: ALL WEB RESPONDENTS (Q149/1)
Q280
FINAL COMPUTE FOR AGE:
PN: COMPUTE AGE FROM Q270
|__|__|__|__|
[ALL RESPONDENTS WHO ARE Q149/2 AND Q600/1, AUTO FILL WITH 25+ AT Q280]
[PN: IF US RESPONDENT (Q264/244) AND LESS THAN 18 (Q280<18) SKIP TO Q115 AFTER Q283/284]

2

Downloaded from circoutcomes.ahajournals.org at NIH Library on March 5, 2010

BASE: ALL WEB RESPONDENTS (Q149/1)
Q258
In which country or region do you currently reside?
[PROGRAMMER: DISPLAY CODES IN ALPHABETICAL ORDER]
[DISPLAY RESPONSES IN TWO COLUMNS GOING DOWN.]
[PM/RESEARCHER NOTE: IF TARGETING COUNTRIES BEYOND THE LIST BELOW, ADD
THE APPROPRIATE CODES FROM THE STANDARD COUNTRY LIST.]
14
15
24
42
60
76
85
89
123
286
168
171
179
190
215
223
224
244
266
267
268
285
996

Australia
Austria
Belgium
Canada
Denmark
France
Germany
Greece
Italy
Ireland (Republic of Ireland)
Netherlands
New Zealand
Norway
Portugal
Spain
Sweden
Switzerland
United States of America [ANCHOR AT TOP OF LIST]
England
Scotland
Wales
Northern Ireland
Other country

[NOTE: Q260 IS FILLED WITH FINAL COUNTRY FOR ONLINE AND ASKED FOR PHONE]
BASE: ALL WEB RESPONDENTS AND FEMALE PHONE RESPONDENTS 25+ (Q149/1 AND
Q258/996) OR (Q149/2 AND Q600/1)
Q260
In which country or region do you currently reside?
[SEE MASTER DEMOGRAPHIC DOCUMENT FOR CODE FRAME]
[IF [Q149(1) AND Q256(NE 1) AND Q258(1/286)] THEN AUTO FILL WITH Q258]
BASE: ALL WEB RESPONDENTS AND FEMALE PHONE RESPONDENTS 25+ (Q149/1 OR (Q149/2
AND Q600/1)
Q264
[HIDDEN QUESTION – FINAL COUNTRY QUESTION FOR SURVEY LOGIC]
[IF U.K. (U.K., Scotland, Wales, England, Northern Ireland, Jersey, Isle of Man, Guernsey Island,
Great Britain (Q260/266, 267, 268, 271, 285, 243, 127, 121, 105)) GET CODE 243. ELSE GET
CODE FROM Q260.]
BASE: ALL WEB US RESPONDENTS 18+ AND FEMALE PHONE RESPONDENTS 25+ ((Q149/1 AND
Q280/18+ AND Q264/244) OR (Q149/2 AND Q600/1))
Q474
Are you of Spanish or Hispanic origin, such as Latin American, Mexican, Puerto Rican, or Cuban?

1
2
4
9

Yes, of Hispanic origin
No, not of Hispanic origin
Decline to answer
UNKNOWN

[DO NOT DISPLAY]

3

Downloaded from circoutcomes.ahajournals.org at NIH Library on March 5, 2010

[PROGRAMMER NOTE: INSERT BELOW CHOICES Why
do we ask this question?.]
BASE: ALL WEB US RESPONDENTS 18+ AND FEMALE PHONE RESPONDENTS 25+ ((Q149/1 AND
Q280/18+ AND Q264/244) OR (Q149/2 AND Q600/1))
Q480
Do you consider yourself…?
[IF PHONE Q149/2 INSERT: [INTERVIEWER: READ LIST]
[PROGRAMMER NOTE: IF U.S. (Q264/244) PRESENT CODES 1-4,8,5,6,94.]
[PROGRAMMER NOTE: IF CANADIAN (Q264/42) PRESENT CODES 1,2,9-17,5,6,94.]
[PROGRAMMER NOTE: DISPLAY IN ONE COLUMN.]
[DISPLAY CODES 5, 6, AND 94 IN ORDER AS LAST THREE CATEGORIES.]
1
2
3
4
5
6
7
8
9
10
12
13
14
15
16
17
94

White
Black
Asian or Pacific Islander
Native American or Alaskan Native
Mixed Race
Some other race
Hispanic
African American
First Nation/Native Canadian
South Asian
Chinese
Korean
Japanese
Other Southeast Asian
Filipino
Arab/West Asian
Decline to Answer

[ANCHOR]
[ANCHOR]

[ANCHOR]

[PROGRAMMER NOTE: INSERT BELOW CHOICES Why
do we ask this question?.]
BASE: OTHER RACE (Q480/6)
Q482
What other race do you consider yourself?
[NON-MANDATORY TEXT BOX]

4

Downloaded from circoutcomes.ahajournals.org at NIH Library on March 5, 2010

BASE: U.S. RESIDENT AND MIXED RACIAL BACKGROUND (Q264/244 & Q480/5)
Q484
You indicated that you consider yourself of a mixed racial background. With which of the following
racial groups do you most closely identify?
[PN: IF WEB Q149/1 INSERT: Please select all that apply.]
[PN: IF PHONE Q149/2 INSERT: [INTERVIEWER: READ LIST AND ACCEPT MULTIPLE RESPONSES]]
[MULTIPLE RESPONSE]
[PROGRAMMER NOTE: IF U.S. (Q264/244) PRESENT CODES 1-4,8,6,7,9,10,12-17,94.]
1
2
3
4
5
6
7
8
9
10
12
13
14
15
16
17
94

White
Black
Asian or Pacific Islander
Native American or Alaskan Native
Mixed Race
Some other race
Hispanic
African American
First Nation/Native Canadian
South Asian
Chinese
Korean
Japanese
Other Southeast Asian
Filipino
Arab/West Asian
Decline to Answer

[ANCHOR][EXCLUSIVE]

BASE: ALL WEB US RESPONDENTS 18+ AND FEMALE PHONE RESPONDENTS 25+ ((Q149/1 AND
Q280/18+ AND Q264/244) OR (Q149/2 AND Q600/1))
Q485
[HIDDEN COMPUTE QUESTION]
[IF ANSWERED HISPANIC (Q474/1) ANSWER TO Q485 IS CODE 7, OTHERWISE Q485=Q480.]
1
2
3
4
5
6
7
8
9
10
12
13
14
15
16
17
94

White
Black
Asian or Pacific Islander
Native American or Alaskan native
Mixed racial background
Other race
Hispanic
African American
First Nation/Native Canadian
South Asian
Chinese
Korean
Japanese
Other Southeast Asian
Filipino
Arab/West Asian
Decline to Answer

5

Downloaded from circoutcomes.ahajournals.org at NIH Library on March 5, 2010

SECTION 300: GENERAL AWARENESS OF WOMEN’S HEALTH ISSUES
BASE: QUALIFIED WEB RESPONDENTS (Q149/1 & Q99/1)
Q800 (Q300)
[IF WEB (Q149/1) INSERT: Our first few questions are about your views on women’s
health issues today.]

What do you think is the one greatest health problem facing women today?
[IF ONLINE (Q149/1) INSERT MANDATORY TEXT BOX; DO NOT DISPLAY LIST]
[NOTE: PHONE LIST IS CODE FRAME FOR ONLINE OPEN END]
BASE: QUALIFIED PHONE RESPONDENTS (Q149/2 & Q99/1)
Q805
I would first like to ask you your views on women’s health issues today.
What do you think is the one greatest health problem facing women today?
[IF PHONE (Q149/2) INSERT: [INT: DO NOT READ LIST]
[SINGLE RESPONSE]
01
02
03
04
05
06
07
08
09
10
11
12
96
98
99

AIDS
Alzheimer’s
Breast cancer
Cancer (general)
Diabetes
Drug addiction/Alcoholism
Heart disease/Heart attack
Lung cancer
Obesity
Osteoporosis
Smoking
Stroke
Other (VOL) [SPECIFY AT Q810]
Don’t know (VOL)
Refused (VOL)

BASE: PHONE RESPONDENT AND OTHER GREATEST HEALTH PROBLEM FACING WOMEN TODAY
(Q149/2 AND Q805/96)
Q810 (Q301)
[INT: ASK IF NECESSARY] What do you think is the one greatest health problem facing
women today?
[INT: RECORD RESPONSE VERBATIM]
[MANDATORY TEXT BOX]
BASE: QUALIFIED WEB RESPONDENTS (Q149/1 & Q99/1)
Q815 (Q305)
As far as you know, what is the leading cause of death for all women?
[IF ONLINE (Q149/1) INSERT MANDATORY TEXT BOX; DO NOT DISPLAY LIST]
[NOTE: PHONE LIST IS CODE FRAME FOR ONLINE OPEN END]

6

Downloaded from circoutcomes.ahajournals.org at NIH Library on March 5, 2010

BASE: QUALIFIED PHONE RESPONDENTS (Q149/2 & Q99/1)
Q820
As far as you know, what is the leading cause of death for all women?
[IF PHONE (Q149/2) INSERT:
[INT: DO NOT READ LIST]
[SINGLE RESPONSE]
01
02
03
04
05
06
07
08
09
10
11
12
13
96
98
99

Accidental death
AIDS
Alzheimer’s
Breast cancer
Cancer (general)
Diabetes
Drug addiction/Alcoholism
Heart disease/Heart attack
Lung cancer
Osteoporosis
Smoking
Stroke
Violent crime
Other (VOL) [SPECIFY AT Q825]
Don’t know (VOL)
Refused (VOL)

BASE: PHONE RESPONDENT AND OTHER LEADING CAUSE OF DEATH FOR WOMEN (Q149/2 AND
Q820/96)
Q825
[INT: ASK IF NECESSARY] What is the leading cause of death for all women?
[INT: RECORD RESPONSE VERBATIM]
[MANDATORY TEXT BOX]

7

Downloaded from circoutcomes.ahajournals.org at NIH Library on March 5, 2010

SECTION 400: COMMUNICATIONS AND BEHAVIORS RELATED TO HEART DISEASE PREVENTION

BASE: QUALIFIED WEB RESPONDENTS (Q149/1 & Q99/1)
Q905 (Q405)
[IF WEB (Q149/1) INSERT: Our next several questions are about heart disease, which
includes among others, heart attack, stroke, high blood pressure and angina.]
In the past 12 months, where have you seen, heard or read about women and heart disease?
[IF ONLINE (Q149/1) INSERT MANDATORY TEXT BOX; DO NOT DISPLAY LIST]
[NOTE: PHONE LIST IS CODE FRAME FOR ONLINE OPEN END]
BASE: QUALIFIED PHONE RESPONDENTS (Q99/1 AND Q149/2)
Q910
I would now like to ask you several questions about heart disease, which includes among others,
heart attack, stroke, high blood pressure and angina.
In the past 12 months, where have you seen, heard or read about women and heart disease?
[IF PHONE (Q149/2) INSERT:
[INT: DO NOT READ LIST; RECORD ALL THAT APPLY]
[INT: ACCEPT MULTIPLE RESPONSES]
[MULTIPLE RESPONSES]
01
02
03
04
05
06
07
08
09
10
96
11
98
99

In a magazine
On the radio
In a book
On TV
Information in a brochure
Provided by physician, nurse or other healthcare professional
In a newspaper
On the Internet or World Wide Web
From a friend or relative
Library
Other (VOL) [SPECIFY AT Q915]
Did not see, hear or read anything (VOL) [E]
Don’t know (VOL)
[E]
Refused (VOL)
[E]

BASE: PHONE RESPONDENT AND OTHER PLACES HAVE SEEN, HEARD, OR READ INFORMATION
ABOUT HEART DISEASE WITHIN THE PAST 12 MONTHS (Q149/2 AND Q910/96)
Q915
[INT: ASK IF NECESSARY] Where else have you seen, heard, or read this information?
[INT: RECORD RESPONSE VERBATIM]
[MANDATORY TEXT BOX]

8

Downloaded from circoutcomes.ahajournals.org at NIH Library on March 5, 2010

BASE: QUALIFIED ONLINE RESPONDENTS Q99/1 AND Q149/1)
Q920 Have you used any of the following internet sources to learn more about women and heart disease in
the last 12 months? Please select all that apply.
[RANDOMIZE]
[MULTIPLE RESPONSES]
1
News websites such as CNN.com, NYTimes.com, Univision.com, Telemundo.com etc.
2
Medical information websites such as WebMD.com, Mayoclinic.com, etc.
3
Internet portals such as iVillage.com, MSN.com, Terra.com, etc.
4
Search engines such as Google.com, Yahoo.com, etc.
5
Government websites such as Medlineplus.gov, NIH.gov, CDC.gov, etc.
6
Magazine websites such as Oprah.com, Vanidades, Ebony, etc.
7
General information websites such as Wikipedia.org, About.com, etc.
8
Social networking sites such as Facebook.com, MySpace.com, MiGente.com, etc.
9
Nonprofit health organization sites such as American Heart Association or National
Women’s Health Resource Center
10
Other websites
ANCHOR
11
I have not used any internet sources to learn more about women and heart disease
[ANCHOR; EXCLUSIVE]
BASE: QUALIFIED RESPONDENTS OR ALL HPOL RESPONDENTS (Q99/1 OR Q75/1) (SOFT EXIT #1)
Q925 (Q415)
Have any of your doctors ever discussed heart disease with you when discussing your
health?
[RESULTS LABEL – Percent indicating doctors have discussed health disease with them]
1
2
8
9

Yes
No
Don’t know (VOL) [INSERT IF PHONE (Q149/2)]
Refused (VOL) [INSERT IF PHONE (Q149/2)]

BASE: QUALIFIED RESPONDENTS (Q99/1)
Q930 (Q420)
How informed are you about heart disease in women? Would you say you are:
[Q149/2 INSERT: INT: READ LIST]
[SINGLE RESPONSE]
1
2
3
4
8
9

Very well informed
Well informed
Moderately informed
Not at all informed
Don’t know (VOL) [INSERT IF PHONE (Q149/2)]
Refused (VOL) [INSERT IF PHONE (Q149/2)]

BASE: QUALIFIED RESPONDENTS (Q99/1)
Q935 (Q425)
How informed are you about stroke or “brain attack” in women? Would you say you are:
IF PHONE (Q149/2) INSERT [INT: READ LIST]]
1
2
3
4
5
6

Very well informed
Well informed
Moderately informed
Not at all informed
Don’t know (VOL) [INSERT IF PHONE (Q149/2)]
Refused (VOL) [INSERT IF PHONE (Q149/2)]

9

Downloaded from circoutcomes.ahajournals.org at NIH Library on March 5, 2010

BASE: QUALIFIED RESPONDENTS OR ALL HPOL RESPONDENTS (Q99/1 OR Q75/1) (SOFT EXIT #2)
Q940 (Q475)
Have you been diagnosed with diabetes?
[RESULTS LABEL – Percent indicating they have been diagnosed with diabetes]
1
2
8
9

Yes
No
Don’t know (VOL) [INSERT IF PHONE (Q149/2)]
Refused (VOL) [INSERT IF PHONE (Q149/2)]

BASE: QUALIFIED RESPONDENTS OR ALL HPOL RESPONDENTS (Q99/1 OR Q75/1) (SOFT EXIT #3)
Q950 (Q478)
Have you ever had a heart attack?
[RESULTS LABEL – Percent indicating they have had a heart attack]
1
2
8
9

Yes
No
Don’t know (VOL) [INSERT IF PHONE (Q149/2)]
Refused (VOL) [INSERT IF PHONE (Q149/2)]

BASE: QUALIFIED RESPONDENTS OR ALL HPOL RESPONDENTS (Q99/1 OR Q75/1) (SOFT EXIT #4)
Q955 (Q480)
Have you ever had a stroke or “brain attack”?
[RESULTS LABEL – Percent indicating they have had a stroke or “brain attack”]
1
2
8
9

Yes
No
Don’t know (VOL) [INSERT IF PHONE (Q149/2)]
Refused (VOL) [INSERT IF PHONE (Q149/2)]

10

Downloaded from circoutcomes.ahajournals.org at NIH Library on March 5, 2010

SECTION 500: SPECIFIC UNDERSTANDING OF HEART DISEASE AMONG WOMEN/BEHAVIORS
ASSOCIATED WITH PREVENTION
BASE: QUALIFIED WEB RESPONDENTS (Q149/1 & Q99/1)
Q1000 (Q525)
Based on what you know, what warning signs do you associate with having a heart
attack?
[IF ONLINE Q149/1 INSERT LARGE MANDATORY TEXT BOX; DO NOT DISPLAY LIST]
[NOTE: PHONE CODES SERVE AS ONLINE CODE FRAME]
BASE: QUALIFIED PHONE RESPONDENTS (Q149/2 & Q99/1)
Q1005 Based on what you know, what warning signs do you associate with having a heart attack?
[Q149/2 INSERT:
[INT: DO NOT READ LIST; RECORD ALL THAT APPLY]
[INT: ACCEPT MULTIPLE RESPONSES]
[MULTIPLE RESPONSES]
01
02
03
04
05
06
96
98
99

Chest pain
Fatigue
Nausea
Pain that spreads to the shoulders, neck, or arms
Shortness of breath
Tightness of the chest
Other (VOL) [SPECIFY AT Q1010]
Don’t know (VOL)
E
Refused (VOL)
E

BASE: PHONE RESPONDENT AND OTHER WARNING SIGNS OF HAVING HEART ATTACK (Q149/2
AND Q1005/96)
Q1010 (Q526)
[INT: ASK IF NECESSARY] What other warning signs do you associate with having a
heart attack?
[INT: RECORD RESPONSE VERBATIM]
[MANDATORY TEXT BOX]
BASE: QUALIFIED WEB RESPONDENTS (Q149/1 & Q99/1)
Q1015 (Q1527) If you thought you were experiencing signs of a heart attack, what is the first thing you
would do?
[IF ONLINE Q149/1 INSERT LARGE MANDATORY TEXT BOX; DO NOT DISPLAY LIST]
[NOTE: PHONE CODES SERVE AS ONLINE CODE FRAME]
BASE: QUALIFIED PHONE RESPONDENTS (Q149/2 & Q99/1)
Q1020 If you thought you were experiencing signs of a heart attack, what is the first thing you would do?
[Q149/2 INSERT:
[INT: DO NOT READ LIST]
[SINGLE RESPONSE]
1
Take an aspirin
2
Call your doctor
3
Call a family member
4
Call 911
5
Go to the hospital
96 Other (VOL) [SPECIFY AT Q1025]
97 Don’t know (VOL)
98 Refused (VOL)

11

Downloaded from circoutcomes.ahajournals.org at NIH Library on March 5, 2010

BASE: PHONE RESPONDENT AND OTHER ACTIONS IF HAVING HEART ATTACK SYMPTOMS
(Q149/2 AND Q1020/96)
Q1025 (Q1528) [INT: ASK IF NECESSARY] What else would you do if you thought you were experiencing
signs of a heart attack?
[INT: RECORD RESPONSE VERBATIM]
[MANDATORY TEXT BOX]
BASE: QUALIFIED RESPONDENTS
Q2230 (Q529)
Now, [INSERT IF PHONE (Q149/2): I IF WEB (Q149/1): we] would like to discuss ways to
prevent heart disease.
Which of the following activities do you believe can prevent or reduce the risk of getting heart disease?
[Q149/2 INSERT: INT: READ LIST]
[RANDOMIZE]
[DISPLAY GRID HEADERS AT TOP, MIDDLE AND BOTTOM OF LIST]
Q2231
1.
2.
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21

Yes
No

Quitting smoking
Getting physical exercise
Taking special vitamins like E, C or A
Losing weight
Reducing dietary cholesterol intake
Reducing stress
Taking multivitamins with folic acid
Taking hormone-replacement therapy
Reducing sodium or salt in the diet
Reducing animal products in your diet (such as meat, whole milk, butter and cream)
Aromatherapy
Taking aspirin regularly
Maintaining a healthy blood pressure
Maintaining a healthy cholesterol level
Fish oil/Omega 3 fatty acids
Fiber
Antioxidants
Plant Stanols and Sterols
Preventing gum disease
Praying or meditating
Getting adequate sleep

12

Downloaded from circoutcomes.ahajournals.org at NIH Library on March 5, 2010

BASE: QUALIFIED RESPONDENTS (Q99/1)
Q2240 Have you done any of the following things to monitor or improve your health in the last year?
[IF Q149/2 INSERT: INT: READ LIST]
[RANDOMIZE]
Q2241
1.
2.

Yes
No

01
02
03
04
05
06
07
08
09
10

Went to see a doctor or other health care professional
Increased physical activity
Decreased consumption of unhealthy foods
Quit smoking/using tobacco products
Lost weight
Tried to better manage stress
Got a diagnostic test for heart disease such as a stress test or heart scan
Had cholesterol checked
Had blood pressure checked
Started taking vitamins or dietary supplements

BASE: ONLINE RESPONDENT AND DID ANYTHING TO MONITOR OR IMPROVE HEALTH (Q149/1
AND SELECTED ONE OR MORE ITEMS AT Q2240/1-10 AND Q2241/1)
Q638
Thinking about the things you have done to improve your own health, please tell us if any of the
following prompted you to take action.
[RANDOMIZE]
[MULTIPLE RESPONSE]
1 I saw, heard, or read information related to heart disease
2 My health care professional encouraged me to take action
3 A family member or relative encouraged me to take action
4 A friend encouraged me to take action
5 A family member/relative developed heart disease, got sick, or died
6 A friend developed heart disease, got sick, or died
7 I experienced symptoms that I thought were related to heart disease
8 I wanted to feel better
9 I wanted to avoid taking medications
10 I wanted to improve my health
11 I wanted to live longer
12 I did it for my family
13 Something else
ANCHOR

13

Downloaded from circoutcomes.ahajournals.org at NIH Library on March 5, 2010

BASE: QUALIFIED ONLINE RESPONDENTS (Q149/1 AND Q99/1)
Q640
The following is a list of things some women have said about living a heart healthy lifestyle. Please
tell us if you strongly agree, somewhat agree, somewhat disagree or strongly disagree with each item.
Q641
1
2
3
4

Strongly disagree
Somewhat disagree
Somewhat agree
Strongly agree

[RANDOMIZE]
[PN: DISPLAY GRID HEADERS AT TOP, MIDDLE AND BOTTOM]
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20

I don't perceive myself to be at risk for heart disease
I don't want to change my lifestyle
I don't think changing my behavior will reduce my risk of developing heart disease
I'm fearful of change
I'm not confident that I can successfully change my behavior
I am too stressed to do the things that need to be done
I am too depressed to do the things that need to be done
I am too ill/old to make changes
I don't have the money or insurance coverage to do what needs to be done
I have family obligations and other people to take care of
My family/friends have told me that I don't need to change
I don't have the time to take care of myself
My health care professional doesn't think I need to worry about heart disease
My health care professional doesn't speak my language
I am confused by what I'm supposed to do to change my lifestyle
I feel the changes required are too complicated
I don't know what I should do
There is too much confusion in the media about what to do
My health care professional doesn't explain clearly what I should do
God or some higher power ultimately determines my health

BASE: QUALIFIED ONLINE RESPONDENTS (Q149/1 AND Q99/1)
Q2000 Do you have a health care professional who you see on a regular basis?
1.
2.

Yes
No

BASE: ONLINE RESPONDENT AND HAS A HEALTH CARE PROFESSIONAL (Q149/1 AND Q99/1 AND
Q2000/1)
Q2005 When did you last speak with a health care professional about your risk of heart disease? Was it?
1
2
3
4
5

Within the past 6 months
More than 6 months ago but less than 1 year ago
More than 1 year ago but less than 2 years ago
More than 2 years ago
Never

14

Downloaded from circoutcomes.ahajournals.org at NIH Library on March 5, 2010

BASE: ONLINE RESPONDENT AND HAS NOT SPOKEN TO A HEALTH CARE PROFESSIONAL
ABOUT THEIR RISK OF HEART DISEASE IN THE PAST YEAR (Q149/1 AND /Q99/1 AND Q2005/3,4,5)
Q2010 Below is a list of reasons people have given for why they have not recently spoken with their health
care professional about how to reduce their risk of heart disease. For each one, please tell us if it is a major
reason, minor reason or not a reason for why you have not spoken to your health care professional about
reducing your risk of heart disease in the last year.
Q2011
1
Major reason
2
Minor reason
3
Not a reason
[INT: READ LIST]
[RANDOMIZE]
1
My health care professional does not bring it up
2
My health care professional does not know about heart disease
3
My health care professional seems too busy to discuss my risk of heart disease
4
My health care professional is usually more focused on treating illness or health problems
than on prevention
5
I don’t know what to ask my health care professional or how to bring it up
6
I don’t feel the need to talk about heart disease with my health care professional
7
I already know what to do about reducing my risk of heart disease
8
I don’t feel that I am at higher risk for heart disease than others
BASE: QUALIFIED RESPONDENTS (Q99/1)
Q1035 How helpful do you think each of the following would be in leading you to follow a more heart
healthy lifestyle? [IF Q149/2 INSERT: Would you say each is very helpful, somewhat helpful, not very helpful
or not at all helpful? How helpful would [READ LIST] be?]
Q1036
1
2
3
4
5
6

[PN: FOR WEB DISPLAY ATTRIBUTES FROM 4 TO 1]
Very helpful
Somewhat helpful
Not very helpful
Not at all helpful
Don’t know (VOL) [INSERT IF PHONE (Q149/2)]
Refuse (VOL) [INSERT IF PHONE (Q149/2)]

[RANDOMIZE]
1 Access to more or better fruits, vegetables and other healthy foods
2 Greater access to indoor and outdoor public recreational facilities
3 Bans on trans fats in restaurants
4 Smoking bans
5 Stricter regulations on pollution
6 Requiring all restaurants to post nutrition information for menu items
7 Increased public safety in public recreation areas
BASE: QUALIFIED ONLINE RESPONDENTS (Q149/1 AND Q99/1)
Q1040 (Q530) Based on what you know, what warning signs do you associate with having a stroke or
“brain attack”?
[IF ONLINE (Q149/1) INSERT LARGE MANDATORY TEXT BOX; DO NOT DISPLAY LIST]
[NOTE: LIST BELOW IS CODE FRAME FOR ONLINE OPEN END]

15

Downloaded from circoutcomes.ahajournals.org at NIH Library on March 5, 2010

BASE: QUALIFIED PHONE RESPONDENTS (Q149/2 AND Q99/1)
Q2245 Based on what you know, what warning signs do you associate with having a stroke or “brain
attack”?
[IF PHONE (Q149/2) INSERT: [INT: READ LIST]]
[MULTIPLE RESPONSES]
01
02
03
04
05
06
07

Loss of/trouble talking or trouble understanding speech
Sudden dimness/loss of vision, often in one eye
Sudden, severe headache
Sudden weakness/numbness of face or limb on one side
Unexplained dizziness
[IF PHONE (Q149/2): Don’t Know (VOL)]
[IF PHONE (Q149/2): Refused (VOL)]

BASE: QUALIFIED ONLINE RESPONDENTS (Q149/1 AND Q99/1)
Q1045 (Q1532) If you thought you were experiencing signs of a stroke or “brain attack,” what is the first
thing you would do?
[IF ONLINE (Q149/1) INSERT LARGE MANDATORY TEXT BOX; DO NOT DISPLAY LIST]
[NOTE: LIST BELOW IS CODE FRAME FOR ONLINE OPEN END]
BASE: QUALIFIED PHONE RESPONDENTS (Q149/2 AND Q99/1)
Q2250 If you thought you were experiencing signs of a stroke or “brain attack,” what is the first thing you
would do?
[IF PHONE (Q149/2) INSERT: [INT: READ LIST]]
1
2
3
4
5
6

Go to the hospital
Call your doctor
Call 911
Call your spouse or family
[IF PHONE (Q149/2) INSERT: Don’t know (VOL)]
[IF PHONE (Q149/2) INSERT: Refused (VOL)]

16

Downloaded from circoutcomes.ahajournals.org at NIH Library on March 5, 2010

SECTION 700: CAREGIVING
BASE: QUALIFIED RESPONDENTS (Q99/1)
Q1100 Next, [PHONE: I WEB: we] have some questions about care you may be providing to an adult
friend or family member. If you have provided care for more than one adult friend or family member, please
respond thinking about the one for whom you spent the greatest amount of time on care giving
responsibilities.
To what extent are you involved in the care (such as assistance with daily activities, doctor visits, and/or
medications) of an adult friend or family member? [IF Q149/2 INSERT: [INT: READ ENTIRE LIST
BEFORE ACCEPTING RESPONSE]]
1
2
3
4
5
6
7
8

[PHONE: You are WEB: I am] a primary caregiver for an adult friend or family member
[PHONE: You WEB: I] care for an adult friend or family member most of the time
[PHONE: You WEB: I] care for an adult friend or family member some of the time
[PHONE: You WEB: I] care for an adult friend or family member occasionally
[PHONE: You WEB: I] cared for an adult friend or family member in the past but no longer
provide care
[PHONE: You WEB: I] have never been involved in the care of an adult friend or family
member
Don’t know (VOL) [INSERT IF PHONE (Q149/2)]
ANCHOR, E
Refused (VOL)
[INSERT IF PHONE (Q149/2)]
ANCHOR, E

BASE: CAREGIVERS (Q1100/1,2,3,4,5)
Q1110 On average, about how many hours [IF Q1100/1-4 INSERT: do you; IF Q1100/5 INSERT: did you]
spend on care giving responsibilities for an adult friend or family member each week?
[Q149/2 INSERT: INT: READ IF NECESSARY]
01 Less than 1 hour
02 2-5 hours
03 6-10 hours
04 11-20 hours
05 21-40 hours
06 More than 40 hours
07 Don’t know (VOL) [INSERT IF PHONE (Q149/2)]
08 Refused (VOL)
[INSERT IF PHONE (Q149/2)]

ANCHOR, E
ANCHOR, E

BASE: CAREGIVERS (Q1100/1,2,3,4,5)
Q1115 How do you feel your care giving responsibilities have impacted your health? [IF Q149/2 INSERT:
Would you say they have had a…]
[Q149/2 INSERT: INT: READ LIST]
[PN: DISPLAY ATTRIBUTES FROM 5 TO 1 FOR WEB]
1
2
3
4
5
6
7

Very positive impact
Somewhat positive impact
No impact
Somewhat negative impact
Very negative impact
Don’t know (VOL) [INSERT IF PHONE (Q149/2)]
Refused (VOL) [INSERT IF PHONE (Q149/2)]

17

ANCHOR, E
ANCHOR, E

Downloaded from circoutcomes.ahajournals.org at NIH Library on March 5, 2010

BASE: NEGATIVE IMPACT (Q1115/4,5)
Q2255 Have your care giving responsibilities negatively impacted your health in any of the following ways?
[Q149/2 INSERT: INT: READ LIST]
[RANDOMIZE]
Q2256
1. Yes
2. No
1
2
3
4
5
6
7
8
9
10
11

[PHONE: Your WEB: My] care giving has caused [PHONE: your WEB: my] stress to
increase
[PHONE: You WEB: I] don’t have time to exercise
[PHONE: You aren’t WEB: I am not] following a healthy diet
[PHONE: You WEB: I] don’t have enough money left over for healthy food or to cover
health care
[PHONE: You are WEB: I am] more exhausted than [PHONE: you WEB: I] used to be
[PHONE: You WEB: I] have not gone to the doctor when [PHONE: you were WEB: I was]
sick
[PHONE: You WEB: I] don’t have enough time for [PHONE: yourself WEB: myself]
[PHONE: You WEB: I] don’t spend enough time with other friends and family members
[PHONE: You WEB: I] have gained or lost weight
[PHONE: You WEB: I] have trouble sleeping
Something else
ANCHOR

18

Downloaded from circoutcomes.ahajournals.org at NIH Library on March 5, 2010

SECTION 100: CLASSIFICATION DATA
[PN: PRESENT ALL DEMOGRAPHIC QUESTIONS TO PHONE AND WEB UNLESS SPECIFIED
OTHERWISE]
BASE: QUALIFIED PHONE RESPONDENTS (Q149/2 AND Q99/1)
Q1300 (Q110) Next, I have a few more general questions. Which of the following ranges represents your
age?
[Q149/2 INSERT: INT: READ LIST UNTIL ANSWERED]
01
02
03
04
05
06
07
08
09
10
11
99

25-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65-74
75-84
85 or older
Refused (VOL) [DISPLAY IF PHONE (Q149/2)]

[PN: DISPLAY Q1305 AFTER Q372]
BASE: QUALIFIED RESPONDENTS (Q99/1)
Q1305 In total, how many generations currently live in your household?
[IF Q149/1: SHOW ALL; IF Q149/2 INSERT: [INT: IF NEEDED:] For example, if you live alone or only with a
spouse or roommate, that would be one generation. If you live with your parents or your children, that would
be two generations. If you live with your parents and your children, that would be three generations.
[MANDATORY TEXT BOX]
[__] RANGE: 1-5
BASE: QUALIFIED RESPONDENTS (Q99/1)
Q1310 [IF Q149/1 INSERT: Next, I have a few more general questions. ]
Which of the following types of health insurance, if any, do you currently have?
[Q149/2 INSERT: INT: READ LIST BEFORE ACCEPTING RESPONSES]
[RANDOMIZE]
[MULTIPLE RESPONSE]
1
2
3
4
5
6
7
8
9
10

Health insurance provided by [PHONE: your WEB: my] employer or school
Health insurance through a family member’s employer or school
Private insurance coverage that you pay for out-of-pocket
Medicare
Medicaid or other public insurance
Veteran’s Affairs (VA)
Some other type of insurance
ANCHOR
No insurance coverage
ANCHOR, E
Don’t know (VOL) [DISPLAY IF PHONE (Q149/2)]
ANCHOR, E
Refused (VOL)
[DISPLAY IF PHONE (Q149/2)] ANCHOR, E

19

Downloaded from circoutcomes.ahajournals.org at NIH Library on March 5, 2010

BASE: ALL QUALIFIED (Q99/1)
Q1315 What is your current height?
[IF Q149/2 INSERT: INT: IF DOES NOT KNOW ENTER 98. IF REFUSES ENTER 99.]
[NON-MANDATORY RANGE = (feet = 0-7,98,99) (inches = 0-11,98,99)]
|_| feet

|_|_| inches

BASE: ALL QUALIFIED (Q99/1)
Q1320 What is your current weight?
[IF Q149/2 INSERT: INT: IF DOES NOT KNOW ENTER 998. IF REFUSES ENTER 999.]
[NON-MANDATORY RANGE: 25 – 800, 998, 999]
|_|_|_| pounds
[PN: INSERT Q1325-Q1355 AFTER Q492]
BASE: HISPANIC RESPONDENTS (Q485/7)
Q1325 Which language do you usually speak at home?
[PROGRAMMER: PLEASE DISPLAY RESPONSES HORIZONTALLY WITH RESPONSES
UNDER RADIO BUTTONS]
[SHRINK FONT 1 SIZE AND MAKE BOLD]
[PN: DISPLAY ATTRIBUTES FROM 5 TO 1 ON PHONE (Q149/2)
1
2
3
4
5
9

Only Spanish
Spanish morethan English
Spanish andEnglish equally
English morethan Spanish
Only English
Decline to answer

BASE: HISPANIC RESPONDENTS (Q485/7)
Q1330 Would you say you can carry on a conversation in Spanish, both understanding and
speaking…?
[PN: DISPLAY ATTRIBUTES FROM 4 TO 1 ON PHONE (Q149/2)]
1
2
3
4
8
9

Not at all
Just a little
Pretty well
Very well
Don’t know (VOL) [DISPLAY IF PHONE (Q149/2)]
ANCHOR, E
Refused (VOL)
[DISPLAY IF PHONE (Q149/2)] ANCHOR, E

BASE: HISPANIC RESPONDENTS (Q485/7)
Q1335 Would you say you can carry on a conversation in English, both understanding and
speaking…?
[PN: DISPLAY ATTRIBUTES FROM 4 TO 1 ON PHONE (Q149/2)]
1
2
3
4
5
6

Not at all
Just a little
Pretty well
Very well
Don’t know (VOL) [DISPLAY IF PHONE (Q149/2)]
ANCHOR, E
Refused (VOL)
[DISPLAY IF PHONE (Q149/2)] ANCHOR, E

20

Downloaded from circoutcomes.ahajournals.org at NIH Library on March 5, 2010

BASE: HISPANIC RESPONDENTS (Q485/7)
Q1340 Would you say you can read a newspaper or book in Spanish…?
[PN: DISPLAY ATTRIBUTES FROM 4 TO 1 ON PHONE (Q149/2)]
1
2
3
4
5
6

Not at all
Just a little
Pretty well
Very well
Don’t know (VOL) [DISPLAY IF PHONE (Q149/2)]
ANCHOR, E
Refused (VOL)
[DISPLAY IF PHONE (Q149/2)] ANCHOR, E

BASE: HISPANIC RESPONDENTS (Q485/7)
Q1345 Would you say you can read a newspaper or book in English…?
[PN: DISPLAY ATTRIBUTES FROM 4 TO 1 ON PHONE (Q149/2)]
1
2
3
4
5
6

Not at all
Just a little
Pretty well
Very well
Don’t know (VOL) [DISPLAY IF PHONE (Q149/2)]
ANCHOR, E
Refused (VOL)
[DISPLAY IF PHONE (Q149/2)] ANCHOR, E

BASE: HISPANIC RESPONDENTS (Q485/7)
Q1350 You indicated that you consider yourself Hispanic. From what country or region did you or your
ancestors come? Please select all that apply.
[MULTIPLE RESPONSE]
[INCLUDE WHY DO WE ASK THIS LINK]
1
2
3
4
6
9

Cuba
Mexico
Puerto Rico
Central or South America
Another country or region
Decline to answer

E

BASE: SELECTED ANOTHER COUNTRY OR REGION (Q1350/6)
Q1355 (Q567) From what country or region did you or your ancestors come?
[NON-MANDATORY TEXT BOX]
[PN: INSERT AFTER Q368]
BASE: QUALIFIED RESPONDENTS (Q99/1)
Q1360 (Q140)
Including you, how many women, 25 or over, live in this household?
(Q149/2 INSERT: [INTERVIEWER NOTE: RECORD NOT SURE AS 98 AND DECLINE TO ANSWER AS
99.])
[RANGE: 1-20, 98, 99]
[PROGRAMMER NOTE: PLEASE DISPLAY Q1400 AND Q1405 ON ONE SCREEN]

21

Downloaded from circoutcomes.ahajournals.org at NIH Library on March 5, 2010

BASE: QUALIFIED RESPONDENTS (Q99/1)
Q434
What is the highest level of education you have completed or the highest degree you have
received?
1
2
3
4
70
5
6
7

Less than high school
Completed some high school
Completed high school
Completed some college
Associate Degree
Completed College
Completed some graduate school
Completed graduate school

BASE: QUALIFIED RESPONDENTS (Q99/1)
Q460 Which of the following income categories best describes your total 2008 household income before
taxes?
1
2
3
4
5
6
7
8
9
10
11
9994

Less than $15,000
$15,000 to $24,999
$25,000 to $34,999
$35,000 to $49,999
$50,000 to $74,999
$75,000 to $99,999
$100,000 to $124,999
$125,000 to $149,999
$150,000 to $199,999
$200,000 to $249,999
$250,000 or more
Decline to answer

22

Downloaded from circoutcomes.ahajournals.org at NIH Library on March 5, 2010