Attachment 1a- MSM Sample-- NHBS QUESTIONS FOR COGNITIVE TESTING
The Public Health Service Act provides us with the authority to do this research (42 United States Code 242k). All information which would permit identification of any individual, a practice, or an establishment will be held confidential, will be used only by NCHS staff, contractors, and agents only when required and with necessary controls, and will not be disclosed or released to other persons without the consent of the individual or the establishment in accordance with section 308(d) of the Public Health Service Act (42 USC 242m) and the Confidential Information Protection and Statistical Efficiency Act (PL-107-347).
Public reporting burden for this collection of information is estimated to average 90 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to CDC/ATSDR Reports Clearance Officer; 1600 Clifton Road, MS D-24, Atlanta, GA 30333, ATTN: PRA (0920-0222).
OMB #0920-0222; Expiration Date: 03/31/2013
Introduction to the Cognitive Interview:
Thank you for agreeing to participate in this study today. You have read the Informed Consent and you have chosen to take part in this research study. Is that correct? [Interviewer waits for verbal acknowledgment]. You have given your permission for me to tape record your interview today, and to play it to other people working on this study. Is that correct? [Interviewer waits for verbal acknowledgment].
I have in front of me a questionnaire that asks about behaviors that may put someone at risk for contracting HIV, the virus that causes AIDS. These questions will be used on large-scale surveys to help us understand more about patterns of HIV transmission in the United States. Before they are used on these surveys, we are testing the questions out to see whether they are phrased well, whether they are too difficult to answer, and whether they make sense to people.
In a minute, I will ask you these questions, and I will also ask you questions about how you interpreted some of the questions and how you came up with your answers. I’d also like it if you could tell me if any question seems strange or confusing.
Do you understand what I am asking you to do? (Explain again if needed). Do you have any (more) questions? (If no questions) OK, let’s begin.
MSM Sample
Part 1
E1. What is your date of birth?
__ __/ __ __ / __ __ __ __
[Refused = 77/7777, Don't know = 99/9999] (M M / D D / Y Y Y Y )
E4. Do you consider yourself to be Hispanic or Latino/a?
No………………….…………………………… 0 Yes………………………………………………1
Refused to answer……………………………… 7
Don't know……………..……………………... 9
If E4 in (0, 7, 9), skip to E5
E4a. What best describes your Hispanic or Latino ancestry?
[READ CHOICES. CHECK ALL that apply.]
Mexican…………….…..……………………… 1
Puerto Rican………..…………………………... 2
Cuban…………...…………………..………….. 3
Dominican……...…………………..………….. 4
Some other ancestry (Specify_____)…………... 5
Refused to answer………....…………………… 7
Don't know………………………..……………. 9
E5. [GIVE RESPONDENT FLASHCARD A.] Which racial group or groups do you consider yourself to be in? You may choose more than one option. [READ CHOICES. CHECK ALL THAT APPLY.]
American Indian or Alaska Native…………… 1
Asian ..……………………..………………....... 2
Black or African American ……………..…….. 3
Native Hawaiian or Other Pacific Islander……..4
White ……………..…………………………….5
Refused to answer………………………………7
Does not apply ………………………………..8
Don’t know……………………………………..9
E6. What county do you currently live in? _______________________________________
Other…………………………………………. 88
(Specify other county: _____________________)
[Refused = 77, Don't know = 99]
(See Interview Guidance for Question E6 -- Eligible counties counties in Washington, DC and Baltimore MSAs.. For E6a auto-fill project area with “Washington, DC” or “Baltimore, MD” depending on county.) If county falls under Washington, DC area auto-fill Washington, DC. If the county falls under Baltimore area auto-fill Baltimore, MD.
E6a. How long have you been living in [project area]? (Interviewer: If response is in months, enter 0 below and then enter the number of months in the next screen.)
Years __ __ [Refused = 777, Don't know = 999]
If E6a= 1-99, 777, or 999, skip to E7
E6b.
Number of months: __ __ [Refused = 77, Don't know = 99]
range of values= 1-11
E7. What was your sex at birth? [CHECK only ONE]
Male…...……………………………………….. 1
Female…....…....……………………………….. 2
Intersex/ambiguous………....………………….. 3
Refused to answer………....…………………… 7
Don't know……………..……………………... 9
E8. Do you consider yourself to be male, female, or transgender? [CHECK only ONE]
Male…………………………………………….. 1
Female …………………………………………. 2
Transgender .……………………………………. 3
Refused to answer……………………………… 7
Don't know……………..……………………... 9
DEMOGRAPHICS
SAY: Next, I'd like to ask you some questions about where you live. Please remember your answers will be kept private.
D1. In the past 12 months, have you been homeless at any time? By homeless, I mean you were living on the street, in a shelter, in a Single Room Occupancy hotel (SRO), or in a car.
No………………….…………………………… 0
Yes……………………………………………… 1
Refused to answer……………………………… 7
Don't know……………..……………………….. 9
If D1 in (0, 7, 9) Skip to D2
D1a. Are you currently homeless?
No………………….……………….………….. 0
Yes….……………………………….……......... 1
Refused to answer………………………..…….. 7
Don't know.……………..……………….......... 9
D2. Next, I would like to ask you some questions about your background. What country were you born in? [DO NOT read choices. Check only ONE.]
United States….………………….………….…. 1
Mexico….………………….………….……….. 2
Puerto Rico..….………………...………….……3
Cuba…….………………….………….……….. 4
Other (Specify_________________)………...… 5
Refused to answer………………………….…... 77
Don't know…….………………………….…... 99
If D2 in (1, 77, 99), skip to D4
D3. What year did you first come to live in the United States?
[7777 = Refused, 9999 = Don't know] __ __ __ __
(Y Y Y Y )
D4. What is your current marital status? [READ CHOICES. CHECK only ONE.]
Married………………………………………….1
Living together as married……………………...2
Separated…….……….…………………..……..3
Divorced…….…….…………………..………..4
Widowed….………..…………………………...5
Never married………..………………………….6
Refused to answer………………………..…….. 7
Don't know.……………..……………….......... 9
If D4= 2, ask D4a. Otherwise, skip to D5.
D4a. Is your formal marital status separated, divorced, widowed, or never married?
Separated…….……….…………………..……..1
Divorced…….…….…………………..………..2
Widowed….………..…………………………...3
Never married………..………………………….4
Refused to answer………………………..…….. 7
Don't know.……………..……………….......... 9
D5. What is the highest level of education you completed?
[DO NOT read choices. Check only ONE.]
Never attended school….…………………………. 00
Grades 1 through 8….…………………...……….. 01
Grades 9 through 11..…………………….…….…. 02
Grades 12 or GED...….……..…..………………… 03
Some college, Associate’s Degree, or
Technical Degree………………………………. 04
Bachelor’s Degree..………….…………….……… 05
Any post graduate studies ………….……………. 06
Refused to answer………………..……………….. 77
Don't know……..………………..……………….. 99
D6. What best describes your employment status? Are you:
[READ CHOICES. CHECK only ONE.]
Employed full-time………………….…………. 01
Employed part-time……………………………. 02
A homemaker….……….…………………...….. 03
A full-time student…….…….………………… 04
Retired….………..……………………………... 05
Unable to work for health reasons .……………. 06 Unemployed………..…………………………... 07
Other………..………………………….............. 08
Refused to answer………………………..…….. 77
Don't know.……………..……………….......... 99
D7. What was your [insert household income if D1 in (0,7,9) OR D1a in (0,7,9); insert income if D1a=1] last year from all sources before taxes?
GIVE RESPONDENT FLASHCARD B. DO NOT read choices.
SAY: Please take a look at this card and tell me the letter that best corresponds to your monthly or yearly income.
Monthly Income Yearly Income
a. 0 to $417……………... a. 0 to $4,999………………. 00
b. $418 to $833………… b. $5,000 to $9,999……….. 01
c. $834 to $1041…………c. $10,000 to $12,499...….. 02
d. $1042 to $1250………..d. $12,500 to $14,999...….. 03
e. $1251 to $1667.……....e. $15,000 to $19,999....….. 04
f. $1668 to $2082………..f. $20,000 to $24,999....….. 05
g. $2083 to $2500……….g $25,000 to $29,999....….. 06
h. $2501 to $2916……….. h. $30,000 to $34,999…….. 07
i $2917 to $3333…………i $35,000 to $39,999...….. 08
j. $3334 to $4167………. j. $40,000 to $49,999…….. 09
k. $4168 to $4999………. k. $50,000 to $59,999…….. 10
l. $5000 to $6,250………. l. $60,000 to $74,999...….. 11
m. $6251 or more………...m. $75,000 or more.……… 12
Refused to answer………. ………………………………. 77
Don't know……..………………………………………..... 99
If D6=77 or 99, skip to D8
D7a. Including yourself, how many people depended on this income?
[MUST BE AT LEAST 1.]
[Refused = 77, Don't know = 99] ___ ___
D8. Do you currently consider yourself to be: [READ CHOICES. CHECK ONLY ONE.]
Heterosexual or "Straight"…………….……...... 1
Homosexual, Gay, or Lesbian…………………. 2
Bisexual……………………………………….. 3
Other…………………………………………… 4
Refused to answer…………………..…………. 7
Don’t know................……………………….…. 9
SEXUAL BEHAVIORS
SAY: Next, I'm going to ask you some questions about having sex. Please remember your answers will be kept private. I need to ask you all the questions, even if some may not apply to your situation.
S1. Have you ever had vaginal or anal sex with a woman?
No………………….…………………………… 0
Yes……………………………………………... 1
Refused to answer……………………………… 7
Don't know……………..……………………..... 9
S2. In the past 12 months, that is, since [interview month] of last year, with how many different women have you had oral, vaginal, or anal sex?
___ ___ ____ ____ [Refused = 7777, Don't know = 9999]
SAY: Now I'm going to ask you some questions about having sex with other men.
For these questions, "having sex" means oral or anal sex. Oral sex means he put his mouth on your penis or you put your mouth on his penis. Anal sex means you put your penis in his anus (butt) or he put his penis in your anus (butt).
S3. Have you ever had oral or anal sex with a man?
No………………….………….……………….. 0 Yes………………………………..…………..... 1
Refused to answer…………………………..….. 7
Don't know……………..………….………...... 9
S4. In the past 12 months, that is, since <interview month> of last year, with how many different men have you had oral or anal sex?
___ ___ ____ ____ [Refused = 7777, Don't know = 9999]
HIV TESTING
SAY: Now I’m going to ask you a few questions about getting tested for HIV. Remember, an HIV test checks whether someone has the virus that causes AIDS.
H1. Have you ever been tested for HIV?
No…………………………...………….............. 0
Yes………………..…………………….............. 1
Refused to answer……………………………… 7
Don't know……………..……………………... 9
If H1 in (0, 7, 9), skip to instructions before H10
H2. When did you have your most recent HIV test?
[77/7777 = Refused, 99/9999 = Don't know] __ __/ __ __ __ __
(M M / Y Y Y Y )
H3. What was the result of your most recent HIV test? [DO NOT Read choices, check only ONE.]
Negative………………….…………………….. 1 Positive………………………….………............ 2
Never obtained results………………….…......... 3
Indeterminate…………..……………..………… 4 Refused to answer…………...….………………. 7
Don't know…...………………………….......... 9
If H3 in (1, 3, 4, 7, 9), skip to Instructions before H10.
Questions for participants who have ever tested HIV+
H4. Have you ever been seen by a doctor, nurse, or other health care provider for a medical evaluation or care related to your HIV infection?
No………………….…………………………… 0
Yes……………………………………………... 1
Refused to answer……………………………… 7
Don't know……………..………....................... 9
If H4 in (0, 7, 9), skip to Instructions before H8.
H5. When did you first go to your health care provider after learning you had HIV?
[77/7777=Refused, 99/9999 = Don't know] __ __/ __ __ __ __
(M M / Y Y Y Y )
H6. When did you last go to your health care provider for HIV care?
[77/7777=Refused, 99/9999 = Don't know] __ __/ __ __ __ __
(M M / Y Y Y Y )
H7. Are you currently taking antiretroviral medicines to treat your HIV infection?
No………………….…………………..……… 0
Yes………………………………………..……. 1
Refused to answer…………………………….. 7
Don't know……………..………………........... 9
Pre- and Post-exposure Prophylaxis Questions for HIV+ participants
SAY: Researchers are studying whether antiretroviral medicines could possibly be taken to prevent HIV infection. Currently, it is unknown whether such a pill would work to prevent HIV. But if such a pill were found, it would probably have to be taken every day.
H8. Before today, have you ever heard of people who do not have HIV taking antiretroviral medicines, to keep from getting HIV?
No………………….…………………..……… 0
Yes………………………………………..……. 1
Refused to answer…………………………….. 7
Don't know……………..………………............. 9
If H8 in (0, 7, 9) OR H7 in (0, 7, 9) skip to End.
H9. In the past 12 months, have you given your antiretroviral medicines to a sex partner who was HIV-negative because you thought it might keep them from getting HIV?
No………………….…………………..……… 0
Yes………………………………………..……. 1
Refused to answer…………………………….. 7
Don't know……………..………………........... 9
Skip to END.
Pre- and Post-exposure Prophylaxis Questions for participants who have not tested HIV+
SAY: Researchers are studying whether anti-HIV medicine -- a pill -- could possibly be taken to prevent HIV infection. Currently, it is unknown whether such a pill would work to prevent HIV. But if such a pill were found, it would probably have to be taken every day.
H10. Before today, have you ever heard of people who do not have HIV taking anti-HIV medicines, to keep from getting HIV?
No………………….…………………..……… 0
Yes………………………………………..……. 1
Refused to answer…………………………….. 7
Don't know……………..………………............. 9
H11. In the past 12 months, have you taken anti-HIV medicines after sex because you thought it would keep you from getting HIV?
No………………….…………………..……… 0
Yes………………………………………..……. 1
Refused to answer…………………………….. 7
Don't know……………..………………............. 9
H12. In the past 12 months, have you taken anti-HIV medicines before sex because you thought it would keep you from getting HIV?
No………………….…………………..……… 0
Yes………………………………………..……. 1
Refused to answer…………………………….. 7
Don't know……………..………………............. 9
If H11 = 0, 7, OR 9 AND H12 = 0, 7, or 9, skip to H14.
H13. Please tell me if you got any of the anti-HIV medicines you took from the following people or places. Did you get them from…[GIVE RESPONDENT FLASHCARD C. READ ALL CHOICES.]
No Yes Refused Don’t
to answer know
a. Pharmacy or drug store..……………………………… 0…… 1…… 7……. 9
b. Doctor or other health care provider………………...... 0…… 1…… 7……. 9
c. Sex partner, friend, relative, or acquaintance………..... 0…… 1…… 7……. 9
d. Internet……………………...………………………… 0…… 1…… 7……. 9
e. Some other place……………………………………… 0…… 1…… 7……. 9
(Specify ___________________________)
H14. Would you be willing to take HIV medicines every day to lower your chances of getting HIV?
No………………….…………………..……… 0
Yes………………………………………..……. 1
Refused to answer…………………………….. 7
Don't know……………..………………............. 9
Part 2
Image Identification
Hand respondent images. Probe: “I’m going to show you a series of images. “Do you relate to any of the following images? You may choose more than one.”
[Insert images]
End interview.
Interview Guidance for Question E6 -- Eligible counties and cities of residence
Washington, DC |
Baltimore, MD |
District of Columbia |
Baltimore City |
Montgomery County, MD |
Anne Arundel |
Prince Georges County, MD |
Baltimore County |
Calvert County, MD |
Carroll |
Charles County, MD |
Hartford |
Alexandria City, VA |
Howard |
Fairfax City, VA |
Queen Anne’s |
Falls Church City, VA |
|
Fredericksburg City, VA |
|
Manassas City, VA |
|
Manassas Park City, VA |
|
Arlington County, VA |
|
Clarke County, VA |
|
Fairfax County, VA |
|
Fauquier County, VA |
|
Loudon County, VA |
|
Prince William County, VA |
|
Spotsylvania County, VA |
|
Stafford County, VA |
|
Warren County, VA |
|
Jefferson County, WV |
|
FLASHCARD A
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
FLASHCARD B
|
MONTHLY INCOME |
OR |
|
YEARLY INCOME |
A. |
$0 to $417 |
|
A. |
$0 to $4,999 |
B. |
$418 to $833 |
|
B. |
$5,000 to $9,999 |
C. |
$834 to $1,041 |
|
C. |
$10,000 to $12,499 |
D. |
$1,042 to $1,250 |
|
D. |
$12,500 to $14,999 |
E. |
$1,251 to $1,667 |
|
E. |
$15,000 to $19,999 |
F. |
$1,668 to $2,082 |
|
F. |
$20,000 to $24,999 |
G. |
$2,083 to $2,500 |
|
G. |
$25,000 to $29,999 |
H. |
$2,501 to $2,916 |
|
H. |
$30,000 to $34,999 |
I. |
$2,917 to $3,333 |
|
I. |
$35,000 to $39,999 |
J. |
$3,334 to $4,167 |
|
J. |
$40,000 to $49,999 |
K. |
$4,168 to $4,999 |
|
K. |
$50,000 to $59,999 |
L. |
$5,000 to $6,250 |
|
L. |
$60,000 to $74,999 |
M. |
$6,251 or more |
|
M. |
$75,000 or more |
FLASHCARD C
Pharmacy or drug store
Doctor or other health care provider
Sex partner, friend, relative, or acquaintance
Internet
Some other place
Attachment 1b- IDU Sample-- NHBS QUESTIONS FOR COGNITIVE TESTING
Introduction to the Cognitive Interview:
Thank you for agreeing to participate in this study today. You have read the Informed Consent and you have chosen to take part in this research study. Is that correct? [Interviewer waits for verbal acknowledgment]. You have given your permission for me to tape record your interview today, and to play it to other people working on this study. Is that correct? [Interviewer waits for verbal acknowledgment].
I have in front of me a questionnaire that asks about behaviors that may put someone at risk for contracting HIV, the virus that causes AIDS. These questions will be used on large-scale surveys to help us understand more about patterns of HIV transmission in the United States. Before they are used on these surveys, we are testing the questions out to see whether they are phrased well, whether they are too difficult to answer, and whether they make sense to people.
In a minute, I will ask you these questions, and I will also ask you questions about how you interpreted some of the questions and how you came up with your answers. I’d also like it if you could tell me if any question seems strange or confusing.
Do you understand what I am asking you to do? (Explain again if needed). Do you have any (more) questions? (If no questions) OK, let’s begin.
Part 1
IDU Sample
E1. What is your date of birth?
__ __/ __ __ / __ __ __ __
[Refused = 77/7777, Don't know = 99/9999] (M M / D D / Y Y Y Y )
E4. Do you consider yourself to be Hispanic or Latino/a?
No………………….…………………………… 0 Yes………………………………………………1
Refused to answer……………………………… 7
Don't know……………..……………………... 9
If E4 in (0, 7, 9), skip to E5
E4a. What best describes your Hispanic or Latino ancestry?
[READ CHOICES. CHECK ALL that apply.]
Mexican…………….…..……………………… 1
Puerto Rican………..…………………………... 2
Cuban…………...…………………..………….. 3
Dominican……...…………………..………….. 4
Some other ancestry (Specify_____)…………... 5
Refused to answer………....…………………… 7
Don't know………………………..……………. 9
E5. [GIVE RESPONDENT FLASHCARD A.] Which racial group or groups do you consider yourself to be in? You may choose more than one option. [READ CHOICES. CHECK ALL THAT APPLY.]
American Indian or Alaska Native…………… 1
Asian ..……………………..………………....... 2
Black or African American ……………..…….. 3
Native Hawaiian or Other Pacific Islander……..4
White ……………..…………………………….5
Refused to answer………………………………7
Does not apply ………………………………..8
Don’t know……………………………………..9
E6. What county do you currently live in? _______________________________________
Other…………………………………………. 88
(Specify other county: _____________________)
[Refused = 77, Don't know = 99]
(See Interview Guidance for Question E6 -- Eligible counties counties in Washington, DC and Baltimore MSAs.. For E6a auto-fill project area with “Washington, DC” or “Baltimore, MD” depending on county.) If county falls under Washington, DC area auto-fill Washington, DC. If the county falls under Baltimore area auto-fill Baltimore, MD.
E6a. How long have you been living in [project area]? (Interviewer: If response is in months, enter 0 below and then enter the number of months in the next screen.)
Years __ __ [Refused = 777, Don't know = 999]
If E6a= 1-99, 777, or 999, skip to E7
E6b.
Number of months: __ __ [Refused = 77, Don't know = 99]
range of values= 1-11
E7. Do you consider yourself to be male, female, or transgender? [CHECK only ONE]
Male…………………………………………….. 1
Female …………………………………………. 2
Transgender .……………………………………. 3
Refused to answer……………………………… 7
Don't know……………..……………………... 9
E8. Have you ever in your life shot up or injected any drugs other than those prescribed for you? By shooting up, I mean anytime you might have used drugs with a needle, either by mainlining, skin popping, or muscling.
No………………….…………………………… 0 Yes……………………………………………… 1
Refused to answer……………………………… 7
Don't know……………..……………………... 9
E9. When was the last time you injected any drug? That is, how many days or months or years ago did you last inject?
[Interviewer: Enter the number below. If today, enter 0]
Number __ ___ ___ [Refused = 777, Don't know = 999]
If E9 in (777, 999), skip to SAY box before INT2.
E9a. Interviewer: Was this days or months or years? [If today, enter “days”]
Days…………….. 1
Months…………….. 2
Years……………….. 3
NETWORK QUESTIONS
(For N1-N2 auto-fill project area with “Washington, DC” or “Baltimore, MD” depending on county.)
SAY: I'm going to start by asking you about people you know in [project area] who inject.” [Go to N1.]
N1. How many people in [project area] do you know who inject? (By “know,’ I mean you know their name OR you see them around even if you don’t know their name).
[Refused= 7777, Don’t Know= 9999] ___ ___ ___
If R reported network size of 0:
N1a: You said you don’t know anyone in [insert project area] who injects. Is this correct? Remember, by “know,” I mean you know their name OR you see them around even if you don’t know their name.
If R reported network size of 1-3:
N1b: Is there anyone else you know in [insert project area] who injects? Remember, by “know,” I mean you know their name OR you see them around even if you don’t know their name.
If N1 = 7777, 9999, skip to D1.
N2. Of those ________[insert number from N1] people who live in [project area] and you know inject, how many have you seen at least once in the past 30 days? (Again by “know,’ I mean you know their name OR you see them around even if you don’t know their name).
[Refused= 7777, Don’t Know= 9999] ___ ___ ___
If R reported network size of 0:
N2a: You said you don’t know anyone in [insert project area] who injects and who you’ve seen at least once in the past 30 days. Is this correct? Remember, by “know,” I mean you know their name OR you see them around even if you don’t know their name.
If R reported network size of 1-3:
N2b: Is there anyone else you know in [insert project area] who injects and who
you’ve seen at least once in the past 30 days? Remember, by “know,” I mean you
know their name OR you see them around even if you don’t know their name.
If N2 = 1, ask N3a and N3b then skip to Say Box before D1. Else, if N2 >1, skip to N4a.
If N2 = 7777, 9999, skip to D1.
N3a. Is this person male or female?
Male…………………………………………… 1
Female………………………………………... 2
Refused to answer………....…………………… 7
Don't know………………………..…………… 9
N3b. What is this person’s racial or ethnic background? Is [if N3a=1, fill= ‘he’; if N3a=2, fill = ‘she’; if N3a=7 or 9, fill = ‘this person’] white, Black, Hispanic, or another race?
White…………………………………………… 1
Black…………………………………………... 2
Hispanic……………………………………… 3
Another race…………………………………... 4
Refused to answer………....…………………… 7
Don't know………………………..…………… 9
GO TO SAY box before D1.
N4a. Of the ________[insert number from N2] people who inject that you have seen in the past 30 days, how many are male?
[Refused= 7777, Don’t Know= 9999] ___ ___ ___
If N4a = N2,
SAY: “So, all the people you know who inject and that you have seen in the past 30 days are male?”
If correct: go to N4c
If incorrect: go to N4a, ask again, and enter correct response. Then go to N4b.
N4b. Of the ________[insert number from N2] people who inject that you have seen in the past 30 days, how many are female?
[Refused= 7777, Don’t Know= 9999] ___ ___ ___
SAY: What is the race or ethnic background of the __ [insert number from N2] people who inject that you have seen in the past 30 days? That is, how many were white, black, Hispanic, or another race?
N4c. White [Refused= 7777, Don’t Know= 9999] ___ ___ ___
N4d. Black [Refused= 7777, Don’t Know= 9999] ___ ___ ___
N4e. Hispanic [Refused= 7777, Don’t Know= 9999] ___ ___ ___
N4f. Another Race [Refused= 7777, Don’t Know= 9999] ___ ___ ___
DEMOGRAPHICS
SAY: Next, I'd like to ask you some questions about where you live. Please remember your answers will be kept private.
D1. In the past 12 months, have you been homeless at any time? By homeless, I mean you were living on the street, in a shelter, in a Single Room Occupancy hotel (SRO), or in a car.
No………………….…………………………… 0
Yes……………………………………………… 1
Refused to answer……………………………… 7
Don't know……………..……………………….. 9
If D1 in (0, 7, 9) Skip to D2
D1a. Are you currently homeless?
No………………….……………….………….. 0
Yes….……………………………….……......... 1
Refused to answer………………………..…….. 7
Don't know.……………..……………….......... 9
D2. Next, I would like to ask you some questions about your background. What country were you born in? [DO NOT read choices. Check only ONE.]
United States….………………….………….…. 1
Mexico….………………….………….……….. 2
Puerto Rico..….………………...………….……3
Cuba…….………………….………….……….. 4
Other (Specify_________________)………...… 5
Refused to answer………………………….…... 77
Don't know…….………………………….…... 99
If D2 in (1, 77, 99), skip to D4
D3. What year did you first come to live in the United States?
[7777 = Refused, 9999 = Don't know] __ __ __ __
(Y Y Y Y )
D4. What is your current marital status? [READ CHOICES. CHECK only ONE.]
Married………………………………………….1
Living together as married……………………...2
Separated…….……….…………………..……..3
Divorced…….…….…………………..………..4
Widowed….………..…………………………..5
Never married………..………………………….6
Refused to answer………………………..……. 7
Don't know.……………..……………….......... 9
If D4= 2, ask D4a. Otherwise, skip to D5.
D4a. Is your formal marital status separated, divorced, widowed, or never married?
Separated…….……….…………………..……..1
Divorced…….…….…………………..………..2
Widowed….………..…………………………..3
Never married………..………………………….4
Refused to answer………………………..……. 7
Don't know.……………..……………….......... 9
D5. What is the highest level of education you completed?
[DO NOT read choices. Check only ONE.]
Never attended school….…………………………. 00
Grades 1 through 8….…………………...……….. 01
Grades 9 through 11..…………………….…….…. 02
Grades 12 or GED...….……..…..………………… 03
Some college, Associate’s Degree, or
Technical Degree………………………………. 04
Bachelor’s Degree..………….…………….……… 05
Any post graduate studies ………….……………. 06
Refused to answer………………..……………….. 77
Don't know……..………………..……………….. 99
D6. What best describes your employment status? Are you:
[READ CHOICES. CHECK only ONE.]
Employed full-time………………….…………. 01
Employed part-time……………………………. 02
A homemaker….……….…………………...….. 03
A full-time student…….…….………………… 04
Retired….………..……………………………... 05
Unable to work for health reasons .……………. 06 Unemployed………..…………………………... 07
Other………..………………………….............. 08
Refused to answer………………………..…….. 77
Don't know.……………..……………….......... 99
D7. What was your [insert household income if D1 in (0,7,9) OR D1a in (0,7,9); insert income if D1a=1] last year from all sources before taxes?
GIVE RESPONDENT FLASHCARD B. DO NOT read choices.
SAY: Please take a look at this card and tell me the letter that best corresponds to your monthly or yearly income.
Monthly Income Yearly Income
a. 0 to $417……………... a. 0 to $4,999………………. 00
b. $418 to $833………… b. $5,000 to $9,999……….. 01
c. $834 to $1041…………c. $10,000 to $12,499...….. 02
d. $1042 to $1250………..d. $12,500 to $14,999...….. 03
e. $1251 to $1667.……....e. $15,000 to $19,999....….. 04
f. $1668 to $2082………..f. $20,000 to $24,999....….. 05
g. $2083 to $2500……….g $25,000 to $29,999....….. 06
h. $2501 to $2916……….. h. $30,000 to $34,999…….. 07
i $2917 to $3333…………i $35,000 to $39,999...….. 08
j. $3334 to $4167………. j. $40,000 to $49,999…….. 09
k. $4168 to $4999………. k. $50,000 to $59,999…….. 10
l. $5000 to $6,250………. l. $60,000 to $74,999...….. 11
m. $6251 or more………...m. $75,000 or more.……… 12
Refused to answer………. ………………………………. 77
Don't know……..………………………………………..... 99
If D7=77 or 99, skip to D8
D7a. Including yourself, how many people depended on this income?
[MUST BE AT LEAST 1.]
[Refused = 77, Don't know = 99] ___ ___
D8. Do you currently consider yourself to be: [READ CHOICES. CHECK ONLY ONE.]
Heterosexual or "Straight"…………….……...... 1
Homosexual, Gay, or Lesbian…………………. 2
Bisexual……………………………………….. 3
Other…………………………………………… 4
Refused to answer…………………..…………. 7
Don’t know................……………………….…. 9
SEXUAL BEHAVIORS
SAY: The next question is about having sex. Please remember your answers will be kept private.
For this question, oral sex means mouth on the vagina or penis; vaginal sex means penis in the vagina; and anal sex means penis in the anus (butt).
If E7=2 (if participant is female), skip to S3.
S1. Have you ever had vaginal or anal sex with a woman?
No………………….…………………………… 0
Yes……………………………………………... 1
Refused to answer……………………………… 7
Don't know……………..……………………..... 9
If S1 in (0, 7, 9), skip to HIV Testing Section
S2. In the past 12 months, that is, since [interview month] of last year, with how many different women have you had oral, vaginal, or anal sex?
___ ___ ____ ____ [Refused = 7777, Don't know = 9999]
Skip to HIV Testing Section.
S3. Have you ever had vaginal or anal sex with a man?
No………………….…………………………… 0
Yes……………………………………………... 1
Refused to answer……………………………… 7
Don't know……………..……………………... 9
If S3 in (0, 7, 9), skip to HIV Testing Section
S4. In the past 12 months, that is, since <interview month> of last year, with how many different men have you had oral, vaginal, or anal sex?
___ ___ ____ ____ [Refused = 7777, Don't know = 9999]
HIV TESTING
SAY: Now I’m going to ask you a few questions about getting tested for HIV. Remember, an HIV test checks whether someone has the virus that causes AIDS.
H1. Have you ever been tested for HIV?
No…………………………...………….............. 0
Yes………………..…………………….............. 1
Refused to answer……………………………… 7
Don't know……………..……………………... 9
If H1 in (0, 7, 9), skip to instructions before H10
H2. When did you have your most recent HIV test?
[77/7777 = Refused, 99/9999 = Don't know] __ __/ __ __ __ __
(M M / Y Y Y Y )
H3. What was the result of your most recent HIV test? [DO NOT Read choices, check only ONE.]
Negative………………….…………………….. 1 Positive………………………….………............ 2
Never obtained results………………….…......... 3
Indeterminate…………..……………..………… 4 Refused to answer…………...….………………. 7
Don't know…...………………………….......... 9
If H3 in (1, 3, 4, 7, 9), skip to Instructions before H10.
Questions for participants who have ever tested HIV+
H4. Have you ever been seen by a doctor, nurse, or other health care provider for a medical evaluation or care related to your HIV infection?
No………………….…………………………… 0
Yes……………………………………………... 1
Refused to answer……………………………… 7
Don't know……………..………....................... 9
If H4 in (0, 7, 9), skip to Instructions before H8.
H5. When did you first go to your health care provider after learning you had HIV?
[77/7777=Refused, 99/9999 = Don't know] __ __/ __ __ __ __
(M M / Y Y Y Y )
H6. When did you last go to your health care provider for HIV care?
[77/7777=Refused, 99/9999 = Don't know] __ __/ __ __ __ __
(M M / Y Y Y Y )
H7. Are you currently taking antiretroviral medicines to treat your HIV infection?
No………………….…………………..……… 0
Yes………………………………………..……. 1
Refused to answer…………………………….. 7
Don't know……………..………………........... 9
Pre- and Post-exposure Prophylaxis Questions for HIV+ participants
SAY: Researchers are studying whether antiretroviral medicines could possibly be taken to prevent HIV infection. Currently, it is unknown whether such a pill would work to prevent HIV. But if such a pill were found, it would probably have to be taken every day.
H8. Before today, have you ever heard of people who do not have HIV taking antiretroviral medicines, to keep from getting HIV?
No………………….…………………..……… 0
Yes………………………………………..……. 1
Refused to answer…………………………….. 7
Don't know……………..………………............. 9
If H8 in (0, 7, 9) OR H7 in (0, 7, 9) skip to End.
H9. In the past 12 months, have you given your antiretroviral medicines to a sex partner who was HIV-negative because you thought it might keep them from getting HIV?
No………………….…………………..……… 0
Yes………………………………………..……. 1
Refused to answer…………………………….. 7
Don't know……………..………………........... 9
Skip to END.
Pre- and Post-exposure Prophylaxis Questions for participants who have not tested HIV+
SAY: Researchers are studying whether anti-HIV medicine -- a pill -- could possibly be taken to prevent HIV infection. Currently, it is unknown whether such a pill would work to prevent HIV. But if such a pill were found, it would probably have to be taken every day.
H10. Before today, have you ever heard of people who do not have HIV taking anti-HIV medicines, to keep from getting HIV?
No………………….…………………..……… 0
Yes………………………………………..…… 1
Refused to answer…………………………….. 7
Don't know……………..………………............. 9
H11. In the past 12 months, have you taken anti-HIV medicines after sex because you thought it would keep you from getting HIV?
No………………….…………………..……… 0
Yes………………………………………..…… 1
Refused to answer…………………………….. 7
Don't know……………..………………............. 9
H12. In the past 12 months, have you taken anti-HIV medicines before sex because you thought it would keep you from getting HIV?
No………………….…………………..……… 0
Yes………………………………………..…… 1
Refused to answer…………………………….. 7
Don't know……………..………………............. 9
If H11 = 0, 7, OR 9 AND H12 = 0, 7, or 9, skip to H14.
H13. Please tell me if you got any of the anti-HIV medicines you took from the following people or places. Did you get them from…[GIVE RESPONDENT FLASHCARD C. READ ALL CHOICES.]
No Yes Refused Don’t
to answer know
a. Pharmacy or drug store..……………………………… 0…… 1…… 7……. 9
b. Doctor or other health care provider………………...... 0…… 1…… 7……. 9
c. Sex partner, friend, relative, or acquaintance………..... 0…… 1…… 7……. 9
d. Internet……………………...………………………… 0…… 1…… 7……. 9
e. Some other place……………………………………… 0…… 1…… 7……. 9
(Specify ___________________________)
H14. Would you be willing to take HIV medicines every day to lower your chances of getting HIV?
No………………….…………………..……… 0
Yes………………………………………..…… 1
Refused to answer…………………………….. 7
Don't know……………..………………............. 9
Part 2
Image Identification
Hand respondent images. Probe: “I’m going to show you a series of images. “Do you relate to any of the following images? You may choose more than one.”
[Insert images]
End interview.
Interview Guidance for Question E6 -- Eligible counties and cities of residence
Washington, DC |
Baltimore, MD |
District of Columbia |
Baltimore City |
Montgomery County, MD |
Anne Arundel |
Prince Georges County, MD |
Baltimore County |
Calvert County, MD |
Carroll |
Charles County, MD |
Hartford |
Alexandria City, VA |
Howard |
Fairfax City, VA |
Queen Anne’s |
Falls Church City, VA |
|
Fredericksburg City, VA |
|
Manassas City, VA |
|
Manassas Park City, VA |
|
Arlington County, VA |
|
Clarke County, VA |
|
Fairfax County, VA |
|
Fauquier County, VA |
|
Loudon County, VA |
|
Prince William County, VA |
|
Spotsylvania County, VA |
|
Stafford County, VA |
|
Warren County, VA |
|
Jefferson County, WV |
|
FLASHCARD A
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
FLASHCARD B
|
MONTHLY INCOME |
OR |
|
YEARLY INCOME |
A. |
$0 to $417 |
|
A. |
$0 to $4,999 |
B. |
$418 to $833 |
|
B. |
$5,000 to $9,999 |
C. |
$834 to $1,041 |
|
C. |
$10,000 to $12,499 |
D. |
$1,042 to $1,250 |
|
D. |
$12,500 to $14,999 |
E. |
$1,251 to $1,667 |
|
E. |
$15,000 to $19,999 |
F. |
$1,668 to $2,082 |
|
F. |
$20,000 to $24,999 |
G. |
$2,083 to $2,500 |
|
G. |
$25,000 to $29,999 |
H. |
$2,501 to $2,916 |
|
H. |
$30,000 to $34,999 |
I. |
$2,917 to $3,333 |
|
I. |
$35,000 to $39,999 |
J. |
$3,334 to $4,167 |
|
J. |
$40,000 to $49,999 |
K. |
$4,168 to $4,999 |
|
K. |
$50,000 to $59,999 |
L. |
$5,000 to $6,250 |
|
L. |
$60,000 to $74,999 |
M. |
$6,251 or more |
|
M. |
$75,000 or more |
FLASHCARD C
Pharmacy or drug store
Doctor or other health care provider
Sex partner, friend, relative, or acquaintance
Internet
Some other place
Attachment 1c- HET Sample-- NHBS QUESTIONS FOR COGNITIVE TESTING
Introduction to the Cognitive Interview:
Thank you for agreeing to participate in this study today. You have read the Informed Consent and you have chosen to take part in this research study. Is that correct? [Interviewer waits for verbal acknowledgment]. You have given your permission for me to tape record your interview today, and to play it to other people working on this study. Is that correct? [Interviewer waits for verbal acknowledgment].
I have in front of me a questionnaire that asks about behaviors that may put someone at risk for contracting HIV, the virus that causes AIDS. These questions will be used on large-scale surveys to help us understand more about patterns of HIV transmission in the United States. Before they are used on these surveys, we are testing the questions out to see whether they are phrased well, whether they are too difficult to answer, and whether they make sense to people.
In a minute, I will ask you these questions, and I will also ask you questions about how you interpreted some of the questions and how you came up with your answers. I’d also like it if you could tell me if any question seems strange or confusing.
Do you understand what I am asking you to do? (Explain again if needed). Do you have any (more) questions? (If no questions) OK, let’s begin.
Part 1
HET Sample
E1. What is your date of birth?
__ __/ __ __ / __ __ __ __
(M M / D D / Y Y Y Y )
E4. Do you consider yourself to be Hispanic or Latino/a?
No………………….…………………………… 0 Yes………………………………………………1
Refused to answer……………………………… 7
Don't know……………..……………………... 9
If E4 in (0, 7, 9), skip to E5
E4a. What best describes your Hispanic or Latino ancestry?
[READ CHOICES. CHECK ALL that apply.]
Mexican…………….…..……………………… 1
Puerto Rican………..…………………………... 2
Cuban…………...…………………..………….. 3
Dominican……...…………………..………….. 4
Some other ancestry (Specify_____)…………... 5
Refused to answer………....…………………… 7
Don't know………………………..……………. 9
E5. [GIVE RESPONDENT FLASHCARD A.] Which racial group or groups do you consider yourself to be in? You may choose more than one option. [READ CHOICES. CHECK ALL THAT APPLY.]
American Indian or Alaska Native…………… 1
Asian ..……………………..………………....... 2
Black or African American ……………..…….. 3
Native Hawaiian or Other Pacific Islander……..4
White ……………..…………………………….5
Refused to answer………………………………7
Does not apply ………………………………..8
Don’t know……………………………………..9
E6. What county do you currently live in? _______________________________________
(See Interview Guidance for Question E6 -- Eligible counties counties in Washington, DC and Baltimore MSAs.. For E6a auto-fill project area with “Washington, DC” or “Baltimore, MD” depending on county.) If county falls under Washington, DC area auto-fill Washington, DC. If the county falls under Baltimore area auto-fill Baltimore, MD.
E6a. How long have you been living in [project area]? (Interviewer: If response is in months, enter 0 below and then enter the number of months in the next screen.)
Years __ __ [Refused = 777, Don't know = 999]
If E6a= 1-99, 777, or 999, skip to E7
E6b.
Number of months: __ __ [Refused = 77, Don't know = 99]
range of values= 1-11
E7. Do you consider yourself to be male, female, or transgender? [CHECK only ONE]
Male…………………………………………….. 1
Female …………………………………………. 2
Transgender .……………………………………. 3
Refused to answer……………………………… 7
Don't know……………..……………………... 9
SAY: The next question is about having sex. Please remember your answers will be kept private. "Having sex" means vaginal sex - penis in the vagina; or anal sex - penis in the anus (butt).
E8. Have you had vaginal or anal sex with a [insert “man” if respondent is female; insert “woman” if respondent is male] in the past 12 months?
No……………………………………………… 0
Yes……………………………………………... 1
Refused to answer………....…………………… 7
Don't know………………………..…………… 9
NETWORK QUESTIONS
(For N1-N2 auto-fill project area with “Washington, DC” or “Baltimore, MD” depending on county.)
SAY: I'm going to start by asking you about other people you know in [project area] who you are close to.” [Go to N1.]
N1. Please tell me how many friends, relatives or people you are close to who are at least 18 years of age, and live in [project area]. [GIVE RESPONDENT FLASHCARD B.]
[Refused= 7777, Don’t Know= 9999] ___ ___ ___
If N2 in (0, 7777, 9999), skip to D1.
If R reported network size of 0:
N1a: You said you don’t have ANY friends, relatives or people you are close to who are at least 18 years of age, live in [insert project area], and you have seen in the past 30 days. Is this correct?
If R reported network size of 1-3:
N1b: Do you have ANY OTHER friends, relatives or people you are close to who are at least 18 years of age, live in [insert project area], and you have seen in the past 30 days?
N2. Of those ________[insert number from N1] people, how many have you seen at least once in the past 30 days?
[Refused= 7777, Don’t Know= 9999] ___ ___ ___
If N2 in (0, 7777, 9999), skip to D1.
If N2 = 1, ask N3a and N3b then skip to Say Box before D1. Else, if N2 >1, skip to N4a.
N3a. Is this person male or female?
Male…………………………………………… 1
Female………………………………………... 2
Refused to answer………....…………………… 7
Don't know………………………..…………… 9
N3b. What is this person’s racial or ethnic background? Is [if N3a=1, fill= ‘he’; if N3a=2, fill = ‘she’; if N3a=7 or 9, fill = ‘this person’] white, Black, Hispanic, or another race?
White…………………………………………… 1
Black…………………………………………... 2
Hispanic……………………………………… 3
Another race…………………………………... 4
Refused to answer………....…………………… 7
Don't know………………………..…………… 9
GO TO SAY box before D1.
N4a. Of the ________[insert number from N2] people that you have seen in the past 30 days, how many are male?
[Refused= 7777, Don’t Know= 9999] ___ ___ ___
If N4a = N2,
SAY: “So, all the friends, relatives, or people you are close to who are at least 18 years old, who live in [insert project area] and you have seen in the past 30 days are male?”
If correct: go to N4c
If incorrect: go to N4a, ask again, and enter correct response. Then go to N4b.
N4b. Of the ________[insert number from N2] people that you have seen in the past 30 days, how many are female?
[Refused= 7777, Don’t Know= 9999] ___ ___ ___
SAY: What is the race or ethnic background of the __ [insert number from N2] people that you have seen in the past 30 days? That is, how many were white, black, Hispanic, or another race?
N4c. White [Refused= 7777, Don’t Know= 9999] ___ ___ ___
N4d. Black [Refused= 7777, Don’t Know= 9999] ___ ___ ___
N4e. Hispanic [Refused= 7777, Don’t Know= 9999] ___ ___ ___
N4f. Another Race [Refused= 7777, Don’t Know= 9999] ___ ___ ___
DEMOGRAPHICS
SAY: Next, I'd like to ask you some questions about where you live. Please remember your answers will be kept private.
D1. In the past 12 months, have you been homeless at any time? By homeless, I mean you were living on the street, in a shelter, in a Single Room Occupancy hotel (SRO), or in a car.
No………………….…………………………… 0
Yes……………………………………………… 1
Refused to answer……………………………… 7
Don't know……………..………………………. 9
If D1 in (0, 7, 9) Skip to D2
D1a. Are you currently homeless?
No………………….……………….………….. 0
Yes….……………………………….……......... 1
Refused to answer………………………..…….. 7
Don't know.……………..……………….......... 9
D2. Next, I would like to ask you some questions about your background. What country were you born in? [DO NOT read choices. Check only ONE.]
United States….………………….………….…. 1
Mexico….………………….………….……….. 2
Puerto Rico..….………………...………….……3
Cuba…….………………….………….……….. 4
Other (Specify_________________)………...… 5
Refused to answer………………………….…... 77
Don't know…….………………………….…... 99
If D2 in (1, 77, 99), skip to D4
D3. What year did you first come to live in the United States?
[7777 = Refused, 9999 = Don't know] __ __ __ __
(Y Y Y Y )
D4. What is your current marital status? [READ CHOICES. CHECK only ONE.]
Married………………………………………….1
Living together as married……………………...2
Separated…….……….…………………..……..3
Divorced…….…….…………………..………..4
Widowed….………..…………………………..5
Never married………..………………………….6
Refused to answer………………………..…….. 7
Don't know.……………..……………….......... 9
If D4= 2, ask D4a. Otherwise, skip to D5.
D4a. Is your formal marital status separated, divorced, widowed, or never married?
Separated…….……….…………………..……1
Divorced…….…….…………………..……….2
Widowed….………..………………………….3
Never married………..………………………….4
Refused to answer………………………..…… 7
Don't know.……………..……………….......... 9
D5. What is the highest level of education you completed?
[DO NOT read choices. Check only ONE.]
Never attended school….…………………………. 00
Grades 1 through 8….…………………...……….. 01
Grades 9 through 11..…………………….…….…. 02
Grades 12 or GED...….……..…..………………… 03
Some college, Associate’s Degree, or
Technical Degree………………………………. 04
Bachelor’s Degree..………….…………….……… 05
Any post graduate studies ………….……………. 06
Refused to answer………………..……………….. 77
Don't know……..………………..……………….. 99
D6. What best describes your employment status? Are you:
[READ CHOICES. CHECK only ONE.]
Employed full-time………………….…………. 01
Employed part-time……………………………. 02
A homemaker….……….…………………...….. 03
A full-time student…….…….………………… 04
Retired….………..……………………………... 05
Unable to work for health reasons .……………. 06 Unemployed………..…………………………... 07
Other………..………………………….............. 08
Refused to answer………………………..…….. 77
Don't know.……………..……………….......... 99
D7. What was your [insert household income if D1 in (0,7,9) OR D1a in (0,7,9); insert income if D1a=1] last year from all sources before taxes?
GIVE RESPONDENT FLASHCARD C. DO NOT read choices.
SAY: Please take a look at this card and tell me the letter that best corresponds to your monthly or yearly income.
Monthly Income Yearly Income
a. 0 to $417……………... a. 0 to $4,999………………. 00
b. $418 to $833………… b. $5,000 to $9,999……….. 01
c. $834 to $1041…………c. $10,000 to $12,499...….. 02
d. $1042 to $1250………..d. $12,500 to $14,999...….. 03
e. $1251 to $1667.……....e. $15,000 to $19,999....….. 04
f. $1668 to $2082………..f. $20,000 to $24,999....….. 05
g. $2083 to $2500……….g $25,000 to $29,999....….. 06
h. $2501 to $2916……….. h. $30,000 to $34,999…….. 07
i $2917 to $3333…………i $35,000 to $39,999...….. 08
j. $3334 to $4167………. j. $40,000 to $49,999…….. 09
k. $4168 to $4999………. k. $50,000 to $59,999…….. 10
l. $5000 to $6,250………. l. $60,000 to $74,999...….. 11
m. $6251 or more………...m. $75,000 or more.……… 12
Refused to answer………. ………………………………. 77
Don't know……..………………………………………..... 99
If D7=77 or 99, skip to D8
D7a. Including yourself, how many people depended on this income?
[MUST BE AT LEAST 1.]
[Refused = 77, Don't know = 99] ___ ___
D8. Do you currently consider yourself to be: [READ CHOICES. CHECK ONLY ONE.]
Heterosexual or "Straight"…………….……...... 1
Homosexual, Gay, or Lesbian…………………. 2
Bisexual……………………………………….. 3
Other…………………………………………… 4
Refused to answer…………………..…………. 7
Don’t know................……………………….…. 9
SEXUAL BEHAVIORS
SAY: The next question is about having sex. Please remember your answers will be kept private. I need to ask you all the questions, even if some may not apply to your situation.
For this question, oral sex means mouth on the vagina or penis; vaginal sex means penis in the vagina; and anal sex means penis in the anus (butt).
If E7=2 (if participant is female), skip to S2.
S1. In the past 12 months, that is, since [interview month] of last year, with how many different women have you had oral, vaginal, or anal sex?
___ ___ ____ ____ [Refused = 7777, Don't know = 9999]
Skip to Injection Drug Use.
S2. In the past 12 months, that is, since <interview month> of last year, with how many different men have you had oral, vaginal, or anal sex?
___ ___ ____ ____ [Refused = 7777, Don't know = 9999]
DRUG USE HISTORY
Injection Drug Use
SAY: The next questions are about injection drug use. This means injecting drugs yourself or having someone who isn't a health care provider inject you. Please remember your answers will be kept private.
I1. Have you ever in your life shot up or injected any drugs other than those prescribed for you? By shooting up, I mean anytime you might have used drugs with a needle, either by mainlining, skin popping, or muscling.
No………………….…………………………… 0 Yes……………………………………………… 1
Refused to answer……………………………… 7
Don't know……………..……………………... 9
If I1 in (0, 7, 9), skip to HIV Testing Section
I2. When was the last time you injected any drug? That is, how many days or months or years ago did you last inject?
[Interviewer: If respondent answers today, enter “000” in # of Days field]
# of Days: __ __ __
# of Months: __ __ __
# of Years: __ __ __
[Refused = 777, Don't know = 999]
HIV TESTING
SAY: Now I’m going to ask you a few questions about getting tested for HIV. Remember, an HIV test checks whether someone has the virus that causes AIDS.
H1. Have you ever been tested for HIV?
No…………………………...………….............. 0
Yes………………..…………………….............. 1
Refused to answer……………………………… 7
Don't know……………..……………………... 9
If H1 in (0, 7, 9), skip to instructions before H10
H2. When did you have your most recent HIV test?
[77/7777 = Refused, 99/9999 = Don't know] __ __/ __ __ __ __
(M M / Y Y Y Y )
H3. What was the result of your most recent HIV test? [DO NOT Read choices, check only ONE.]
Negative………………….…………………….. 1 Positive………………………….………............ 2
Never obtained results………………….…......... 3
Indeterminate…………..……………..………… 4 Refused to answer…………...….………………. 7
Don't know…...………………………….......... 9
If H3 in (1, 3, 4, 7, 9), skip to Instructions before H10.
Questions for participants who have ever tested HIV+
H4. Have you ever been seen by a doctor, nurse, or other health care provider for a medical evaluation or care related to your HIV infection?
No………………….…………………………… 0
Yes……………………………………………... 1
Refused to answer……………………………… 7
Don't know……………..………....................... 9
If H4 in (0, 7, 9), skip to Instructions before H8.
H5. When did you first go to your health care provider after learning you had HIV?
[77/7777=Refused, 99/9999 = Don't know] __ __/ __ __ __ __
(M M / Y Y Y Y )
H6. When did you last go to your health care provider for HIV care?
[77/7777=Refused, 99/9999 = Don't know] __ __/ __ __ __ __
(M M / Y Y Y Y )
H7. Are you currently taking antiretroviral medicines to treat your HIV infection?
No………………….…………………..……… 0
Yes………………………………………..……. 1
Refused to answer…………………………….. 7
Don't know……………..………………........... 9
Pre- and Post-exposure Prophylaxis Questions for HIV+ participants
SAY: Researchers are studying whether antiretroviral medicines could possibly be taken to prevent HIV infection. Currently, it is unknown whether such a pill would work to prevent HIV. But if such a pill were found, it would probably have to be taken every day.
H8. Before today, have you ever heard of people who do not have HIV taking antiretroviral medicines, to keep from getting HIV?
No………………….…………………..……… 0
Yes………………………………………..……. 1
Refused to answer…………………………….. 7
Don't know……………..………………............. 9
If H8 in (0, 7, 9) OR H7 in (0, 7, 9) skip to End.
H9. In the past 12 months, have you given your antiretroviral medicines to a sex partner who was HIV-negative because you thought it might keep them from getting HIV?
No………………….…………………..……… 0
Yes………………………………………..……. 1
Refused to answer…………………………….. 7
Don't know……………..………………........... 9
Skip to END.
Pre- and Post-exposure Prophylaxis Questions for participants who have not tested HIV+
SAY: Researchers are studying whether anti-HIV medicine -- a pill -- could possibly be taken to prevent HIV infection. Currently, it is unknown whether such a pill would work to prevent HIV. But if such a pill were found, it would probably have to be taken every day.
H10. Before today, have you ever heard of people who do not have HIV taking anti-HIV medicines, to keep from getting HIV?
No………………….…………………..……… 0
Yes………………………………………..……. 1
Refused to answer…………………………….. 7
Don't know……………..………………............. 9
H11. In the past 12 months, have you taken anti-HIV medicines after sex because you thought it would keep you from getting HIV?
No………………….…………………..……… 0
Yes………………………………………..……. 1
Refused to answer…………………………….. 7
Don't know……………..………………............. 9
H12. In the past 12 months, have you taken anti-HIV medicines before sex because you thought it would keep you from getting HIV?
No………………….…………………..……… 0
Yes………………………………………..……. 1
Refused to answer…………………………….. 7
Don't know……………..………………............. 9
If H11 = 0, 7, OR 9 AND H12 = 0, 7, or 9, skip to H14.
H13. Please tell me if you got any of the anti-HIV medicines you took from the following people or places. Did you get them from…[GIVE RESPONDENT FLASHCARD D. READ ALL CHOICES.]
No Yes Refused Don’t
to answer know
a. Pharmacy or drug store..……………………………… 0…… 1…… 7……. 9
b. Doctor or other health care provider………………...... 0…… 1…… 7……. 9
c. Sex partner, friend, relative, or acquaintance………..... 0…… 1…… 7……. 9
d. Internet……………………...………………………… 0…… 1…… 7……. 9
e. Some other place……………………………………… 0…… 1…… 7……. 9
(Specify ___________________________)
H14. Would you be willing to take HIV medicines every day to lower your chances of getting HIV?
No………………….…………………..……… 0
Yes………………………………………..……. 1
Refused to answer…………………………….. 7
Don't know……………..………………............. 9
Part 2
Image Identification
Hand respondent images. Probe: “I’m going to show you a series of images. “Do you relate to any of the following images? You may choose more than one.”
[Insert images]
End interview.
Interview Guidance for Question E6 -- Eligible counties and cities of residence
Washington, DC |
Baltimore, MD |
District of Columbia |
Baltimore City |
Montgomery County, MD |
Anne Arundel |
Prince Georges County, MD |
Baltimore County |
Calvert County, MD |
Carroll |
Charles County, MD |
Hartford |
Alexandria City, VA |
Howard |
Fairfax City, VA |
Queen Anne’s |
Falls Church City, VA |
|
Fredericksburg City, VA |
|
Manassas City, VA |
|
Manassas Park City, VA |
|
Arlington County, VA |
|
Clarke County, VA |
|
Fairfax County, VA |
|
Fauquier County, VA |
|
Loudon County, VA |
|
Prince William County, VA |
|
Spotsylvania County, VA |
|
Stafford County, VA |
|
Warren County, VA |
|
Jefferson County, WV |
|
FLASHCARD A
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
FLASHCARD B
How many people do you know who are:
Friends, relatives, or other people you are close to, AND
Who are at least 18 years of age, AND
Who live in [insert project area]
FLASHCARD C
|
MONTHLY INCOME |
OR |
|
YEARLY INCOME |
A. |
$0 to $417 |
|
A. |
$0 to $4,999 |
B. |
$418 to $833 |
|
B. |
$5,000 to $9,999 |
C. |
$834 to $1,041 |
|
C. |
$10,000 to $12,499 |
D. |
$1,042 to $1,250 |
|
D. |
$12,500 to $14,999 |
E. |
$1,251 to $1,667 |
|
E. |
$15,000 to $19,999 |
F. |
$1,668 to $2,082 |
|
F. |
$20,000 to $24,999 |
G. |
$2,083 to $2,500 |
|
G. |
$25,000 to $29,999 |
H. |
$2,501 to $2,916 |
|
H. |
$30,000 to $34,999 |
I. |
$2,917 to $3,333 |
|
I. |
$35,000 to $39,999 |
J. |
$3,334 to $4,167 |
|
J. |
$40,000 to $49,999 |
K. |
$4,168 to $4,999 |
|
K. |
$50,000 to $59,999 |
L. |
$5,000 to $6,250 |
|
L. |
$60,000 to $74,999 |
M. |
$6,251 or more |
|
M. |
$75,000 or more |
FLASHCARD D
Pharmacy or drug store
Doctor or other health care provider
Sex partner, friend, relative, or acquaintance
Internet
Some other place
Attachment 1d- (Non-NHBS targeted) Sample-- NHBS QUESTIONS FOR COGNITIVE TESTING
Introduction to the Cognitive Interview:
Thank you for agreeing to participate in this study today. You have read the Informed Consent and you have chosen to take part in this research study. Is that correct? [Interviewer waits for verbal acknowledgment]. You have given your permission for me to tape record your interview today, and to play it to other people working on this study. Is that correct? [Interviewer waits for verbal acknowledgment].
I have in front of me a short questionnaire that asks questions about your background and your sexual identity. These questions will be used on large-scale surveys to help us understand more about patterns of health in the United States. Before they are used on these surveys, we are testing the questions out to see whether they are phrased well, whether they are too difficult to answer, and whether they make sense to people.
In a minute, I will ask you these questions, and I will also ask you questions about how you interpreted some of the questions and how you came up with your answers. I’d also like it if you could tell me if any question seems strange or confusing.
Do you understand what I am asking you to do? (Explain again if needed). Do you have any (more) questions? (If no questions) OK, let’s begin.
Non-NHBS targeted
Part 1
Q1. What is your date of birth?
__ __/ __ __ / __ __ __ __
(M M / D D / Y Y Y Y )
Q2. Do you consider yourself to be Hispanic or Latino/a?
No………………….…………………………… 0 Yes………………………………………………1
Refused to answer……………………………… 7
Don't know……………..……………………... 9
If Q2 is (0, 7, 9), skip to Q4
Q3. What best describes your Hispanic or Latino ancestry?
[READ CHOICES. CHECK ALL that apply.]
Mexican…………….…..……………………… 1
Puerto Rican………..…………………………... 2
Cuban…………...…………………..………….. 3
Dominican……...…………………..………….. 4
Some other ancestry (Specify_____)…………... 5
Refused to answer………....…………………… 7
Don't know………………………..……………. 9
Q4. [GIVE RESPONDENT FLASHCARD A.] Which racial group or groups do you consider yourself to be in? You may choose more than one option. [READ CHOICES. CHECK ALL THAT APPLY.]
American Indian or Alaska Native…………… 1
Asian ..……………………..………………....... 2
Black or African American ……………..…….. 3
Native Hawaiian or Other Pacific Islander……..4
White ……………..…………………………….5
Refused to answer………………………………7
Does not apply ………………………………..8
Don’t know……………………………………..9
Q5. What was your sex at birth? [CHECK only ONE]
Male…...……………………………………….. 1
Female…....…....……………………………….. 2
Intersex/ambiguous………....………………….. 3
Refused to answer………....…………………… 7
Don't know……………..……………………... 9
Q6. Do you consider yourself to be male, female, or transgender? [CHECK only ONE]
Male…………………………………………….. 1
Female …………………………………………. 2
Transgender .……………………………………. 3
Refused to answer……………………………… 7
Don't know……………..……………………... 9
Q7. What is your current marital status? [READ CHOICES. CHECK only ONE.]
Married………………………………………….1
Living together as married……………………...2
Separated…….……….…………………..……..3
Divorced…….…….…………………..………..4
Widowed….………..…………………………..5
Never married………..………………………….6
Refused to answer………………………..…….. 7
Don't know.……………..……………….......... 9
If Q7= 2, ask Q8. Otherwise, skip to Q9.
Q8. Is your formal marital status separated, divorced, widowed, or never married?
Separated…….……….…………………..……..1
Divorced…….…….…………………..………..2
Widowed….………..…………………………...3
Never married………..………………………….4
Refused to answer………………………..…….. 7
Don't know.……………..……………….......... 9
Q9. What is the highest level of education you completed?
[DO NOT read choices. Check only ONE.]
Never attended school….…………………………. 00
Grades 1 through 8….…………………...……….. 01
Grades 9 through 11..…………………….…….…. 02
Grades 12 or GED...….……..…..………………… 03
Some college, Associate’s Degree, or
Technical Degree………………………………. 04
Bachelor’s Degree..………….…………….……… 05
Any post graduate studies ………….……………. 06
Refused to answer………………..……………….. 77
Don't know……..………………..……………….. 99
Q10. What best describes your employment status? Are you:
[READ CHOICES. CHECK only ONE.]
Employed full-time………………….…………. 01
Employed part-time……………………………. 02
A homemaker….……….…………………...….. 03
A full-time student…….…….………………… 04
Retired….………..……………………………... 05
Unable to work for health reasons .……………. 06 Unemployed………..…………………………... 07
Other………..………………………….............. 08
Refused to answer………………………..…….. 77
Don't know.……………..……………….......... 99
Q11. What was your household income last year from all sources before taxes?
GIVE RESPONDENT FLASHCARD B. DO NOT read choices.
SAY: Please take a look at this card and tell me the letter that best corresponds to your monthly or yearly income.
Monthly Income Yearly Income
a. 0 to $417……………... a. 0 to $4,999………………. 00
b. $418 to $833………… b. $5,000 to $9,999……….. 01
c. $834 to $1041…………c. $10,000 to $12,499...….. 02
d. $1042 to $1250………..d. $12,500 to $14,999...….. 03
e. $1251 to $1667.……....e. $15,000 to $19,999....….. 04
f. $1668 to $2082………..f. $20,000 to $24,999....….. 05
g. $2083 to $2500……….g $25,000 to $29,999....….. 06
h. $2501 to $2916……….. h. $30,000 to $34,999…….. 07
i $2917 to $3333…………i $35,000 to $39,999...….. 08
j. $3334 to $4167………. j. $40,000 to $49,999…….. 09
k. $4168 to $4999………. k. $50,000 to $59,999…….. 10
l. $5000 to $6,250………. l. $60,000 to $74,999...….. 11
m. $6251 or more………...m. $75,000 or more.……… 12
Refused to answer………. ………………………………. 77
Don't know……..………………………………………..... 99
If Q11=77 or 99, skip to Q13
Q12. Including yourself, how many people depended on this income?
[MUST BE AT LEAST 1.]
[Refused = 77, Don't know = 99] ___ ___
Q13. Do you currently consider yourself to be: [READ CHOICES. CHECK ONLY ONE.]
Heterosexual or "Straight"…………….……...... 1
Homosexual, Gay, or Lesbian…………………. 2
Bisexual……………………………………….. 3
Other…………………………………………… 4
Refused to answer…………………..…………. 7
Don’t know................……………………….…. 9
Part 2
Image Identification
Hand respondent images. Probe: “I’m going to show you a series of images. “Do you relate to any of the following images? You may choose more than one.”
[Insert images]
End interview.
FLASHCARD A
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
FLASHCARD B
|
MONTHLY INCOME |
OR |
|
YEARLY INCOME |
A. |
$0 to $417 |
|
A. |
$0 to $4,999 |
B. |
$418 to $833 |
|
B. |
$5,000 to $9,999 |
C. |
$834 to $1,041 |
|
C. |
$10,000 to $12,499 |
D. |
$1,042 to $1,250 |
|
D. |
$12,500 to $14,999 |
E. |
$1,251 to $1,667 |
|
E. |
$15,000 to $19,999 |
F. |
$1,668 to $2,082 |
|
F. |
$20,000 to $24,999 |
G. |
$2,083 to $2,500 |
|
G. |
$25,000 to $29,999 |
H. |
$2,501 to $2,916 |
|
H. |
$30,000 to $34,999 |
I. |
$2,917 to $3,333 |
|
I. |
$35,000 to $39,999 |
J. |
$3,334 to $4,167 |
|
J. |
$40,000 to $49,999 |
K. |
$4,168 to $4,999 |
|
K. |
$50,000 to $59,999 |
L. |
$5,000 to $6,250 |
|
L. |
$60,000 to $74,999 |
M. |
$6,251 or more |
|
M. |
$75,000 or more |
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | krs0 |
| File Modified | 0000-00-00 |
| File Created | 2021-02-03 |