Baseline Survey

The next set of questions asks about your outdoor activities yesterday. 
We know it can be hard to remember, but please try to answer as
accurately as you can.

Thinking about yesterday, did you spend any time outside between the
time you woke up and 12:00 noon? Please only include times when you were
outside for at least 10 minutes continuously. Do not include time spent
in your car or other vehicle.

Yes [skip to Q3]

No[skip to Q5]

Don’t know

[if Don’t know] Okay, let’s start when you woke up; think carefully
about each activity you did after you woke up and before noon. Did you
do anything outside for at least 10 minutes?  

Yes

No [skip to Q5]

How much time did you spend outside?  Please provide your best estimate.

Hours___, minutes_______

Now I want to ask you about your activities when you were outside. 
During this time, did you engage in moderate or vigorous physical
activity? Moderate activities cause only light sweating or a slight to
moderate increase in breathing or heart rate. Some examples are brisk
walking, bicycling for pleasure, golf, or dancing.  Vigorous activities
cause heavy sweating or large increases in breathing or heart rate. 

Yes

No

Now let’s move on.  Did you spend any time outside between 12:00 noon
and 4:00 pm in the afternoon? Again, please only include times when you
were outside for at least 10 minutes continuously and do not include
time spent in your car or other vehicle.

Yes[skip to Q7]

No [skip to Q9]

Don’t know

[if Don’t know] Okay, let’s start at noon; think carefully about
each activity you did after noon and before 4:00 pm. Did you do anything
outside for at least 10 minutes?  

Yes

No [skip to Q9]

How much time did you spend outside? Please provide your best estimate.

Hours___, minutes_______

During this time, did you engage in any moderate or vigorous physical
activity? Remember, Moderate activities cause only light sweating or a
slight to moderate increase in breathing or heart rate. Some examples
are brisk walking, bicycling for pleasure, golf, or dancing.  Vigorous
activities cause heavy sweating or large increases in breathing or heart
rate. 

Yes

No

Now, please think about the end of the day. Did you spend any time
outside after 4:00 pm? Again, please only include times when you were
outside for at least 10 minutes continuously and do not include time
spent in your car or other vehicle.

Yes [skip to Q11]

No [skip to Q13]

Don’t know

[if Don’t know] Okay, let’s start with 4:00 pm; think carefully
about each activity you did after 4:00 pm. Did you do anything outside
for at least 10 minutes?  

Yes

No [skip to Q13]

How much time did you spend outside? Please provide your best estimate.

Hours___, minutes_______

During this time, did you engage in any moderate or vigorous physical
activity? Remember, Moderate activities cause only light sweating or a
slight to moderate increase in breathing or heart rate. Some examples
are brisk walking, bicycling for pleasure, golf, or dancing.  Vigorous
activities cause heavy sweating or large increases in breathing or heart
rate. 

Yes

No

Yesterday, how much time total did you spend driving or riding in a
vehicle? Again, please give us your best estimate.

____ hours and ____ minutes

During a typical week in the summer (June, July or August) do you
exercise or engage in other moderate or vigorous physical activity at
least 2 times a week for your job or for leisure? This could be either
indoors or outdoors.

Yes

No [skip to Q17]

In the summer, does your physical activity usually take place only
indoors, only outdoors, or both indoors and outdoors?

Only indoors [skip to Q17]

Only outdoors

Both indoors and outdoors

Thinking about the times you are outdoors and physically active in the
summer, on average how many minutes of moderate or vigorous physical
activity do you do per day on days when you are active? This could be
activity for work or leisure.

________minutes

These next questions are about your health. Would you say that in
general your health is excellent, very good, good, fair or poor? 

Excellent

Very good 

Good 

Fair 

Poor 

Do you have any allergies to grasses, pollen, or other plants?

Yes

No

Don’t know

Has a doctor ever told you that you have high blood pressure? 

Yes

No

Don’t know

Has a doctor ever told you that you have heart disease? 

Yes

No

Don’t know

Has a doctor ever told you that you have heart failure or congestive
heart failure? 

Yes

No

Don’t know

Has a doctor ever told you that you had a stroke? 

Yes

No

Don’t know

Has a doctor ever told you that you have asthma? 

Yes

No

Don’t know

Do you still have asthma? 

Yes

No

Don’t know

Has a doctor ever told you that you have a lung disease other than
asthma, such as emphysema or COPD? COPD means Chronic Obstructive
Pulmonary Disease and is also known as Chronic Lower Respiratory
Disease. Do not include Tuberculosis (TB). 

Yes

No

Don’t know

Do you have any other health conditions that limit the amount of time
you spend outdoors?

yes

no

What type of vehicle do you usually drive? 

Regular fuel car

Hybrid or biofuel car

Minivan 

Full-size Passenger Van 

SUV 

Motorcycle 

Pickup 

Other, __________

I do not drive

How would you describe where you live?

Urban setting

Suburban setting

Rural setting

How many years have you lived in [name of city]?

____Years

Do you speak a language other than English at home? 

Yes

No [skip to Q32]

If yes, what language____________

Are you currently employed?

Yes

No [skip to Q40]

How many jobs do you currently have?

1

2

3

4

More than 4

In an average week how many hours do you work in total for all paid
jobs?

0-10 hours

11-20 hours

21-30 hours

31-40 hours

41-50 hours

51-60 hours

More than 60 hours

If you have more than one job, answer the next five questions for the
job at which you spend the most hours.

When you are at work, which of the following best describes what you do?


Mostly sitting (at a desk or table) or 

Mostly standing

Mostly walking, but not heavy labor

Mostly heavy labor or physically demanding work

When you are at work, which of the following best describes how much
time you spend outdoors?

All or most of my time at work is spent outdoors

About half my time at work is spent outdoors

A quarter or less of my time at work is spent outdoors

I do not spend any time at work outdoors

How did you usually get to work last week? If you usually use more than
one method of transportation during your trip to work, select the one
used for most of the distance. 

Alone in a car, truck, or van

With at least one other adult in a car, truck, or van

Bus, trolley, or streetcar

Subway, elevated train, or railroad

Ferryboat

Motorcycle

Bicycle

Walked

Worked at home [skip to Q40]

Other

How many minutes did it usually take you to get from home to work last
week?

____ minutes

How many miles is your one way trip to work?

____miles

Do you own any of the following?

Wood stove

Wood burning fire place

Natural gas fire place

Motorboat or personal watercraft (PWC)

Motorhome or RV

Snowmobile

Bicycle

Which best describes the building you live in? 

A mobile home

A one-family house detached from any other house

A one-family house attached to one or more other houses

A building with 2 apartments

A building with 3 or more apartments

Boat, RV, van, etc.

Other, ______________

Which of the following income categories best describes your total 2007
household income before taxes?

Less than $10,000		

$10,000 to $14,999

$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 $149,999

$150,000 to $199,999

$200,000 or more

When it comes to politics do you usually think of yourself as

Extremely liberal

Liberal

Slightly liberal

Moderate or middle of the road

Slightly conservative

Conservative

Extremely conservative

I haven’t thought about this much

Please rate the following statements for yourself

	1 

Not true 	2	3	4	5 

Very True 

  SEQ CHAPTER \h \r 1 It would be hard for me to break any of my bad
habits.





	  SEQ CHAPTER \h \r 1 I always know why I like things.





	

Thank you for completing the survey.  This survey is part of a research
project on daily activities.  You have been selected to participate in
the next step in the research project.  To collect more information
about individuals’ activities, we will be sending you a set of
activity diaries.  An activity diary is a survey that asks you questions
about what you did during the day.  The data from these diaries will be
used to provide a better understanding of how people spend their day.
The data collected from these diaries will be kept confidential – as
always, your name will never be associated with the information from the
surveys you take.  

We will be sending you a total of 7 activity diaries this summer. 
First, we will ask you to fill out diaries for 4 days in a row and then
later in the summer you will fill out diaries for another 3 days in a
row.  To alert you that a diary will be coming, you will receive an
email 2 days before we send the first diary.  We designed the diaries so
that they will be easy to fill out, so the diary surveys shouldn’t
take more than about 10 minutes to complete.

Your participation in this survey is very important for the overall
success of the research project. You are part of a group of 1,600 people
who will be completing activity diaries, and for our sample to be
representative we need everyone to participate.

To thank you for your participation, you will receive a $36 bonus for
completing all the surveys in this project.

The public reporting and recordkeeping burden for this collection of
information is estimated to average 15 minutes per response.  Send
comments on the Agency's need for this information, the accuracy of the
provided burden estimates, and any suggested methods for minimizing
respondent burden, including through the use of automated collection
techniques to the Director, Collection Strategies Division, U.S.
Environmental Protection Agency (2822T), 1200 Pennsylvania Ave., NW,
Washington, D.C. 20460.  Include the OMB control number in any
correspondence.  Do not send the completed survey to this address.

OMB Control Number 2060-XXXX

Approval Expires xx/xx/xxxx

