Community Preparedness and Participation Survey

DHS Household Survey OMB Control #: 1670-NEW formerly 3067-NEW

Exp. Date: XX/XX/20XX

INTRODUCTION

Hello, my name is ____________ and I am calling from ORC Macro.. We are conducting public opinion research under contract with the U.S. Department of Homeland Security. For this research, we are obtaining people’s views about how well prepared they are for an emergency or disaster in their communities.

The survey will only take about 15 minutes.

Your telephone number was chosen randomly. I will not ask for your name, address, or other personal information that can identify you. You do not have to answer any question you do not want to, and you can end the interview at any time. Your participation in this survey is entirely voluntary. Your answers to the survey questions will be held confidential by ORC Macro. Your name or any other information that could identify you will not be associated with your responses or used in any reports. If you have any questions, I will provide a telephone number—either here at ORC Macro or at the Department of Homeland Security—for you to call to get more information or to validate this research.

[For questions about the survey administration/confidentiality concerns: Carol Freeman (ORC Macro) 301-572-0581]

[For questions about the nature of the study or validity of the study: Karen Marsh (DHS) 202-786-9530]

A. SCREENER

A1. In your current residence, do you live…?

1 With family members

2 With roommates

3 With both family members and roommates

4 Alone

[if A1=1,3]

A2. Are there children under the age of 18 living in your residence?

1 Yes

2 No

[if A2=1]

A3. Does at least one of your children currently attend a school outside of your home, including day care or part-time kindergarten?

1. Yes

2. No

A4. Which best describes your job status?

1 Work full-time

2 Work part-time

3 Student

4 Unemployed

5 Other

B. Severity / efficacy

I’d like to ask you some questions about different kinds of disasters. Throughout this survey, when I use the term “disaster”, I am referring to events that could disrupt water, power, transportation, and also emergency and public services for up to three days.

B1. In a natural disaster, such as an earthquake, a hurricane, a flood, a tornado, or wildfires, which of the following statements best represents your belief?

1. I can handle the situation without any preparation.

2. Preparation, planning, and emergency supplies will help me handle the situation.

3. Nothing I do to prepare will help me handle the situation.

B2. In an act of terrorism, such as a biological, chemical, radiological, or explosive attack, which of the following statements best represents your belief? [repeat a, b, and c from above]

B3. In a hazardous materials accident, such as a transportation accident or a power plant accident, which of the following statements best represents your belief? [repeat a, b, and c from above]

B4. In a disease outbreak, such as a bird flu epidemic, which of the following statements best represents your belief? [repeat a, b, and c from above]

C. RISK AWARENESS / PERCEPTION

On a scale of 1 to 5, with 5 being “very likely” and 1 being “not likely at all,” how likely do you think…?

C1. Some type of natural disaster such as earthquakes, floods, hurricanes, tornadoes, and wildfires will occur in your community in the next 12 months?

[if C1=1-4]

C2. Some type of natural disaster will ever occur in your community? Please use the same scale of 1 to 5, with 5 being “very likely” and 1 being “not likely at all.”

C3. Some type of terrorism, including biological, chemical, radiological, or explosive attack will occur in your community in the next 12 months?

[if C3=1-4]

C4. Some type of terrorism will ever occur in your community? [repeat scale as necessary]

C5. Some type of hazardous materials accident, such as a chemical transportation accident or a power plant accident will occur in your community in the next 12 months?

[if C5=1-4]

C6. Some type of hazardous materials accident will ever occur in your community? [repeat scale as necessary]

C7. Some type of widespread disease outbreak such as the bird flu will occur in your community in the next 12 months?

[if C7=1-4]

C8. Some type of disease outbreak will ever occur in your community? [repeat scale as necessary]

D. STAGES OF CHANGE

D1. Which of the following statements best describes your preparedness for the types of disasters that may affect your community?

1. I have never thought about doing anything to prepare.

2. I have thought about preparing, but I have not done so yet.

3. I have taken some steps to prepare, but could do more.

4. I am fully prepared.

[If D1=1, 2, or 3]

D2. For each of the following statements, please tell me whether it is “The primary reason”, “Somewhat of a reason,” or “Not a reason at all” why you have not taken any [if D1=3, insert “further”] disaster preparedness steps?

1. I don’t know what I’m supposed to do.

2. I just haven’t had the time.

3. I don’t want to think about it

4. It costs too much.

5. I don’t think it will be make a difference

6. I don’t think I’d be able to

7. I think that emergency responders, such as fire, police or emergency personnel, will help me.

E. RELIANCE

E1. In the first 72 hours following a disaster, please indicate how much you would expect to rely on the following for assistance. Please use a scale of 1 to 5, with 5 being “expect to rely on a great deal” and 1 being “do not expect to rely on at all.”

1. Household members

2. People in my neighborhood

3. Non-profit organizations, such as the American Red Cross or the Salvation Army

4. My faith community, such as a congregation

5. Fire, police, emergency personnel

6. State and federal government agencies, including FEMA

E2a. If a disaster happened in your community, how would you find out what was happening or where to go and what to do? [Record response]

E2b. If that does not work, what would you do next? [If respondent says anything that requires electricity or similar, ask them what they would do if there was no power. Probe until unproductive. Record all.]

E3. In the event of a disaster, would you expect to need help to evacuate or get to a shelter?

1. Yes

2. No

F. PERSONAL RESPONSE

F1. How confident are you in your ability to know what to do in the first 5 minutes of [fill in from below]? Please use a scale of 1 to 5, with 5 being “very confident” and 1 being “not at all confident.”

1. A radiological or dirty bomb?

2. The release of a chemical agent?

3. An explosion or bomb?

4. A sudden natural disaster such as an earthquake or tornado?

F2. How much do you think preparing for a disaster will help you to handle the disaster?

1. Very much

2. Somewhat

3. Very little

4. Not at all

F3. How confident are you about your own ability to handle a disaster? Please use a scale of 1 to 5, with 5 being “very confident” and 1 being “not at all confident.”

F4. Have you talked to anyone about the need to be prepared for disasters that may affect your community?

1. Yes

2. No

[If F4=1]

F5. Who have you talked to? [PROBE: Anyone else? Do not read list. Record all responses]

1. Household members

2. People in my neighborhood

3. People from work/school

4. My faith community

5. Other [record response]

F6. In the past 2 years, have you done any of the following?

a. Attended a meeting on how to be better prepared for a disaster

1. Yes

2. No

b. Attended CPR training (yes/no)

c. Attended first aid skills training (yes/no)

d. Attended training as part of a Community Emergency Response Team or CERT (yes/no)

[If any of F6a-d=1]

F7. What motivated you to take this training? [PROBE: Anything else? Do not read list. Record all responses]

1. Mandatory for job/school

2. Easy to sign up (e.g., offered at work, school or place of worship)

3. Concern for personal safety

4. Concern for safety of family or others

5. To have the necessary skills to help others

6. General interest/hobby

7. To be prepared

8. Because others (family or friends) did

9. Other [record response]

[If all of F6a-d=2 ask F8]

F8. What is the main reason you have not received any preparedness training? [PROBE: Anything else? Do not read list. Record all responses]

1. Lack of time

2. Lack of money/too expensive

3. Don’t think it’s important

4. Haven’t thought about it

5. Difficult to get information on what to do

6. Don’t think it will be effective

7. Other [record response]

G. PREVENTION

Now I’d like to ask you a series of questions about your past experiences and behaviors…

G1. In the past 12 months, have you seen any suspicious behavior or circumstances?

1. Yes

2. No

[If G1=1]

G2. What did you do? [Do not read list. Record all responses]

1. Called police and/or a tipline

2. Called neighbor/friend

3. Waited for someone else to do something

4. Left the area/situation/event

5. Nothing

6. Other [record response]

G3. Do you feel you have a personal responsibility to report suspicious behavior or circumstances to the authorities?

1. Yes

2. No

H. DISASTER SupplIES

For this next set of questions, I’d like to ask you about some specific things you may or may not have done to prepare yourself and/or your household.

H1. Do you have supplies set aside in your home to be used only in the case of a disaster?

1. Yes

2. No

[if H1=1]

H2. Could you tell me the disaster supplies you have in your home? [PROBE: Anything else? Do not read list. Record all responses]

1. A supply of bottled water

2. A supply of packaged food

3. A flashlight

4. A portable, battery-powered radio

5. Batteries

6. A first aid kit

7. Eyeglasses

8. Medications

9. Photocopies of personal identification

10. Financial documents

11. Cash

12. Other [record response]

[if H1=1]

H3. How often do you update these supplies?

1. Never

2. Less than once a year

3. Once a year

4. More than once a year

H4. Do you have supplies set aside in your car to be used only in the case of a disaster?

1. Yes

2. No

[if A4=1 or 2]

H5. Do you have supplies set aside in your workplace to be used only in the case of a disaster?

1. Yes

2. No

I. Household Plan

I1. Does your household have an emergency plan that includes instructions for all household members about where to go and what to do in the event of a disaster?

1. Yes

2. No

[if I1=1]

I2. Have you discussed this plan with all of the members in your household?

1. Yes

2. No

I3. Do you have copies of important financial and insurance documents in a safe place to help you rebuild or seek assistance following a disaster?

1. Yes

2. No

J. COMMUNITY PLAN

J1.    Using a scale of 1 to 5 with 5 being “very familiar” and 1 being “not at all familiar,” how familiar are you with… 

1. Alerts and warning systems in your community?

2. Official sources of public safety information?

3. Evacuation routes?

4. Shelter locations near you?

5. How to get help with evacuating or getting to a shelter?

[if A3=1]

J2. Are you aware of the details of the emergency or evacuation plan of your child(ren)’s school including where the school plans to evacuate and how to get information about your child in the event of a disaster?

1. Yes

2. No

K. DRILLS/EXERCISES

K1. Aside from a fire drill, in the past 12 months, have you participated in any of the following?

1. A home evacuation drill

1. Yes

2. No

2. A home shelter in place drill (yes/no)

[if A4=1 or 2]

2. A workplace evacuation drill (yes/no)

[if A4=1 or 2]

2. A workplace shelter in place drill (yes/no)

[if A3=1]

2. A school evacuation drill [screen for student or employed] (yes/no)

[if A3=1]

2. A school shelter in place drill [screen for student or employed] (yes/no)

L. VOLUNTEERING

L1. During the past 12 months, have you given any time to help support emergency or an organization that focuses on community safety, such as Neighborhood Watch?

1. Yes

2. No

[if L1=1]

L2. Which one or ones? [Record all responses]

L3. Have you ever volunteered to help in a disaster?

1. Yes

2. No

[if L3=1]

L4. What role did you play? [Record all responses]

L5. Would you be willing to take a 20 hour training course to be qualified to help your community recover from disasters?

1. Yes

2. No

M. DISABILITY

M1. Do you have a physical or other disability that would affect your capacity to respond to an emergency situation?

1. Yes

2. No

[if M1=1]

M2. Have you received any training or done any preparations, specific to your disability, that would allow you to respond better in the event of a disaster or emergency situation?

1. Yes

2. No

M3. Do you currently live with or care for someone with a physical or other disability, including someone elderly who requires assistance?

1. Yes

2. No

[if M3=1]

M4. Have you received any specific information or training in order to assist that person in the event of a disaster or emergency situation?

1. Yes

2. No

N. OUTREACH

There are several organizations that are responsible for helping citizens such as yourself understand preparedness and assist you in being more prepared for disasters.

N1. What would be the best way for an official organization to provide you with information on preparedness and training to help make you safer in a disaster? [PROBE: Anything else? Do not read list. Record all responses]

1. Regular mail

2. E-mail

3. Internet

4. TV or radio broadcasts

5. Local newspaper

6. Community events

7. Place of worship

8. Information placed at local businesses, libraries, post offices

9. Place of employment

10. Schools

11. Personal contact by phone or in person

12. Other [Record response]

O. Brand Awareness

Next I’d like to ask you about a few specific organizations that you may or may not have heard of.

O1. Have you ever heard of Citizen Corps?

1. Yes

2. No

[if O1=1]

O2. How would you describe Citizen Corps? [Record response]

O3. Before taking this survey, had you ever heard of Community Emergency Response Teams or CERT?

1. Yes

2. No

[if O3=1]

O4. How would you describe CERT? [Record response]

O5. Have you ever heard of Ready.gov?

1. Yes

2. No

[if O5=1]

O6. How would you describe Ready.gov? [Record response. Probe for more than “Web site.”]

p. Demographics and Context

Lastly, I would like to ask you for some information about you and your household. Again, all information that you provide will be held confidential.

P1. Would you describe the location of your residence as…?

1. Urban

2. Suburban

3. Rural

[if A4=1-3]

P2 Do you generally use public transportation, such as subways or buses, to get to school or work?

1. Yes

2. No

[if A4=1-2]

P3. Do you feel that, based on the type or location of your job, you are at higher risk for certain types of disasters or emergencies?

1. Yes

2. No

[if A4=1-2]

P4 Do you feel that, based on the type or location of your job, you will have a higher level of responsibility in the event of certain types of disasters or emergencies?

1. Yes

2. No

P5. Does your household have a pet or service animal?

1. Yes

2. No

P6. What is the highest level of education that you attained? Would it be…?

1. Less than 12^th Grade (no diploma)

2. High School Graduate or GED

3. Some College but No Degree

4. Associate Degree in College

5. Bachelor’s Degree

6. Masters Degree

7. Doctorate Degree

P7. How religious would you say you are?

1. Very religious

2. Somewhat religious

3. Barely religious

4. Not at all religious

P8. Which of the following best describes your race? Would you consider yourself to be…?

1. White

2. Black or African American

3. Asian

4. American Indian or Alaska Native

5. Native Hawaiian or Other Pacific Islander

6. Something else

P9. Are you of Hispanic or Latino or Spanish origin? ///choppy wording. Can we replace with standard census language?

1. Yes

2. No

P10. What year were you born? _ _ _ _

P11. Which of the following income ranges represents your annual household income in 2006? Feel free to stop me at the correct range. Would your household income be…? ///we’re fielding in 2006 so we can’t be certain about HH income for the year if it’s not yet over. Is this supposed to be 2005 income?

1. Less than $25,000

2. $25,000 or more, but less than $50,000

3. $50,000 or more, but less than $75,000

4. $75,000 or more

P12. What state do you live in? _ _

P13. What is your zip code? _ _ _ _ _

P14. Record gender [Do not ask]

1. Male

2. Female

Those are all of the questions that I have. On behalf of ORC Macro and the Department of Homeland Security, I would like to thank you for your time and participation. Thank you again.

6 /19/2006 10