Not Assigned Adult AIDS Knowledge and Attitudes

National Health Interview Survey

07-ADS

NHIS 2007 Adult Core Questionnaire

OMB: 0920-0214

Document [doc]
Download: doc | pdf

Page 1 of 12

2007 NHIS Questionnaire - Sample Adult

AIDS Knowledge & Attitudes

Document Version Date: 12-Jul-06

Question ID: ADS.010_00.000 Instrument Variable Name: BLDGV QuestionnaireFileName: Sample Adult

QuestionText: Now, I am going to ask about giving blood donations to a blood bank such as the American Red Cross.

Have you donated blood since March 1985?

1 Yes

2 No

7 Refused

9 Don't know

UniverseText: Sample adults 18+

SkipInstructions: <1> [goto BLDG12M]

<2,R,D> [goto HIVTST]

Question ID: ADS.020_00.000 Instrument Variable Name: BLDG12M QuestionnaireFileName: Sample Adult

QuestionText: During the PAST 12 MONTHS, that is, since [fill: 12-month ref. Date], have you donated blood?

1 Yes

2 No

7 Refused

9 Don't know

UniverseText: Sample adults 18+ who have given blood since March 1985

SkipInstructions: <1,2,R,D> [goto HIVTST]

Question ID: ADS.040_00.000 Instrument Variable Name: HIVTST QuestionnaireFileName: Sample Adult

QuestionText: The next questions are about the test for HIV (the virus that causes AIDS).

[fill: Except for tests you may have had as part of blood donations, have you ever been tested for HIV?/Have you ever been

tested for HIV?]

1 Yes

2 No

7 Refused

9 Don't know

UniverseText: Sample adults 18+

SkipInstructions: <1> [goto TST12M_M]

<2> [goto WHYTST]

<R,D> [goto EXTST12M]

Page 2 of 12

2007 NHIS Questionnaire - Sample Adult

AIDS Knowledge & Attitudes

Document Version Date: 12-Jul-06

Question ID: ADS.050_00.000 Instrument Variable Name: WHYTST QuestionnaireFileName: Sample Adult

QuestionText: (book) A14

I am going to show you a list of reasons why some people have not been tested for HIV (the virus that causes AIDS).

Which one of these would you say is the MAIN reason why you have not been tested?

01 It's unlikely you've been exposed to HIV

02 You were afraid to find out if you were HIV positive (that you had HIV)

03 You didn't want to think about HIV or about being HIV positive

04 You were worried your name would be reported to the government if you tested positive

05 You didn't know where to get tested

06 You don't like needles

07 You were afraid of losing job, insurance, housing, friends, family, if people knew you were positive for AIDS infection

08 Some other reason

09 No particular reason

97 Refused

99 Don't know

UniverseText: Sample adults 18+ who have not been tested for HIV

SkipInstructions: <1-7,9,R,D> [goto EXTST12M]

<8> [goto WHYSPEC]

Question ID: ADS.055_00.000 Instrument Variable Name: WHYSPEC QuestionnaireFileName: Sample Adult

QuestionText: What was the main reason why you have not been tested?

7 Refused

9 Don't know

Verbatim Verbatim Response

UniverseText: Sample adults 18+ with some other reason for no HIV test

SkipInstructions: <20 char long> [goto EXTST12M]

Page 3 of 12

2007 NHIS Questionnaire - Sample Adult

AIDS Knowledge & Attitudes

Document Version Date: 12-Jul-06

Question ID: ADS.060_01.000 Instrument Variable Name: TST12M_M QuestionnaireFileName: Sample Adult

QuestionText: 1 of 2

[fill: Not including blood donations, in what month and year was your last test for HIV (the virus that causes AIDS)?/In

what month and year was your last test for HIV, (the virus that causes AIDS)?]

* Enter month of last HIV test.

* Enter "96" to go to the time period format.

01 January

02 February

03 March

04 April

05 May

06 June

07 July

08 August

09 September

10 October

11 November

12 December

96 Time period format

97 Refused

99 Don't know

UniverseText: Sample adults 18+ who have been tested for HIV/AIDS

SkipInstructions: <R,96> [goto TIMETST]

<1-12,D> [goto TST12M_Y]

Question ID: ADS.060_02.000 Instrument Variable Name: TST12M_Y QuestionnaireFileName: Sample Adult

QuestionText: 2 of 2

* Enter year of last HIV test.

1985-2006 1985-2006

9996 Time period format

9997 Refused

9999 Don't know

UniverseText: Sample adults 18+ who gave a month for their last HIV test or who didn't know the month

SkipInstructions: <1880-2030> [goto REATST]

<R,D> [goto TIMETST]

[if TST12M_M and TST12M_Y = a future date] goto ERR1_TST12M_Y

[if TST12M_M and TST12M_Y = a date prior to birth date] goto ERR2_TST12M_Y

Page 4 of 12

2007 NHIS Questionnaire - Sample Adult

AIDS Knowledge & Attitudes

Document Version Date: 12-Jul-06

Question ID: ADS.061_00.000 Instrument Variable Name: TIMETST QuestionnaireFileName: Sample Adult

QuestionText: Was it:

* Read answer categories.

1 6 months or less

2 More than 6 months but not more than 1 year ago

3 More than 1 year, but not more than 2 years ago

4 More than 2 years, but not more than 5 years ago

5 More than 5 years ago

7 Refused

9 Don't know

UniverseText: Sample adults 18+ who have been tested for HIV who refused or or requested the time period format at

TEST12M_M or refused or don't know the year of their last HIV test.

SkipInstructions: <1-5,R,D> [goto REATST]

Question ID: ADS.065_00.000 Instrument Variable Name: REATST QuestionnaireFileName: Sample Adult

QuestionText: (book) A15

I am going to show you a list of reasons why some people have been tested for HIV (the virus that causes AIDS).

[fill: Not including your blood donations, which of these would you say was the MAIN reason for your last HIV

test?/Which of these would you say was the MAIN reason for your last HIV test?]

01 Someone suggested you should be tested

02 You might have been exposed through sex or drug use

03 You might have been exposed through your work or at work

04 You just wanted to find out if you were infected or not

05 For part of a routine medical check-up, or for hospitalization or surgical procedure

06 You were sick or had a medical problem

07 You were pregnant or delivered a baby

08 For health or life insurance coverage

09 For military induction, separation, or military service

10 For immigration

11 For marriage license or to get married

12 You were concerned you could give HIV to someone

13 You wanted medical care or new treatments if you tested positive

14 Some other reason

15 No particular reason

97 Refused

99 Don't know

UniverseText: Sample adults 18+ who have been tested for HIV

SkipInstructions: <1>[goto REASWHO]

<2-13,15,R,D> [goto LASTST]

<14> [goto REASPEC]

Page 5 of 12

2007 NHIS Questionnaire - Sample Adult

AIDS Knowledge & Attitudes

Document Version Date: 12-Jul-06

Question ID: ADS.066_00.000 Instrument Variable Name: REASWHO QuestionnaireFileName: Sample Adult

QuestionText: Who suggested you should be tested - a doctor, nurse or other health care professional, a sex partner, someone at the health

department, or someone else?

1 Doctor, nurse or other health care professional

2 Sex partner

3 Someone at health department

4 Family member or friend

5 Other

7 Refused

9 Don't know

UniverseText: Sample adults 18+ who have been tested for HIV because someone suggested it

SkipInstructions: <1-4,R,D> [goto LASTST]

<5> [goto WHOSPEC]

Question ID: ADS.067_00.000 Instrument Variable Name: WHOSPEC QuestionnaireFileName: Sample Adult

QuestionText: Who suggested you should be tested?

7 Refused

9 Don’t know

Verbatim Verbatim Response

UniverseText: Sample adults 18+ who have been tested for HIV because someone not listed in REASWHO suggested it

SkipInstructions: <20 char long> [goto LASTST]

Question ID: ADS.069_00.000 Instrument Variable Name: REASPEC QuestionnaireFileName: Sample Adult

QuestionText: What was the main reason for your last HIV test?

7 Refused

9 Don't know

Verbatim Verbatim Response

UniverseText: Sample adults 18+ who have been tested for HIV for some reason not listed in REATST

SkipInstructions: <20 char long>[goto LASTST]

Page 6 of 12

2007 NHIS Questionnaire - Sample Adult

AIDS Knowledge & Attitudes

Document Version Date: 12-Jul-06

Question ID: ADS.070_00.000 Instrument Variable Name: LASTST QuestionnaireFileName: Sample Adult

QuestionText: (book) A16

[fill: Not including your blood donations, where did you have your last HIV test?/Where did you have your last HIV test?]

01 Private doctor/HMO

02 AIDS clinic/counseling/testing site

03 Hospital, emergency room, outpatient clinic

04 Other type of clinic

05 Public health department

06 At home

07 Drug treatment facility

08 Military induction or military service site

09 Immigration site

10 In a correctional facility (jail or prison)

11 Other location

97 Refused

99 Don't know

UniverseText: Sample adults 18+ who have been tested for HIV

SkipInstructions: <1-3,5,7-10,R,D> [goto GIVNAM]

<4> [goto CLINTYP]

<6> [goto WHOADM]

<11> [goto LASTSPEC]

Question ID: ADS.072_00.000 Instrument Variable Name: CLINTYP QuestionnaireFileName: Sample Adult

QuestionText: What type of clinic did you go to for your last HIV test?

01 Family planning clinic

02 Prenatal clinic

03 Tuberculosis clinic

04 STD clinic

05 Community health clinic

06 Clinic run by employer or insurance company

07 Other

97 Refused

99 Don't know

UniverseText: Sample adults 18+ who have been tested for HIV at an other type of clinic

SkipInstructions: <1-7,R,D> [goto GIVNAM]

Page 7 of 12

2007 NHIS Questionnaire - Sample Adult

AIDS Knowledge & Attitudes

Document Version Date: 12-Jul-06

Question ID: ADS.074_00.000 Instrument Variable Name: WHOADM QuestionnaireFileName: Sample Adult

QuestionText: Was this test administered by a nurse or other health worker, or did you use a self-sampling kit?

1 Nurse or health worker

2 Self-sampling kit

7 Refused

9 Don't know

UniverseText: Sample adults 18+ who have been tested for HIV at home

SkipInstructions: <1,2,R,D> [goto GIVNAM]

Question ID: ADS.076_00.000 Instrument Variable Name: LASTSPEC QuestionnaireFileName: Sample Adult

QuestionText: Where did you have your last HIV test?

* This should be a specific location that is not on the list.

7 Refused

9 Don't know

Verbatim Verbatim Response

UniverseText: Sample adults 18+ who were tested at an other location

SkipInstructions: <20 char long> [goto GIVNAM]

Question ID: ADS.080_00.000 Instrument Variable Name: GIVNAM QuestionnaireFileName: Sample Adult

QuestionText: The last time you were tested, did you have to give your first and last names?

1 Yes

2 No

7 Refused

9 Don't know

UniverseText: Sample adults 18+ who have been tested for HIV

SkipInstructions: <1,2,R,D> [goto EXTST12M]

Question ID: ADS.110_00.000 Instrument Variable Name: EXTST12M QuestionnaireFileName: Sample Adult

QuestionText: [fill: Do you expect to have another test for HIV in the next 12 months, not including blood donations?/Do you expect to

have a test for HIV in the next 12 months, not including blood donations?]

1 Yes

2 No

7 Refused

9 Don't know

UniverseText: Sample adults 18+

SkipInstructions: <1,2,R,D> [goto CHNSADS]

Page 8 of 12

2007 NHIS Questionnaire - Sample Adult

AIDS Knowledge & Attitudes

Document Version Date: 12-Jul-06

Question ID: ADS.140_00.000 Instrument Variable Name: CHNSADS QuestionnaireFileName: Sample Adult

QuestionText: What are your chances of GETTING HIV (the virus that causes AIDS)?

Would you say high, medium, low, or none?

1 High

2 Medium

3 Low

4 None

5 Already have HIV or AIDS

7 Refused

9 Don't know

UniverseText: Sample adults 18+

SkipInstructions: <1-5,R,D> [goto STMTRU]

Question ID: ADS.150_00.000 Instrument Variable Name: STMTRU QuestionnaireFileName: Sample Adult

QuestionText: (book) A17

Tell me if ANY of these statements is true for YOU. Do NOT tell me WHICH Statement or statements are true for you.

Just IF ANY of them are.

* Read if necessary.

(a) You have hemophilia and have received clotting factor concentrations.

(b) You are a man who has had sex with other men, even just one time.

(c ) You have taken street drugs by needle, even just one time.

(d) You have traded sex for money or drugs, even just one time.

(e) You have tested positive for HIV (the virus that causes AIDS).

(f) You have had sex (even just one time) with someone who would answer "yes" to any of these statements.

1 Yes, at least one statement is true

2 No, none of these statements are true

7 Refused

9 Don't know

UniverseText: Sample adults 18+

SkipInstructions: <1,2,R,D> [If AGE GE <50> [go to TBHRD] else [go to STD]]

Page 9 of 12

2007 NHIS Questionnaire - Sample Adult

AIDS Knowledge & Attitudes

Document Version Date: 12-Jul-06

Question ID: ADS.160_00.000 Instrument Variable Name: STD QuestionnaireFileName: Sample Adult

QuestionText: The next questions are about other sexually transmitted diseases or STDs. STDs are also known as venereal diseases or

VD. Examples of STDs are gonorrhea, chlamydia (CLUH-MIH-DEE-UH), syphilis, herpes, and genital warts.

In the past five years, have you had an STD other than HIV or AIDS?

* If asked, tell respondent to include newly contracted STDs and recurring flare-ups of previously contracted STDs.

1 Yes

2 No

7 Refused

9 Don't know

UniverseText: Sample adults 18-49

SkipInstructions: <1> [goto STDDOC]

<2,R,D> [goto TBHRD]

Question ID: ADS.170_00.000 Instrument Variable Name: STDDOC QuestionnaireFileName: Sample Adult

QuestionText: The last time you had an STD other than HIV or AIDS, did you see a doctor or other health professional to get it checked?

1 Yes

2 No

7 Refused

9 Don't know

UniverseText: Sample adults 18 - 49 who have had an STD other than HIV or AIDS in the past 5 years

SkipInstructions: <1> [goto STDWHER]

<2,R,D> [goto TBHRD]

Question ID: ADS.180_00.000 Instrument Variable Name: STDWHER QuestionnaireFileName: Sample Adult

QuestionText: Where did you go to be checked?

* Read answer choices only if necessary.

1 Private doctor

2 Family planning clinic

3 STD clinic

4 Emergency room

5 Health department

6 Some other place

7 Refused

9 Don't know

UniverseText: Sample adults 18-49 who have had an STD other than HIV or AIDS who saw a doctor or other health professional

SkipInstructions: <1-5,R,D> [goto TBHRD]

<6> [goto STDWOTH]

Page 10 of 12

2007 NHIS Questionnaire - Sample Adult

AIDS Knowledge & Attitudes

Document Version Date: 12-Jul-06

Question ID: ADS.190_00.000 Instrument Variable Name: STDWOTH QuestionnaireFileName: Sample Adult

QuestionText: Where did you go to be checked?

7 Refused

9 Don't know

Verbatim Verbatim Response

UniverseText: Sample adults 18-49 who have had an STD other than HIV or AIDS who were tested at some other place

SkipInstructions: <20 char long> [goto TBHRD]

Question ID: ADS.200_00.000 Instrument Variable Name: TBHRD QuestionnaireFileName: Sample Adult

QuestionText: The next questions are about tuberculosis, or TB.

Have you ever heard of tuberculosis?

1 Yes

2 No

7 Refused

9 Don't know

UniverseText: Sample adults 18+

SkipInstructions: <1> [goto TBKNOW]

<2,R,D> [goto HOMELESS]

Question ID: ADS.210_00.000 Instrument Variable Name: TBKNOW QuestionnaireFileName: Sample Adult

QuestionText: Have you ever personally known anyone who had TB?

1 Yes

2 No

7 Refused

9 Don't know

UniverseText: Sample adults 18+ who have heard of tuberculosis

SkipInstructions: <1,2,R,D> [goto TB]

Page 11 of 12

2007 NHIS Questionnaire - Sample Adult

AIDS Knowledge & Attitudes

Document Version Date: 12-Jul-06

Question ID: ADS.220_00.000 Instrument Variable Name: TB QuestionnaireFileName: Sample Adult

QuestionText: How much do you know about TB - a lot, some, a little, or nothing?

1 A lot

2 Some

3 A little

4 Nothing

7 Refused

9 Don't know

UniverseText: Sample adults 18+ who have heard of tuberculosis

SkipInstructions: <1-3> [goto TBSPRD]

<4> [goto TBCHANC]

<R,D> [goto HOMELESS]

Question ID: ADS.230_00.000 Instrument Variable Name: TBSPRD QuestionnaireFileName: Sample Adult

QuestionText: (book) A18

How is TB spread?

* Probe: Can TB be spread in any other way?

* Mark all that apply, separate with commas.

1 Breathing the air around a person who is sick with TB

2 Sharing eating/drinking utensils

3 Through semen or vaginal secretions shared during sexual intercourse

4 From smoking

5 From mosquito or other insect bites

6 Other

7 Refused

9 Don't know

UniverseText: Sample adults 18+ who have knowledge of tuberculosis

SkipInstructions: <1-6,R,D> goto TBCURED

Question ID: ADS.240_00.000 Instrument Variable Name: TBCURED QuestionnaireFileName: Sample Adult

QuestionText: As far as you know, can TB be cured?

1 Yes

2 No

7 Refused

9 Don't know

UniverseText: Sample adults 18+ who have knowledge of tuberculosis

SkipInstructions: <1,2,R,D> [goto TBCHANC]

Page 12 of 12

2007 NHIS Questionnaire - Sample Adult

AIDS Knowledge & Attitudes

Document Version Date: 12-Jul-06

Question ID: ADS.250_00.000 Instrument Variable Name: TBCHANC QuestionnaireFileName: Sample Adult

QuestionText: What are your chances of getting TB? Would you say high, medium, low, or none?

1 High

2 Medium

3 Low

4 None

5 Already have TB

7 Refused

9 Don't know

UniverseText: Sample adults 18+ who have knowledge or heard of tuberculosis or know nothing about tuberculosis

SkipInstructions: <1-5,R,D> [goto TBSHAME]

Question ID: ADS.260_00.000 Instrument Variable Name: TBSHAME QuestionnaireFileName: Sample Adult

QuestionText: (Fill1: If a member of your family were diagnosed with TB, would you feel ashamed or embarrassed?)

(Fill2: If you or a member of your family were diagnosed with TB, would you feel ashamed or embarrassed?)

1 Yes

2 No

7 Refused

9 Don't know

UniverseText: Sample adults 18+ who have knowledge or heard of tuberculosis or know nothing about tuberculosis

SkipInstructions: <1,2,R,D> [goto HOMELESS]

Question ID: ADS.270_00.000 Instrument Variable Name: HOMELESS QuestionnaireFileName: Sample Adult

QuestionText: Have you ever spent more than 24 hours living on the streets, in a shelter, or in a jail or prison?

1 Yes

2 No

7 Refused

9 Don't know

UniverseText: Sample adults 18+

SkipInstructions: <1,2,R,D> [goto next section]

File Typeapplication/msword
File Modified0000-00-00
File Created0000-00-00

© 2024 OMB.report | Privacy Policy