03-02-2011
Gulf States Population Survey
Telephone Questionnaire
GULF STATES POPULATION SURVEY 2
INTRO/SCREENER FOR LANDLINE TELEPHONES 2
INTRO/SCREENER FOR CELL TELEPHONES 8
Life Satisfaction and Emotional Support 13
Lifetime Anxiety and Depression 20
Patient Health Questionnaire 8 21
Generalized Anxiety Disorder 7 23
Employment Status Questions 28
Suicidal Thoughts and Behaviors 44
GSPS CATI Version 0920-xxxx
OMB #0920-xxxx
Expiration date _______
Public reporting burden of this collection of information is estimated to average 25-30 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining 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 Reports Clearance Officer; 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (0920-xxxx
// //ask all//
INTRO1. Hello, I am calling for CDC, the Centers for Disease Control and Prevention. My name is (name) . We are gathering information about the health of Gulf Coast residents. Your telephone number has been chosen randomly, and I would like to ask some questions about health and health practices.
//IF RESUMED INTERVIEW: “This call may be monitored or recorded for quality assurance purposes.”//
Is this (phone number) ?
01 Correct Number (proceed to next question)
02 Answering Machine (RESIDENCE)
03 Answering Machine (UNKNOWN)
05 [SELECTED RESPONDENT] ON THE PHONE
06 Fax Machine
07 Termination Screen
08 Hang Up – Before Intro
09 Number reached is not the number above.
12 Respondent refused to transfer to selected-1x
14 continue in spanish [reset to intro1]
//ask if intro1=01, 05//
HS1. Is this a private residence?
01 Yes
02 No
//if HS1 = 02//
X2. Thank you very much, but we are only interviewing private residences. [STOP]
//assign dispo 22 Not a Private Residence//
//asK if HS1=01//
HS2. Is this a cellular telephone?
[READ ONLY IF NECESSARY: “BY CELLULAR (OR CELL) TELEPHONE WE MEAN A TELEPHONE THAT IS MOBILE AND USABLE OUTSIDE OF YOUR NEIGHBORHOOD.” ]
01 No - Not a Cellular Telephone
02 Yes
//if HS2=02//
Thank you very much, but we are only interviewing land line telephones and private residences. [STOP]
//assign dispo 8 cell phone//
//ask if HS2=01//
ADULTS. I need to randomly select one adult who lives in your household to be interviewed. How many members of your household, including yourself, are 18 years of age or older?
__ Number of adults [RANGE 0-18]
//IF ADULTS >5//
NOTE2
I am sorry. I just want to make sure I recorded this correctly.
You said that there are [INSERT # FROM ADULTS] adults living in your household.
Is that correct?
01 CORRECT
02 NO, //GO BACK TO ADULTS//
//IF ADULTS =0//
ADULT0
You are saying there are NO adults 18 or over in your household.
Is that correct?
1 Yes, correct: NO adults 18 or over in household
2 No, incorrect
//if ADULTS = 0 //
NOADULT. I’m sorry we are only interviewing adult residents who are 18 years of age or older.
Thank you.”
// if adults=0 assign dispo 13//
//ask if ADULTS = 01//
ONEADULT Are you the adult?
21 Yes and the respondent is Male
22 Yes and the respondent is Female
03 No
[IF "YES"] Then you are the person I need to speak with.
[ENTER 1 MAN OR 1 WOMAN BELOW]
[ASK GENDER IF NECESSARY]
//goto?
//if ONEADULT=03//
ASKGENDR. Is the adult a man or a woman?
21 Male
22 Female
//if ONEADULT=03//
GETADULT. May I speak with [FILL IN (HIM/HER) FROM PREVIOUS QUESTION]?
01 Yes, Adult coming to the phone.
*** INTERVIEWER: IF NOT AVAILABLE - TYPE SUSPEND ***
If GETADULT=01 GO TO NEWADULT
IF getadult=02 terminate, schedule appointment for best time to reach adult
//ASK IF ADULTS>1//
MEN. How many of these adults are men
__ Number of men [RANGE 0-18]
IF MEN > 5
NOTE3
I am sorry. I just want to make sure I recorded this correctly.
You said that there are [INSERT # from MEN ] men living in your household.
Is that correct?
1 Yes, correct as is\
2 No, re-ask question
//ASK IF ADULTS>1//
WOMEN. … and how many are women?
__ Number of women [RANGE 0-18]
//ASK IF WOMEN > 5//
NOTE4
I am sorry. I just want to make sure I recorded this correctly.
You said that there are [INSERT # WOMEN] women living in your household.
Is that correct?
1 Yes, correct as is
2 No, re-ask question
RANDOMLY SELECT ADULT; Assign selected value:
01 Oldest Female
02 2nd Oldest Female
03 3rd Oldest Female
04 4th Oldest Female
05 5th Oldest Female
06 6th Oldest Female
07 7th Oldest Female
08 8th Oldest Female
09 9th Oldest Female
11 Oldest Male
12 2nd Oldest Male
13 3rd Oldest Male
14 4th Oldest Male
15 5th Oldest Male
16 6th Oldest Male
17 7th Oldest Male
18 8th Oldest Male
19 9th Oldest Male
20 No respondent selected
21 One person HH - Male
22 One person HH – Female
//ASK IF ADULTS > 1//
ASKFOR. The person in your household that I need to speak with is the [INSERT SELECTED]. Are you the person?
01 Yes
02 No
//if ASKFOR = 02//
GETNEWAD. May I speak with him or her?
01 Yes, Adult coming to the phone (go to newadult)
02 Go back to Adults question.
[WARNING: A NEW RESPONDENT MAY BE SELECTED & YOU NEED SUPERVISOR'S PERMISSION TO USE THIS OPTION]
*** [INTERVIEWER: IF RESPONDENT IS NOT AVAILABLE - TYPE SUSPEND]
//if getnewad=01 or getadult = 01//
NEWADULT. Hello, I am calling for CDC, the Centers for Disease Control and Prevention. My name is (name) . We are gathering information about the health of Gulf Coast residents. Your telephone number has been chosen randomly, and I would like to ask some questions about health and health practices.
//ask all//
YOURTHE1. I will not ask for your last name, address, or other personal information that can identify you. You do not have to answer any question you do not want to, and you can end the interview at any time. Any information you give me will be confidential. The interview takes approximately 20 minutes to complete. This call may be monitored or recorded for quality assurance purposes. If you have any questions about the survey, please call [insert phone number]
[INTERVIEWER NOTE: Type “suspend” if respondent does not want to continue.]
001 Person Interested, continue.
002 GO BACK TO ADULTS QUESTION
//ask of all//
INTRO1. Hello, I am calling for CDC, the Centers for Disease Control and Prevention. My name is (name). We are gathering information about the health of residents of Gulf Coast States. Your telephone number has been chosen randomly, and I would like to ask some questions about health and health practices.
//IF RESUMED INTERVIEW: “This call may be monitored or recorded for quality assurance purposes.”//
I have just a few questions to find out if you are eligible for the study.
01 Continue
02 No Answer
03 Busy
04 Answering Machine
06 Respondent says they do not live in the state
08 Termination screen
09 Not a safe time/driving
14 CONTINUE IN SPANISH [reset to intro1]
//ask if intro1=01//
SAFETY Is this a safe time to talk with you now or are you driving?
INTERVIEWER NOTE: If respondent indicates it is not safe to talk now, ask “When is a better time to try to call back?” and schedule an appointment.
1 SAFE TIME/NOT DRIVING
2 DRIVING/NOT A SAFE TIME [go to cb]
9 REFUSED [go to cb]
//ask if SAFETY=1//
RSPSTATE In what state do you live?
Alabama
Florida
Louisiana
Mississippi
any other state
DRIVING/NOT A SAFE TIME [go to cb]
7 DON’T KNOW / NOT SURE
9 REFUSED
IF “Don’t Know”, “Refused”, /if rspstate=7,9//
If Don’t know/Refused:
I’m sorry, but our data is compiled by state. In order to qualify for the interview we need to know which state you live in. Thank you for your time. STOP TERMDISP =31
IF “any other state”, /if rspstate=5// termdisp=//
Thank you very much, but we are only interviewing persons living in certain states at this time. STOP.
//ask if rspstate =1,2,3,4//
CTELNUM1
Is this (phone number) ?
[INTERVIEWER: PLEASE CONFIRM NEGATIVE RESPONSES TO ENSURE THAT RESPONDENT HAS HEARD AND UNDERSTOOD CORRECTLY.]
1 YES [Go to CELLFON2]
2 NO
3 NOT A SAFE TIME/DRIVING [GO TO CB]
7 DON’T KNOW / NOT SURE
9 REFUSED
If "no,” //if CTELNUM1=2//
Thank you very much, but I seem to have dialed the wrong number. It’s possible that your number may be called at a later time. STOP TERMDISP = 23
If “Don’t Know”, “Refused”, //If CTELNUM1=7, 9// TERMDISP =24
Thank you for your time. STOP
//If CTELNUM1=1 ask CELLFON2//
CELLFON2
Is this a cellular telephone?
[Read only if necessary: “By cellular telephone we mean a telephone that is mobile and usable outside of your neighborhood”.]
INTERVIEWER: PLEASE CONFIRM NEGATIVE RESPONSES TO ENSURE THAT RESPONDENT HAS HEARD AND UNDERSTOOD CORRECTLY.
1 YES [Go to CADULT]
2 NO
3 NOT A SAFE TIME/DRIVING [GO TO CB]
7 DON’T KNOW / NOT SURE
9 REFUSED
IF "No”, //If CELLFON2=2// TERMDISP =25
Thank you very much, but we are only interviewing cell telephones at this time. STOP
If “Don’t Know”, “Refused”, //If CELLFON2=7,9// TERMDISP =26
Thank you for your time. STOP
//If CELLFON2=1 ask CADULT/
CADULT
Are you 18 years of age or older?
[INTERVIEWER: PLEASE CONFIRM NEGATIVE RESPONSES TO ENSURE THAT RESPONDENT HAS HEARD AND UNDERSTOOD CORRECTLY. ASK GENDER IF NECESSARY.]
1 YES, Male Respondent [Go to PVTRESD2]
2 YES, Female Respondent [Go to PVTRESD2]
3 NO
4 NOT A SAFE TIME/DRIVING [Go to CB]
7 DON’T KNOW / NOT SURE
9 REFUSED
IF "No”, //If CADULT=3// TERMDISP =//
Thank you very much, but we are only interviewing persons aged 18 or older at this time. STOP.
IF “Don’t Know”, “Refused”, //If CADULT=7,9// TERMDISP =28
Thank you very much for your time. STOP
//IF CADULT=1,2 ask PVTRESD2//
PVTRESD2
Do you live in a private residence, that is, not in a dormitory or other type of group living situation?
READ ONLY IF NECESSARY: “By private residence, we mean someplace like a house or apartment.”
[INTERVIEWER: PLEASE CONFIRM NEGATIVE RESPONSES TO ENSURE THAT RESPONDENT HAS HEARD AND UNDERSTOOD CORRECTLY. THE PERSON DOES NOT NEED TO BE PHYSICALLY LOCATED IN THEIR PRIVATE RESIDENCE.]
1 YES [Go to landline]
2 NO
3 NOT A SAFE TIME/DRIVING [GO TO CB]
7 DON’T KNOW / NOT SURE
9 REFUSED
//if pvtresd2=2//
Thank you very much, but we are only interviewing persons who live in a private residence at this time. //STOP – TERMDISP = 35/
IF “Don’t Know”, “Refused”, //If PVTRESD2=7,9//
Thank you very much for your time. //STOP TERMDISP =29//
//If PVTRESD2=1 ask landline//
LANDLINE Do you also have a landline telephone in your home that is used to make and receive calls?
[READ ONLY IF NECESSARY: “By landline telephone, we mean a “regular” telephone in your home that is connected to outside telephone lines through a cable or cord and is used for making or receiving calls. Please include landline phones used for both business and personal use.”]
NOTE: Telephone service over the internet counts as landline service.
PLEASE CONFIRM NEGATIVE RESPONSES TO ENSURE THAT RESPONDENT HAS HEARD AND UNDERSTOOD CORRECTLY.
1 YES [GOTO PCTCELL]
2 NO [Go to svintro]
7 DON’T KNOW / NOT SURE
9 REFUSED
IF "No”, GO TO svintro
IF "Don’t Know” or “Refused”, GO TO TERMINATION TERMDISP =32
//If LANDLINE=1 ask PCTCELL//
//If LANDLINE=2 go to svintro//
//If LANDLINE = 7, 9 go to termination//
PCTCELL
Thinking about all the phone calls that you receive on your landline and cell phone, what percent, between 0 and 100, are received on your cell phone?
_ _ _ Enter Percent (1 to 100)
8 8 8 Zero
7 7 7 Don’t know/Not sure
9 9 9 Refused
//If any response to PCTCELL go to termination// TERMDISP =33
OR if landline=7, 9, go to termination
SURVEYINTRO
I will not ask for your last name, address, or other personal information that can identify you. You do not have to answer any question you do not want to, and you can end the interview at any time. Any information you give me will be confidential. The interview takes approximately 20 minutes to complete. The call may be monitored or recorded for quality assurance purposes. If you have any questions about the survey, please call [insert number].
//If INTRO1=9// or //If sAFETY=2,9// or //CTELNUM1=3// Or //If CELLFON2=3// or //If CADULT=4// OR //If PVTRESD2=3// OR //If rspSTATE=6//
//ask all//
1. LSATISFY. In general, how satisfied are you with your life?
READ LIST
01 Very satisfied
02 Satisfied
03 Dissatisfied
04 Very dissatisfied
97 Don’t know/ Not sure
99 Refused
//ask all//
2. EMTSUPRT. How often do you get the social and emotional support that you need?
READ LIST
01 Always
02 Usually
03 Sometimes
04 Rarely
05 Never
97 Don’t know/ Not sure
99 Refused
//ask all//
3. PHYSHTH2. How would you rate your physical health?
READ LIST
01 Excellent
02 Very good
03 Good
04 Fair
05 Poor
97 Don’t know/ Not sure
99 Refused
//ask all//
4.
MNTHTH2. How would you rate your mental health?
READ LIST
01 Excellent
02 Very good
03 Good
04 Fair
05 Poor
97 Don’t know/ Not sure
99 Refused
/ASK
ALL/
//RECORD ELAPSED TIME IN SECTIOn//
TMGNHLTH
/ASK ALL/
5. GENHLTH. How would you rate your general health?
READ LIST
01 Excellent
02 Very good
03 Good
04 Fair
05 Poor
97 Don’t know/ Not sure
99 Refused
//ask all//
6. PHYSHLTH. Now thinking about your physical health, which includes physical illness and injury, for about how many days during the past 30 days was your physical health not good?
__ 01-30 days
88 None
97 Don’t know/ Not sure
99 Refused
/ASK
ALL/
//RECORD ELAPSED TIME IN SECTIOn//
TMMENHLT
//ask all//
7. MENTHLTH. Now thinking about your mental health, which includes stress, depression, and problems with emotions, for how many days during the past 30 days was your mental health not good?
__ 01-30 days
88 None
97 Don’t know/ Not sure
99 Refused
//ask all//
The next questions are about how you see the world. Please tell me how much you agree that each statement describes you.
//ask all//
How strongly do you agree or disagree that:
8. COPE1. I have little control over the things that happen to me. Would you say you…
READ LIST FOR FIRST ITEM, AS NECESSARY THEREAFTER.
01 Strongly disagree
02 Disagree
03 Neither agree or disagree
04 Agree
05 Strongly agree
97 Don’t know/ Not sure
99 Refused
//ask all//
9. COPE2. What happens to me in the future mostly depends on me.
[READ LIST IF NECESSARY]
01 Strongly disagree
02 Disagree
03 Neither agree or disagree
04 Agree
05 Strongly agree
97 Don’t know/ Not sure
99 Refused
//ask all//
10. COPE3. I can do just about anything I really set my mind to do.
[READ LIST IF NECESSARY]
01 Strongly disagree
02 Disagree
03 Neither agree or disagree
04 Agree
05 Strongly agree
97 Don’t know/ Not sure
99 Refused
//ask all//
11. COPE4. I am confident in my ability to handle unexpected problems.
[READ LIST IF NECESSARY]
01 Strongly disagree
02 Disagree
03 Neither agree or disagree
04 Agree
05 Strongly agree
97 Don’t know/ Not sure
99 Refused
//ask all//
12. COPE5. When I need suggestions about how to deal with personal problems, I know there is someone I can turn to.
[READ LIST IF NECESSARY]
01 Strongly disagree
02 Disagree
03 Neither agree or disagree
04 Agree
05 Strongly agree
97 Don’t know/ Not sure
99 Refused
ASK ALL//
PRESC Now, I am going to ask you about several factors that can affect a person’s health.
//ask all//
13. SCHOME. How often would you say you are worried or stressed about having enough money to pay your rent/mortgage? Would you say you are worried or stressed ---
READ LIST
01 Always
02 Usually
03 Sometimes
04 Rarely
05 Never
97 Don’t know/ Not sure
99 Refused
//ask all//
14. SCMEAL. How often would you say you are worried or stressed about having enough money to buy nutritious meals? Would you say you are worried or stressed ---
READ LIST
01 Always
02 Usually
03 Sometimes
04 Rarely
05 Never
97 Don’t know/ Not sure
99 Refused
//ask all//
15. CHLDRN. How many children less than 18 years of age live in your household?
__ Number of children [RANGE= 1-20]
88 None
99 Refused
//rotate
the order of presentation CHLDDIF1-4
PROGRAMMING AND DP: USE
ROTCHLDA, ROTCHLDB, ROTCHLDC, and
ROTCHLDD to hold rotation order. Rotation order presentation order
will be: 1,2,3, or 4. ROTCHLA always represents what was asked first,
ROTCHLB represents what was aksed second, and so on. A value of 1
represents CHLDDIF1, a 2 represents CHLDDIF2, etc
For example, ROTCHLDA=1 means CHLDDIF1 was asked first//
ask if ≤1CHLDRN≤20
16. CHLDDIF. During the past 30 days, [IF CHLDRN=2-20 INSERT “have any of the children”, IF CHLDRN=1 INSERT “has the child” ] in your household experienced any of the following difficulties:
ask if ≤1CHLDRN≤20
//Programming display text of CHLDDIF for each of CHLDDIF1 THROUGH CHLDDIF4 AS [IF NEEDED: During the past 30 days, have any of the children in your household experienced any of the following difficulties:]
16a.CHLDDIF1 Been very sad or depressed?
01 Yes
02 No
97 Don’t know/ Not sure
99 Refused
/ask if ≤1CHLDRN≤20/
16b.CHLDDIF2 Felt nervous or afraid?
01 Yes
02 No
97 Don’t know/ Not sure
99 Refused
/ask if ≤1CHLDRN≤20/
16c.CHLDDIF3 Had problems sleeping?
01 Yes
02 No
97 Don’t know/ Not sure
99 Refused
/ask if ≤1CHLDRN≤20/
16d.CHLDDIF4 Had problems getting along with other children?
01 Yes
02 No
97 Don’t know/ Not sure
99 Refused
ask all/
And now I’m going to ask you questions about yourself.
//ask all//
17.ANX. Has a doctor or other healthcare provider EVER told you that you had an anxiety disorder, including acute stress disorder, anxiety, generalized anxiety disorder, obsessive-compulsive disorder, panic disorder, phobia, posttraumatic stress disorder, or social anxiety disorder?
01 Yes
02 No
97 Don’t know/ Not sure
99 Refused
//ask all//
18.DEPRESS. Has a doctor or other healthcare provider EVER told you that you had a depressive disorder, including depression, dysthymia, or minor depression?
01 Yes
02 No
97 Don’t know/ Not sure
99 Refused
Now I am going to ask you some questions about your mood. When answering these questions, please think about how many days each of the following has occurred in the past 2 weeks.
ask all
begtime
//ask all//
19.ADPLEASR. Over the last 2 weeks, how many days have you had little interest or pleasure in doing things?
//RANGE= 01-14, 88,97,99//
__ 01-14 days
88 None
97 Don’t know/ Not sure
99 Refused
//ask all//
20. ADDOWN. [MUST READ] Over the last 2 weeks, how many days have you felt down, depressed or hopeless?
//RANGE= 01-14, 88,97,99//
__ 01-14 days
88 None
97 Don’t know/ Not sure
99 Refused
//ask all//
21. ADSLEEP. [MUST READ] Over the last 2 weeks, how many days have you had trouble falling asleep or staying asleep or sleeping too much? //RANGE= 01-14, 88,97,99//
__ 01-14 days
88 None
97 Don’t know/ Not sure
99 Refused
//ask all//
22. ADENERGY. [MUST READ] Over the last 2 weeks, how many days have you felt tired or had little energy? //RANGE= 01-14, 88,97,99//
__ 01-14 days
88 None
97 Don’t know/ Not sure
99 Refused
//ask all//
23. ADEAT1. [MUST READ] Over the last 2 weeks, how many days have you had a poor appetite or eaten too much? //RANGE= 01-14, 88,97,99//
__ 01-14 days
88 None
97 Don’t know/ Not sure
99 Refused
//ask all//
24. ADFAIL. [MUST READ] Over the last 2 weeks, how many days have you felt bad about yourself or that you were a failure or had let yourself or your family down? //RANGE= 01-14, 88,97,99//
__ 01-14 days
88 None
97 Don’t know/ Not sure
99 Refused
//ask all//
25. ADTHINK. [MUST READ] Over the last 2 weeks, how many days have you had trouble concentrating on things, such as reading the newspaper or watching the TV?//RANGE= 01-14, 88,97,99//
__ 01-14 days
88 None
97 Don’t know/ Not sure
99 Refused
//ask all//
26. ADMOVE. [MUST READ] Over the last 2 weeks, how many days have you moved or spoken so slowly that other people could have noticed? Or the opposite – being so fidgety or restless that you were moving around a lot more than usual?//RANGE= 01-14, 88,97,99//
__ 01-14 days
88 None
97 Don’t know/ Not sure
99 Refused
//ask all//
PREANX Over the last two weeks, for how many days have you been bothered by the following problems…
//ask all//
27. ANXDIS1. [MUST READ] Over the last 2 weeks, how many days have you been nervous, anxious, or on edge?
//RANGE= 01-14, 88,97,99//
_ _ 01-14 days
88 None
97 Don’t know / Not sure
99 Refused
//ask all//
28. ANXDIS2. [MUST READ] Over the last 2 weeks, how many days have you not been able to stop or control worrying?
//RANGE= 01-14, 88,97,99//
_ _ 01-14 days
88 None
97 Don’t know / Not sure
99 Refused
//ask all//
29. ANXDIS3. [MUST READ] Over the last 2 weeks, how many days have you worried too much about different things?
//RANGE= 01-14, 88,97,99//
_ _ 01-14 days
88 None
97 Don’t know / Not sure
99 Refused
//ask all//
30. ANXDIS4. [MUST READ] Over the last 2 weeks, how many days have you had trouble relaxing?//RANGE= 01-14, 88,97,99//
_ _ 01-14 days
88 None
97 Don’t know / Not sure
99 Refused
//ask all//
31. ANXDIS5. [MUST READ] Over the last 2 weeks, how many days have you been so restless that it was hard to sit still?//RANGE= 01-14, 88,97,99//
_ _ 01-14 days
88 None
97 Don’t know / Not sure
99 Refused
//ask all//
32. ANXDIS6. [MUST READ] Over the last 2 weeks, how many days have you been easily annoyed or irritable?
//RANGE= 01-14, 88,97,99//
_ _ 01-14 days
88 None
97 Don’t know / Not sure
99 Refused
//ask all//
33. ANXDIS7. [MUST READ] Over the last 2 weeks, how many days have you felt afraid as if something awful might happen?
//RANGE= 01-14, 88,97,99//
_ _ 01-14 days
88 None
97 Don’t know / Not sure
99 Refused
ask all
endtime
danxt – total time for anxiety and depression sections
//ask all//
PSPILL Now I have some questions about environmental factors that may affect people’s health.
//ask all//
34. SPILL1. Are you aware of the Gulf oil spill that occurred in the Gulf of Mexico on April 20, 2010?
01 Yes
02 No
97 Don’t know/Not sure
99 Refused
if spill1=01
35. OILTCH1. Did you have direct contact with the oil from the Gulf oil spill?
01 Yes
02 No
97 Don’t know / Not sure
99 Refused
ask if oiltch1=01
36. OILTCH2. Did you have contact through:
ask if oiltch1=01/
//PROGRAMMING, PLEASE ROTATE ORDER OF OILTCHa, OILTCHb, and OILTCHc//
//USE ROTOIL TO HOLD DISPLAY ORDER OF OILTCHa through OILCHc. Will contain the following depending on order display ABC, BCA, CAB/
PROGRAMMING AND DP: USE ROTOIL_A, ROTOIL_B, ROTOIL_C, to hold rotation order. Rotation order presentation order will be: A, B, or C. ROTOIL_A always represents what was asked first, ROTOIL_B represents what was asked second, and so on. A value of A represents OILTCHa, a B represents OILTCHB
For example, ROTOIL_A=A means OILTCHa was asked first.//
/
36a.OILTCHa. [Did you have contact through] Your skin?
01 Yes
02 No
97 Don’t know / Not sure
99 Refused
/ask if oiltch1=01/
36b.OILTCHb. [Did you have contact through] Inhalation (for example, breathing it in)?
01 Yes
02 No
97 Don’t know / Not sure
99 Refused
/ask if oiltch1=01/
36c.OILTCHc. [Did you have contact through] Ingestion (for example, swallowing)?
01 Yes
02 No
97 Don’t know / Not sure
99 Refused
/ask if oiltch1=01/
36d.OILTCHd. Did you have contact in any other way?
01 Yes
02 No
97 Don’t know / Not sure
99 Refused
if OILTCHd=01
36e.OILTCHDo [In what other way did you have contact?] SPECIFY WAY
/IF
SPILL1=01/
//RECORD ELAPSED TIME IN SECTIOn//
TMOILEM
if spill1=01
37. OILEMPLY. What was your employment status before the Gulf oil spill?
[INTERVIEWER: IF RESPONDENT PROVIDES MORE THAN ONE RESPONSE, e.g. “ employed For wages” and “student”, please probe for the main answer/what the respondent did most. If the REsPONDENT SAYS THEY WERE UNEMPLOYED OR OUT OF WORK, PLEASE PROBE TO FIND IT IF IT WAS FOR MORE OR LESS than one year.]
[READ LIST]
01 Employed for wages
02 Self-employed
03 Out of work for more than 1 year
04 Out of work for less than 1 year
05 A homemaker
06 A student
07 Retired
08 Unable to work
97 DON’t KNOW
99 Refused
if spill1=01
38. OILINC. How did the Gulf oil spill affect your household income?
READ LIST
01 Decreased
02 Increased
03 No change
97 Don’t know / Not sure
99 Refused
if oilemply in (01,02)
39. OILIND //DP DELIVER AS OILINDSY//. What type of industry were you employed in prior to the Gulf oil spill?
//Allow multiple responses//
[MUL=9]
READ LIST
[INTERVIEWER, CHOOSE ALL THAT APPLY]
01 Fishing, agriculture, forestry, hunting
02 Oil and gas extraction, mining
03 Construction
04 Manufacturing
05 Wholesale or retail
06 Hotels, restaurants, recreation, arts, and entertainment
07 Healthcare, social assistance
08 Real estate, rental, and leasing
09 Something else
97 Don’t know/Not sure
99 Refused
ask if OILIND =09/
OILINDO. SPECIFY INDUSTRY
_________________
if spill1=01
40.
LOSTJOB. Including yourself, how many people in your household lost
their jobs due to the Gulf oil spill?
__RECORD NUMBER OF PEOPLE [1-9, 10=10 or more ]
88 None
97 Don’t know/ Not sure
99 Refused
if spill1=01
41. OILCLN1. Did you participate in the Gulf oil spill cleanup activities?
01 Yes
02 No
97 Don’t know / Not sure
99 Refused
ask if oilcln1=01
42. OILCLN2. Were you a volunteer or did you get paid?
01 Volunteer
02 Paid
97 Don’t know/Not sure
99 Refused
ask if oilcln1=01
43. What type of cleanup activities did you participate in? Did you help with…
ask if oilcln1=01/
43a.
OILCLN31 [IF NEEDED: What type of cleanup activities did you
participate in? Did you help with…]
Beach or marsh
cleanup?
01 YES
02 NO
97 Don’t know/Not sure
99 Refused
ask if oilcln1=01/
43b.OILCLN32
[IF NEEDED: What type of cleanup activities did you participate in?
Did you help with…]
Birds or wildlife cleanup?
01 YES
02 NO
97 Don’t know/Not sure
99 Refused
ask if oilcln1=01/
43c.
OILCLN33 [IF NEEDED: What type of cleanup activities did you
participate in? Did you help with…]
Boom deployment and
recovery or off-shore skimming?
01 YES
02 NO
97 Don’t know/Not sure
99 Refused
/ask if oilcln1=01/
44d.OILCLN34
[IF NEEDED: What type of cleanup activities did you participate in?
Did you help with…]
Decontamination or Waste stream
management?
01 YES
02 NO
97 Don’t know/Not sure
99 Refused
/ask if oilcln1=01/
44e.
OILCLN35 [IF NEEDED: What type of cleanup activities did you
participate in? Did you help
At the well-head or controlled
burning?
01 YES
02 NO
97 Don’t know/Not sure
99 Refused
/ask if oilcln1=01/
44f.OILCLN36
[IF NEEDED: What type of cleanup activities did you participate in?
Did you help with…]
Administrative, logistical, or
medical support ?
01 YES
02 NO
97 Don’t know/Not sure
99 Refused
/ask if oilcln1=01/
44g.
OILCLN37 [IF NEEDED: What type of cleanup activities did you
participate in? Did you help with…]
Anything else?
01 YES
02 NO
97 Don’t know/Not sure
99 Refused
/ASK IF OILCLN37=01/
44h.OILCLN3o(DP please deliver as OILCLN37o)
What
other type of cleanup activities did you participate in?
ENTER
OTHER SPECIFY
//ask all//
45.SEX. [INTERVIEWER, ASK ONLY IF UNSURE] I’m sorry but I have to ask. What is your gender?
01 Male
02 Female
//ASK SEXA THROUGH SEXD IF GENDER FROM SCREENER DIFFERENT FROM GENDER IN SEX//
INTERVIEWER: Are you sure the respondent is FEMALE?
The respondent selected was the \:list:
You need to go back and correct the mistake.
//ask all//
46.AGE. What is your age?
[RANGE=18-96]
[INTERVIEWER
USE 96 FOR AGES 96 AND OLDER]
__ code age in years
97 Don’t know/Not sure
99 Refused
//ask IF AGE= 97 OR 99//
AGECAT.
In which of these age categories do you belong?
[READ LIST]
01 18-24
02 25-34
03 35-44
04 45-54
05 55-64
06 65 or older
97 dk
99 Refused
/ASK
ALL/
//RECORD ELAPSED TIME IN SECTIOn//
TMHISP
//ask all//
47. HISP. Are you Hispanic or Latino?
01 Yes
02 No
97 Don’t know/Not sure
99 Refused
//ask all//
48.
RACE. Which one of these groups would you say best represents your
race?
[INTERVIEWER NOTE: IF RESPONDENT PROVIDES A RESPONSE OF “DON’T KNOW” OR “REFUSE” Please probe with “I understand that these categories are not fully inclusive. Of the categories provided, which one would you say best represents your race?” (Read list again if necessary)]
[READ LIST]
01 American Indian or Alaska Native
02 Asian
03 Black or African American
04 Native Hawaiian or Other Pacific Islander
05 White
[DO NOT READ]
06 Respondent provides category of race not listed above
97 Don’t know/Not sure
99 Refused
//ASK ALL//
//RECORD ELAPSED TIME IN SECTION
TMEMPLY
//ask all//
49. EMPLOY. What is your employment status?
[IF NEEDED: WE’D LIKE TO KNOW YOUR CURRENT EMPLOYMENT STATUS. CAN YOU TELL ME: WHAT IS YOUR CURRENT EMPLOYMENT STATUS?]
[INTERVIEWER: IF RESPONDENT PROVIDES MORE THAN ONE RESPONSE, e.g. “employed For Wages” and “student”, please probe for the main answer/what the respondent did most. If the REsPONDENT SAYS THEY WERE UNEMPLOYED OR OUT OF WORK, PLEASE PROBE TO FIND IT IF IT WAS FOR MORE OR LESS than one year.]
[READ LIST]
01 Employed for wages
02 Self-employed
03 Out of work for more than 1 year
04 Out of work for less than 1 year
05 A homemaker
06 A student
07 Retired
08 Unable to work
97 DK
99 Refused
Ask if employ in (01,02)
50. INDST //DP DELIVER AS INDSTRY//. What type of industry are you currently employed in?
[READ LIST]
allow multiple responses/
[MUl=9]
[INTERVIEWER: CHOOSE ALL THAT APPLY]
01 Fishing, agriculture, forestry, hunting
02 Oil and gas extraction, mining
03 Construction
04 Manufacturing
05 Wholesale or retail
06 Hotels, restaurants, recreation, arts, and entertainment
07 Healthcare, social assistance
08 Real estate, rental, and leasing or
09 Something else
97 Don’t know/Not sure
99 Refused
ask if INDST=09
INDSTO //DP DELIVER AS INDSTRYo//. SPECIFY INDUSTRY
_________________
//ask all//
51. MRTL. What is your current marital status?
[READ LIST]
01 Married
02 Divorced
03 Widowed
04 Separated
05 Never married
06 A member of an unmarried couple
97 DK
99 Refused
//ask all//
52. CTY. What [IF sample/LSTATE= Al/Alabama, Fl/Florida, MS/MISSISSIPPI USE “COUNTY”. IF SAMPLE/LSTATE= LA/LOUISIANA, THEN “PARISH”] do you live in?
Programmer
note: pull down list to include sampled counties within the state
specified on the sample frame; other counties will be write-ins with
a readback to the respondent for verification
[PROGRAMMING/DP
NOTE:
LSTATE=AL Means Sampled state=ALABAMa
LSTATE=FL MEANS SAMPLED STATE=FLORIDA
LSTATE=MS MEANS SAMPLED STATE=MISSISSIPPI
LSTATE=LA MEANS SAMPLED STATE=LOuisianA
001 GAVE COUNTY
997 DON’T KNOW/NOT SURE
999. REFUSED
//ask all//
53. ZIP. What is your zip code?
ENTER RESPONSE /numeric 00000-99996.
___ record response /range 00000-99996/
99997 don’t KNOW
99999 REFUSED
//ask all//
54. CVDINFR4. Has a doctor, nurse, or other health professional EVER told you that you had a heart attack, also called a myocardial infarction?
01 Yes
02 No
97 Don’t know/Not sure
99 Refused
//ask all//
55. CVDCRHD4. [MUST READ] Has a doctor, nurse, or other health professional EVER told you that you had angina or coronary heart disease?
01 Yes
02 No
97 Don’t know/Not sure
99 Refused
//ask all//
56. CVDSTRK3. [MUST READ] Has a doctor, nurse, or other health professional EVER told you that you had a stroke?
01 Yes
02 No
97 Don’t know/Not sure
99 Refused
//ask all//
57. ASTHMA2. [MUST READ] Have you ever been told by a doctor, nurse, or other health professional that you had asthma?
01 Yes
02 No
97 Don’t know/Not sure
99 Refused
//ask if Ashtma2=01//
58. ASTHNOW. Do you still have asthma?
01 Yes
02 No
97 Don’t know/Not sure
99 Refused
//ask all//
59. DIABETE2. [MUST READ] Have you ever been told by a doctor that you have diabetes? [INTERVIEWER: If “Yes” and respondent is female, ask: “Was this only when you were pregnant?” ]
[INTERVIEWER: If respondent says they have been told they have “sugar” “high sugar” “blood sugar” or “high blood sugar” code as 01)
[INTERVIEWER: If respondent says pre-diabetes or borderline diabetes, use response code 4. ]
01 Yes
02 Yes, but female told only during pregnancy
03 No
04 No, pre-diabetes or borderline diabetes
97 Don’t know / Not sure
99 Refused
//ask all//
60. HAVARTH2. [MUST READ] Have you ever been told by a doctor or other health professional that you have some form of arthritis, rheumatoid arthritis, gout, lupus, or fibromyalgia?
[INTERVIEWER
NOTE: Arthritis
diagnoses include:
rheumatism, polymyalgia rheumatica
osteoarthritis (not osteoporosis)
tendonitis, bursitis, bunion, tennis elbow
carpal tunnel syndrome, tarsal tunnel syndrome
joint infection, Reiter’s syndrome
ankylosing spondylitis; spondylosis
rotator cuff syndrome
connective tissue disease, scleroderma, polymyositis, Raynaud’s syndrome
vasculitis (giant cell arteritis, Henoch-Schonlein purpura, Wegener’s granulomatosis, polyarteritis nodosa)]
01 Yes
02 No
97 Don’t know/Not sure
99 Refused
//ask all//
61. EXERANY2. During the past 30 days, other than your regular job, did you participate in any physical activities or exercises such as running, calisthenics, golf, gardening, or walking for exercise?
01 Yes
02 No
97 Don’t know/Not sure
99 Refused
//ask all//
62. ALCDAY4. During the past 30 days how many days per week or per month did you have at least one drink of any alcoholic beverage?
[RANGE=101-107,201-230, 888, 997, and 999]
1 _ _ Days per week
2 _ _ Days in past 30 days
888 No drinks in past 30 days
997 Don’t know / Not sure
999 Refused
//ask all//
//ASK IF ALCDAY4= 101-107,201-230, 997//
63. AVEDRNK2. One drink is equivalent to a 12-ounce beer, a 5 ounce glass of wine, or a drink with one shot of liquor. During the past 30 days, on the days when you drank, about how many drinks did you drink on the average? [NOTE: A 40 OUNCE BEER WOULD COUNT AS 3 DRINKS, OR A COCKTAIL DRINK WITH 2 SHOTS WOULD COUNT AS 2 DRINKS].
_ _ Number of drinks [Range 1-76, 97,99]
97 Don’t know / Not sure
99 Refused
//ask IFALCDAY4=101-101-107, 201-230, 997
64. DRNK3GE5. Considering all types of alcoholic beverages, how many times during the past 30 days did you have [INSERT ”5” IF SEX=01 MALE; INSERT “4” IF SEX=02 FEMALE] or more drinks on one occasion?
_ _ Number of times [Range 1-76, 88, 97, 99]
88 None
97 Don’t know / Not sure
99 Refused
//ask all//
65. SMOKE100. Have you smoked at least 100 cigarettes in your entire life? [Note: 5 packs = 100 cigarettes]
01 Yes
02 No
97 Don’t know/ Not sure
99 Refused
//if smoke100 in (01)
66. SMOKDAY2. Do you smoke cigarettes every day, some days, or not at all?
01 Every day
02 Some days
03 Not at all
97 Don’t know/Not sure
99 Refused
//ask all//
67. SCRIP. In the past 30 days, have you increased your level of prescription or non-prescription medication use without the advice of a doctor or other health care professional?
01 Yes
02 No
97 Don’t know/Not sure
99 Refused
//ask all//
68. USEEQUIP. Do you have a health problem that requires you to use special equipment, such as a cane, a wheelchair, a special bed, or a special telephone? Including occasional use or use in certain circumstances.
01 Yes
02 No
97 Don’t know/Not sure
99 Refused
//ask all//
69. DIS1MNT. During the past 30 days, for about how many days did a mental health condition or emotional problem keep you from doing your work or other usual activities?
__ 01-30 days
88 None
97 Don’t know/Not sure
99 Refused
//ask all//
70. DIS1PHS. During the past 30 days, for about how many days did a physical health problem keep you from doing your work or other usual activities?
__ 01-30 days
88 None
97 Don’t know/Not sure
99 Refused
//ask all//
71. HLTHPLAN. Do you have any kind of health care coverage, including health insurance, prepaid plans such as HMOs, or government plans such as Medicare?
01 Yes
02 No
97 Don’t know/Not sure
99 Refused
ask if HLTHPLAN=1
72. MHCOV. Does your health care plan include mental health coverage?
01 Yes
02 No
97 Don’t know/Not sure
99 Refused
//ask all//
73. COUNSEL1. Have you EVER received any sort of counseling for problems with your emotions, nerves, or mental health? [INTERVIEWER PLEASE READ: Please include counseling from a family doctor, psychiatrist, psychologist, social worker, therapist, or clergy.]
01 Yes
02 no
97 Don’t know/Not sure
99 Refused
If Counsel1=1
74. COUNSEL2. In the past year, how many times have you received counseling for problems with emotions, nerves, or mental health?
[INTERVIEWER: DO NOT HELP THE SR DO THE MATH IF THEY SAY SOMETHING LIKE “I GO ONCE A WEEK”. INSTEAD, PROBE FOR THEIR BEST GUESS AND CODE AS “DON’T KNOW” IF, AFTER PROBING, THEY DO NOT PROVIDE A NUMBER FOR THE PAST 12 MONTHS.]
/RANGE=1-365, 888, 997, OR 999/
___ 1-365 [verification starting at 100]
888 HASN’t received COUNSELING WITHIN THE PAST YEAR
997Don’t know/ Not sure
999 Refused
/ASK IF COUNSEL2 >=100 AND COUNSEL2 <=365/
CNSL2VER
I
just want to make sure I recorded that correctly. You said you
received counseling [INSERT NUMBER FROM COUNSEL2] times within the
past year. Is that correct?
01 YES
02 NO /GO BACK TO COUNSEL2/
If Counsel1=1
75. COUNSEL3. Were you EVER prescribed medication for problems with your emotions, nerves, or mental health?
01 Yes
02 No
97 Don’t know / Not sure
99 Refused
ask if counsel3=1/
76. COUNSEL4. When were you first prescribed medication for problems with your emotions, nerves, or mental health?
READ LIST
01 Within the past month- that is, anytime less than 1 month ago.
02 Within the past year- that is, 1 month but less than 12 months ago.
03 Within the past 2 years- that is, 1 year but less than 2 years ago.
04 two or more years ago.
97 Don’t know/ Not sure
99 Refused
//ask all//
PRESU The next few questions deal with suicide and intimate partner violence. We realize that these topics are quite personal and can be difficult to think and talk about, but we would appreciate it if you would try to answer these questions to the best of your ability
The next questions deal with thoughts of suicide. We wish to remind you that you don't have to answer any questions you don't want to.
01 Continue
99 Refused – does not want to answer this section of question
//if presu in (01)
77. SUICIDE1. At any time in the past 12 months, did you seriously think about trying to kill yourself?
01 Yes
02 No
97 Don’t know/Not sure
99 Refused
//if suicide1 in (01,97)
78. SUICIDE2. At any time in the past 12 months, did you make any plans to kill yourself?
01 Yes
02 No
97 Don’t know/Not sure
99 Refused
// if suicide1 in (01,97)
79. SUICIDE3. At any time in the past 12 months, did you try to kill yourself?
01 Yes
02 No
97 Don’t know/Not sure
99 Refused
//ask all//
HOTLINE. We are giving this information to everyone.... If you or someone you know would like to talk to a trained counselor, there is a confidential, toll-free, national suicide prevention, telephone hotline you can call 1-800-273-TALK. That is 8255. Would you like me to repeat the number?
01 Respondent requests hotline number repeated
02 Respondent does not need hotline number repeated
if hotline in (01)
HOTLINE1 Again, the number is 1-800-273-TALK. That is 8255
//ask all//
PREVIO
The
next questions are about different types of violence in relationships
with an intimate partner. By an intimate partner I mean any current
or former spouse, boyfriend, or girlfriend. Someone you were dating,
or romantically or sexually intimate with would also be considered an
intimate partner.
This information will help us to better understand the problem of violence in relationships.
This is a sensitive topic. Some people may feel uncomfortable with these questions.
At the end of this section, I will give you phone numbers of organizations that can provide information and referral for these issues.
Please keep in mind that if you are not in a safe place you can ask me to skip any question you do not want to answer.
[INTERVIEWER: FOR RESPONDENT’S SAFETY, IF YOU SUSPECT THAT SOMEONE IN THE RESPONDENT’S HOUSEHOLD IS LISTENING ON THE LINE, CODE 99 WITHOUT ASKING THE INTIMATE PARTNER VIOLENCE QUESTIONS]
01 Continue
99 Refused – does not want to answer this section of question
//ask if previo in (01)
80. VIOLENC1. Are you in a safe place to answer these questions?
[INTERVIEWER: FOR RESPONDENT’S SAFETY, IF YOU SUSPECT THAT SOMEONE IN THE RESPONDENT’S HOUSEHOLD IS LISTENING ON THE LINE, CODE 99 WITHOUT ASKING THE INTIMATE PARTNER VIOLENCE QUESTIONS]
01 Yes
02 No
97 Don’t know/Not sure
99 Refused
ASK IF VIOLENC1=01
81. VIOLENC2. At any time in the past 12 months has an intimate partner hit, slapped, pushed, kicked, or hurt you in any way?
[INTERVIEWER: FOR RESPONDENT’S SAFETY, IF YOU SUSPECT THAT SOMEONE IN THE RESPONDENT’S HOUSEHOLD IS LISTENING ON THE LINE, CODE 99 WITHOUT ASKING THE INTIMATE PARTNER VIOLENCE QUESTIONS]
01 Yes
02 No
97 Don’t know/Not sure
99 Refused
ASK IF VIOLENC1=01/
82. VIOLENC3. At any time in the past 12 months has an intimate partner put you down, humiliated you or tried to control what you can do?
[INTERVIEWER: FOR RESPONDENT’S SAFETY, IF YOU SUSPECT THAT SOMEONE IN THE RESPONDENT’S HOUSEHOLD IS LISTENING ON THE LINE, CODE 99 WITHOUT ASKING THE INTIMATE PARTNER VIOLENCE QUESTIONS]
01 Yes
02 No
97 Don’t know/Not sure
99 Refused
//ask all//
HOTLINE2. We are giving this information to everyone...We realize that this topic may bring up past experiences that some people may wish to talk about. If you or someone you know would like to talk to a trained counselor, there is a toll-free and confidential intimate partner violence telephone hotline you can call. The number is 1- 800-799-SAFE. That is 7233. Would you like me to repeat the number?
[INTERVIEWER: FOR RESPONDENT’S SAFETY, IF YOU SUSPECT THAT SOMEONE IN THE RESPONDENT’S HOUSEHOLD IS LISTENING ON THE LINE, CODE 99 WITHOUT ASKING THE INTIMATE PARTNER VIOLENCE QUESTIONS]
01 Respondent requests hotline number repeated
02 Respondent does not need hotline number repeated
99 DID NOT READ HOTLINE NUMBER/INFO SUSPECT SOMEONE LISTENING IN
if hotline2 in (01)
HOTLINE3 Again, the number is 1- 800-799-SAFE. That is 7233.
//ask all//
PINCOME I have just one final question about your household.
//ask all//
83. INCOME. What was your estimated household income from all sources in 2010? Was it....IF RESPONDENT REFUSES AT ANY INCOME LEVEL, CODE ‘99’ REFUSED
INCOME0 Less than $25,000 [IF “NO,” ASK 05; IF “YES,” ASK 03]
($20,000 to less than $25,000)
01 Yes
02 No
97 Don’t Know
99 Refused
//ask if income0= 01//
INCOME03 Less than $20,000 [IF “NO,” ASK 05; IF “YES,” ASK 03]
($15,000 to less than $20,000)
01 Yes
02 No
97 Don’t Know
99 Refused
//ask if income03 = 01//
INCOME02 Less than $15,000 [IF “NO,” ASK 05; IF “YES,” ASK 03]
($10,000 to less than $15,000)
01 Yes
02 No
97 Don’t Know
99 Refused
//ask if income02= 01//
INCOME01 Less than $10,000 [IF “NO,” CODE 02]
01 Yes
02 No
97 Don’t Know
99 Refused
//ask if income0= 02//
INCOME05 Less than $35,000 [IF “NO,” ASK 06]
($25,000 to less than $35,000)
01 Yes
02 No
97 Don’t Know
99 Refused
//ask if income05 = 02//
INCOME06 Less than $50,000 [IF “NO,” ASK 07]
($35,000 to less than $50,000)
01 Yes
02 No
97 Don’t Know
99 Refused
//ask if income06 = 02//
INCOME07 Less than $75,000 [IF “NO,” CODE 08]
($50,000 to less than $75,000)
01 Yes
02 No
97 Don’t Know
99 Refused
//ask if income07 = 02//
INCOME08 $75,000 or more ?
01 Yes
02 No
97 Don’t Know
99 Refused
//Data processor: USE INCVER TO STORE FINAL INCOME//
INCVER:
01 less than $10,000
02 $10,000 to less than $15,000
03 $15,000 to less than $20,000
04 $20,000 to less than $25,000
05 $25,000 to less than $35,000
06 $35,000 to less than $50,000
07 $50,000 to less than $75,000
08 $75,000 or more
77 Don't know/ Not sure
99 Refused
/ASK ALL/
CLOSE
Those are all the questions I have for you today. On behalf of the CDC, Centers for Disease Control and Prevention, I thank you for participating in this important survey. Thank you for your time
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | tws2 |
| File Modified | 0000-00-00 |
| File Created | 2021-02-01 |