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National Epidemiologic Survey on Alcohol and Related Conditions-III (NIAAA)

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OMB: 0925-0628

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`ATTACHMENT 21

SCREENER AND RECONTACT SCRIPTS


_____________________________________________________________________________________________English text: Including yourself, how many people live in this household and have no usual place of residence
elsewhere?
_________________________________________________________________________________


Spanish text: Incluyéndose usted mismo(a), ¿cuántas personas viven en este hogar y no tienen un sitio de residencia habitual en otro lugar?

SCQAskNumberrInHH

Item number: SCQ1010

Item tag: SCQ1010

Item type: Question

Type class: Integer

Field kind: Datafield FieldSize: 18

Answers allowed: 1 Min value: 1

Help tag: Max value: 25

Answer type: {Continuous Answer.} ArrayMin:

ArrayMax:


Number Label Route

Attribute Route
Refusal SCQ1015 - Route : If Then

English text: [Enter continuous answer.]

1 [Continuous answer.] SCQ1015 – Route : If Then




Notes: Start enumeration timing here.


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Route : If Then

Item number: SCQ1015 Item tag: SCQ1015 Item type: Route

Type class: If Then

Route details: The following variables - name, respondent, gender, age, age range, ethnicity, race, military status, and the misreported field (SCQ1020-SCQ1090) - should appear as a grid. All enumeration information is entered in this grid.

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SCQNameHHM

Item number: SCQ1020

Item tag: SCQ1020

Item type: Question

Type class: String

Field kind: Datafield FieldSize: 25

Answers allowed: 1 Min value:

Help tag: Max value:

Answer type: {Continuous Answer.} ArrayMin:

ArrayMax:


English text: [A] What is the first name of the person, or one of the persons, who is living in the household who owns or rents this home?

  1. Next, please tell me the names of all other members of this household (starting with your spouse, if applicable).

  2. Please tell me the names of all other members of this household.

[HOUSEHOLD (HH) MEMBERS INCLUDE PEOPLE WHO THINK OF THIS HH AS THEIR PRIMARY PLACE OF RESIDENCE. IT INCLUDES PEOPLE WHO USUALLY STAY IN THE HH BUT ARE TEMPORARILY AWAY ON BUSINESS, VACATION, IN A HOSPITAL, OR LIVING AT SCHOOL IN A DORM, FRATERNITY OR SORORITY.]

[DO NOT INCLUDE COLLEGE STUDENTS LIVING IN OFF-CAMPUS HOUSING AS HH MEMBERS.]

[PRESS THE DOWN ARROW KEY TO MOVE TO THE NEXT BLANK LINE. WHEN ALL NAMES ARE ENTERED, USE UP AND RIGHT ARROW KEYS TO GET TO NEXT QUESTION.]

Spanish text: [A] ¿Cuál es el nombre de la persona, o de una de las personas, que está viviendo en el hogar y que es dueña de esta vivienda o la arrienda?

[B] A continuación, por favor dígame los nombres de todos los demás miembros de este hogar (empezando por su esposo(a), si corresponde).

[HOUSEHOLD (HH) MEMBERS INCLUDE PEOPLE WHO THINK OF THIS HH AS THEIR PRIMARY PLACE OF RESIDENCE. IT INCLUDES PEOPLE WHO USUALLY STAY IN THE HH BUT ARE TEMPORARILY AWAY ON BUSINESS, VACATION, IN A HOSPITAL, OR LIVING AT SCHOOL IN A DORM, FRATERNITY OR SORORITY.]

[DO NOT INCLUDE COLLEGE STUDENTS LIVING IN OFF-CAMPUS HOUSING AS HH MEMBERS.]

[PRESS THE DOWN ARROW KEY TO MOVE TO THE NEXT BLANK LINE. WHEN ALL NAMES ARE ENTERED, USE UP AND RIGHT ARROW KEYS TO GET TO NEXT QUESTION.]

Number Label Route

1 [Continuous answer.] SCQ1025 - SCQWholsRespondent

English text: [Enter continuous answer.]

Display instructions: This variable should appear as the first column on the grid.

For the first line on the grid, display text A. For the second line, display text B. For all

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SCQNameHHM

subsequent lines, display text C.

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SCQWholsRespondent

Item number: SCQ1025

Item tag: SCQ1025

Item type: Question

Type class: Enumerated

Field kind: Datafield

Answers allowed: 1

Help tag:

Answer type: {User Defined.}

FieldSize: Min value: Max value: ArrayMin: ArrayMax:



English text: [ENTER '1' NEXT TO THE RESPONDENT.]

[IF NOT OBVIOUS, ASK: Thank you for telling me about all the people who live in this household. Now, I need to ask your name, so I know which household member you are.]

Spanish text: [ENTER '1' NEXT TO THE RESPONDENT.]

[IF NOT OBVIOUS, ASK: Gracias por decirme todas las personas que viven en este hogar. Ahora, necesito preguntarle su nombre, para saber qué miembro del hogar es usted.]

Number Label Route

1 Respondent


SCQ1030 - Route : If Then


English text: RESPONDENT

Display instructions: This variable should appear as the second column on the grid.

Notes: Allow only one response to this question.

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SCQAnyoneElse

Item number: SCQ1027 Item tag:

Item type: Question Type class: Enumerated

Field kind: Datafield

Answers allowed: 1

Help tag:

Answer type: {User Defined.}

FieldSize: Min value: Max value: ArrayMin: ArrayMax:


English text: Anyone else?

[HOUSEHOLD (HH) MEMBERS INCLUDE PEOPLE WHO THINK OF THIS HH AS THEIR PRIMARY PLACE OF RESIDENCE. IT INCLUDES PEOPLE WHO USUALLY STAY IN THE HH BUT ARE TEMPORARILY AWAY ON BUSINESS, VACATION, IN A HOSPITAL, OR LIVING AT SCHOOL IN A DORM, FRATERNITY OR SORORITY.]

[DO NOT INCLUDE COLLEGE STUDENTS LIVING IN OFF-CAMPUS HOUSING AS HH MEMBERS.]

Spanish text: ¿0tros nombres?

Number Label Route

1 YES SCQ1020 - SCQNameHHM

English text: YES

2 NO SCQ1030 - Route : If Then

English text: NO

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Route : If Then

Item number: SCQ1030 Item tag: SCQ1030 Item type: Route

Type class: If Then

Route details: For each household member, go through items SCQ1040-SCQ1095 (following appropriate skips). Complete all items for each household member before going to the next household member.

Start with the reference person (first row in SCQ1020) and ask questions about additional household members in the order in which the household members were reported.

If there are no additional household members, go to SCQ1102.

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SCQGender

Item number: SCQ1040

Item tag: SCQ1040

Item type: Question

Type class: Enumerated

Field kind: Datafield

Answers allowed: 1

Help tag:

Answer type: {User Defined.}

FieldSize: Min value: Max value: ArrayMin: ArrayMax:



English text: [CODE GENDER. IF NOT OBVIOUS, ASK: {Are you/Is NAME} male or female?]

Spanish text: [CODE GENDER. IF NOT OBVIOUS, ASK: ¿Es {usted/NAME} de sexo femenino o masculino?]

Number Label Route

1 Male SCQ1050 - SCQAge

English text: MALE

2 Female SCQ1050 - SCQAge

English text: FEMALE

Attribute Route

Don't know SCQ1050 - SCQAge

Refusal SCQ 1050 - SCQAge

Display instructions: This variable should appear as the third column on the grid.

For {Are you/Is NAME}, if asking about screener respondent, display "Are you". Else, display "Is NAME".

SPANISH DISPLAY:

For {usted/NAME}, if asking about screener respondent, display "usted". Else, display "NAME".

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SCQAge

Item number: SCQ1050

Item tag: SCQ1050

Item type: Question

Type class: Integer

Field kind: Datafield

Answers allowed: 1

Help tag:

Answer type: {Continuous Answer.}

FieldSize: 18

Min value: Max value: ArrayMin: ArrayMax:

0 130



English text: How old {are you/is NAME}?

[IF UNDER 1 YEAR, ENTER AS "0"]

Spanish text: ¿Qué edad tiene (usted/NAME}?

[IF UNDER 1 YEAR, ENTER AS "0"]

Number Label Route

1 [Continuous answer.] SCQ1055 - Check : Soft

English text: [Enter continuous answer.]

Attribute Route

Don't know SCQ l060 - SCQAgeRange

Refusal SCQ 1060 - SCQAgeRange

Display instructions: This variable should appear as the fourth column on the grid.

For {are you/is NAME}, if asking about screener respondent, display "are you". Else, display "is NAME".

SPANISH DISPLAY:

For {usted/ NAME}, if asking about screener respondent, display "usted". Else, display "NAME".

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Check : Soft

Item number: SCQ1055

Item tag: SCQ1055

Item type: Check

Type class: Soft

Check details: Associated variable: SCQ1050

English text: If outside the range of 0 to 99, display the following: "I just need to check that {your/NAME's} age is {SCQ1050}. Is this right?

Spanish text: If outside the range of 0 to 99, display the following: "Solamente necesito verificar que la edad de {usted/NAME} es {SCQ1050}. ¿,Es correcto?"

Number Label Route

1 [Check executed.] SCQ1075 - SCQEthnicity

Notes:

For {your/NAME's}, if asking about screener respondent, display "your". Else, display "NAME".

SPANISH DISPLAY:

For {usted/NAME}, if asking about screener respondent, display "usted". Else, display "NAME".

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SCQAgeRange

Item number: SCQ1060 Field kind: Datafield

Item tag: SCQ1060 Answers allowed: 1

Item type: Question Help tag:

Type class: Enumerated Answer type: {User Defined.}

FieldSize: Min value: Max value: ArrayMin: ArrayMax:


English text: {Are you/Is NAME}...

Spanish text: ¿Tiene {usted/NAME}..


Number Label

Route

1

Underl8YearsOld

SCQ1075 - SCQEthnicity


English text: Under 18 years old?



Spanish text: menos de 18 años de edad?


2

Fl8To29YearsOld

SCQ1075 - SCQEthnicity


English text: 18 to 29 years old?



Spanish text: 18 a 29 años de edad?


3

F30To39YearsOld

SCQ1075 - SCQEthnicity


English text: 30 to 39 years old?



Spanish text: 30 a 39 años de edad?


4

F40To49YearsOld

SCQ1075 - SCQEthnicity


English text: 40 to 49 years old?



Spanish text: 40 a 49 años de edad?


5

F50To59YearsOld

SCQ1075 - SCQEthnicity


English text: 50 to 59 years old?



Spanish text: 50 a 59 años de edad?


6

F60To69YearsOld

SCQ1075 - SCQEthnicity


English text: 60 to 69 years old?



Spanish text: 60 a 69 años de edad?


7

F70YearsOldOrOlder

SCQ1075 - SCQEthnicity


English text: 70 years old or older?

Spanish text: 70 años de edad o más?

Attribute Route

Don't know SCQ1075 - SCQEthnicity

Refusal SCQ1075 - SCQEthnicity

Display instructions: This variable should appear as the fifth column on the grid.

For {Are you/Is NAME}, if asking about screener respondent, display "Are you". Else, display "Is NAME".

SPANISH:

For {usted/ NAME}, if asking about screener respondent, display "usted". Else, display "NAME".

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SCQEthnicity

Item number: SCQ 1075

Item tag: SCQ1075

Item type: Question

Type class: Enumerated

Field kind: Datafield

Answers allowed: 4

Help tag:

Answer type: {User Defined.}

FieldSize: Min value: Max value: ArrayMin: ArrayMax:


English text: SHOW CARD 1

Do any of the following groups represent {your/NAME's} national origin or ancestry? Mexican/Mexican-American, Puerto Rican, Cuban, other Hispanic or Latino? You can select more than one answer.

[SELECT ALL THAT APPLY.]

Spanish text: SHOW CARD 1

¿Alguno de los siguientes grupos representa el origen nacional o ancestro {suyo/de NAME}? ¿Mexicano/mexicoamericano, puertorriqueño, cubano, otro hispano o latino? Puede seleccionar más de una respuesta.

[SELECT ALL THAT APPLY.]

Number Label Route

1 MexicanOrMexicanAmerican SCQ1080 - Check : Hard

English text: MEXICAN/MEXICAN-AMERICAN

2 PuertoRican SCQ1080 - Check : Hard

English text: PUERTO RICAN

3 Cuban SCQ1080 - Check : Hard

English text: CUBAN

4 OtherHispanicOrLatino SCQ1080 - Check : Hard

English text: OTHER HISPANIC OR LATINO

5 NotHispanic SCQ1080 - Check : Hard

English text: NOT HISPANIC

Attribute Route

Don't know SCQ 1077 - Route : If Then

Refusal SCQ 1077 - Route : If Then

Display instructions: This variable should appear as the sixth column on the grid.

For {your/NAME's}, if asking about screener respondent, display "your". Else, display "NAME's".

SPANISH DISPLAY:

For {suyo/de NAME}, if asking about screener respondent, display "suyo". Else, display "de NAME".

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Route : If Then

Item number: SCQ1077 Item tag:

Item type: Route

Type class: If Then

Route details: If SCQ 1075 = DK or RF for Screener respondent, go to SCQ1078. Else, go to SCQ1080.

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RespondentEthnicObs

Item number: SCQ1078 Item tag:

Item type: Question Type class: Enumerated

Field kind: Datafield

Answers allowed: 1

Help tag:

Answer type: {User Defined.}

FieldSize: Min value: Max value: ArrayMin: ArrayMax:


English text: [RECORD RESPONDENT'S ETHNICITY BY OBSERVATION, IF POSSIBLE.]

Spanish text: [RECORD RESPONDENT'S ETHNICITY BY OBSERVATION, IF POSSIBLE.]

Number Label Route

1 HispanicOrLatino SCQ1085 - SCQRace

English text: HISPANIC OR LATINO

2 NotHispanic SCQ1085 - SCQRace

English text: NOT HISPANIC

Attribute Route

Don't know SCQ 1085 - SCQRace

Display instructions: This variable should appear as the seventh column on the grid.

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Check : Hard

Item number: SCQ1080

Item tag: SCQ1080

Item type: Check

Type class: Hard

Check details:

English text: If SCQ1075=5 in combination with another other response, display: "I'm sorry, but NOT HISPANIC is not allowed with any other response."

Spanish text: If SCQ1075=5 and another response, display: "Lo lamento, pero NO HISPANO no se permite con ninguna otra respuesta."

Number Label Route

1 [Check executed.] SCQ1085 - SCQRace

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SCQRace

Item number: SCQ1085

Item tag: SCQ1085

Item type: Question

Type class: Enumerated

Field kind: Datafield

Answers allowed: 5

Help tag:

Answer type: {User Defined.}

FieldSize: Min value: Max value: ArrayMin: ArrayMax:


English text: SHOW CARD 2

What race do you consider {yourself/NAME} to be? White, Black or African American, Asian, Native Hawaiian or other Pacific Islander, or American Indian or Alaska Native? You can select more than one answer.

[SELECT ALL THAT APPLY.]

Spanish text: SHOW CARD 2

¿De qué raza considera que es {usted/NAME}? Blanca, negra o afroamericana, asiática, nativa de Hawái, o de otra isla del Pacifico, o india americana o nativa de Alaska? Puede seleccionar más de una respuesta.

[SELECT ALL THAT APPLY.]

Number Label Route

1 White SCQ1089 - SCQActiveMilitary

English text: WHITE

2 BlackOrAfricanAmerican SCQ1089 - SCQActiveMilitary

English text: BLACK/AFRICAN AMERICAN

3 Asian SCQ1089 - SCQActiveMilitary

English text: ASIAN

4 NativeHawaiian PacificIslander SCQ1089 - SCQActiveMilitary

English text: NATIVE HAWAIIAN/PACIFIC ISLANDER

5 AmericanIndianOrAlaskan SCQ1089 - SCQActiveMilitary

English text: AMERICAN INDIAN/ALASKA NATIVE

Attribute Route

Don't know SCQ 1087 - Route : If Then

Refusal SCQ 1087 - Route : If Then

Display instructions: This variable should appear as the eighth column on the grid.

For {yourself/NAME}, if asking about screener respondent, display "yourself". Else, display "NAME".

SPANISH DISPLAY:

For {usted/NAME}, if asking about screener respondent, display "usted". Else, display "NAME".

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Route : If Then

Item number: SCQ1087 Item tag:

Item type: Route

Type class: If Then

Route details: If SCQ 1085 = DK or RF for Screener respondent, go to SCQ 1088. Else, go to SCQ1089.

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RespondentRaceObs

Item number: SCQ1088 Item tag:

Item type: Question Type class: Enumerated

Field kind: Datafield

Answers allowed: 1

Help tag:

Answer type: {User Defined.}

FieldSize: MM value: Max value: ArrayMin: ArrayMax:


English text: [RECORD RESPONDENT'S RACE BY OBSERVATION, IF POSSIBLE.]

Spanish text: [RECORD RESPONDENT'S RACE BY OBSERVATION, IF POSSIBLE.]

Number Label Route

1 White SCQ1089 - SCQActiveMilitary

English text: WHITE

2 Black_AfricanAmerican SCQ1089 - SCQActiveMilitary

English text: BLACK/AFRICAN AMERICAN

3 Asian SCQ1089 - SCQActiveMilitary

English text: ASIAN

4 NativeHawaiian PacificIslander SCQ1089 - SCQActiveMilitary

English text: NATIVE HAWAIIAN/PACIFIC ISLANDER

5 AmericanIndian AlaskaNative SCQ1089 - SCQActiveMilitary

English text: AMERICAN INDIAN/ALASKA NATIVE

Attribute Route

Don't know SCQ 1089 - SCQActiveMilitary

Display instructions: This variable should appear as the ninth column on the grid.

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SCQActiveMilitary

Item number: SCQ1089

Item tag:

Item type: Question Type class: Enumerated

Field kind: Datafield

Answers allowed: 1

Help tag:

Answer type: {User Defined.}

FieldSize: MM value: Max value: ArrayMin: ArrayMax:


English text: {Are you/Is NAME} currently serving on active duty in the U.S. Armed Forces, Military Reserves or National Guard?


[ACTIVE DUTY DOES NOT INCLUDE TRAINING FOR THE RESERVES OR NATIONAL GUARD, BUT DOES INCLUDE ACTIVATION.]


Spanish text: ¿Está {usted/NAME} sirviendo actualmente en el servicio activo de las Fuerzas Armadas, Reservas Militares o la Guardia Nacional de Estados Unidos?


[ACTIVE DUTY DOES NOT INCLUDE TRAINING FOR THE RESERVES OR NATIONAL GUARD, BUT DOES INCLUDE ACTIVATION.]


Number Label Route


1 YES SCQ1090 – SCQMisreport

2 NO SCQ1090 - SCQMisreport



Attribute Route


Don't know SCQ 1090 – SCQMisreport

Refused SCQ 1090 - SCQMisreport



Display instructions: This variable should appear as the tenth column on the grid.



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SCQMisreport

Item number: SCQ1090

Item tag: SCQ1090

Item type: Instruction

Type class: Enumerated

Field kind: Datafield Answers allowed: 1 Help tag:

Answer type: TContinue

FieldSize: Min value: Max value: ArrayMin: ArrayMax:



English text: [LEAVE EMPTY UNLESS PERSON WAS MISREPORTED AND IS NOT A HOUSEHOLD MEMBER. IF MISREPORTED, ENTER "X".]

Spanish text: [LEAVE EMPTY UNLESS PERSON WAS MISREPORTED AND IS NOT A HOUSEHOLD MEMBER. IF MISREPORTED, ENTER "X".]

Number Label Route

1 MISREPORTED SCQ1095 - Route : If Then

English text: MISREPORTED

Display instructions:: Do not allow "MISREPORT" as an option on the first line of the grid (reference person).

If a person is marked as "MISREPORTED," all other fields on the grid associated with this person should be "show only."

This variable should appear as the eleventh column on the grid. Notes: The default for this field is blank - it will only be filled if necessary.

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Route : If Then

Item number: SCQ1095 Item tag: SCQ1095 Item type: Route

Type class: If Then

Route details: If additional household members, go to SCQ1040. Ask questions about the household members in the order in which they were originally reported. Else, go to SCQ1102.

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Route : If Then

Item number: SCQ1102 Item tag: SCQ1102 Item type: Route

Type class: If Then

Route details: Check enumeration grid to ensure that all necessary items have been answered. If any required fields are blank, return to grid. Else, go to SCQ1105.

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SCQAnyoneElse

Item number: SCQ1105

Item tag: SCQ1105

Item type: Question

Type class: Enumerated

Field kind: Datafield

Answers allowed: 1

Help tag:

Answer type: {User Defined.}

FieldSize: Min value: Max value: ArrayMin: ArrayMax:


English text: We have listed {NUMBER} household member{s}:

{NAME/GENDER/AGE}

Have we missed any other...

  • members of this household who are related to {you/REFERENCE PERSON}?

- people living here who are not related to {you/REFERENCE PERSON}, including friends or boarders?

- household members who usually live here but are not here currently, such as someone away on vacation, business, in a hospital, or a student living in a dormitory?

Spanish text: Tenemos anotado {NUMBER} miembro(s) del hogar :

{NAME/GENDER/AGE}

¿Hemos olvidado

  • algún otro miembro de este hogar que esté emparentado con {usted/REFERENCE PERSON}?

  • alguna otra persona que viva aquí que no esté emparentada con {usted/REFERENCE PERSON}, incluyendo amigos o huéspedes?

- algún otro miembro del hogar que usualmente viva aquí pero que actualmente no esté aquí, tal como alguien que esté lejos de vacaciones, negocio, en un hospital, o un estudiante viviendo en una residencia para estudiantes?

Number Label Route

1 Yes SCQ1020 - SCQNameHHM English text: YES

2 No SCQ1110 - Route : If Then

English text: NO

Display instructions:: For {NUMBER}, display the number of household members collected in the enumeration grid.

For member{s}, if household contains one person, display "member". Else, display "members".

For {NAME/GENDER/AGE}, display the name, gender and age of each household member collected in the grid.

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SCQAnyoneElse

For {you/REFERENCE PERSON}, if screener respondent = reference person, display "you". Else, display name of first person on grid in "REFERENCE PERSON".

SPANISH DISPLAY:

For {usted/REFERENCE PERSON}, if screener respondent = reference person, display "usted". Else, display name of first person on grid in "REFERENCE PERSON".

Notes: The number of household members collected in the enumeration grid is the value that should be stored as household size.

End enumeration timing here when SCQ1105=2.

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Route : If Then

Item number: SCQ1110 Item tag: SCQ1110 Item type: Route

Type class: If Then

Route details: Insert sampling messages here.

If an SP has been selected, then go to SCQ1111. Else, go to SCQ1124.

Notes: Eligibility is determined at the time enumeration is completed. SCQ1105 is the final enumeration question that must be answered to determine eligibility.

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SCQldentifySP

Item number: SCQ1111
Item tag: SCQ1111

Item type: Instruction Type class: Enumerated

Field kind: Datafield Answers allowed: 1 Help tag:

Answer type: TContinue

FieldSize: Min value: Max value: ArrayMin: ArrayMax:


English text: Based on the information you have provided, we have selected {SP FILL 1} {and SP FILL 2} to participate in the study.

[PRESS 1 AND ENTER TO CONTINUE.]

Spanish text: Basados en la información que usted ha proporcionado, hemos seleccionado a {SP FILL 1} {y SP FILL 2} para participar en el estudio.

[PRESS 1 AND ENTER TO CONTINUE.]

Number Label Route

1 Continue SCQ1112 - Route : Begin Loop

English text: CONTINUE

Display instructions: SP FILL 1 = display SP #1 NAME/AGE/GENDER If second SP selected, display SP FILL 2. Else, blank. SP FILL 2 = display SP #2 NAME/AGE/GENDER

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Route : Begin Loop

Item number: SCQ1112 Item tag: SCQ1112 Item type: Route

Type class: Begin Loop

Route details: Ask SCQ1113 for each household member reported on enumeration grid in relation to SP #1. Repeat for SP #2, as needed.

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RelationshipSP

Item number: SCQ1113

Item tag: SCQ1113

Item type: Question

Type class: Enumerated

Field kind: Datafield

Answers allowed: 1

Help tag:

Answer type: {User Defined.}

FieldSize: Min value: Max value: ArrayMin: ArrayMax:


English text: What is {NAME's/your} relationship to {SP/you}? For example: wife or husband, son, daughter, son-in-law, sister, foster son, partner, lodger, lodger's wife, etc. IF NEEDED: In other words, {NAME} is {SP}'s..

Spanish text: ¿Cual es {la relación o parentesco de NAME/su relación o parentesco} con {SP/usted}? Por ejemplo, esposa o esposo, hijo, hija, yerno, hermana, hijo en adopción temporal, pareja, esposa del inquilino, etc. IF NEEDED: En otras palabras, {NAME} es el /la ... de {SP}

Number Label Route

1 SP SCQ1116 - Route : If Then

English text: SP

2 HusbandWife SCQ1116 - Route : If Then

English text: {HUSBAND/WIFE}

3 DomesticPartner SCQ1116 - Route : If Then

English text: DOMESTIC PARTNER

4 BoyfriendGirlfriend SCQ1116 - Route : If Then

English text: {BOYFRIEND/GIRLFRIEND}

5 NaturalBloodChild SCQ1116 - Route : If Then

English text: {SON/DAUGHTER} (NATURAL OR BLOOD)

6 AdoptedChild SCQ1116 - Route : If Then

English text: ADOPTED {SON/DAUGHTER}

7 StepchildFoster SCQ1116 - Route : If Then

English text: STEP {SON/DAUGHTER}/FOSTER {SON/DAUGHTER}

8 SoninlawDaughterinlaw SCQ1116 - Route : If Then

English text: {SON-IN-LAW/DAUGHTER-IN-LAW}

9 Grandchild SCQ1116 - Route : If Then

English text: GRAND {SON/DAUGHTER}

10 BrotherSiste:r SCQ1116 - Route : If Then

English text: {BROTHER/SISTER}

11 StepBrotherSister SCQ1116 - Route : If Then

English text: {STEP-BROTHER/STEP-SISTER}

12 BrotherSisterinLaw SCQ1116 - Route : If Then

English text: {BROTHER-IN-LAW/SISTER-IN-LAW}

13 MotherFather SCQ1116 - Route : If Then

English text: {MOTHER/FATHER}

14 StepMotherFather SCQ1116 - Route : If Then

English text: {STEP-MOTHER/STEP-FATHER}

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RelationshipSP

15 MotherFatherinLaw SCQ1116 - Route : If Then

English text: {MOTHER-IN-LAW/FATHER-IN-LAW}

16 Grandparent SCQ1116 - Route : If Then

English text: GRAND {MOTHER/FATHER}

17 Cousin SCQ1116 - Route : If Then

English text: COUSIN

18 UncleAunt SCQ1116 - Route : If Then

English text: {UNCLE/AUNT}

19 NephewNiece SCQ1116 - Route : If Then

English text: {NEPHEW/NIECE}

20 OtherRelative SCQ1116 - Route : If Then

English text: OTHER RELATIVE

21 RoommateHousemate SCQ1116 - Route : If Then

English text: ROOMMATE/HOUSEMATE

22 RoomerBoarder SCQ1116 - Route : If Then

English text: ROOMER/BOARDER

23 OtherNonrelative SCQ1116 - Route : If Then

English text: OTHER NONRELATIVE

Attribute Route

Don't know SCQ1116 - Route : If Then

Refusal SCQ 1116 - Route : If Then

Display instructions: For {NAME'S/your}, when collecting information for Screener respondent, display "your". Else, display name of each household member collected in enumeration grid in "NAME's".

For {SP/you}, if screener respondent = SP, display "you". Else, display SP name in "SP".

For response options, if SCQ1040=1, display: 2=husband; 4=boyfriend; 5=son (natural or blood); 6=adopted son; 7=stepson/foster son; 8=son-in-law; 9=grandson; 10=brother; 11=step-brother; 12=brother-in-law; 13=father; 14=step-father; 15=father-in-law; 16=grandfather; 18=uncle; 19=nephew

Else, display 2=wife; 4=girlfriend; 5=daughter (natural or blood); 6=adopted daughter; 7=stepdaughter/foster daughter; 8=daughter-in-law; 9=granddaughter; 10=sister; 11=step­sister; 12=sister-in-law; 13=mother; 14=step-mother; 15=mother-in-law; 16=grandmother; 18=aunt; 19=niece

SPANISH DISPLAY:

For {la relación o parentesco de NAME/su relación o parentesco}, when collecting information for Screener respondent, display "su relación o parentesco". Else, display name of each household member collected in enumeration grid in "la relación o parentesco de NAME".

For {SP/usted}, if screener respondent = SP, display "usted". Else, display SP name in "SP".

Monday, September 13, 2010 Page 31


RelationshipSP

Notes: When collecting information for screener respondent, if screener respondent = SP, assign ‘01’ and go to next name in enumeration grid.

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Route : If Then

Item number: SCQ1116 Item tag: SCQ1116 Item type: Route

Type class: If Then

Route details: Review SCQ1075 and SCQ1085 for SP #1 (and SP #2) only:

If SCQ1075 = DK or RF, then go to SCQ1117.

Else if SCQ1085 = DK or RF, then go to SCQ1121. Else, go to SCQ1124.

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SCQSPEthnicity

Item number: SCQ1117

Item tag: SCQ1117

Item type: Question

Type class: Enumerated

Field kind: Datafield

Answers allowed: 7

Help tag:

Answer type: {User Defined.)

FieldSize: Min value: Max value: ArrayMin: ArrayMax:


English text: SHOW CARD 1

Because {you were/NAME was} selected for this study, it is very important that we collect some demographic information about {you/him/her}. Please remember that anything you tell me is completely private.

Do any of the following groups represent {your/NAME's} national origin or ancestry? Mexican/Mexican-American, Puerto Rican, Cuban, other Hispanic or Latino? You can select more than one answer.

[SELECT ALL THAT APPLY.]

Spanish text: SHOW CARD 1

Dado que {usted/NAME } fue seleccionado(a) para este estudio, es muy importante que reunamos información demográfica sobre {usted/él/ella}. Recuerde que cualquier cosa que usted me diga se mantendrá completamente privado.

¿Representa alguno de los siguientes grupos el origen nacional o ancestro {suyo/de NAME)? Mexicano/mexicoamericano, puertorriqueño, cubano, otro hispano o latino? Puede seleccionar más de una respuesta.

[SELECT ALL THAT APPLY.]

Number Label Route

1 Mexican_Mexican_American SCQ1118 - Check : Hard

English text: MEXICAN/MEXICAN-AMERICAN

2 PuertoRican SCQ1118 - Check : Hard

English text: PUERTO RICAN

3 Cuban SCQ1118 - Check : Hard

English text: CUBAN

4 OtherHispanicOrLatino SCQ1118 - Check : Hard

English text: OTHER HISPANIC OR LATINO

5 NotHispanic SCQ1118 - Check : Hard

English text: NOT HISPANIC

Attribute Route

Don't know SCQ1119 - SCQEthnicityObserve

Refusal SCQ1119 - SCQEthnicityObserve

Display instructions: For {you were/NAME was}, if screener respondent = SP, display "you were". Else, display "NAME was".

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SCQSPEthnicity

For {you/him/her}, if screener respondent = SP, display "you". Else, if SCQ1040 for SP = 1, display "him". Else, display "her".

SPANISH DISPLAY:

For {usted/NAME}, if screener respondent = SP, display "usted". Else, display "NAME".

For {usted/él/ella}, if screener respondent = SP, display "usted". Else, if SCQ1040 for SP = 1, display "él". Else, display "ella".

Notes: If SP = Screener respondent and SCQ1078 was already answered for SP, go to SCQ1120.

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Check : Hard

Item number: SCQ 1118

Item tag: SCQ 1118

Item type: Check

Type class: Hard

Check details:

English text: If SCQ1117=5 in combination with any other response, display: "I'm sorry, but NOT HISPANIC is not allowed with any other response."

Spanish text: If SCQ1117=5 and another response, display: "Lo lamento, pero NO HISPANO no se permite con ninguna otra respuesta."

Number Label Route

I [Check executed.] SCQ1120 - Route : If Then


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SCQEthnicityObserve

Item number: SCQ1119

Item tag: SCQ1119

Item type: Question

Type class: Enumerated

Field kind: Datafield

Answers allowed: 1

Help tag:

Answer type: {User Defined.}

FieldSize: Min value: Max value: ArrayMin: ArrayMax:


English text: [RECORD SP'S ETHNICITY BY OBSERVATION, IF POSSIBLE.]

Spanish text: [RECORD SP'S ETHNICITY BY OBSERVATION, IF POSSIBLE.]

Number Label Route

1 HispanicOrLatino SCQ1120 - Route : If Then

English text: HISPANIC OR LATINO

2 NotHispanic SCQ1120 - Route : If Then

English text: NOT HISPANIC/LATINO

Attribute Route

Don't know SCQ1120 - Route : If Then

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Route : If Then

Item number: SCQ1120 Item tag: SCQ1120 Item type: Route

Type class: If Then

Route details: If SCQ1085 = DK or RF for SP #1 or #2, go to SCQ1121. Else, go to SCQ1124.

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SCQSPRace

Item number: SCQ1121

Item tag: SCQ1121

Item type: Question

Type class: Enumerated

Field kind: Datafield

Answers allowed: 7

Help tag:

Answer type: {User Defined.}

FieldSize: Min value: Max value: ArrayMin: ArrayMax:


English text: SHOW CARD 2

What race do you consider {yourself/NAME} to be? White, Black or African American, Asian, Native Hawaiian or other Pacific Islander, or American Indian or Alaska Native? You can select more than one answer.

[SELECT ALL THAT APPLY.]

Spanish text: SHOW CARD 2

¿De que raza considera que es {usted/NAME}? blanca, negra o afroamericana, asiática, nativa de Hawái, o de otra isla del Pacifico, o india americana o nativa de Alaska? Puede seleccionar más de una respuesta.

[SELECT ALL THAT APPLY.]

Number Label Route

1 White SCQ1123 - Route : If Then

English text: WHITE

2 Black AfricanAmerican SCQ1123 - Route : If Then

English text: BLACK/AFRICAN AMERICAN

3 Asian SCQ1123 - Route : If Then

English text: ASIAN

4 NativeHawaiianPacificIslander SCQ1123 - Route : If Then

English text: NATIVE HAWAIIAN/PACIFIC ISLANDER

5 AmericanIndianAlaskaNative SCQ1123 - Route : If Then

English text: AMERICAN INDIAN/ALASKA NATIVE

Attribute Route

Don't know SCQ 1122 - SCQRaceObserve

Refusal SCQ 1122 - SCQRaceObserve

Display instructions: For {yourself/NAME}, if screener respondent = SP, display "yourself'. Else, display "NAME".

SPANISH DISPLAY:

For {USTED/NAME}, if screener respondent = SP, display "usted". Else, display "NAME".

Notes: If SP = Screener respondent and SCQ1088 was already answered for this SP, go to SCQ1123.

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SCQRaceObserve

Item number: SCQ1122

Item tag: SCQ1122

Item type: Question

Type class: Enumerated

Field kind: Datafield

Answers allowed: 1

Help tag:

Answer type: {User Defined.}

FieldSize: Min value: Max value: ArrayMin: ArrayMax:


English text: [RECORD SP'S RACE BY OBSERVATION, IF POSSIBLE.]

Spanish text: [RECORD SP'S RACE BY OBSERVATION, IF POSSIBLE.]

Number Label Route

1 White SCQ1123 - Route : If Then

English text: WHITE

2 Black AfricanAmerican SCQ1123 - Route : If Then

English text: BLACK/AFRICAN AMERICAN

3 Asian SCQ1 123 - Route : If Then

English text: ASIAN

4 NativeHawaiianPacificIslander SCQ1123 - Route : If Then

English text: NATIVE HAWAIIAN/PACIFIC ISLANDER

5 AmericanIndian AlaskaNative SCQ1123 - Route : If Then

English text: AMERICAN INDIAN/ALASKA NATIVE

Attribute Route

Don't know SCQ1123 - Route : If Then

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Route : If Then

Item number: SCQ1123 Item tag:

Item type: Route

Type class: If Then

Route details: If household contains second SP, go to SCQ1116. Else, go to SCQ1124.

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SCQRespondentPhone

Item number: SCQ1124 Field kind: Datafield

Item tag: SCQ1124 Answers allowed: 1

Item type: Question Help tag:

Type class: Enumerated Answer type: {User Defined.}

FieldSize: Min value: Max value: ArrayMin: ArrayMax:


English text: What is your telephone number (in case my office wants to check my work)?

Spanish text: ¿Cuál es el número de teléfono de su hogar (en caso que alguien en mi oficina quiera verificar mi trabajo)?

Number Label Route

1 EnterPhoneNumber SCQ1125 - SCQCollectRespondentPhone

English text: ENTER PHONE NUMBER

2 NoPhoneNumber SCQ1150 - SCQOtherNumber

English text: NO PHONE NUMBER

Attribute Route

Refusal SCQ1150 - SCQOtherNumber

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SCQCollectRespondentPhone

Item number: SCQ1125

Item tag: SCQ1125

Item type: Question

Type class: Integer

Field kind: Datafield

Answers allowed: 1

Help tag:

Answer type: {Continuous Answer.}

FieldSize: 18 Min value: Max value: ArrayMin: ArrayMax:


English text: [What is your telephone number (in case my office wants to check my work)?] ENTER THE AREA CODE AND NUMBER.

Spanish text: [¿Cuál es el número de teléfono de su hogar (en caso que alguien en mi oficina quiera verificar mi trabajo)?]

ENTER THE AREA CODE AND NUMBER. Number Label Route

1 [Continuous answer.] SCQ1140 - SCQRPhoneConfirm

English text: [Enter continuous answer.]

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SCQRPhoneConfirm

Item number: SCQ1140

Item tag: SCQ1140

Item type: Question

Type class: Enumerated

Field kind: Datafield

Answers allowed: 1

Help tag:

Answer type: {User Defined.}

FieldSize: Min value: Max value: ArrayMin: ArrayMax:


English text: I have your phone number as: {(xxx)xxx-xxxx} Is this correct?

Spanish text: Tengo anotado que su número de teléfono es: {(xxx)xxx-xxxx} ¿Correcto?

Number Label Route

1 Yes SCQ1145 - SCQRPhoneLocation


English text: YES

2 No

English text: NO


SCQ1125 - SCQCollectRespondentPhone



Display instructions: For {(xxx)xxx-xxxx}, display response from SCQ1125.

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SCQRPhoneLocation

Item number: SCQ1145 Item tag:

Item type: Question Type class: Enumerated

Field kind: Datafield

Answers allowed: 1

Help tag:

Answer type: {User Defined.}

FieldSize: Min value: Max value: ArrayMin: A rrayMax:


English text: Where is this phone located? Is it in your home, at work, someplace else, or is it a cellular or mobile phone?

Spanish text: ¿De dónde es este número? ¿Es de su hogar, del trabajo, de otro lugar o es de un teléfono celular?

Number Label Route

1 Home SCQ1150 - SCQOtherNumber


English text: HOME




2 Work SCQ1150 - SCQOtherNumber


English text: WORK




3 CellMobile SCQ1150 - SCQOtherNumber

English text: CELLULAR OR MOBILE PHONE

91 OthSpecify SCQ1150 - SCQOtherNumber

English text: OTHER, SPECIFY

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SCQOtherNumber

Item number: SCQ1150

Item tag: SCQ1150

Item type: Question

Type class: Enumerated

Field kind: Datafield

Answers allowed: 1

Help tag:

Answer type: {User Defined.}

FieldSize: Min value: Max value: ArrayMin: ArrayMax:


English text: Is there {a/another} telephone number where {you/SP} could be reached?

Spanish text: ¿Hay {un/otro} número de teléfono donde nos podamos comunicar con {usted/SP}?

Number Label Route


1 Yes

SCQ1155 - SCQCollectOtherNumber


English text: YES

2 NoOtherPhone SCQ1200

English text: NO OTHER PHONE

Attribute Route

Refusal

SCQ1200







Display instructions: If SCQ1124=1, display "another". Else, display "a".

If an SP was selected, and SP is not screener respondent, display name of SP in "SP". Else, display "you". Repeat for SP #2 if applicable.

SPANISH DISPLAY:

If SCQ1124=1, display "otro". Else, display "un"

If an SP was selected, and SP is not screener respondent, display name of SP in "SP". Else, display "usted". Repeat for SP #2 if applicable.

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SCQCollectOtherNumber

Item number: SCQ1155 Field kind: Datafield

Item tag: SCQ1155 Answers allowed: 1

Item type: Question Help tag:

Type class: Integer Answer type: {Continuous Answer.}

FieldSize: 18 Min value: Max value: ArrayMin: ArrayMax:


English text: [What is that phone number?]

ENTER THE AREA CODE AND NUMBER.

Spanish text: [¿Cuál es ese número de teléfono?]

ENTER THE AREA CODE AND NUMBER.

Number Label Route

1 [Continuous answer.] SCQ1170 - SCQOtherConfirmPhone

English text: [Enter continuous answer.]

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SCQOtherConfirmPhone

Item number: SCQ1170

Item tag: SCQ1170

Item type: Question

Type class: Enumerated

Field kind: Datafield

Answers allowed: 1

Help tag:

Answer type: {User Defined.}

FieldSize: Min value: Max value: ArrayMin: ArrayMax:


English text: I have that phone number as: {(xxx)-xxx-xxxx} Is this correct?

Spanish text: Tengo anotado que ese número de teléfono es: {(xxx)-xxx-xxxx} ¿Correcto?

Number Label Route

1 Yes SCQ1180 - SCQOtherPhoneLocated

English text: YES

2 No SCQ1155 - SCQCollectOtherNumber

English text: NO

Display instructions: For {(xxx)xxx-xxxx}, display response from SCQ1155.

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SCQOtherPhoneLocated


Item number: SCQ1180 Field kind: Datafield

Item tag: SCQ1180 Answers allowed: 1

Item type: Question Help tag:

Type class: Enumerated Answer type: {User Defined.}

FieldSize: Min value: Max value: ArrayMin: ArrayMax:



English text: Where is this phone located? Is it in your home, at work, someplace else, or is it a cellular or mobile phone?

Spanish text: ¿De dónde es este número? ¿Es de {su hogar/del hogar de SP1}, del trabajo, de otro lugar o es de un teléfono celular?

Number Label Route

1 Home SCQ1200 - MailingAddressDifferent

English text: HOME

2 Work SCQ1200 - MailingAddressDifferent

English text: WORK

3 CellMobile SCQ1200 - MailingAddressDifferent

English text: CELLULAR OR MOBILE PHONE

910 OthSpecify SCQ1200 - MailingAddressDifferent

English text: OTHER, SPECIFY

Attribute Route

Don't know SCQ1200

Refusal SCQ1200

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MailingAddressDifferent

Item number: SCQ1200 Item tag:

Item type: Question Type class: Enumerated

Field kind: Datafield

Answers allowed: 1

Help tag:

Answer type: {User Defined.}

FieldSize: Min value: Max value: ArrayMin: ArrayMax:



English text: Is your mailing address the same as your street address?

Spanish text: ¿Es su dirección postal igual que la dirección de su vivienda?

Number Label Route

1 YES SCQ2005 - SCQScreenerLanguage

English text: YES

2 No SCQ1205 - MailingAddress

English text: NO

Attribute Route

Don't know SCQ2005 - SCQScreenerLanguage

Refusal SCQ2005 - SCQScreenerLanguage

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MailingAddress

Item number: SCQ1205 Item tag:

Item type: Question Type class: String

Field kind: Datafield

Answers allowed: 1

Help tag:

Answer type: {Continuous Answer.)

FieldSize: 255 Min value: Max value: ArrayMin: ArrayMax:


English text: What is your mailing address (in case my office needs to follow-up with you)?

Spanish text: ¿Cuál es su dirección postal (en caso de que mi oficina necesite volver a comunicarse con usted)?

Number Label Route

1 [Continuous answer.] SCQ2005 - SCQScreenerLanguage

Display instructions: Entry should include the following fields:

House Number

Directional Prefix Street Name

Street Type

Unit Type

Unit Number

Directional Suffix City

State

Zipcode

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SCQScreenerLanguage

Item number: SCQ2005

Item tag: SCQ2005

Item type: Question

Type class: Enumerated

Field kind: Datafield

Answers allowed: 1

Help tag:

Answer type: {User Defined.}

FieldSize: Min value: Max value: ArrayMin: ArrayMax:


English text: [THIS SCREENER INTERVIEW WAS CONDUCTED IN:]

Spanish text: [THIS SCREENER INTERVIEW WAS CONDUCTED IN:]

Number Label Route

1 English SCQ2010 - Route : If Then

English text: ENGLISH

2 Spanish SCQ2010 - Route : If Then

English text: SPANISH


3 Korean

SCQ2010 - Route : If Then




English text: KOREAN






4 Mandarin SCQ2010 - Route : If Then

English text: MANDARIN

5 Cantonese SCQ2010 - Route : If Then

English text: CANTONESE

6 Vietnamese SCQ2010 - Route : If Then

English text: VIETNAMESE

910 OthSpecify SCQ2010 - Route : If Then

English text: OTHER, SPECIFY

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Route : If Then

Item number: SCQ2010 Item tag:

Item type: Route

Type class: If Then

Route details: If household contains one SP and Screener R = SP, then go to SCQ3010.

Else if household contains two SPs and Screener R = SP #1 or SP #2, go to SCQ2015 and ask about SP who is not the Screener R.

Else, ask SCQ2015 for each SP.

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SCQAUDADISLanguage

Item number: SCQ2015 Item tag:

Item type: Question Type class: Enumerated

Field kind: Datafield

Answers allowed: 1

Help tag:

Answer type: {User Defined.}

FieldSize: Min value: Max value: ArrayMin: ArrayMax:



English text: Is {SP} able to speak English well enough to complete an interview in English?

Spanish text: ¿Puede {SP} hablar inglés lo suficientemente bien como para hacer la entrevista en inglés?

Number Label Route

1 Yes SCQ3010 - Route : If Then

English text: YES

2 No SCQ2020 - SCQSPLangPreference

English text: NO

Attribute Route

Don't know SCQ3010 - Route : If Then

Display instructions: Repeat for SP #2 as needed.

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SCQSPLangPreference

Item number: SCQ2020 Item tag:

Item type: Question Type class: Enumerated

Field kind: Datafield

Answers allowed: 1

Help tag:

Answer type: {User Defined.}

FieldSize: Min value: Max value: ArrayMin: ArrayMax:


English text: In what language would {SP} be able to complete the interview?

Spanish text: ¿En que idioma podría {SP} hacer la entrevista?


Number Label

Route

1

Spanish

SCQ3010 - Route : If Then


English text: SPANISH


2

Korean

SCQ3010 - Route : If Then


English text: KOREAN


3

Mandarin

SCQ3010 - Route : If Then


English text: MANDARIN


4

Cantonese

SCQ3010 - Route : If Then


English text: CANTONESE


5

Vietnamese

SCQ3010 - Route : If Then


English text: VIETNAMESE


91

OthSpecify

SCQ3010 - Route : If Then


English text: OTHER, SPECIFY

Attribute Route

Don't know SCQ3010 - Route : If Then

Display instructions: For each SP, if screener R = SP, then display response to SCQ2005 as preferred AUDADIS language on Browse Case and Browse Person screens of IMS.

If SCQ2015 = 1, then display ENGLISH as preferred AUDADIS language on Browse Case and Browse Person screens of IMS.

Else if SCQ2015 = 2, then display response to SCQ2020 as preferred AUDADIS language on Browse Case and Browse Person screens of IMS.

Notes: Do not display response from SCQ2005 as an option here.

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Route : If Then

Item number: SCQ3010 Item tag: SCQ3010 Item type: Route

Type class: If Then

Route details: If hidden DU procedure is required, go to SCQ3012. Else, go to SCQ3015.

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SCQHiddenDU

Item number: SCQ3012 Field kind: Datafield

Item tag: SCQ3012 Answers allowed: 1

Item type: Question Help tag:

Type class: Enumerated Answer type: {User Defined.}

FieldSize: Min value: Max value: ArrayMin: ArrayMax:


English text: We want to be sure that every household in this area has been given a chance to participate in this important study. Are there any other living quarters attached to this unit, like a basement or other apartment, that we might have missed?

IF NO, CODE 2

IF YES, DO THE DUS THAT R MENTIONED APPEAR ON THE LISTING SHEETS?

IF YES, CODE 2

IF NO, DO DUS MEET DEFINITION OF DU? (PERSONS LIVE/EAT SEPARATELY
AND HAVE ENTRANCE DIRECTLY FROM OUTSIDE OR THROUGH COMMON HALL)

IF YES, CODE 1 IF NO, CODE 2

Spanish text: Queremos asegurarnos de que a todos los hogares en esta zona se les ha dado la oportunidad de participar en este importante estudio. ¿Hay alguna otra vivienda en esta unidad, como por ejemplo un sótano u otro apartamento, que no hayamos incluido?

IF NO, CODE 2

IF YES, DO THE DUS THAT R MENTIONED APPEAR ON THE LISTING SHEETS?

IF YES, CODE 2

IF NO, DO DUS MEET DEFINITION OF DU? (PERSONS LIVE/EAT SEPARATELY
AND HAVE ENTRANCE DIRECTLY FROM OUTSIDE OR THROUGH COMMON HALL)

IF YES, CODE 1 IF NO, CODE 2

Number Label Route

1 ConductHDUProcedure SCQ3013 - SCQ3013

English text: CONDUCT HIDDEN DU PROCEDURE

2 HDUProcedureNotRequired SCQ3013 - SCQ3013

English text: HIDDEN DU PROCEDURE NOT REQUIRED

Attribute Route

Don't know SCQ3013 - SCQ3013

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SCQ3013

Item number: SCQ3013 Item tag:

Item type: Instruction Type class: Enumerated

Field kind: Datafield Answers allowed: 1 Help tag:

Answer type: TContinue

FieldSize: Min value: Max value: ArrayMin: ArrayMax:


English text: If SCQ3012 is YES then update tblCaselnfo.HiddenCasePendingYN to Y; If SCQ3012 is DK then update tblCaselnfo.HiddenCasePendingYN to Y; If SCQ3012 is NO then update tblCaselnfo.HiddenCasePendingYN to N.

Number Label Route

1 Continue SCQ3015 - Route : If Then

English text: CONTINUE

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Route : If Then

Item number: SCQ3015 Item tag: SCQ3015 Item type: Route

Type class: If Then

Route details: If an SP was identified, go to SCQ4005.
Else, go to SCQ 4010.

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SCQCompleteSP

Item number: SCQ4005

Item tag: SCQ4005

Item type: Instruction

Type class: Enumerated

Field kind: Datafield Answers allowed: 1 Help tag:

Answer type: TContinue

FieldSize: Min value: Max value: ArrayMin: ArrayMax:


English text: [END OF SCREENER. PROVIDE $10 INCENTIVE TO {RESPONDENT NAME}]

[ATTEMPT TO ADMINISTER AUDADIS WITH {SP NAME} {OR SP NAME} . IF {SP NAME} {OR SP NAME} NOT AVAILABLE, SET APPOINTMENT.]

[PRESS 1 AND ENTER TO CONTINUE.]

Spanish text: [END OF SCREENER. PROVIDE $10 INCENTIVE TO {RESPONDENT NAME}]

[ATTEMPT TO ADMINISTER AUDADIS WITH {SP NAME} {OR SP NAME}. IF {SP NAME} {OR SP NAME} NOT AVAILABLE, SET APPOINTMENT.]

[PRESS 1 AND ENTER TO CONTINUE.]

Number Label Route

1 Continue

English text: CONTINUE

Display instructions: For {RESPONDENT NAME}, display name of Screener respondent. For {SP NAME}, display name of SP #1.

For {AND/OR SP NAME}, if household contains SP #2, display name of SP#2. Else, blank.

Notes: End instrument timing here.

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SCQCompletelnelig

Item number: SCQ4010

Item tag: SCQ4010

Item type: Instruction

Type class: Enumerated

Field kind: Datafield Answers allowed: 1 Help tag:

Answer type: TContinue

FieldSize: Min value: Max value: ArrayMin: ArrayMax:



English text: Thank you very much for your time today. Based on the information you have given us, no one in your household is eligible to participate in our study. As mentioned earlier, you will still receive $10 to thank you for participating. [PROVIDE $10 INCENTIVE.]

[PRESS 1 AND ENTER TO CONTINUE.]

Spanish text: Muchas gracias por el tiempo que me ha dado hoy. Basado en la información que nos ha dado,

nadie en su hogar cumple con los requisitos para participar en nuestro estudio. Como lo mencioné

anteriormente, aun así usted recibirá 10 dólares como agradecimiento por su participación.

[PROVIDE $10 INCENTIVE.]

[PRESS 1 AND ENTER TO CONTINUE.]

Number Label Route

1 Continue

English text: CONTINUE

Notes: End instrument timing here.

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RECBestTimeGeneral

Item number: REC 1005 Item tag:

Item type: Question Type class: Enumerated

Field kind: Datafield

Answers allowed: 1

Help tag:

Answer type: {User Defined.}

FieldSize: Min value: Max value: ArrayMin: ArrayMax:


English text: Like many businesses and organizations, Westat conducts a quality control program to ensure that our interviewers are following procedures. Therefore, you may be contacted in the next few weeks to follow-up on this interview.

Number

What would be the best time in general to contact you - weekdays, evenings or weekends?

Label

Route

1

Weekdays

REC1010 - RECBestTimeSpecific


English text: WEEKDAYS


2

Evenings

REC1010 - RECBestTimeSpecific


English text: EVENINGS


3

Weekends

REC1010 - RECBestTimeSpecific


English text: WEEKENDS

Attribute Route

Don't know REC1025 - Route : If Then

Refusal REC 1025 - Route : If Then

Wednesday, September 22, 2010 Page 1


RECBestTimeSpecific

Item number: REC 1010 Field kind: Datafield FieldSize: 255

Item tag: Answers allowed: 1 Min value:

Item type: Question Help tag: Max value:

Type class: String Answer type: {Continuous Answer.} ArrayMin:

ArrayMax:

English text: Is there a specific day or time that is best to contact you?

Number Label Route

1 [Continuous answer.]

Wednesday, September 22, 2010 Page 2


Route : If Then

Item number: REC1025 Item tag:

Item type: Route

Type class: If Then

Route details: IF SP=SCREENER R AND SCQ1124=1, GO TO REC1030. ELSE, GO TO REC1035.

Wednesday, September 22, 2010 Page 3


RECScreenerPhoneCorrect

Item number: REC1030 Item tag:

Item type: Question Type class: Enumerated

Field kind: Datafield

Answers allowed: 1

Help tag:

Answer type: {User Defined.}

FieldSize: Min value: Max value: ArrayMin: ArrayMax:



English text: Based on information you provided earlier, I have your {TYPE} phone number as {NUMBER}. {I
also have your {TYPE2} phone number as {NUMBER2} }. {Is this/Are these} correct?

Number Label Route

1 Yes REC1065 - RECRelValConsent

English text: YES

2 No REC1035 - RECBestNumberAvailable

English text: NO

Attribute Route

Don't know REC1035 - RECBestNumberAvailable

Refusal REC1035 - RECBestNumberAvailable

Display instructions: TYPE = SCQ 1170 (home/work/cell or mobile/other) NUMBER = SCQ1155

TYPE2 = SCQ 1145 (home/work/cell or mobile/other) NUMBER2 = SCQ1125

IF SCQ1150=1, display 2nd sentence. Else, blank.

Wednesday, September 22, 2010 Page 4


RECBestNumberAvailable

Item number: REC1035 Item tag:

Item type: Question Type class: Enumerated

Field kind: Datafield

Answers allowed: 1

Help tag:

Answer type: {User Defined.}

FieldSize: Min value: Max value: ArrayMin: ArrayMax:


English text: What is the best phone number to reach you?

Number Label Route

1 EnterPhoneNumber REC1040 - RECBestNumberSpecific

English text: ENTER PHONE NUMBER

2 NoPhoneNumber REC1065 - RECRelValConsent

English text: NO PHONE NUMBER

Attribute Route

Don't know REC1065 - RECRelValConsent

Refusal REC1065 - RECRelValConsent

Wednesday, September 22, 2010 Page 5


RECBestNumberSpecific

Item number: REC1040 Item tag:

Item type: Question Type class: String

Field kind: Datafield

Answers allowed: 1

Help tag:

Answer type: {Continuous Answer.}

FieldSize: 255 Min value:

Max value:

ArrayMin : ArrayMax:



English text: ENTER PHONE NUMBER, INCLUDING AREA CODE.

Number Label Route

1 [Continuous answer.] REC1045 - RECBestNumberLocation

Wednesday, September 22, 2010 Page 6


RECBestNumberLocation

Item number: REC1045 Item tag:

Item type: Question Type class: Enumerated

Field kind: Datafield

Answers allowed: 1

Help tag:

Answer type: {User Defined.}

FieldSize: Min value: Max value: ArrayMin: ArrayMax:



English text: Is this in your home, at work, someplace else, or is it a cellular or mobile phone?

Number Label Route

1 HOME REC1050 - RECSecondNumberAvailable

English text: HOME

2 Work REC1050 - RECSecondNumberAvailable

English text: WORK

3 CellularMobilePhone REC1050 - RECSecondNumberAvailable

English text: CELLULAR OR MOBILE PHONE

91 OthSp REC1050 - RECSecondNumberAvailable

English text: OTHER, SPECIFY

Attribute Route

Don't know REC1050 - RECSecondNumberAvailable

Refusal REC1050 - RECSecondNumberAvailable

Wednesday, September 22, 2010 Page 7


RECSecondNumberAvailable

Item number: REC1050 Item tag:

Item type: Question Type class: Enumerated

Field kind: Datafield

Answers allowed: 1

Help tag:

Answer type: (User Defined.}

FieldSize: Min value: Max value: ArrayMin: ArrayMax:


English text: Is there a second telephone number where you could be called?

Number Label Route

1 EnterPhoneNumber REC1055 - RECSecondNumberSpecific

English text: ENTER PHONE NUMBER

2 NoSecondNumber REC1065 - RECRelValConsent

English text: NO SECOND NUMBER

Attribute Route

Don't know REC1065 - RECRelValConsent

Refusal REC 1065 - RECRelValConsent

Wednesday, September 22,2010 Page 8


RECSecondNumberSpecific

Item number: REC1055 Item tag:

Item type: Question Type class: String

Field kind: Datafield

Answers allowed: 1

Help tag:

Answer type: {Continuous Answer.}

FieldSize: 255 Min value:

Max value: ArrayMin: ArrayMax:



English text: ENTER PHONE NUMBER, INCLUDING AREA CODE.

Number Label Route

1 [Continuous answer.] REC1060 - RECSecondNumberLocation

Wednesday, September 22, 2010 Page 9


RECSecondNumberLocation

Item number: REC1060 Item tag:

Item type: Question Type class: Enumerated

Field kind: Datafield

Answers allowed: 1

Help tag:

Answer type: {User Defined.}

FieldSize: Min value: Max value: ArrayMin: ArrayMax:


English text: Is this in your home, at work, someplace else, or is it a cellular or mobile phone?


Number Label

Route

1

Home

REC1065 - RECRelValConsent


English text: HOME


2

Work

REC1065 - RECRelValConsent


English text: WORK


3

CellularMobilePhone

REC1065 - RECRelValConsent


English text: CELLULAR OR MOBILE PHONE

Attribute Route

Don't know REC 1065 - RECRelValConsent

Refusal REC1065 - RECRelValConsent

Wednesday, September 22, 2010 Page 10



RECRelValConsent

Item number: REC 1065 Item tag:

Item type: Question Type class: Enumerated

Field kind: Datafield

Answers allowed: 1

Help tag:

Answer type: {User Defined.}

FieldSize: Min value: Max value: ArrayMin: ArrayMax:


English text: HAND RECONTACT CONSENT FORM TO SP. READ CONSENT FORM ALOUD. CONSENT FORM TEXT TO BE INSERTED ONCE FINALIZED.

Number Label Route

1 Yes REC1070 - Route : If Then

English text: YES, AGREE TO PARTICIPATE

2 No REC1160 - RECThankYou

English text: NO, DO NOT AGREE TO PARTICIPATE

Wednesday, September 22, 2010 Page 11


Route : If Then

Item number: REC1070 Item tag:

Item type: Route

Type class: If Then

Route details: IF REC1040 IS BLANK OR REC1030 = NO, GO TO REC1075. ELSE, GO TO REC1090.

Wednesday, September 22, 2010 Page 12


RECValidityNumberAvailable

Item number: REC1075 Item tag:

Item type: Question Type class: Enumerated

Field kind: Datafield

Answers allowed: I

Help tag:

Answer type: {User Defined.}

FieldSize: Min value: Max value: ArrayMin: ArrayMax:


English text: One of the follow-up interviews must be conducted over the telephone. Is there a telephone number where we could reach you to conduct this interview, if you are selected?

Number Label Route

1 Yes REC1080 - RECValidityNumberSpecific

English text: YES

2 No REC1090 - RECValidityBest

English text: NO

Wednesday, September 22, 2010 Page 13


RECValidityNumberSpecific

Item number: REC1080 Item tag:

Item type: Question Type class: String

Field kind: Datafield

Answers allowed: 1

Help tag:

Answer type: {Continuous Answer.}

FieldSize: 255 Min value:

Max value: ArrayMin: ArrayMax:



English text: ENTER PHONE NUMBER, INCLUDING AREA CODE.

Number Label Route

1 [Continuous answer.] REC1085 - RECValidityNumberLocation

Wednesday, September 22, 2010 Page 14


RECValidityNumberLocation

Item number: REC1085 Item tag:

Item type:

Question Type class: Enumerated

Field kind: Datafield

Answers allowed: 1

Help tag:

Answer type: {User Defined.}

FieldSize: Min value: Max value: ArrayMin: ArrayMax:



English text: Is this in your home, at work, someplace else, or is it a cellular or mobile phone?

Number Label Route

1 Home REC1090 - RECValidityBest

English text: HOME

2 Work REC1090 - RECValidityBest

English text: WORK

3 CellularMobile REC1090 - RECValidityBest

English text: CELLULAR OR MOBILE PHONE

91 OthSp REC1090 - RECValidityBest

English text: OTHER, SPECIFY

Attribute Route

Don't know REC1090 - RECValidityBest

Refusal REC1090 - RECValidityBest

Wednesday, September 22, 2010 Page 15


RECValidityBest

Item number: REC 1090 Field kind: Datafield FieldSize:

Item tag: Answers allowed: 1 Min value:

Item type: Question Help tag: Max value:

Type class: Enumerated Answer type: {User Defined.} ArrayMin:

ArrayMax:

English text: If selected, which telephone number should we call for this interview?

Number Label Route

1 Numbers REC 1100 - RECEmail

English text: NUMBERS COLLECTED PREVIOUSLY

2 OtherNumber REC1095 - RECValidityBestSpecific

English text: OTHER NUMBER

3 NoNumber REC1100 - RECEmail

English text: NO NUMBER

Display instructions: DISPLAY ALL TELEPHONE NUMBERS COLLECTED/CONFIRMED IN REC1030, REC1035, REC1050 AND/OR REC1080 AS RESPONSE OPTIONS.

Wednesday, September 22, 2010 Page 16


RECValidityBestSpecific

Item number: REC1095 Item tag:

Item type: Question Type class: String

Field kind: Datafield

Answers allowed: 1

Help tag:

Answer type: {Continuous Answer.}

FieldSize: 255 Min value:

Max value: ArrayMin: ArrayMax:



English text: ENTER PHONE NUMBER, INCLUDING AREA CODE.

Number Label Route

1 [Continuous answer.] REC1100 - RECEmail

Wednesday, September 22, 2010 Page 17



RECEmail

Item number: REC1100 Item tag:

Item type: Question Type class: String

Field kind: Datafield

Answers allowed: 1

Help tag:

Answer type: {Continuous Answer.}

FieldSize: 255 Min value: Max value: ArrayMin: ArrayMax:



English text: If we are unable to reach you at that phone number, we may need another way to contact you. What is your email address?

Number Label Route

1 [Continuous answer.] REC1105 - RECRelativeName

Attribute Route

Refusal REC1105 - RECRelativeName

Wednesday, September 22, 2010 Page 18

RECRelativeName

Item number: REC1105 Field kind: Datafield FieldSize: 255

Item tag: Answers allowed: 1 Min value:

Item type: Question Help tag: Max value:

Type class: String Answer type: {Continuous Answer.} ArrayMin:

ArrayMax:

English text: In case we are unable to reach you directly, please give me the name and telephone number of a close relative or friend who would know how to reach you. Please begin with that person's first name.

Number Label Route

1 [Continuous answer.] REC1110 - RECRelativeRelationship

Attribute Route

Don't know REC1130 - RECPlanMove

Refusal REC1130 - RECPlanMove

Display instructions: RESPONSE AREA SHOULD HAVE 2 LABELED FIELDS:

FIRST NAME: LAST NAME:

Wednesday, September 22, 2010 Page 19


RECRelativeRelationship

Item number: REC1110 Item tag:

Item type: Question Type class: Enumerated

Field kind: Datafield

Answers allowed: 1

Help tag:

Answer type: {User Defined.}

FieldSize: Min value: Max value: ArrayMin: ArrayMax:


English text: What is that person's relationship to you?

Number Label Route

1 Parent REC1120 - RECRelativeNumberAvailable

English text: PARENT

2 Child REC1120 - RECRelativeNumberAvailable

English text: CHILD

3 OtherRelative REC1120 - RECRelativeNumberAvailable

English text: OTHER RELATIVE

4 Friend REC1120 - RECRelativeNumberAvailable

English text: FRIEND

91 OthSp REC1120 - RECRelativeNumberAvailable

English text: OTHER, SPECIFY

Attribute Route

Refusal REC1120 - RECRelativeNumberAvailable

Wednesday, September 22, 2010 Page 20


RECRelativeNumberAvailable

Item number: REC 1120 Item tag:

Item type: Question Type class: Enumerated

Field kind: Datafield

Answers allowed: 1

Help tag:

Answer type: {User Defined.}

FieldSize: Min value: Max value: ArrayMin: ArrayMax:


English text: What is that person's telephone number?

Number Label Route

1 EnterPhoneNumber REC1125 - RECRelativeNumberSpecific

English text: ENTER PHONE NUMBER

2 NoPhoneNumber REC1130 - RECPlanMove

English text: NO PHONE NUMBER

Attribute Route

Don't know REC1130 - RECPlanMove

Refusal REC1130 - RECPlanMove

Wednesday, September 22, 2010 Page 21


RECRelativeNumberSpecific

Item number: REC 1125 Item tag:

Item type: Question Type class: String

Field kind: Datafield

Answers allowed: 1

Help tag:

Answer type: {Continuous Answer.}

FieldSize: 255 Min value:

Max value: ArrayMin: ArrayMax:



English text: ENTER PHONE NUMBER, INCLUDING AREA CODE.

Number Label Route

1 [Continuous answer.] REC1130 - RECPlanMove

Display instructions: MASKED ENTRY FIELD.

Wednesday, September 22,2010 Page 22



RECPIanMove

Item number: REC1130 Item tag:

Item type: Question Type class: Enumerated

Field kind: Datafield

Answers allowed: 1

Help tag:

Answer type: {User Defined.}

FieldSize: Min value: Max value: ArrayMin: ArrayMax:



English text: Do you plan to move within the next 6 weeks?

Number Label Route

1 Yes REC1135 - RECMoveDate

English text: YES

2 No REC1160 - RECThankYou

English text: NO

Attribute Route

Don't know REC1160 - RECThankYou

Refusal REC 1160 - RECThankYou

Wednesday, September 22, 2010 Page 23



RECMoveDate

Item number: REC1135 Item tag:

Item type: Question Type class: String

Field kind: Datafield

Answers allowed: 1

Help tag:

Answer type: {Continuous Answer.}

FieldSize: 255 Min value: Max value: ArrayMin: ArrayMax:



English text: When do you plan to move?
ENTER DATE.

Number Label Route

1 [Continuous answer.] REC1140 - RECFutureAddressAvailable

Attribute Route

Don't know REC1140 - RECFutureAddressAvailable

Refusal REC 1140 - RECFutureAddressAvailable

Wednesday, September 22, 2010 Page 24


RECFutureAddressAvailable

Item number: REC 1140 Item tag:

Item type: Question Type class: Enumerated

Field kind: Datafield

Answers allowed: 1

Help tag:

Answer type: {User Defined.}

FieldSize: Min value: Max value: ArrayMin: ArrayMax:


English text: Do you know what your new address will be?

Number Label Route

1 Yes REC1145 - RECFutureAddressSpecific

English text: YES

2 No REC1150 - RECFutureNumberAvailable

English text: NO

Attribute Route

Refusal REC1150 - RECFutureNumberAvailable

Wednesday, September 22, 2010 Page 25


RECFutureAddressSpecific

Item number: REC 1145 Item tag:

Item type: Question Type class: String

Field kind: Datafield

Answers allowed: 1

Help tag:

Answer type: {Continuous Answer.}

FieldSize: 255 Min value:

Max value: ArrayMin: ArrayMax:


English text: ENTER FUTURE ADDRESS

Number Label Route

1 [Continuous answer.] REC1150 - RECFutureNumberAvailable

Display instructions: MASKED ENTRY FIELD

Wednesday, September 22, 2010 Page 26


RECFutureNumberAvailable

Item number: REC1150 Item tag:

Item type: Question Type class: Enumerated

Field kind: Datafield

Answers allowed: 1

Help tag:

Answer type: {User Defined.}

FieldSize: Min value: Max value: ArrayMin: ArrayMax:



English text: Do you know what your new telephone number will be?


Number Label

Route

1

Yes

REC1155 - RECFutureNumberSpecific


English text: YES


2

No

REC1160 - RECThankYou


English text: NO


3

NumberUnchanged

REC1160 - RECThankYou


English text: NUMBER UNCHANGED




Attribute Route

Refusal REC 1160 - RECThankYou

Wednesday, September 22, 2010 Page 27

RECFutureNumberSpecific

Item number: REC1155 Item tag:

Item type: Question Type class: String

Field kind: Datafield

Answers allowed: 1

Help tag:

Answer type: {Continuous Answer.}

FieldSize: 255 Min value:

Max value: ArrayMin: ArrayMax:



English text: ENTER NEW TELEPHONE NUMBER AFTER MOVE, INCLUDING AREA CODE.

Number Label Route

1 [Continuous answer.] REC1160 - RECThankYou

Wednesday, September 22, 2010 Page 28



RECThankYou

Item number: REC1160 Item tag:

Item type: Instruction Type class: Enumerated

Field kind: Datafield Answers allowed: 1 Help tag:

Answer type: TContinue

FieldSize: Min value: Max value: ArrayMin: ArrayMax:


English text: Thank you. Now we'll move to the next part of the interview. [PROVIDE SP WITH AUDADIS INCENTIVE #2.]

Number Label Route

1 Continue

English text: CONTINUE

Wednesday, September 22, 2010 Page 29



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Authorfstinson
Last Modified Byfstinson
File Modified2010-12-01
File Created2010-11-29
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