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This is an example of a simple risk appraisal that can be used at health fairs
and community meetings. More in-depth appraisals can be located at the
Healthy Volusia
or
Healthy People 2010
web sites or for further
information call
(386) 274-0551
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Diabetes
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1. Do you currently have or has a doctor ever told you that you have diabetes?
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2. Do you take medication for diabetes (pills or insulin)? Please tell us which.
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3. Do you have your glycosylated hemoglobin measurements at least once per year?
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4. Do you have an annual dilated eye exam?
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5. Do you have at least an annual foot examination?
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6. Do you perform self blood-glucose monitoring at least once daily?
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7. Have you received formal education regarding your diabetes?
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8. Do you know the signs and symptoms for diabetes?
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Heart Disease and Stroke
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1. Do you know the early warning symptoms and signs of a heart attack and the
importance of call 911?
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2. Do you know the early warning symptoms and signs of stroke?
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3. Do you have or have you ever been told that you have high blood pressure?
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4. Do you take medication to control your blood pressure?
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5. Is your blood pressure currently under control?
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6. Have you had your blood pressure monitored with in the past two years?
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7. Can you state whether your blood pressure measurement was high?
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8. Are you currently taking action to help control or reduce your blood pressure
(losing weight, increasing physical activity, reducing salt intake)?
If yes, state what you are currently doing.
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9. Do you know what cholesterol is?
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10. Do you know how it affects your heart and blood vessels?
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11. Have you had your blood cholesterol level checked within the past five years?
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12. Do you remember if your total blood cholesterol level was high?
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13. Are you currently taking medication to reduce your blood cholesterol level?
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14. Are you currently taking other actions to reduce your blood cholesterol level
such as exercising, losing weight, and low-fat diet?
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15. Do you know what High Lipid Density (HDL) cholesterol means?
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16. Do you what Low Lipid Density (LDL) cholesterol means?
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17. Do you know what triglycerides mean?
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18. Did you know that heart disease is the number one killer of women and
men in the United States and Florida
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Nutrition and Overweight
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1. Have you been told by your doctor that you are at a healthy weight for your height?
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2. Have you ever been told by your doctor that you are overweight or obese?
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3. What is your Body Mass Index(BMI)?
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4. Are you currently doing anything to lose weight such as exercising, low-fat
diet, etc? Please explain.
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5. Do you eat two or more servings of fruit per day?
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6. What type of fruits do you typically eat?
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7. Do you eat three or more servings of vegetables per day?
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8. What types of vegetables do you typically eat?
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Pnysical Activity and Fitness
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1. Do you participate in any leisure-time activities that involve physical
activity such as gardening, jogging, sports, etc? Please explain.
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2. Do you participate in regular, preferably daily, moderate physical activity for
at least 30 minutes per day? If so, how many days?
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3. Do you participate in vigorous physical activity that promotes cardio respiratory
fitness three or more days per week for 20 or more minutes per time?
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4. How many hours do you watch TV per day?
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5. How many trips do you make by walking? (Example: Grocery store, to school,
to the bank, etc.)
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6. How many trips do you make by bicycling? (Example: Grocery store, to school,
to the bank, etc.)
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Adult Tobacco Use
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1. Have you ever smoked?
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2. Do you currently smoke?
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3. If so, how many packets per day?
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4. Do you use spit tobacco?
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5. If yes, how often?
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6. Do you currently smoke cigars?
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7. If yes, how many?
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8. Have you ever tried to quite tobacco use?
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9. If yes, how many times?
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10. Is smoking allowed in your home?
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11. If yes, do you have children in the home? How many?
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