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pdfAppendix A
PIAAC Main Study Screener
SCQ1010
SCQAskNumberInHH
Item Type: Question
Item Class: Integer
Item Text: Including yourself, how many people live in this household and have no usual place of
residence elsewhere?
Display:
Notes: Start enumeration timing here.
Lower Range: 1
CATA: NO
Answers Allowed:
Response
1 [Enter continuous answer.]
1
Upper Range: 25
Value Label
990 REFUSED
Version Date:
Skip To
SCQ1015
SCQ1015
Page 1 of 43
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A-1
SCQ1015
Item Type: Route
Item Class: Begin Loop
Item Text: The following variables -- name, Screener respondent, gender, age, age range, and the
misreported field (SCQ1020-SCQ1090) -- should appear as a grid. All enumeration
information is entered in this grid.
Display:
Notes:
Response
1 [Route executed.]
Version Date:
Value Label
Skip To
SCQ1020
Page 2 of 43
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A-2
SCQ1020
SCQNameHHM
Item Type: Question
Item Class: String
Item 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?
[B] Next, please tell me the names of all other members of this household (starting with
your spouse, if applicable).
[C] 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 PERSONS 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.]
[PRESS THE DOWN ARROW KEY TO MOVE TO THE NEXT BLANK LINE. WHEN ALL
NAMES ARE ENTERED, USE ARROW UP AND RIGHT KEYS TO GET TO NEXT
QUESTION.]
[PRESS ENTER ON A BLANK LINE TO EXIT THE GRID.]
Display: For the first line on the grid, display text A. For the second line, display text B. For all
subsequent lines, display text C.
Notes: Allow 25 characters for names.
This variable should appear as the first column on the grid.
Lower Range:
CATA: NO
Answers Allowed:
Response
1 [Enter continuous answer.]
Version Date:
Upper Range:
Value Label
Skip To
SCQ1025
Page 3 of 43
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A-3
SCQ1025
SCQWhoIsRespondent
Item Type: Question
Item Class: Enumerated
Item Text: [ENTER A '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.]
Display:
Notes: Allow only one response to this question. This variable should appear as the second
column in the grid.
CATA: NO
Answers Allowed:
Response
1 RESPONDENT
Version Date:
1
Value Label
Respondent
Skip To
SCQ1030
Page 4 of 43
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A-4
SCQ1030
Item Type: Route
Item Class: If Then
Item Text: Allow open movement through grid. Do not require users to ask all items for each person
before going to the next person.
Display:
Notes:
Response
1 [Route executed.]
Version Date:
Value Label
Skip To
SCQ1040
Page 5 of 43
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A-5
SCQ1040
SCQGender
Item Type: Question
Item Class: Enumerated
Item Text: [CODE GENDER. IF NOT OBVIOUS, ASK: Is {NAME} male or female?]
Display:
Notes: This variable should appear as the third column on the grid.
CATA: NO
Version Date:
Answers Allowed:
1
Response
1 MALE
Value Label
Male
Skip To
SCQ1050
2 FEMALE
Female
SCQ1050
Page 6 of 43
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A-6
SCQ1050
SCQAge
Item Type: Question
Item Class: Integer
Item Text: How old {are you/is NAME}?
[IF UNDER 1 YEAR, ENTER AS "0"]
Display:
Notes: This variable should appear as the fourth column on the grid.
Lower Range: 0
CATA: NO
Answers Allowed:
Response
1 [Enter continuous answer.]
1
Upper Range: 130
Value Label
Skip To
SCQ1055
980 DON'T KNOW
SCQ1060
990 REFUSED
SCQ1060
Version Date:
Page 7 of 43
10/26/2009
A-7
SCQ1055
Item Type: Check
Item Class: Soft
Item 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?"
Associated variable: SCQ1050
Display:
Notes:
Response
1 [Check executed.]
Version Date:
Value Label
Skip To
SCQ1090
Page 8 of 43
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A-8
SCQ1060
SCQAgeRange
Item Type: Question
Item Class: Enumerated
Item Text: {Are you/Is NAME}...
Display:
Notes: This variable should appear as the fifth column on the grid.
CATA: NO
Answers Allowed:
1
Response
1 Under 16 years old?
Value Label
Under16YearsOld
Skip To
SCQ1090
2 16 to 25 years old?
F16To25YearsOld
SCQ1090
3 26 to 35 years old?
F26To35YearsOld
SCQ1090
4 36 to 45 years old?
F36To45YearsOld
SCQ1090
5 46 to 55 years old?
F46To55YearsOld
SCQ1090
6 56 to 65 years old?
F56To65YearsOld
SCQ1090
7 66 years old or older?
F66YearsOldOrOlder
SCQ1090
980 DON'T KNOW
SCQ1061
990 REFUSED
SCQ1061
Version Date:
Page 9 of 43
10/26/2009
A-9
SCQ1061
SCQBroadAgeRange
Item Type: Question
Item Class: Enumerated
Item Text: {Are you/Is NAME}…
Display:
Notes: This variable should appear as the sixth column on the grid.
CATA: NO
Version Date:
Answers Allowed:
Response
1 Under 16 years old?
Value Label
Under16YearsOld_
Skip To
SCQ1090
2 16 to 39 years old?
_16To39YearsOld_
SCQ1090
3 40 to 65 years old?
_40To65YearsOld
SCQ1090
4 66 years old or older?
_66YearsOldOrOlder
SCQ1090
Page 10 of 43
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A-10
SCQ1090
SCQMisreportedHHM
Item Type: Instruction
Item Class: Enumerated
Item Text: [LEAVE EMPTY UNLESS PERSON WAS MISREPORTED AND IS NOT A HOUSEHOLD
MEMBER. IF MISREPORTED, ENTER "1".]
Display: 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."
Notes: The default for this field is blank - it will only be filled if necessary.
This variable should appear as the seventh column on the grid.
Response
1 MISREPORTED
Version Date:
Value Label
Misreported
Skip To
SCQ1100
Page 11 of 43
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A-11
SCQ1100
SCQAllInfoEntered
Item Type: Question
Item Class: Enumerated
Item Text: [HAVE YOU ENTERED ALL NECESSARY INFORMATION ON THE GRID?]
Display:
Notes: This item should appear in the first column of the first empty row.
CATA: NO
Version Date:
Answers Allowed:
1
Response
1 YES
Value Label
Yes
Skip To
SCQ1102
2 NO
No
SCQ1102
Page 12 of 43
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A-12
SCQ1102
Item Type: Route
Item Class: If Then
Item Text: Check enumeration grid to ensure that all necessary items have been answered. If any
necessary fields are blank, return to grid. Else, go to SCQ1105.
Display:
Notes:
Response
Version Date:
Value Label
Skip To
Page 13 of 43
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A-13
SCQ1105
SCQAnyoneElse
Item Type: Question
Item Class: Enumerated
Item 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?
Display: Display the number of household members collected in the enumeration grid in
{NUMBER}. Display the name, gender and age of all household members collected in
the grid in {NAME/GENDER/AGE}.
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.
CATA: NO
Answers Allowed:
1
Response
1 YES
Value Label
Yes
Skip To
SCQ1106
2 NO
No
SCQ1110
990 REFUSED
Version Date:
SCQ1110
Page 14 of 43
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A-14
SCQ1106
Item Type: Check
Item Class: Hard
Item Text: PLEASE ADD ADDITIONAL INFORMATION TO THE TABLE.
Display:
Notes:
Response
1 [Check executed.]
Version Date:
Value Label
Skip To
SCQ1020
Page 15 of 43
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A-15
SCQ1110
Item Type: Route
Item Class: If Then
Item Text: Insert sampling messages here. Based on collected household characteristics,
determine if there is at least one eligible person in the household.
If there is at least one eligible person, then go to SCQ1115.
Else, go to SCQ1124.
Display:
Notes: Eligibility is determined at the time enumeration is completed. SCQ1105 is the final
enumeration question that must be answered to determine eligibility.
Response
1 [Route executed.]
Version Date:
Value Label
Skip To
Page 16 of 43
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A-16
SCQ1115
SCQEligiblePersons
Item Type: Instruction
Item Class: Enumerated
Item Text: Based on the information you have provided, we have selected the following people to
participate in the study: {PERSON(S)}
[PRESS 1 AND ENTER TO CONTINUE.]
Display:
Notes: Display name, age and gender of eligible SP(s) in "PERSON(S)".
Response
1 CONTINUE
Version Date:
Value Label
Continue
Skip To
SCQ1117
Page 17 of 43
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A-17
SCQ1117
SCQSPEthnicity
Item Type: Question
Item Class: Enumerated
Item Text: [SHOWCARD 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.]
Display:
Notes:
CATA: YES
Answers Allowed:
Response
1 MEXICAN/MEXICAN-AMERICAN
Value Label
Mexican_Mexican_American
Skip To
SCQ1118
2 PUERTO RICAN
PuertoRican
SCQ1118
3 CUBAN
Cuban
SCQ1118
4 OTHER HISPANIC OR LATINO
OtherHispanicOrLatino
SCQ1118
5 NOT HISPANIC
NotHispanic
SCQ1118
980 DON'T KNOW
SCQ1119
990 REFUSED
SCQ1119
Version Date:
Page 18 of 43
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A-18
SCQ1118
Item Type: Check
Item Class: Hard
Item Text: If SCQ1117=5 and another response, display: "I'm sorry, but NOT HISPANIC is not
allowed with any other response."
Display:
Notes:
Response
1 [Check executed.]
Version Date:
Value Label
Skip To
SCQ1121
Page 19 of 43
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A-19
SCQ1119
SCQEthnicityObserve
Item Type: Question
Item Class: Enumerated
Item Text: [RECORD SP'S ETHNICITY BY OBSERVATION, IF POSSIBLE.]
Display:
Notes:
CATA: NO
Answers Allowed:
Response
1 MEXICAN/MEXICAN-AMERICAN
Value Label
Mexican_Mexican_American
Skip To
SCQ1121
2 PUERTO RICAN
PuertoRican
SCQ1121
3 CUBAN
Cuban
SCQ1121
4 OTHER HISPANIC OR LATINO
OtherHispanicOrLatino
SCQ1121
5 NOT HISPANIC
NotHispanic
SCQ1121
980 DON'T KNOW
Version Date:
SCQ1121
Page 20 of 43
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A-20
SCQ1121
SCQSPRace
Item Type: Question
Item Class: Enumerated
Item Text: [SHOWCARD 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.]
Display:
Notes:
CATA: YES
Answers Allowed:
Response
1 WHITE
Value Label
White
Skip To
SCQ1123
2 BLACK/AFRICAN AMERICAN
Black_AfricanAmerican
SCQ1123
3 ASIAN
Asian
SCQ1123
4 NATIVE HAWAIIAN/PACIFIC
ISLANDER
5 AMERICAN INDIAN/ALASKA
NATIVE
980 DON'T KNOW
NativeHawaiian_PacificIsland SCQ1123
er
AmericanIndian_AlaskaNativ SCQ1123
e
SCQ1122
990 REFUSED
Version Date:
SCQ1122
Page 21 of 43
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A-21
SCQ1122
SCQRaceObserve
Item Type: Question
Item Class: Enumerated
Item Text: [RECORD SP'S RACE BY OBSERVATION, IF POSSIBLE.]
Display:
Notes:
CATA: NO
Answers Allowed:
Response
1 WHITE
Value Label
White
Skip To
SCQ1123
2 BLACK/AFRICAN AMERICAN
Black_AfricanAmerican
SCQ1123
3 ASIAN
Asian
SCQ1123
4 NATIVE HAWAIIAN/PACIFIC
ISLANDER
5 AMERICAN INDIAN/ALASKA
NATIVE
980 DON'T KNOW
Version Date:
NativeHawaiian_PacificIsland SCQ1123
er
AmericanIndian_AlaskaNativ SCQ1123
e
SCQ1123
Page 22 of 43
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A-22
SCQ1123
Item Type: Route
Item Class: If Then
Item Text: If another SP, go to SCQ1117.
Else, go to SCQ1124.
Display:
Notes:
Response
1 [Route executed.]
Version Date:
Value Label
Skip To
Page 23 of 43
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A-23
SCQ1124
SCQHomePhone
Item Type: Question
Item Class: Enumerated
Item Text: What is your home telephone number (in case my office wants to check my work)?
Display:
Notes:
CATA: NO
Answers Allowed:
1
Response
1 ENTER PHONE NUMBER
Value Label
EnterPhoneNumber
Skip To
SCQ1125
2 NO HOME PHONE
NoHomePhone
SCQ1150
990 REFUSED
Version Date:
SCQ1150
Page 24 of 43
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A-24
SCQ1125
SCQPhoneArea
Item Type: Question
Item Class: Integer
Item Text: [What is your home telephone number (in case my office wants to check my work)?]
NUMBER: ()ENTER THE AREA CODE
Display:
Notes:
Lower Range:
CATA: NO
Answers Allowed:
Response
1 [Enter continuous answer.]
Version Date:
Upper Range:
Value Label
Skip To
SCQ1130
Page 25 of 43
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A-25
SCQ1130
SCQPhoneExchange
Item Type: Question
Item Class: Integer
Item Text: NUMBER: ({AREA})-ENTER THE EXCHANGE
Display:
Notes:
Lower Range:
CATA: NO
Answers Allowed:
Response
1 [Enter continuous answer.]
Version Date:
1
Upper Range:
Value Label
Skip To
SCQ1135
Page 26 of 43
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A-26
SCQ1135
SCQPhoneLocal
Item Type: Question
Item Class: Integer
Item Text: NUMBER: (AREA)-{EXCHANGE}
ENTER THE LOCAL
Display:
Notes:
Lower Range:
CATA: NO
Answers Allowed:
Response
1 [Enter continuous answer.]
Version Date:
1
Upper Range:
Value Label
Skip To
SCQ1140
Page 27 of 43
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A-27
SCQ1140
SCQPhoneConfirm
Item Type: Question
Item Class: Enumerated
Item Text: CONFIRM TELEPHONE NUMBER: ({AREA}) {EXCHANGE}-{LOCAL}
Is this correct?
Display:
Notes:
CATA: NO
Version Date:
Answers Allowed:
1
Response
1 YES
Value Label
Yes
Skip To
SCQ1150
2 NO
No
SCQ1145
Page 28 of 43
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A-28
SCQ1145
Item Type: Check
Item Class: Hard
Item Text: SELECT FIELD TO RE-ENTER.
Display:
Notes:
Response
1 [Check executed.]
Version Date:
Value Label
Skip To
SCQ1150
Page 29 of 43
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A-29
SCQ1150
SCQOtherNumber
Item Type: Question
Item Class: Enumerated
Item Text: Is there {a/another} phone number where you could be reached?
Display: If SCQ1124=1, display "another". Else, display "a".
Notes:
CATA: NO
Answers Allowed:
Response
1 YES
Value Label
Yes
Skip To
SCQ1155
2 NO OTHER PHONE
NoOtherPhone
SCQ2005
990 REFUSED
Version Date:
SCQ2005
Page 30 of 43
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A-30
SCQ1155
SCQOtherArea
Item Type: Question
Item Class: Integer
Item Text: [What is that phone number?]
NUMBER: ()ENTER THE AREA CODE
Display:
Notes:
Lower Range:
CATA: NO
Answers Allowed:
Response
1 [Enter continuous answer.]
Version Date:
Upper Range:
Value Label
Skip To
SCQ1160
Page 31 of 43
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A-31
SCQ1160
SCQOtherExchange
Item Type: Question
Item Class: Integer
Item Text: NUMBER: ({AREA})-ENTER THE EXCHANGE
Display:
Notes:
Lower Range:
CATA: NO
Answers Allowed:
Response
1 [Enter continuous answer.]
Version Date:
Upper Range:
Value Label
Skip To
SCQ1165
Page 32 of 43
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A-32
SCQ1165
SCQOtherLocal
Item Type: Question
Item Class: Integer
Item Text: NUMBER: (AREA)-{EXCHANGE}
ENTER THE LOCAL
Display:
Notes:
Lower Range:
CATA: NO
Answers Allowed:
Response
1 [Enter continuous answer.]
Version Date:
Upper Range:
Value Label
Skip To
SCQ1170
Page 33 of 43
10/26/2009
A-33
SCQ1170
SCQOtherConfirm
Item Type: Question
Item Class: Enumerated
Item Text: I have the phone number as: ({AREA}) {EXCHANGE}-{LOCAL}
Is this correct?
Display:
Notes:
CATA: NO
Version Date:
Answers Allowed:
1
Response
1 YES
Value Label
Yes
Skip To
SCQ1180
2 NO
No
SCQ1175
Page 34 of 43
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A-34
SCQ1175
Item Type: Check
Item Class: Hard
Item Text: SELECT FIELD TO RE-ENTER.
Display:
Notes:
Response
1 [Check executed.]
Version Date:
Value Label
Skip To
SCQ1180
Page 35 of 43
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A-35
SCQ1180
SCQOtherPhoneLocated
Item Type: Question
Item Class: Enumerated
Item Text: Where is this phone located? Is it in your home, at work, someplace else, or is it a
cellular phone?
Display:
Notes:
CATA: NO
Answers Allowed:
Response
1 OWN HOME
Value Label
OwnHome
Skip To
SCQ2005
2 WORK
Work
SCQ2005
3 CELLULAR PHONE
CellPhone
SCQ2005
OthSpecify
SCQ2005
910 OTHER, SPECIFY
980 DON'T KNOW
SCQ2005
990 REFUSED
SCQ2005
Version Date:
Page 36 of 43
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A-36
SCQ2005
SCQLanguage
Item Type: Question
Item Class: Enumerated
Item Text: [THIS SCREENER INTERVIEW WAS CONDUCTED IN:]
Display:
Notes:
CATA: NO
Answers Allowed:
Response
1 ENGLISH
Value Label
English
Skip To
SCQ3010
2 SPANISH
Spanish
SCQ3010
OthSpecify
SCQ3010
910 OTHER, SPECIFY
Version Date:
1
Page 37 of 43
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A-37
SCQ3010
Item Type: Route
Item Class: If Then
Item Text: If hidden DU procedure is required, go to SCQ3012.
Else, go to SCQ3015.
Display:
Notes:
Response
1 [Route executed.]
Version Date:
Value Label
Skip To
Page 38 of 43
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A-38
SCQ3012
SCQHiddenDU
Item Type: Instruction
Item Class: Enumerated
Item 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, like a basement or
garage apartment that we may 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
Display:
Notes:
Response
1 HIDDEN DU PROCEDURE
REQUIRED
2 NO, HIDDEN DU PROCEDURE
NOT REQUIRED
980 DON'T KNOW
Version Date:
Value Label
Skip To
HiddenDuProcedureRequired SCQ3013
No_HiddenDuProcedureNotR SCQ3013
equired
DK
SCQ3013
Page 39 of 43
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A-39
SCQ3013
Item Type: Route
Item Class: If Then
Item Text: If SCQ3012 is YES then update tblCaseInfo.HiddenCasePendingYN to Y;
If SCQ3012 is DK then update tblCaseInfo.HiddenCasePendingYN to Y;
If SCQ3012 is NO then update tblCaseInfo.HiddenCasePendingYN to N.
Display:
Notes:
Response
1 [Route executed.]
Version Date:
Value Label
Skip To
SCQ3015
Page 40 of 43
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A-40
SCQ3015
Item Type: Route
Item Class: If Then
Item Text: If household contains SP(s), go to SCQ4005.
Else, go to SCQ 4010.
Display:
Notes:
Response
1 [Route executed.]
Version Date:
Value Label
Skip To
Page 41 of 43
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A-41
SCQ4005
SCQCompleteEligible
Item Type: Instruction
Item Class: Enumerated
Item Text: [END OF SCREENER. ATTEMPT TO ADMINISTER BQ WITH SP. IF NOT AVAILABLE,
SET APPOINTMENT FOR BQ AND EXERCISE.]
[PRESS F10 AND ENTER TO CONTINUE.]
Display:
Notes: End instrument timing here.
COMPLETE SCREENER, 1-2 SAMPLE PERSONS SELECTED
Response
1 F10
Version Date:
Value Label
F10
Skip To
END
Page 42 of 43
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A-42
SCQ4010
SCQCompleteInelig
Item Type: Instruction
Item Class: Enumerated
Item 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. Thank you.
[PRESS F10 AND ENTER TO CONTINUE.]
Display:
Notes: End instrument timing here.
COMPLETE SCREENER, NO ELIGIBLE SAMPLE PERSON(S)
Response
1 F10
Version Date:
Value Label
F10
Skip To
END
Page 43 of 43
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File Type | application/pdf |
File Modified | 2011-03-02 |
File Created | 2009-10-26 |