Form Approved
OMB No. 0920-XXXX
Exp. Date XX/XX/20XX
Attachment 3
Generic
Information Collection Through Web-based Surveys for Evaluating Act Against AIDS (AAA) Social Marketing Campaign Phases Targeting Consumers
Sample Survey Item Bank
August 3, 2011
Public reporting burden of this collection of information is estimated to average 30 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Reports Clearance Officer; 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; Attn: OMB-PRA (0920-XXXX)
Table of Contents
Section Page
Section A: Background Information 2-4
Knowledge of Testing Services 2-16
Communication about HIV Status and Testing 2-18
Testing Attitudes and Intentions 2-19
HIV Protective Behavioral Intentions 2-21
Section E: High-Risk Behaviors 2-23
Section F: Knowledge, Attitudes, and Beliefs (KABs) 2-30
Social Support and Life Satisfaction 2-30
KABs about Risky Sexual Behaviors 2-30
Sexual Risks Scale—Perceived Susceptibility 2-32
KABs about HIV/AIDS and Testing 2-33
Perceived Behavioral Control and Self-Efficacy for HIV Prevention 2-41
Feelings toward Persons with AIDS 2-44
Coercive Attitudes and Blame 2-45
Avoidant Behavioral Intentions 2-45
Transmission through Homosexuality and Drug Use 2-47
Negative Judgments of People Living with HIV 2-48
Enacted Stigma or Discrimination 2-49
Personal Relevance of HIV/AIDS 2-49
View of U.S. Agenda Related to HIV/AIDS 2-50
Awareness of New HIV/AIDS Prevention Methods 2-52
Self-Protection Motivation 2-58
Section G: Items Related to Sexual Orientation and Race/Ethnicity 2-59
Comfort Level with Sexual Identity 2-59
Perceived Social Norm for HIV/AIDS Prevention 2-60
Experiences Related to Race/Ethnicity 2-67
Experiences Related to Sexual Orientation 2-68
Experiences in the Gay Community 2-70
Dealing with Others’ Reactions to My Race/Ethnicity 2-75
Dealing with Others’ Reactions to Sexual Orientation 2-77
Section H: Media-Related Items 2-81
Media Use and Information Seeking 2-81
HIV/AIDS Information and Seeking Behaviors 2-96
How old are you?
Age__________
1. Don’t know
2. Refuse to answer
What is your gender?
1. Male
2. Female
3. Other [Specify: ]
4. Don’t know
5. Refuse to answer
Are you of Hispanic or Latino origin?
1. Yes
2. No
3. Don’t know
4. Refuse to answer
Which of the following best describes your race?
1. American Indian or Alaska Native
2. Asian
3. Black or African American
4. Native Hawaiian or Other Pacific Islander
5. White
6. Other race [Specify: ]
7. Don’t know
8. Refuse to answer
What is the highest grade or year of school you finished?
1. Never attended school or only attended kindergarten
2. Grades 1 through 8 (elementary)
3. Grades 9 through 11 (some high school)
4. Grade 12 or GED (high school graduate)
5. College 1 year to 3 years (some college or technical school)
6. College 4 years or more (college graduate)
7. Don’t know
8. Refuse to answer
Which best describes your total personal income during the past year?
1. Less than $20,000
2. $21,000 to $30,000
3. $31,000 to $40,000
4. $41,000 to $50,000
5. $51,000 or more
6. Don’t know
7. Refuse to answer
Which of the following statements best describes your current employment situation?
1. Working full-time (35 hours or more per week)
2. Working part-time (less than 35 hours per week)
3. Unemployed or laid off
4. Full-time homemaker
5. Other
6. Don’t know
7. Refuse to answer
What is your current job title? What term would you use to describe your current profession? ________________
Are you currently a college student?
1. Yes
2. No
3. Don’t know
4. Refuse to answer
Which do you consider yourself to be?
1. Gay, homosexual, or same gender loving
2. Bisexual or two spirited
3. Straight or heterosexual
4. Other [Specify: ]
5. None of the above/unsure
6. Don’t know
7. Refuse to answer
What is your current relationship status? Are you…?
1. Single
2. Married to a man
3. Married to a woman
4. In a relationship with a man
5. In a relationship with a woman
6. Divorced or widowed
7. Don’t know
8. Refuse to answer
At this time, are you living alone or are there others living in your household? Please select one or more.
1. Live alone
2. Live with roommate(s)
3. Live with children
4. Live with family (e.g., mother, father, sister, aunt)
5. Live with partner/boyfriend
6. Other(s) in household
7. Don’t know
8. Refuse to answer
How many children less than 18 years of age live in your household?
Number of children _______________
1. Don’t know
2. Refuse to answer
What is your religion, if any?
1. Protestant
2. Roman Catholic
3. Jewish
4. Other, specify
5. No religion
6. Don’t know
7. Refuse to answer
In politics today, do you consider yourself a…
1. Republican
2. Democrat
3. Independent
4. Other [Specify: ]
5. Don’t know
6. Refuse to answer
Would you say your views in most political matters are liberal, moderate, or conservative?
1. Liberal
2. Moderate
3. Conservative
4. Don’t know
5. Refuse to answer
Were you born in the United States?
1. Yes
2. No
3. Don’t know
4. Refuse to answer
Do you currently own or rent your home?
1. Own
2. Rent
3. Occupied without paying
4. Monetary rent
5. Don’t know
6. Refuse to answer
In what zip code do you currently live? _________
Do you have an unlimited messaging plan on your cell phone?
1. Yes
2. No
3. Don’t know
4. Refuse to answer
Before being contacted for this study, had you ever heard of CDC or the Centers for Disease Control and Prevention?
1. Yes
2. No
5. Don’t know
6. Refuse to answer
Do you have a primary care doctor?
1. Yes
2. No
3. Don’t know
4. Refuse to answer
Do you have health insurance?
1. Yes
2. No
3. Don’t know
4. Refuse to answer
How do you pay for your health care needs?
1. Self pay/cash
2. Go to free clinics
3. Other [Specify: ]
4. Don’t know
5. Refuse to answer
What kind of health insurance do you have? [MARK ALL THAT APPLY.]
1. Private insurance, either through an employer or that I purchased on my own
2. Medicare, a federal government program for people aged 65 or older and certain disabled people
3. Medicaid, a state program that helps people with low income
4. The military, TRICARE, or the VA
5. Some other source [Specify: ]
6. Don’t know
7. Refuse to answer
In general, would you say your health is…
1. Excellent
2. Very good
3. Good
4. Fair
5. Poor
6. Don’t know
7. Refuse to answer
During the past 30 days, how often did you feel so sad that nothing could cheer you up?
1. All of the time
2. Most of the time
3. Some of the time
4. A little of the time
5. None of the time
6. Don’t know
7. Refuse to answer
During the past 30 days, how often did you feel nervous?
1. All of the time
2. Most of the time
3. Some of the time
4. A little of the time
5. None of the time
6. Don’t know
7. Refuse to answer
During the past 30 days, how often did you feel restless or fidgety?
1. All of the time
2. Most of the time
3. Some of the time
4. A little of the time
5. None of the time
6. Don’t know
7. Refuse to answer
During the past 30 days, how often did you feel hopeless?
1. All of the time
2. Most of the time
3. Some of the time
4. A little of the time
5. None of the time
6. Don’t know
7. Refuse to answer
During the past 30 days, how often did you feel that everything was an effort?
1. All of the time
2. Most of the time
3. Some of the time
4. A little of the time
5. None of the time
6. Don’t know
7. Refuse to answer
During the past 30 days, how often did you feel worthless?
1. All of the time
2. Most of the time
3. Some of the time
4. A little of the time
5. None of the time
6. Don’t know
7. Refuse to answer
Have you smoked at least 100 cigarettes in your entire life? [IF NEEDED: 5 packs = 100 cigarettes.]
1. Yes
2. No
3. Don’t know
4. Refuse to answer
Do you now smoke cigarettes…
1. Every day
2. Some days
3 Not at all
4. Don’t know
5. Refuse to answer
On average, how many cigarettes do you now smoke a day? [IF NEEDED: 1 pack = 20 cigarettes.]
Number of cigarettes per day __________
1. Don’t know
2. Refuse to answer
On how many of the past 30 days did you smoke a cigarette?
Number of days __________
1. Don’t know
2. Refuse to answer
On average, when you smoked during the past 30 days, about how many cigarettes did you smoke a day? [IF NEEDED: 1 pack = 20 cigarettes.]
Number of cigarettes per day __________
1. Don’t know
2. Refuse to answer
Have you ever smoked cigarettes every day for at least 6 months?
1. Yes
2. No
3. Don’t know
4. Refuse to answer
Have you ever been tested for HIV? Do not count tests you may have had as part of a blood donation.
1. Yes
2. No
3. Don’t know
4. Refuse to answer
(Alternate method) Which of the following best describes your HIV testing behavior?
1. I have never been tested and am not concerned that I am at risk
2. I
have never been tested but have thought about getting tested to be
sure
I am okay
3. I have been tested at least once, but not on a regular basis
4. I test regularly or after any situation where I might have been exposed to HIV
5. Don’t know
6. Refuse to answer
When was your last HIV test?
1. 0–2 months ago
2. 3–6 months ago
3. 7–12 months ago
4. More than 12 months ago
5. Don’t know
6. Refuse to answer
Not including your blood donations, where did you have your last HIV test?
1. Private doctor
2. STD or AIDS clinic or testing site
3. Hospital or emergency room
4. Public health department
5. Community health center
6. At home
7. Drug treatment facility
8. Other location
9. Don’t know
10. Refuse to answer
How was the HIV test given to you?
1. Blood was drawn from your vein
2. Your finger was pricked and blood was taken from the prick
3. Your mouth was swabbed
4. Don’t know
5. Refuse to answer
Was it a rapid test where you could get your results within a couple of hours?
1. Yes
2. No
3. Don’t know
4. Refuse to answer
Did you get the results of your last HIV test?
1. Yes
2. No
3. Don’t know
4. Refuse to answer
Think about the last time you didn’t get your HIV test result. What was the main reason you didn’t get your result? [DO NOT read response categories. Choose only one response category.]
1. Thought the site would contact me if positive
2. Afraid of getting the result
3. Too busy to get the result
4. Forgot to get the result
5. Moved or out of town
6. Jail-related (jail test or jail before getting result)
7. Unable to get transportation to the testing place
8. Lost appointment card, paperwork, ID number
9. Didn’t want to know/didn’t care about result
10. Didn’t seek the test/didn’t care about being tested
11. Too early to get the results (recent test)
12. Testing was inconvenient (e.g., location, hours)
13. Other [Specify: ]
14. Don’t know
15. Refuse to answer
What was the result of your last HIV test?
1. Positive
2. Negative
3. Have not gotten the results yet
4. Don’t know
5. Refuse to answer
Are you currently being seen by a doctor, nurse, or other health care provider for medical care or treatment related to your HIV infection?
1. Yes
2. No
3. Don’t know
4. Refuse to answer
Have you ever taken any antiretroviral medicines?
1. Yes
2. No
3. Don’t know
4. Refuse to answer
How often do you get an HIV test?
1. Every 3 months
2. Every 6 months
3. Once a year
4. Less often than once a year
5. Other [Specify: ]
6. Don’t know
7. Refuse to answer
Do you get an HIV test after any situation when you think you might have been exposed to HIV?
1. Yes
2. No
3. Don’t know
4. Refuse to answer
Below is a list of reasons why some people have not been tested for HIV. Which of these are the main reasons why you have not been tested? Please select one or more of the following reasons. [MARK ALL THAT APPLY.]
1. You have not been sexually active
2. Your doctor never recommended it
3. You have not had unprotected sex
4. You were afraid to find out if you were HIV positive
5. You didn’t want to think about HIV or about being HIV positive
6. You didn’t think you were at risk of being HIV positive
7. You don’t like needles or giving blood
8. You don’t trust the results to be kept private
9. You had to wait too long for the results
10. You didn’t know where to get tested
11. You trust your sex partner
12. You don’t care about the results
13. You are worried about being labeled as HIV positive
14. Some other reason [Specify: ]
15. Don’t know
16. Refuse to answer
Which of these are the main reasons for your last HIV test? Please select one or more of the following reasons. [MARK ALL THAT APPLY.]
1. It just seemed like a good idea
2. It’s something you do every year
3. Just to find out
4. Worried that you are infected
5. A doctor, nurse, or other health care provider asked you to
6. The health department asked you to
7. Your sex partner asked you to
8. Because of pregnancy
9. To get birth control
10. You found out your sex partner cheated
11. Already had an STD
12. You were starting a new relationship
13. You get tested during your yearly exam
14. A family member or friend was diagnosed with HIV
15. Other reason [Specify: ]
16. Don’t know
17. Refuse to answer
Have you gotten an HIV test since [INSERT DATE OF FIRST EXPOSURE TO STIMULI]?
1. Yes
2. No
3. Don’t know
4. Refuse to answer
What was the result of this HIV test?
1. Positive
2. Negative
3. Have not gotten the results yet
4. Don’t know
5. Refuse to answer
Have you ever talked with a doctor or health care provider about HIV or AIDS?
1. Yes
2. No
3. Don’t know
4. Refuse to answer
Have you ever talked with a partner about HIV or AIDS?
1. Yes
2. No
3. Don’t know
4. Refuse to answer
As far as you know, when you visit your doctor for a routine physical or annual exam, is it standard practice to perform a test for HIV, or do you have to ask your doctor to perform this test?
1. Standard practice
2. Have to ask
3. Don’t know
4. Refuse to answer
The last time you were tested for HIV, how did you know the test was being done? Did you ask to be tested for HIV, did the doctor or nurse tell you this test was being done, or was it your impression that the test was a routine part of the exam?
1. You asked to be tested
2. The doctor or nurse told you this test was being done
3. It was your impression that the test was a routine part of the exam
4. Don’t know
5. Refuse to answer
The last time you were tested for HIV, did you go to a doctor or clinic specifically to get an HIV test, or did you decide to get an HIV test as part of another health visit, such as a routine check-up?
1. Specifically to be tested
2. As part of another visit
3. Don’t know
4. Refuse to answer
And did you get your test results, or not?
1. Yes
2. No
3. Don’t know
4. Refuse to answer
Do you know a place where you can get an HIV test?
1. Yes
2. No
3. Don’t know
4. Refuse to answer
Where can you get an HIV test?
1. HIV counseling and testing site
2. STD clinic
3. Hospital
4. Community health clinic
5. Private physician office
6. Drug treatment program
7. Correctional facility (jail or prison)
8. Military
9. Other [Specify: ]
10. Don’t know
11. Refuse to answer
Is this place in your community?
1. Yes
2. No
3. Don’t know
4. Refuse to answer
How did you find out about this testing location? [MARK ALL THAT APPLY.]
1. Called 1-800-CDC-INFO
2. Called another hotline
3. Visited www.hivtest.org
4. Visited another Web site
5. Friends or family
6. Doctor, nurse, or other health care provider
7. Health department
8. Community health center
9. Church
10. Another organization in my community
11. Other [Specify: ]
12. Don’t know
13. Refuse to answer
Do you know a place where you can get a free HIV test?
1. Yes
2. No
3. Don’t know
4. Refuse to answer
Where can you get a free HIV test?
1. HIV counseling and testing site
2. STD clinic
3. Hospital
4. Community health clinic
5. Private physician office
6. Drug treatment program
7. Correctional facility (jail or prison)
8. Military
9. Other [Specify: ]
10. Don’t know
11. Refuse to answer
Have you talked to your partner about the importance of getting an HIV test?
1. Yes
2. No
3. Don’t know
4. Refuse to answer
How important do you think it is for people to know their HIV status by getting tested?
Would you say:
1. Very important
2. Somewhat important
3. Not at all important
4. Don’t know
5. Refuse to answer
Have you talked to your partner about their [most recent] HIV status?
1. Yes
2. No
3. Don’t know
4. Refuse to answer
Do you know your partner’s [most recent] HIV test result?
1. Yes
2. No
3. Don’t know
4. Refuse to answer
What was your partner’s [most recent] HIV test result?
1. HIV-negative
2. HIV-positive
3. Indeterminate
4. Don’t know
5. Refuse to answer
Have you ever talked to [INSERT] about getting an HIV test?
1. Yes
2. No
3. Don’t know
4. Refuse to answer
Please tell us how much you agree or disagree with the following statement.
It is important to get tested for HIV so that people who test positive can start getting treated right away.
1. Strongly agree
2. Agree
3. Disagree
4. Strongly disagree
5. Don’t know
6. Refuse to answer
If you were to be tested for HIV, do you think it would make people you know think [ROTATE ORDER OF MORE/LESS: (less) of you, think (more) of you], or would it make no difference in how people you know think of you?
1. Less of you
2. More of you
3. Make no difference
4. Some less, some more
5. Don’t know
6. Refuse to answer
Do you plan to have a test for HIV in the next [INSERT TIME FRAME], not including blood donations?
1. Definitely yes
2. Probably yes
3. Probably not
4. Definitely not
5. Don’t know
6. Refuse to answer
If a free test was available to see if you have HIV, would you take it?
1. Definitely yes
2. Probably yes
3. Probably not
4. Definitely not
5. Don’t know
6. Refuse to answer
How often do you think someone should get tested for HIV if they…
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Every
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Every
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Every |
Every couple of years |
Don’t know |
a. Always have sex with a condom |
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b. Have had anal sex without a condom |
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c. Have a sex partner who is HIV positive |
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d. Have unprotected anal sex with a partner whose HIV status they don’t know |
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e. Have had more than one sex partner since their last HIV test |
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f. Exchange sex for drugs |
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On a scale from 1 to 6, where 1 is extremely bad and 6 is extremely good, how would you rate getting tested for HIV [INSERT TIME FRAME]?
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1 |
2 |
3 |
4 |
5 |
6 |
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Extremely bad |
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Extremely good |
On a scale from 1 to 6, where 1 is extremely harmful and 6 is extremely beneficial, how would you rate getting an HIV test [INSERT TIME FRAME]?
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1 |
2 |
3 |
4 |
5 |
6 |
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Extremely harmful |
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Extremely beneficial |
How sure are you that you could get an HIV test at least every 12 months if…
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Very sure I could not |
Somewhat sure I could not |
Slightly sure I could |
Somewhat sure I could |
Very sure I could |
a. You wanted to get an HIV test at least every 12 months? |
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b. You could find a free testing site? |
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c. You had to travel far to find a free testing site? |
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d. You could get the results of your HIV test within 20 minutes? |
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e. You knew that your results would be kept confidential? |
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Please tell us how much you disagree or agree with each of the following statements: “Getting tested at least every 12 months…”
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Strongly disagree |
Disagree |
Neither disagree or agree |
Agree |
Strongly agree |
a. Is expensive. |
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b. Reassures me that I can get into treatment early if I test positive. |
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c. Makes me feel like a ho. |
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d. Is inconvenient. |
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e. Allows me to have unprotected sex with partners who are HIV negative. |
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Do you plan to use a condom the next time you have sex?
1. Definitely yes
2. Probably yes
3. Probably not
4. Definitely not
5. Don’t know
6. Refuse to answer
If your sexual partner does not want to use a condom, do you plan on insisting that the two of you use a condom?
1. Definitely yes
2. Probably yes
3. Probably not
4. Definitely not
5. Don’t know
6. Refuse to answer
Do you plan on having sex only with the person with whom you are in a committed relationship?
1. Definitely yes
2. Probably yes
3. Probably not
4. Definitely not
5. Don’t know
6. Refuse to answer
If you are not in a committed relationship, do you plan on remaining abstinent (that is, to not have sex)?
1. Definitely yes
2. Probably yes
3. Probably not
4. Definitely not
5. Don’t know
6. Refuse to answer
The next time you have sex, do you plan on talking about the use of condoms with your partner?
1. Definitely yes
2. Probably yes
3. Probably not
4. Definitely not
5. Don’t know
6. Refuse to answer
I’m going to read you a list. Please tell me if any of the situations apply to you. Have you…
1. Yes
2. No
3. Don’t know
4. Refuse to answer
a. Used intravenous drugs in the past year?
b. Been treated for a sexually transmitted or venereal disease in the past year?
c. Given or received money or drugs in exchange for sex in the past year?
d. Had anal sex without a condom in the past year?
Has a doctor or other health care provider ever suggested that you be tested for any other sexually transmitted diseases besides HIV?
1. Yes
2. No
3. Don’t know
4. Refuse to answer
What other sexually transmitted diseases besides HIV did your health care provider suggest? [MARK ALL THAT APPLY.]
1. Chlamydia
2. Gonorrhea
3. Syphilis
4. Genital herpes
5. Genital warts
6. Human papillomavirus (HPV)
7. Other [Specify: ]
8. Don’t know
9. Refuse to answer
Have you, yourself, ever been tested for any other sexually transmitted disease besides HIV?
1. Yes
2. No
3. Don’t know
4. Refuse to answer
What other sexually transmitted diseases besides HIV have you been tested for?
1. Chlamydia
2. Gonorrhea
3. Syphilis
4. Genital herpes
5. Genital warts
6. Human papillomavirus (HPV)
7. Other [Specify: ]
8. Don’t know
9. Refuse to answer
During the past [INSERT TIME FRAME], how many people did you have sex with?
NUMBER __________________
1. Don’t know
2. Refuse to answer
How many of your partners in the past [INSERT TIME FRAME] were men?
NUMBER __________________
1. Don’t know
2. Refuse to answer
How many of your partners in the past [INSERT TIME FRAME] were women?
NUMBER __________________
1. Don’t know
2. Refuse to answer
Did you have anal sex with any of your male partner(s) in the past [INSERT TIME FRAME]?
1. Yes
2. No
3. Don’t know
4. Refuse to answer
When you had anal sex with your male partner(s) in the past [INSERT TIME FRAME], how often did you and your partner use a condom?
1. Never used a condom
2. Occasionally used a condom
3. Usually used a condom
4. Always used a condom
5. Don’t know
6. Refuse to answer
How often did you and your partners use a condom?
1. Never
2. Occasionally
3. Usually
4. Always
5. Don’t know
6. Refuse to answer
In the past [INSERT TIME FRAME], did you ever, even one time, have sex without a condom?
1. Yes
2. No
3. Don’t know
4. Refuse to answer
Do you currently have a main sex partner—that is, a partner you would call your spouse, significant other, or life partner?
1. Yes
2. No
3. Don’t know
4. Refuse to answer
How long have you and your main partner been together? If you and your main partner have been together for less than 1 month, please enter 1 month as your answer. ____________
1. Don’t know
2. Refuse to answer
Is your main partner male, female, or transgender?
1. Male
2. Female
3. Transgender
4. Don’t know
5. Refuse to answer
What is your main partner’s HIV status?
1. My main partner is HIV negative
2. My main partner is HIV positive
3. My main partner has not been tested for HIV
4. My main partner has not told me his or her HIV status
5. Don’t know
6. Refuse to answer
Have you heard of barebacking?
1. Yes
2. No
3. Don’t know
4. Refuse to answer
Do you consider yourself to be a barebacker?
1. Yes
2. No
3. Don’t know
4. Refuse to answer
Have you ever, even once, injected any drug?
1. Yes
2. No
3. Don’t know
4. Refuse to answer
In the past [INSERT TIME FRAME], on how many days did you inject any drug?
NUMBER OF DAYS ____________________
1. Don’t know
2. Refuse to answer
How many times in the past [INSERT TIME FRAME] have you used a syringe after someone else had already used it?
1. No time
2. One time
3. Two times
4. 3 to 5 times
5. 6 to 10 times
6. More than 10 times
7. Don’t know
8. Refuse to answer
Which of the following drugs have you used in the last [INSERT TIME FRAME]? For each drug mentioned, please tell me how often you used it. How often did you use...
|
Used drug Yes or No? |
Once a month or less |
About once a week |
Several times a week |
About once a day |
Several times a day |
Don’t know |
Refuse to answer |
a. Amphetamine, meth, speed, crystal, crank, ice |
1 |
2 |
3 |
4 |
5 |
6 |
7 |
8 |
b. Crack |
1 |
2 |
3 |
4 |
5 |
6 |
7 |
8 |
c. Cocaine |
1 |
2 |
3 |
4 |
5 |
6 |
7 |
8 |
d. Downers (Valium, Ativan, Xanax) |
1 |
2 |
3 |
4 |
5 |
6 |
7 |
8 |
e. Painkillers |
1 |
2 |
3 |
4 |
5 |
6 |
7 |
8 |
f. Hallucinogens such as LSD |
1 |
2 |
3 |
4 |
5 |
6 |
7 |
8 |
g. Ecstasy |
1 |
2 |
3 |
4 |
5 |
6 |
7 |
8 |
h. Club drugs such as GHB, ketamine |
1 |
2 |
3 |
4 |
5 |
6 |
7 |
8 |
i. Heroin (smoke, snorted) |
1 |
2 |
3 |
4 |
5 |
6 |
7 |
8 |
j. Marijuana |
1 |
2 |
3 |
4 |
5 |
6 |
7 |
8 |
k. Poppers (amyl nitrite) |
1 |
2 |
3 |
4 |
5 |
6 |
7 |
8 |
l. Other [Specify: _________________] |
1 |
2 |
3 |
4 |
5 |
6 |
7 |
8 |
In the past [INSERT TIME FRAME], have you been high or buzzed on [NAME OF DRUG] during sex?
|
No |
Yes |
Don’t know |
Refuse to answer |
a. Amphetamine, meth, speed, crystal, crank, ice |
1 |
2 |
3 |
4 |
b. Crack |
1 |
2 |
3 |
4 |
c. Cocaine |
1 |
2 |
3 |
4 |
d. Downers (Valium, Ativan, Xanax) |
1 |
2 |
3 |
4 |
e. Painkillers |
1 |
2 |
3 |
4 |
f. Hallucinogens such as LSD |
1 |
2 |
3 |
4 |
g. Ecstasy |
1 |
2 |
3 |
4 |
h. Club drugs such as GHB, ketamine |
1 |
2 |
3 |
4 |
i. Heroin (smoke, snorted) |
1 |
2 |
3 |
4 |
j. Marijuana |
1 |
2 |
3 |
4 |
k. Poppers (amyl nitrite) |
1 |
2 |
3 |
4 |
l. Other [Specify: ________________________] |
1 |
2 |
3 |
4 |
During the past 30 days, have you had at least one drink of any alcoholic beverage such as beer, wine, a malt beverage, or liquor?
1. Yes
2. No
3. Don’t know
4. Refuse to answer
During the past 30 days, how many days per week or per month did you have at least one drink of any alcoholic beverage?
1. ___ days per week
2. ___ days in past 30 days
3. No drinks in past 30 days
4. Don’t know
5. Refuse to answer
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 average? Note: A 40-ounce beer would count as 3 drinks, or a cocktail drink with 2 shots would count as 2 drinks.
1. ___ Number of drinks
2. Don’t know
3. Refuse to answer
Considering all types of alcoholic beverages, how many times during the past 30 days did you have X [INSERT X = 5 for men, X = 4 for women] or more drinks on an occasion?
1. ___ Number of times
2. None
3. Don’t know
4. Refuse to answer
During the past 30 days, what is the largest number of drinks you had on any occasion?
1. ___ Number of drinks
2. Don’t know
3. Refuse to answer
In the past 30 days, have you had more than [XX] alcoholic drinks before having sex?
1. Yes
2. No
3. Don’t know
4. Refuse to answer
The last time you had sex, did you have more than [XX] alcoholic drinks before having sex?
1. Yes
2. No
3. Don’t know
4. Refuse to answer
In the past 30 days, have you been drunk [or buzzed from alcohol] during sex?
1. Yes
2. No
3. Don’t know
4. Refuse to answer
The last time you had sex, were you drunk [or buzzed from alcohol] during sex?
1. Yes
2. No
3. Don’t know
4. Refuse to answer
In general, how satisfied are you with the overall support you get from your friends and family members?
1. Very satisfied
2. Satisfied
3. Dissatisfied
4. Very dissatisfied
5. Don’t know
6. Refuse to answer
How often do you get the social
and emotional support you need?
[INTERVIEWER NOTE: If asked,
say “please include support from any source.”]
1. Always
2. Usually
3. Sometimes
4. Rarely
5. Never
6. Don’t know
7. Refuse to answer
In general, how satisfied are you with your life?
1. Very satisfied
2. Satisfied
3. Dissatisfied
4. Very dissatisfied
5. Don’t know
6. Refuse to answer
Because of new treatments for HIV, I think HIV-negative men are taking more sexual risks.
1. Strongly agree
2. Agree
3. Disagree
4. Strongly disagree
5. Don’t know
6. Refuse to answer
Because of new treatments for HIV, I’m more willing to have unprotected sex with someone who is HIV positive.
1. Strongly agree
2. Agree
3. Disagree
4. Strongly disagree
5. Don’t know
6. Refuse to answer
Because of new treatments for HIV, I’m more willing to have unprotected sex with someone who is HIV positive.
1. Strongly agree
2. Agree
3. Disagree
4. Strongly disagree
5. Don’t know
6. Refuse to answer
Tell me how risky you think each behavior is for getting HIV. Use a scale where 0 is lowest risk and 100 is highest risk. Please assign any number in that range to each of the behaviors listed.
1. Deep kissing
2. Receptive anal sex (“bottom”) with a condom
3. Receptive anal sex (“bottom”) without a condom
4. Mutual masturbation
5. Receptive oral sex (“giving a blow job”) with a condom
6. Receptive oral sex (“giving a blow job”) without a condom
7. Insertive anal sex (“top”) with a condom
8. Receptive anal sex (“top”) without a condom
9. Don’t know
10. Refuse to answer
When should you get an HIV test after having unprotected sex [with a man]?
1. 0–2 months after having unprotected sex
2. 3–6 months after having unprotected sex
3. 7–12 months after having unprotected sex
4. More than 12 months after having unprotected sex
5. When you start to feel sick
6. Don’t know
7. Refuse to answer
Thinking about your sexual partner(s) and the sex you have had over the past [INSERT TIME FRAME], how would you rate your own risk of being infected with HIV during that time?
1. Very risky
2. Somewhat risky
3. Slightly risky
4. Undecided/not sure
5. Slightly safe
6. Somewhat safe
7. Very safe
8. Don’t know
9. Refuse to answer
Please tell us how much you agree or disagree with the following statements.
|
Strongly agree |
Agree |
Disagree |
Strongly disagree |
Don’t know |
Refuse to answer |
a. My sexual experiences do not put me at risk for HIV/AIDS. |
1 |
2 |
3 |
4 |
5 |
6 |
b. There is a possibility that I have HIV/AIDS. |
1 |
2 |
3 |
4 |
5 |
6 |
c. I may have had sex with someone who was at risk for HIV/AIDS. |
1 |
2 |
3 |
4 |
5 |
6 |
d. I am at risk for HIV/AIDS. |
1 |
2 |
3 |
4 |
5 |
6 |
Please tell me whether you think each statement is true or false:
|
True |
False |
Don’t know |
Refuse to answer |
a. A pregnant woman who has HIV can take drugs to reduce the risk of her baby being born infected. |
1 |
2 |
3 |
4 |
b. There is no cure for AIDS at present. |
1 |
2 |
3 |
4 |
c. There are drugs available that can lengthen the lives of people with HIV. |
1 |
2 |
3 |
4 |
d. Magic Johnson has been cured of AIDS. |
1 |
2 |
3 |
4 |
e. There is a vaccine available to prevent people from becoming infected with HIV. |
1 |
2 |
3 |
4 |
f. There are drugs available that can cure HIV and AIDS. |
1 |
2 |
3 |
4 |
g. AIDS is a disease that destroys the body’s natural immunity against infection. |
1 |
2 |
3 |
4 |
h. There is no cure for AIDS. |
1 |
2 |
3 |
4 |
i. AIDS is caused by a virus. |
1 |
2 |
3 |
4 |
j. AIDS is caused by the same virus that causes herpes. |
1 |
2 |
3 |
4 |
k. Symptoms of AIDS will usually appear within 12 to 24 hours after being infected. |
1 |
2 |
3 |
4 |
l. There is a test [available] to tell whether a person has HIV. |
1 |
2 |
3 |
4 |
m. People can get HIV even though they have had sex with only one person. |
1 |
2 |
3 |
4 |
n. There is still no cure for HIV/AIDS. |
1 |
2 |
3 |
4 |
o. You can tell that somebody has HIV just by looking at them. |
1 |
2 |
3 |
4 |
p. People cannot be tested for HIV without requesting it or being told that they will be tested. |
1 |
2 |
3 |
4 |
q. People who are only in committed relationships don’t need to get an HIV test. |
1 |
2 |
3 |
4 |
r. People are automatically tested for HIV when they go to the doctor if their blood is drawn. |
1 |
2 |
3 |
4 |
s. A man may be at risk for HIV if he had unprotected anal sex with a man. By unprotected, we mean sex without a condom. |
1 |
2 |
3 |
4 |
t. A woman may be at risk for HIV if she had unprotected sex with a man. By unprotected sex, we mean sex without a condom. |
1 |
2 |
3 |
4 |
u. Engaging in anal sex without a condom is a primary risk factor for HIV/AIDS transmission. |
1 |
2 |
3 |
4 |
v. Homosexuals, bisexuals, lesbians, and heroin addicts are the only people who can get AIDS. |
1 |
2 |
3 |
4 |
w. Most blacks who get AIDS are homosexual. |
1 |
2 |
3 |
4 |
x. Most babies who get AIDS are white. |
1 |
2 |
3 |
4 |
y. Most babies who get AIDS have been sexually abused. |
1 |
2 |
3 |
4 |
z. You increase the chance of getting AIDS by having sexual intercourse with many different people. |
1 |
2 |
3 |
4 |
aa Using a condom (rubber) during sexual intercourse can prevent the spread of AIDS. |
1 |
2 |
3 |
4 |
bb. You can avoid getting AIDS by eating a balanced diet and taking vitamins. |
1 |
2 |
3 |
4 |
As I read each of the following, please tell me if, as far as you know, a person can become infected with HIV this way or not. (First/Next) how about… [INSERT ITEMS—RANDOMIZE]. Can a person become infected with HIV this way, or not?
|
True |
False |
Don’t know |
Refuse to answer |
a. Sharing a drinking glass |
1 |
2 |
3 |
4 |
b. Touching a toilet seat |
1 |
2 |
3 |
4 |
c. Swimming in a pool with someone who is HIV positive |
1 |
2 |
3 |
4 |
d. Receiving a transfusion with blood infected by the AIDS virus |
1 |
2 |
3 |
4 |
e. Sharing a needle with a drug abuser who has the disease |
1 |
2 |
3 |
4 |
f. Having sexual intercourse with someone who has AIDS |
1 |
2 |
3 |
4 |
g. Shaking hands with someone who has AIDS |
1 |
2 |
3 |
4 |
h. Trying on clothes in a department store |
1 |
2 |
3 |
4 |
i. From casual contact with infected people |
1 |
2 |
3 |
4 |
j. From someone with AIDS who coughs or sneezes in your face |
1 |
2 |
3 |
4 |
k. Donating blood |
1 |
2 |
3 |
4 |
l. Deep kissing, or French kissing, someone with AIDS |
1 |
2 |
3 |
4 |
m. Kissing someone on the cheek who has AIDS |
1 |
2 |
3 |
4 |
n. From a bite by a blood sucking insect that previously bit a person with AIDS |
1 |
2 |
3 |
4 |
o. Hugging a person with HIV |
1 |
2 |
3 |
4 |
p. Working next to a person with HIV |
1 |
2 |
3 |
4 |
q. Caring for a person with HIV |
1 |
2 |
3 |
4 |
Out of all the women in the United States living with AIDS, what percentage would you say are African American?
1. 20%
2. 40%
3. 60%
4. 80%
5. Don’t know
6. Refuse to answer
In the United States, how often is an individual infected with HIV?
1. Every 3½ minutes
2. Every 9½ minutes
3. Every 15½ minutes
4. Every 21½ minutes
5. Don’t know
6. Refuse to answer
If I test positive for HIV, my name will be reported to the government.
1. Strongly agree
2. Agree
3. Disagree
4. Strongly disagree
5. Don’t know
6. Refuse to answer
AIDS is not at all serious; it is like having the common cold.
1. Strongly agree
2. Agree
3. Disagree
4. Strongly disagree
5. Don’t know
6. Refuse to answer
HIV is not my problem.
1. Strongly agree
2. Agree
3. Disagree
4. Strongly disagree
5. Don’t know
6. Refuse to answer
There are medications available to treat HIV.
1. Strongly agree
2. Agree
3. Disagree
4. Strongly disagree
5. Don’t know
6. Refuse to answer
I should get tested for HIV because I may be at risk.
1. Strongly agree
2. Agree
3. Disagree
4. Strongly disagree
5. Don’t know
6. Refuse to answer
I don’t think about HIV often/HIV is not something I think about often.
1. Strongly agree
2. Agree
3. Disagree
4. Strongly disagree
5. Don’t know
6. Refuse to answer
HIV is not a big problem in my community.
1. Strongly agree
2. Agree
3. Disagree
4. Strongly disagree
5. Don’t know
6. Refuse to answer
I am less likely than most people to get HIV.
1. Strongly agree
2. Agree
3. Disagree
4. Strongly disagree
5. Don’t know
6. Refuse to answer
People in my community should get tested for HIV.
1. Strongly agree
2. Agree
3. Disagree
4. Strongly disagree
5. Don’t know
6. Refuse to answer
People need education to learn how to avoid getting HIV.
1. Strongly agree
2. Agree
3. Disagree
4. Strongly disagree
5. Don’t know
6. Refuse to answer
I don’t need to worry about getting HIV because I know everything about my boyfriend/partner/partners.
1. Strongly agree
2. Agree
3. Disagree
4. Strongly disagree
5. Don’t know
6. Refuse to answer
As long as you are in love with someone, you don’t need to worry about getting HIV from them.
1. Strongly agree
2. Agree
3. Disagree
4. Strongly disagree
5. Don’t know
6. Refuse to answer
Treatment and support programs are available to people [in my community/like me] who might test positive for HIV.
1. Strongly agree
2. Agree
3. Disagree
4. Strongly disagree
5. Don’t know
6. Refuse to answer
Knowing my HIV status helps me take responsibility for myself.
1. Strongly agree
2. Agree
3. Disagree
4. Strongly disagree
5. Don’t know
6. Refuse to answer
Knowing my HIV status helps me take responsibility for others.
1. Strongly agree
2. Agree
3. Disagree
4. Strongly disagree
5. Don’t know
6. Refuse to answer
Because of new treatments for HIV, I think [people/ negative men] are taking more sexual risks.
1. Strongly agree
2. Agree
3. Disagree
4. Strongly disagree
5. Don’t know
6. Refuse to answer
Because of new treatments for HIV, I’m more willing to have unprotected sex with someone who is HIV negative.
1. Strongly agree
2. Agree
3. Disagree
4. Strongly disagree
5. Don’t know
6. Refuse to answer
Because of new treatments for HIV, I’m less concerned about infecting someone else.
1. Strongly agree
2. Agree
3. Disagree
4. Strongly disagree
5. Don’t know
6. Refuse to answer
[People with HIV/HIV positive gay men] have a responsibility to keep other [people/gay men] from becoming positive.
1. Strongly agree
2. Agree
3. Disagree
4. Strongly disagree
5. Don’t know
6. Refuse to answer
[People with HIV/HIV positive gay men] have a special obligation to have safe sex with [people who /men who are negative or] do not know their HIV status.
1. Strongly agree
2. Agree
3. Disagree
4. Strongly disagree
5. Don’t know
6. Refuse to answer
When HIV positive and HIV negative [people/men] have sex with each other, they have an equal responsibility for being safe.
1. Strongly agree
2. Agree
3. Disagree
4. Strongly disagree
5. Don’t know
6. Refuse to answer
How would you rate your understanding of HIV prevention?
1. Poor
2. Fair
3. Good
4. Very good
5. Excellent
6. Don’t know
7. Refuse to answer
How would you rate your understanding of the risks of different behaviors for transmitting HIV?
1. Poor
2. Fair
3. Good
4. Very good
5. Excellent
6. Don’t know
7. Refuse to answer
As far as you know, has the HIV epidemic had a greater impact, a smaller impact, or about the same impact on African Americans as it has on whites in the United States?
1. Greater impact
2. Smaller impact
3. About the same impact
4. Don’t know
5. Refuse to answer
If you were to be tested for HIV, do you think it would make people you know think less of you, think more of you, or would it make no difference in how people you know think of you?
1. People would think more of you
2. Would make no difference in how people think of you
3. People would think less of you
4. Don’t know
5. Refuse to answer
In your opinion, how effective are condoms, if used correctly, at preventing HIV/AIDS? Are they…
1. Very effective
2. Somewhat effective
3. Not too effective
4. Not effective at all
5. Don’t know
6. Refuse to answer
How likely do you think it is that you will get HIV/AIDS in the future? Would you say your chance is…
1. Very low
2. Somewhat low
3. Moderate
4. Somewhat high
5. Very high
6. Don’t know
7. Refuse to answer
How often do you worry about getting HIV/AIDS? Would you say…
1. Rarely or never
2. Sometimes
3. Often
4. All the time
5. Don’t know
6. Refuse to answer
How much do you agree or disagree with the following statements?
|
Strongly agree |
Agree |
Disagree |
Strongly disagree |
Don’t know |
Refuse to answer |
a. When I think of HIV/AIDS, I automatically think of death. |
1 |
2 |
3 |
4 |
5 |
6 |
b. HIV/AIDS is most often caused by a person’s behavior or lifestyle. |
1 |
2 |
3 |
4 |
5 |
6 |
c. Getting checked regularly for HIV/AIDS is important. |
1 |
2 |
3 |
4 |
5 |
6 |
d. People can tell they might have HIV/AIDS before being diagnosed. |
1 |
2 |
3 |
4 |
5 |
6 |
e. There’s not much you can do to lower your chances of getting HIV/AIDS. |
1 |
2 |
3 |
4 |
5 |
6 |
Overall, how many people who are diagnosed as having HIV/AIDS do you think survive at least 5 years? Would you say…
1. Less than 25 percent
2. About 25 percent
3. About 50 percent
4. About 75 percent
5. Nearly all
6. Don’t know
7. Refuse to answer
If you wanted to get an HIV test every [INSERT TIME FRAME], how sure are you that you could?
1. Very sure I could not
2. Somewhat sure I could not
3. Slightly sure I could
4. Somewhat sure I could
5. Very sure I could
6. Don’t know
7. Refuse to answer
If you wanted to use a condom every time you have anal sex, how sure are you that you could? [ASK FOR MSM ONLY.]
1. Very sure I could not
2. Somewhat sure I could not
3. Slightly sure I could
4. Somewhat sure I could
5. Very sure I could
6. Don’t know
7. Refuse to answer
I am confident that I can use condoms consistently with partners [who are not infected].
1. Strongly agree
2. Agree
3. Disagree
4. Strongly disagree
5. Don’t know
6. Refuse to answer
How confident are you that you have the skills to persuade your partner to use a condom?
1. Not at all confident
2. Somewhat confident
3. Confident
4. Very confident
5. Don’t know
6. Refuse to answer
I am confident that talking about using a condom with my partner helps to protect me from getting infected with HIV.
1. Strongly agree
2. Agree
3. Disagree
4. Strongly disagree
5. Don’t know
6. Refuse to answer
Would you be able to refuse to have sex if your partner didn’t want you to use a condom?
1. Yes
2. Probably yes
3. Probably no
4. No
5. Don’t know
6. Refuse to answer
I am confident that I can protect myself from getting infected with HIV.
1. Strongly agree
2. Agree
3. Disagree
4. Strongly disagree
5. Don’t know
6. Refuse to answer
I am confident that I can use condoms consistently with my partners.
1. Strongly agree
2. Agree
3. Disagree
4. Strongly disagree
5. Don’t know
6. Refuse to answer
I am confident that if I use a condom every time I have sex, I can protect myself from getting infected with HIV.
1. Strongly agree
2. Agree
3. Disagree
4. Strongly disagree
5. Don’t know
6. Refuse to answer
I am confident that I can reduce the number of people with whom I have sex.
1. Strongly agree
2. Agree
3. Disagree
4. Strongly disagree
5. Don’t know
6. Refuse to answer
I am confident that if I reduce the number of people with whom I have sex, I can reduce my chances of getting HIV.
1. Strongly agree
2. Agree
3. Disagree
4. Strongly disagree
5. Don’t know
6. Refuse to answer
I am confident that I can have sex with only one partner.
1. Strongly agree
2. Agree
3. Disagree
4. Strongly disagree
5. Don’t know
6. Refuse to answer
I am confident that if I have sex with only one partner, I can reduce my chances of getting HIV.
1. Strongly agree
2. Agree
3. Disagree
4. Strongly disagree
5. Don’t know
6. Refuse to answer
People have many different feelings when they think about people who have AIDS. As I read each of the following feelings, please tell me how you personally feel.
How about feeling angry at them? Would you say you feel:
1. Very angry
2. Somewhat
3. A little
4. Not at all angry at people with AIDS
5. Don’t know
6. Refuse to answer
How about feeling afraid of them? Would you say you feel:
1. Very afraid
2. Somewhat
3. A little
4. Not at all afraid of people with AIDS
5. Don’t know
6. Refuse to answer
How about disgusted by them? Would you say you feel:
1. Very disgusted
2. Somewhat
3. A little
4. Not at all disgusted by people with AIDS
5. Don’t know
6. Refuse to answer
Now I’m going to read a list of statements people have made. As I read each one, please tell me how much you agree or disagree.
|
Strongly agree |
Agree |
Disagree |
Strongly disagree |
Don’t know |
Refuse to answer |
a. People with AIDS should be legally separated from others to protect the public health. |
1 |
2 |
3 |
4 |
5 |
6 |
b. The names of people with AIDS should be made public so that others can avoid them. |
1 |
2 |
3 |
4 |
5 |
6 |
c. People who got AIDS through sex or drug use have gotten what they deserve. |
1 |
2 |
3 |
4 |
5 |
6 |
Suppose you had a close friend or relative who developed AIDS. Would you be willing to take care of him/her, or is that something you would not be willing to do?
1. Would be willing to take care of him/her
2. Would not be willing to take care of him/her
3. Don’t know
4. Refuse to answer
F.62a Is that because you would not want to take care of someone with AIDS, or for some other reason?
1. Would not want to take care of someone with AIDS
2. Other reason
3. Don’t know
4. Refuse to answer
Suppose you had a young child who was attending school where one of the students was known to have AIDS. What would you do? Would you send your child to another school, or leave your child in the same school?
1. Send your child to another school
2. Leave your child in the same school
3. Don’t know
4. Refuse to answer
F.63a Would you encourage your child to be especially nice to the student with AIDS, discourage your child from contact with him/her, or encourage your child to treat him/her the same as always?
1. Encourage your child to be especially nice to the student with AIDS
2. Discourage your child from contact with him/her
3. Encourage your child to treat him/her the same as always
4. Don’t know
5. Refuse to answer
Now suppose you had an office job where one of the men working with you developed AIDS. Would you:
1. Still be willing to work with him
2. Ask that he be assigned someplace else
3. Ask to be assigned with someone else
4. Don’t know
5. Refuse to answer
IF F.64 = 1: Would you
1. Go out of your way to help him
2. Try to avoid contact with him
3. Treat him the same as always
4. Don’t know
5. Refuse to answer
Suppose that you found out that the owner of a small neighborhood grocery store where you like to shop had AIDS. Would you:
1. Continue to shop there
2. Probably go someplace else to shop
3. Don’t know
4. Refuse to answer
IF F.65 = 1: Do you think you would shop there…
1. More often
2. Less often than you did before you found out the owner had AIDS
3. Would you continue to shop there as much as you did before you found out
4. Don’t know
5. Refuse to answer
In general, how comfortable would you be, personally, …
|
Very comfortable |
Somewhat comfortable |
Somewhat uncomfortable |
Very uncomfortable |
Don’t know |
Refuse to answer |
a. Working with someone who has HIV or AIDS? |
1 |
2 |
3 |
4 |
5 |
6 |
b. If your children had a teacher who was HIV-positive?* |
1 |
2 |
3 |
4 |
5 |
6 |
c. Having a roommate who is HIV-positive? |
1 |
2 |
3 |
4 |
5 |
6 |
d. Having your food prepared by someone who is HIV-positive? |
1 |
2 |
3 |
4 |
5 |
6 |
*NOTE: For parents with child under age 21.
We’re also interested in knowing what you think the chances are that certain types of people will get AIDS in certain types of situations.
First, think of two healthy homosexual men—neither of whom is infected with the AIDS virus. Now suppose they have sexual intercourse. If they use condoms, would you say that at least one of them is almost sure to become infected, has a fairly strong chance, has very little chance, or has no chance of becoming infected?
1. Almost sure to become infected
2. Has a fairly strong chance
3. Has very little chance
4. Has no chance of becoming infected
5. Don’t know
6. Refuse to answer
Now suppose the same two healthy men have sexual intercourse but this time they do not use condoms. Would you say that at least one of them is almost sure to become infected, has a fairly strong chance, has very little chance, or has no chance of becoming infected?
1. Almost sure to become infected
2. Has a fairly strong chance
3. Has very little chance
4. Has no chance of becoming infected
5. Don’t know
6. Refuse to answer
Now think of someone who uses drugs intravenously (and who is not a homosexual). If this person does not share needles, what do you think this person’s chances are of becoming infected with the AIDS virus? Would you say that person is almost sure to become infected, has a fairly strong chance, has very little chance, or has no chance of becoming infected?
1. Almost sure to become infected
2. Has a fairly strong chance
3. Has very little chance
4. Has no chance of becoming infected
5. Don’t know
6. Refuse to answer
Would you buy fresh vegetables from a shopkeeper or vendor if you knew that this person had the AIDS virus?
1. Yes
2. No
3. Don’t know
4. Refuse to answer
Would you rather not touch someone with HIV because you are scared of infection?
1. Yes
2. No
3. Don’t know
4. Refuse to answer
Indicate your agreement or disagreement with each statement:
|
Strongly agree |
Agree |
Disagree |
Strongly disagree |
Don’t know |
Refuse to answer |
a. AIDS is a punishment for bad behavior. |
1 |
2 |
3 |
4 |
5 |
6 |
b. AIDS is a punishment from God. |
1 |
2 |
3 |
4 |
5 |
6 |
c. A person with HIV must have done something wrong. |
1 |
2 |
3 |
4 |
5 |
6 |
d. People who got HIV through sex or drug use have gotten what they deserve. |
1 |
2 |
3 |
4 |
5 |
6 |
e. People with HIV should be ashamed of themselves. |
1 |
2 |
3 |
4 |
5 |
6 |
Do you personally know someone who has had the following happen to him/her in the past [INSERT TIME FRAME] because of having HIV?
|
Yes |
No |
Don’t know |
Refuse to answer |
a. Excluded from a social gathering. |
1 |
2 |
3 |
4 |
b. Abandoned by spouse/partner. |
1 |
2 |
3 |
4 |
c. Verbally abused or teased. |
1 |
2 |
3 |
4 |
d. Been physically assaulted. |
1 |
2 |
3 |
4 |
e. Been fired from work. |
1 |
2 |
3 |
4 |
f. Had property taken away. |
1 |
2 |
3 |
4 |
g. Been denied health services. |
1 |
2 |
3 |
4 |
Bearing in mind the different ways people can be infected with HIV, how concerned are you about you, personally, becoming infected with HIV?
1. Very concerned
2. Somewhat concerned
3. Not too concerned
4. Not at all concerned
5. Don’t know
6. Refuse to answer
How concerned are you about a son
or daughter becoming infected with HIV?
(NOTE: Asked of parents
of children aged 21 or younger)
1. Very concerned
2. Somewhat concerned
3. Not too concerned
4. Not at all concerned
5. Don’t know
6. Refuse to answer
Do you personally know anyone who now has AIDS, has died from AIDS, or has tested positive for HIV?
1. Yes
2. No
3. Don’t know
4. Refuse to answer
F.76a (If yes, ask) Is that a family member, a close friend, an acquaintance or coworker, or someone else?
1. Yes, close friend or family member
2. Yes, acquaintance or coworker
3. Someone else
4. Don’t know
5. Refuse to answer
What is the most urgent health problem facing this nation today? (open-ended)
_____________________
(Common response codes)
1. Cancer
2. Health insurance/the uninsured
3. Health care—cost
4. Heart disease
5. Lack of good nutrition/junk foods/obesity/weight disorder
6. Health care—access
7. Diabetes
8. AIDS or HIV
9. Elderly
10. Smoking
11. Hunger/malnutrition
12. Drugs
13. Sexually transmitted diseases
14. Pollution/global warming/environment
15. Other
16. Don’t know
17. Refuse to answer
Thinking about the way the problem of HIV/AIDS affects the United States today, do you think the problem is about the same as it has been, that the United States today is making progress in this area, or that the United States today is losing ground?
1. About the same
2. United States is making progress
3. United States is losing ground
4. Don’t know
5. Refuse to answer
Thinking about the way the problem of AIDS is affecting your local community today, do you think AIDS is a more urgent problem for your community than it was a few years ago, a less urgent problem, is it about the same, or has AIDS never been a problem in your community?
1. More urgent
2. Less urgent
3. About the same
4. Never been a problem
5. Don’t know
6. Refuse to answer
Thinking about the HIV/AIDS epidemic in the United States specifically, in general, do you think the federal government spends too much money on HIV/AIDS, too little money on HIV/AIDS, or about the right amount?
1. Too much money on HIV/AIDS
2. Too little money on HIV/AIDS
3. About the right amount
4. Don’t know
5. Refuse to answer
Compared with the amount of money the federal government spends on other health problems, such as heart disease and cancer, do you think federal spending on HIV/AIDS is too high, too low, or about right?
1. Spending on HIV/AIDS is too high
2. Spending on HIV/AIDS is too low
3. Spending on HIV/AIDS is about right
4. Don’t know
5. Refuse to answer
In general, do you think that spending more money on HIV/AIDS prevention in the United States will lead to meaningful progress in slowing the epidemic OR that spending more money won’t make much difference?
1. Lead to meaningful progress
2. Depends
3. Won’t make much difference
4. Don’t know
5. Refuse to answer
In general, do you think that spending more money on HIV/AIDS treatment in the United States will lead to meaningful progress in slowing the epidemic OR that spending more money won’t make much difference?
1. Lead to meaningful progress
2. Depends
3. Won’t make much difference
4. Don’t know
5. Refuse to answer
Have you ever heard of the following methods as a way to reduce the chances of getting HIV/AIDS?
|
Yes |
No |
Don’t know |
Refuse to answer |
a. A person taking HIV medications before they are exposed to HIV to prevent an infection, sometimes called pre-exposure prophylactic use? |
1 |
2 |
3 |
4 |
b. A person taking HIV medications immediately after they have been exposed to HIV, sometimes called post-exposure prophylactic use? |
1 |
2 |
3 |
4 |
c. The practice of circumcision for newborn males? |
1 |
2 |
3 |
4 |
d. A person choosing a sexual partner who has the same HIV/AIDS status? For example, a person with HIV chooses a sexual partner who also has HIV. This is sometimes called sero-sorting. |
1 |
2 |
3 |
4 |
In your opinion, how effective is [INSERT METHOD] at preventing HIV/AIDS? Is this method…
1. Very effective
2. Somewhat effective
3. Not too effective.
4. Not effective at all
5. Don’t know
6. Refuse to answer
Have you ever personally considered [INSERT METHOD] to prevent HIV/AIDS?
1. Yes
2. No
3. Don’t know
4. Refuse to answer
In the past [INSERT TIME FRAME], which of the following HIV/AIDS prevention activities or events have you participated in? [MARK ALL THAT APPLY.]
1. Read an HIV-related publication or newspaper (If yes, which one[s]?)
2. Attended a safer sex workshop (If yes, who was the sponsor?)
3. Attended (or led) a workshop or community forum about HIV-related issues (If yes, who was the sponsor?)
4. Looked at a Web site with information about HIV prevention (If yes, which one[s]?)
5. Looked at an ad about HIV prevention (If yes, where was the ad?)
6. Read a news or magazine article about HIV prevention (If yes, in what publication?)
7. Viewed a TV show or announcement with information about HIV prevention (If yes, on what TV show?)
8. None of these activities/events
9. Don’t know
10. Refuse to answer
Have you, personally, ever donated money to an HIV- or AIDS-related charity?
1. Yes
2. No
3. Don’t know
4. Refuse to answer
Have you ever been a member of the following organizations?
|
Yes |
No |
Don’t know |
Refuse to answer |
a. [INSERT ORGANIZATION] EXAMPLE: 100 Black Men of America |
1 |
2 |
3 |
4 |
b. EXAMPLE: American Urban Radio Networks |
1 |
2 |
3 |
4 |
c. EXAMPLE: Coalition of Black Trade Unionists |
1 |
2 |
3 |
4 |
d. EXAMPLE: Congressional Black Caucus Foundation |
1 |
2 |
3 |
4 |
e. EXAMPLE: National Action Network, National Association for the Advancement of Colored People (NAACP) |
1 |
2 |
3 |
4 |
f. EXAMPLE: National Coalition of 100 Black Women |
1 |
2 |
3 |
4 |
g. EXAMPLE: National Medical Association |
1 |
2 |
3 |
4 |
h. EXAMPLE: National Newspaper Publishers Association |
1 |
2 |
3 |
4 |
i. EXAMPLE: National Organization of Black County Officials |
1 |
2 |
3 |
4 |
j. EXAMPLE: National Urban League |
1 |
2 |
3 |
4 |
k. EXAMPLE: Phi Beta Sigma Fraternity |
1 |
2 |
3 |
4 |
l. EXAMPLE: The Southern Christian Leadership Conference |
1 |
2 |
3 |
4 |
Are you currently a member of [INSERT ORGANIZATION]?
1. Yes
2. No
3. Don’t know
4. Refuse to answer
In the past [INSERT TIME FRAME], have you read a story about HIV/AIDS in a newsletter or other publication from any of the following organizations? [SELECT ALL THAT APPLY.]
|
Yes |
No |
Don’t know |
Refuse to answer |
a. [INSERT ORGANIZATION] EXAMPLE: 100 Black Men of America |
1 |
2 |
3 |
4 |
b. EXAMPLE: American Urban Radio Networks |
1 |
2 |
3 |
4 |
c. EXAMPLE: Coalition of Black Trade Unionists |
1 |
2 |
3 |
4 |
d. EXAMPLE: Congressional Black Caucus Foundation |
1 |
2 |
3 |
4 |
e. EXAMPLE: National Action Network, National Association for the Advancement of Colored People (NAACP) |
1 |
2 |
3 |
4 |
f. EXAMPLE: National Coalition of 100 Black Women |
1 |
2 |
3 |
4 |
g. EXAMPLE: National Medical Association |
1 |
2 |
3 |
4 |
h. EXAMPLE: National Newspaper Publishers Association |
1 |
2 |
3 |
4 |
i. EXAMPLE: National Organization of Black County Officials |
1 |
2 |
3 |
4 |
j. EXAMPLE: National Urban League |
1 |
2 |
3 |
4 |
k. EXAMPLE: Phi Beta Sigma Fraternity |
1 |
2 |
3 |
4 |
l. EXAMPLE: The Southern Christian Leadership Conference |
1 |
2 |
3 |
4 |
In the past [INSERT TIME FRAME], have you received any HIV-related educational pamphlets/brochures/or other materials during a conference organized or sponsored by any of the following organizations? [SELECT ALL THAT APPLY.]
|
Yes |
No |
Don’t know |
Refuse to answer |
a. [INSERT ORGANIZATION] EXAMPLE: 100 Black Men of America |
1 |
2 |
3 |
4 |
b. EXAMPLE: American Urban Radio Networks |
1 |
2 |
3 |
4 |
c. EXAMPLE: Coalition of Black Trade Unionists |
1 |
2 |
3 |
4 |
d. EXAMPLE: Congressional Black Caucus Foundation |
1 |
2 |
3 |
4 |
e. EXAMPLE: National Action Network, National Association for the Advancement of Colored People (NAACP) |
1 |
2 |
3 |
4 |
f. EXAMPLE: National Coalition of 100 Black Women |
1 |
2 |
3 |
4 |
g. EXAMPLE: National Medical Association |
1 |
2 |
3 |
4 |
h. EXAMPLE: National Newspaper Publishers Association |
1 |
2 |
3 |
4 |
i. EXAMPLE: National Organization of Black County Officials |
1 |
2 |
3 |
4 |
j. EXAMPLE: National Urban League |
1 |
2 |
3 |
4 |
k. EXAMPLE: Phi Beta Sigma Fraternity |
1 |
2 |
3 |
4 |
l. EXAMPLE: The Southern Christian Leadership Conference |
1 |
2 |
3 |
4 |
In the past [INSERT TIME FRAME], have you attended an HIV/AIDS-related event organized or sponsored by any of the following organizations? [SELECT ALL THAT APPLY.]
|
Yes |
No |
Don’t know |
Refuse to answer |
a. [INSERT ORGANIZATION] EXAMPLE: 100 Black Men of America |
1 |
2 |
3 |
4 |
b. EXAMPLE: American Urban Radio Networks |
1 |
2 |
3 |
4 |
c. EXAMPLE: Coalition of Black Trade Unionists |
1 |
2 |
3 |
4 |
d. EXAMPLE: Congressional Black Caucus Foundation |
1 |
2 |
3 |
4 |
e. EXAMPLE: National Action Network, National Association for the Advancement of Colored People (NAACP) |
1 |
2 |
3 |
4 |
f. EXAMPLE: National Coalition of 100 Black Women |
1 |
2 |
3 |
4 |
g. EXAMPLE: National Medical Association |
1 |
2 |
3 |
4 |
h. EXAMPLE: National Newspaper Publishers Association |
1 |
2 |
3 |
4 |
i. EXAMPLE: National Organization of Black County Officials |
1 |
2 |
3 |
4 |
j. EXAMPLE: National Urban League |
1 |
2 |
3 |
4 |
k. EXAMPLE: Phi Beta Sigma Fraternity |
1 |
2 |
3 |
4 |
l. EXAMPLE: The Southern Christian Leadership Conference |
1 |
2 |
3 |
4 |
F.93a Did you receive any HIV/AIDS-related educational pamphlets/brochures/or other materials at this (these) event(s)?
1. Yes
2. No
3. Don’t know
4. Refuse to answer
In the past [INSERT TIME FRAME], have you volunteered at an HIV/AIDS-related event organized or sponsored by any of the following organizations? [SELECT ALL THAT APPLY.]
|
Yes |
No |
Don’t know |
Refuse to answer |
a. [INSERT ORGANIZATION] EXAMPLE: 100 Black Men of America |
1 |
2 |
3 |
4 |
b. EXAMPLE: American Urban Radio Networks |
1 |
2 |
3 |
4 |
c. EXAMPLE: Coalition of Black Trade Unionists |
1 |
2 |
3 |
4 |
d. EXAMPLE: Congressional Black Caucus Foundation |
1 |
2 |
3 |
4 |
e. EXAMPLE: National Action Network, National Association for the Advancement of Colored People (NAACP) |
1 |
2 |
3 |
4 |
f. EXAMPLE: National Coalition of 100 Black Women |
1 |
2 |
3 |
4 |
g. EXAMPLE: National Medical Association |
1 |
2 |
3 |
4 |
h. EXAMPLE: National Newspaper Publishers Association |
1 |
2 |
3 |
4 |
i. EXAMPLE: National Organization of Black County Officials |
1 |
2 |
3 |
4 |
j. EXAMPLE: National Urban League |
1 |
2 |
3 |
4 |
k. EXAMPLE: Phi Beta Sigma Fraternity |
1 |
2 |
3 |
4 |
l. EXAMPLE: The Southern Christian Leadership Conference |
1 |
2 |
3 |
4 |
Indicate your agreement or disagreement with each statement:
|
Strongly agree |
Agree |
Disagree |
Strongly disagree |
Don’t know |
Refuse to answer |
Behavioral Intentions |
|
|
|
|
|
|
a. I intend to do something about HIV/AIDS. |
1 |
2 |
3 |
4 |
5 |
6 |
b. I plan on looking into HIV/AIDS. |
1 |
2 |
3 |
4 |
5 |
6 |
c. I mean to research HIV/AIDS. |
1 |
2 |
3 |
4 |
5 |
6 |
d. I have thought about taking action to/for HIV/AIDS. |
1 |
2 |
3 |
4 |
5 |
6 |
e. I have considered doing something about HIV/AIDS. |
1 |
2 |
3 |
4 |
5 |
6 |
f. I will do something about HIV/AIDS. |
1 |
2 |
3 |
4 |
5 |
6 |
g. I am taking action to/for HIV/AIDS right now. |
1 |
2 |
3 |
4 |
5 |
6 |
Involvement |
|
|
|
|
|
|
h. The outcome of HIV/AIDS directly affects my life. |
1 |
2 |
3 |
4 |
5 |
6 |
i. Whether or not people do something about HIV/AIDS is important to my life. |
1 |
2 |
3 |
4 |
5 |
6 |
j. The outcome of HIV/AIDS is relevant to my life. |
1 |
2 |
3 |
4 |
5 |
6 |
k. Whether or not others care about HIV/AIDS is important to me. |
1 |
2 |
3 |
4 |
5 |
6 |
l. The problem of HIV/AIDS is against my personal values. |
1 |
2 |
3 |
4 |
5 |
6 |
m. People who support HIV/AIDS are against all I stand for. |
1 |
2 |
3 |
4 |
5 |
6 |
n. If I thought HIV/AIDS was not a big deal, my friends would think poorly of me. |
1 |
2 |
3 |
4 |
5 |
6 |
o. I am fearful that my circle of friends would think I was dumb for caring about HIV/AIDS. |
1 |
2 |
3 |
4 |
5 |
6 |
p. Whether I do something to improve HIV/AIDS is central to how I view myself. |
1 |
2 |
3 |
4 |
5 |
6 |
Attitudes |
|
|
|
|
|
|
q. I think that HIV/AIDS is a critical issue. |
1 |
2 |
3 |
4 |
5 |
6 |
r. People should make a strong effort to do something about HIV/AIDS. |
1 |
2 |
3 |
4 |
5 |
6 |
s. People that do not do something about HIV/AIDS are inconsiderate. |
1 |
2 |
3 |
4 |
5 |
6 |
t. People who do not care about HIV/AIDS are dumb. |
1 |
2 |
3 |
4 |
5 |
6 |
Response Efficacy |
|
|
|
|
|
|
u. Visiting the Web site/calling the number listed in the message is a good start to (improving) learning more about HIV/AIDS. |
1 |
2 |
3 |
4 |
5 |
6 |
v. By doing the behaviors suggested by the message, my risk of getting HIV/AIDS can be improved. |
1 |
2 |
3 |
4 |
5 |
6 |
w. Generally speaking, it is possible to decrease my risk of getting HIV/AIDS. |
1 |
2 |
3 |
4 |
5 |
6 |
x. There are many things I can do to protect myself from HIV/AIDS. |
1 |
2 |
3 |
4 |
5 |
6 |
Self-Protection Motivation |
|
|
|
|
|
|
y. I want to combat HIV/AIDS. |
1 |
2 |
3 |
4 |
5 |
6 |
z. I want to have the ability to fight HIV/AIDS. |
1 |
2 |
3 |
4 |
5 |
6 |
aa. I want to prevent HIV/AIDS. |
1 |
2 |
3 |
4 |
5 |
6 |
bb. I really don’t care about HIV/AIDS. |
1 |
2 |
3 |
4 |
5 |
6 |
cc. How I handle HIV/AIDS is central to my self-image. |
1 |
2 |
3 |
4 |
5 |
6 |
dd. Handling HIV/AIDS actively is an important part of how I see myself. |
1 |
2 |
3 |
4 |
5 |
6 |
Self-Efficacy |
|
|
|
|
|
|
ee. I feel as though I can make a difference regarding HIV/AIDS. |
1 |
2 |
3 |
4 |
5 |
6 |
ff. The suggestions for HIV/AIDS prevention in the message are doable. |
1 |
2 |
3 |
4 |
5 |
6 |
gg. I personally could do the suggested HIV/AIDS prevention methods in the message. |
1 |
2 |
3 |
4 |
5 |
6 |
hh. Helping reduce my risk of HIV/AIDS is a goal within my reach. |
1 |
2 |
3 |
4 |
5 |
6 |
ii. I am confident that I can protect myself from HIV/AIDS. |
1 |
2 |
3 |
4 |
5 |
6 |
*NOTE: Other possible wording—“HIV/AIDS research” “HIV/AIDS prevention and treatment”?
Whenever I think a lot about being gay or bisexual, I feel proud.
1. Strongly agree
2. Agree
3. Disagree
4. Strongly disagree
5. Don’t know
6. Refuse to answer
Sometimes I wish I were heterosexual.
1. Strongly agree
2. Agree
3. Disagree
4. Strongly disagree
5. Don’t know
6. Refuse to answer
Whenever I think a lot about being gay or bisexual, I feel critical of myself.
1. Strongly agree
2. Agree
3. Disagree
4. Strongly disagree
5. Don’t know
6. Refuse to answer
In the past [INSERT TIME FRAME], which of the following gay community activities or events have you participated in? [MARK ALL THAT APPLY.]
1. Attended gay pride parade or festival
2. Read a gay newspaper
3. Belonged to a gay club, professional group, or community organization
4. Took part in the house, ball, or court systems
5. Went to a gay bar or nightclub
6. Worked out at a gay gym
7. Logged on to a gay Web site, chat room, or online service
8. None of these activities/events
9. Don’t know
10. Refuse to answer
Please tell us how much you disagree or agree with each of the following statements.
|
Do
not agree at all |
2 |
3 |
4 |
5 |
6 |
Agree
Completely |
a. I feel good about being a [gay man]. |
|
|
|
|
|
|
|
b. I often regret that I am a [gay man]. |
|
|
|
|
|
|
|
c. In general, I am glad to be a [gay man]. |
|
|
|
|
|
|
|
d. Overall, I often do not like being a Black gay man |
|
|
|
|
|
|
|
e. Being a [gay man].is important to me |
|
|
|
|
|
|
|
f. If someone says something bad about [gay man], they say something bad about me |
|
|
|
|
|
|
|
Most people who are important to me think I should get tested for HIV regularly. By important to me, we mean people like friends, family, and anyone else who is an important part of your life.
1. Strongly agree
2. Agree
3. Disagree
4. Strongly disagree
5. Don’t know
6. Refuse to answer
Most of my sexual partners get tested for HIV regularly
1. Strongly agree
2. Agree
3. Disagree
4. Strongly disagree
5. Don’t know
6. Refuse to answer
Most [people/gay men] I know get tested for HIV regularly.
1. Strongly agree
2. Agree
3. Disagree
4. Strongly disagree
5. Don’t know
6. Refuse to answer
Most [people/gay men] I know have been tested for HIV.
1. Strongly agree
2. Agree
3. Disagree
4. Strongly disagree
5. Don’t know
6. Refuse to answer
Most people who are important to me think I should use a condom every time I have anal sex.
1. Strongly agree
2. Agree
3. Disagree
4. Strongly disagree
5. Don’t know
6. Refuse to answer
Most [people/gay men] I know use a condom every time they have anal sex.
1. Strongly agree
2. Agree
3. Disagree
4. Strongly disagree
5. Don’t know
6. Refuse to answer
I have little in common with most other males.
1. Strongly agree
2. Agree
3. Disagree
4. Strongly disagree
5. Don’t know
6. Refuse to answer
Men are confusing to me.
1. Strongly agree
2. Agree
3. Disagree
4. Strongly disagree
5. Don’t know
6. Refuse to answer
I don’t feel connected with any group of males.
1. Strongly agree
2. Agree
3. Disagree
4. Strongly disagree
5. Don’t know
6. Refuse to answer
I don’t know of any particular group of males with whom I identify.
1. Strongly agree
2. Agree
3. Disagree
4. Strongly disagree
5. Don’t know
6. Refuse to answer
I am not like most males.
1. Strongly agree
2. Agree
3. Disagree
4. Strongly disagree
5. Don’t know
6. Refuse to answer
I often wonder whether there are other men like myself.
1. Strongly agree
2. Agree
3. Disagree
4. Strongly disagree
5. Don’t know
6. Refuse to answer
Basically I am different from my male friends.
1. Strongly agree
2. Agree
3. Disagree
4. Strongly disagree
5. Don’t know
6. Refuse to answer
I find it difficult to describe who I am as a man.
1. Strongly agree
2. Agree
3. Disagree
4. Strongly disagree
5. Don’t know
6. Refuse to answer
I don’t understand why men are the way they are.
1. Strongly agree
2. Agree
3. Disagree
4. Strongly disagree
5. Don’t know
6. Refuse to answer
I believe there are no other males who think the way I do about things.
1. Strongly agree
2. Agree
3. Disagree
4. Strongly disagree
5. Don’t know
6. Refuse to answer
I feel comfortable relating to different types of males.
1. Strongly agree
2. Agree
3. Disagree
4. Strongly disagree
5. Don’t know
6. Refuse to answer
I feel connected with various types of males.
1. Strongly agree
2. Agree
3. Disagree
4. Strongly disagree
5. Don’t know
6. Refuse to answer
I find differences in men interesting.
1. Strongly agree
2. Agree
3. Disagree
4. Strongly disagree
5. Don’t know
6. Refuse to answer
I believe there is something wrong with guys who are different from me, my male friends, and other males like me.
1. Strongly agree
2. Agree
3. Disagree
4. Strongly disagree
5. Don’t know
6. Refuse to answer
I understand differences in men.
1. Strongly agree
2. Agree
3. Disagree
4. Strongly disagree
5. Don’t know
6. Refuse to answer
It does not matter to me whether my friends and I are all alike.
1. Strongly agree
2. Agree
3. Disagree
4. Strongly disagree
5. Don’t know
6. Refuse to answer
I share a common bond with all males.
1. Strongly agree
2. Agree
3. Disagree
4. Strongly disagree
5. Don’t know
6. Refuse to answer
Although I feel most similar to some males, I am also similar to all males.
1. Strongly agree
2. Agree
3. Disagree
4. Strongly disagree
5. Don’t know
6. Refuse to answer
I am similar in many ways to all males.
1. Strongly agree
2. Agree
3. Disagree
4. Strongly disagree
5. Don’t know
6. Refuse to answer
Although males may differ in some ways, we are essentially all the same.
1. Strongly agree
2. Agree
3. Disagree
4. Strongly disagree
5. Don’t know
6. Refuse to answer
I have much in common with most other males.
1. Strongly agree
2. Agree
3. Disagree
4. Strongly disagree
5. Don’t know
6. Refuse to answer
To some degree, I identify with all males.
1. Strongly agree
2. Agree
3. Disagree
4. Strongly disagree
5. Don’t know
6. Refuse to answer
I only feel connected with a certain group of males.
1. Strongly agree
2. Agree
3. Disagree
4. Strongly disagree
5. Don’t know
6. Refuse to answer
It is important that I share a particular commonality with a certain group of males.
1. Strongly agree
2. Agree
3. Disagree
4. Strongly disagree
5. Don’t know
6. Refuse to answer
Most of my social activities are centered around a particular group of male friends.
1. Strongly agree
2. Agree
3. Disagree
4. Strongly disagree
5. Don’t know
6. Refuse to answer
I feel a common bond with my male friends, but not so much with other males.
1. Strongly agree
2. Agree
3. Disagree
4. Strongly disagree
5. Don’t know
6. Refuse to answer
There are only certain types of males with whom I relate.
1. Strongly agree
2. Agree
3. Disagree
4. Strongly disagree
5. Don’t know
6. Refuse to answer
My male friends and I all share the same perspective.
1. Strongly agree
2. Agree
3. Disagree
4. Strongly disagree
5. Don’t know
6. Refuse to answer
Others might consider my friends and I a clique.
1. Strongly agree
2. Agree
3. Disagree
4. Strongly disagree
5. Don’t know
6. Refuse to answer
Sometimes people have negative experiences based on how others react to race/ethnicity or sexual orientation. This next set of questions asks about some of those possible experiences.
Have you ever in your life been made fun of, harassed, or called names because of your race or ethnicity?
1. Yes
2. No
3. Don’t know
4. Refuse to answer
How often did this occur in the last [INSERT TIME FRAME]?
____________ times
1. Don’t know
2. Refuse to answer
Have you ever in your life been verbally threatened because of your race or ethnicity?
1. Yes
2. No
3. Don’t know
4. Refuse to answer
How often did this occur in the last [INSERT TIME FRAME]?
____________ times
1. Don’t know
2. Refuse to answer
Have you ever in your life been physically threatened or attacked because of your race or ethnicity?
1. Yes
2. No
3. Don’t know
4. Refuse to answer
How often did this occur in the last [INSERT TIME FRAME]?
____________ times
1. Don’t know
2. Refuse to answer
Have you ever in your life been stopped or harassed by the police because of your race or ethnicity?
1. Yes
2. No
3. Don’t know
4. Refuse to answer
How often did this occur in the last [INSERT TIME FRAME]?
____________ times
1. Don’t know
2. Refuse to answer
Overall, when you have been treated differently based on your race/ethnicity, how stressful have these experiences been for you?
1. Not at all
2. Somewhat
3. A moderate amount
4. Quite a bit
5. Don’t know
6. Refuse to answer
Have you ever in your life been made fun of, harassed, or called names (like “faggot”) because of your sexual orientation?
1. Yes
2. No
3. Don’t know
4. Refuse to answer
How often did this occur in the last [INSERT TIME FRAME]?
____________ times
1. Don’t know
2. Refuse to answer
Have you ever in your life been verbally threatened because of your sexual orientation?
1. Yes
2. No
3. Don’t know
4. Refuse to answer
How often did this occur in the last [INSERT TIME FRAME]?
____________ times
1. Don’t know
2. Refuse to answer
Have you ever in your life been physically threatened or attacked because of your sexual orientation?
1. Yes
2. No
3. Don’t know
4. Refuse to answer
How often did this occur in the last [INSERT TIME FRAME]?
____________ times
1. Don’t know
2. Refuse to answer
Have you ever in your life been stopped or harassed by the police because of your sexual orientation?
1. Yes
2. No
3. Don’t know
4. Refuse to answer
How often did this occur in the last [INSERT TIME FRAME]?
____________ times
1. Don’t know
2. Refuse to answer
Have your family or friends ever made fun of gay people in front of you?
1. Yes
2. No
3. Don’t know
4. Refuse to answer
How often did this occur in the last [INSERT TIME FRAME]?
____________ times
1. Don’t know
2. Refuse to answer
Overall, when you have been treated differently based on your sexual orientation, how stressful have these experiences been for you?
1. Not at all
2. Somewhat
3. A moderate amount
4. Quite a bit
5. Don’t know
6. Refuse to answer
Sexual partners have wanted me only because of my race or ethnicity; they pay no attention to other personal characteristics.
1. Strongly agree
2. Agree
3. Disagree
4. Strongly disagree
5. Don’t know
6. Refuse to answer
I’ve been turned down for sex because of my race or ethnicity.
1. Strongly agree
2. Agree
3. Disagree
4. Strongly disagree
5. Don’t know
6. Refuse to answer
I’ve been made to feel unwanted online because of my race or ethnicity.
1. Strongly agree
2. Agree
3. Disagree
4. Strongly disagree
5. Don’t know
6. Refuse to answer
I’ve felt white gay men have acted as if they’re better than me because of my race or ethnicity.
1. Strongly agree
2. Agree
3. Disagree
4. Strongly disagree
5. Don’t know
6. Refuse to answer
I’ve felt ignored or invisible where white gay men hang out because of my race or ethnicity.
1. Strongly agree
2. Agree
3. Disagree
4. Strongly disagree
5. Don’t know
6. Refuse to answer
I’ve felt that white gay men are uncomfortable around me because of my race or ethnicity.
1. Strongly agree
2. Agree
3. Disagree
4. Strongly disagree
5. Don’t know
6. Refuse to answer
Overall, when you have been treated differently in the gay community because of your race/ethnicity, how stressful have these experiences been for you?
1. Not at all
2. Somewhat
3. A moderate amount
4. Quite a bit
5. Don’t know
6. Refuse to answer
How much have these experiences in the gay community influenced where you look for sexual partners?
1. Not at all
2. Somewhat
3. A moderate amount
4. Quite a bit
5. Don’t know
6. Refuse to answer
How much have these experiences in the gay community influenced who your sexual partners are?
1. Not at all
2. Somewhat
3. A moderate amount
4. Quite a bit
5. Don’t know
6. Refuse to answer
Heterosexual/straight friends have appeared uncomfortable around me because of my sexual orientation.
1. Strongly agree
2. Agree
3. Disagree
4. Strongly disagree
5. Don’t know
6. Refuse to answer
I have lost heterosexual/straight friends because of my sexual orientation.
1. Strongly agree
2. Agree
3. Disagree
4. Strongly disagree
5. Don’t know
6. Refuse to answer
Heterosexual/straight friends have distanced themselves because of my sexual orientation.
1. Strongly agree
2. Agree
3. Disagree
4. Strongly disagree
5. Don’t know
6. Refuse to answer
Overall, when these experiences with friends have occurred, how stressful have they been for you?
1. Not at all
2. Somewhat
3. A moderate amount
4. Quite a bit
5. Don’t know
6. Refuse to answer
At times, my parents have made it understood that a boyfriend or lover would not be welcome in their home.
1. Strongly agree
2. Agree
3. Disagree
4. Strongly disagree
5. Don’t know
6. Refuse to answer
Family members have pressured me at different times to get married to a woman.
1. Strongly agree
2. Agree
3. Disagree
4. Strongly disagree
5. Don’t know
6. Refuse to answer
Being open with my family about my sexual orientation has meant risking being cut out of their lives.
1. Strongly agree
2. Agree
3. Disagree
4. Strongly disagree
5. Don’t know
6. Refuse to answer
At times, acting in a manly or masculine manner has felt important when I’m with my family.
1. Strongly agree
2. Agree
3. Disagree
4. Strongly disagree
5. Don’t know
6. Refuse to answer
Overall, when these experiences with family have occurred, how stressful have they been for you?
1. Not at all
2. Somewhat
3. A moderate amount
4. Quite a bit
5. Don’t know
6. Refuse to answer
People with HIV/AIDS face a great deal of unfair discrimination or persecution from others.
1. Strongly agree
2. Agree
3. Disagree
4. Strongly disagree
5. Don’t know
6. Refuse to answer
Even among men who have sex with men, there is discrimination against people with HIV.
1. Strongly agree
2. Agree
3. Disagree
4. Strongly disagree
5. Don’t know
6. Refuse to answer
There is a split in the gay community between men who are HIV-negative and those who are positive.
1. Strongly agree
2. Agree
3. Disagree
4. Strongly disagree
5. Don’t know
6. Refuse to answer
I am concerned that if I were to turn out positive on a future HIV test, that I would be discriminated against by other men who have sex with men.
1. Strongly agree
2. Agree
3. Disagree
4. Strongly disagree
5. Don’t know
6. Refuse to answer
I talk with friends to deal with racism and negative attitudes towards blacks that I encounter.
1. Strongly agree
2. Agree
3. Disagree
4. Strongly disagree
5. Don’t know
6. Refuse to answer
When I feel treated unfairly or discriminated against because of being black, there are family members I can rely on to be there for me.
1. Strongly agree
2. Agree
3. Disagree
4. Strongly disagree
5. Don’t know
6. Refuse to answer
My faith/spirituality gives me strength and comfort that helps to deal with others’ racism.
1. Strongly agree
2. Agree
3. Disagree
4. Strongly disagree
5. Don’t know
6. Refuse to answer
If I’m treated unfairly or disrespectfully because of my race/ethnicity, I speak up and challenge the person’s actions or beliefs.
1. Strongly agree
2. Agree
3. Disagree
4. Strongly disagree
5. Don’t know
6. Refuse to answer
I keep my life private as a way to avoid others’ racism or negative attitudes about blacks.
1. Strongly agree
2. Agree
3. Disagree
4. Strongly disagree
5. Don’t know
6. Refuse to answer
When I hear others express racism or negative attitudes about blacks, I just shrug it off.
1. Strongly agree
2. Agree
3. Disagree
4. Strongly disagree
5. Don’t know
6. Refuse to answer
When others express racist attitudes or prejudices toward others of different races/ethnicities, I try to educate them.
1. Strongly agree
2. Agree
3. Disagree
4. Strongly disagree
5. Don’t know
6. Refuse to answer
A way I deal with others’ prejudice is by hanging out with persons of my race/ethnicity.
1. Strongly agree
2. Agree
3. Disagree
4. Strongly disagree
5. Don’t know
6. Refuse to answer
I avoid race-/ethnicity-based rejection at bars or clubs by using the Internet to hook up with other men.
1. Strongly agree
2. Agree
3. Disagree
4. Strongly disagree
5. Don’t know
6. Refuse to answer
I avoid race-/ethnicity-based rejection at bars or clubs by using phone lines to hook up with other men.
1. Strongly agree
2. Agree
3. Disagree
4. Strongly disagree
5. Don’t know
6. Refuse to answer
When people get to know me as a person, it changes their prejudices or judgments about my race/ethnicity.
1. Strongly agree
2. Agree
3. Disagree
4. Strongly disagree
5. Don’t know
6. Refuse to answer
I talk with friends to deal with homophobia and negative reactions to my sexual orientation that I encounter.
1. Strongly agree
2. Agree
3. Disagree
4. Strongly disagree
5. Don’t know
6. Refuse to answer
When I feel treated unfairly or discriminated against because of my sexual orientation, there are family members I can rely on to be there for me.
1. Strongly agree
2. Agree
3. Disagree
4. Strongly disagree
5. Don’t know
6. Refuse to answer
My faith/spirituality gives me strength and comfort that helps to deal with others’ homophobia and negative reactions to my sexual orientation.
1. Strongly agree
2. Agree
3. Disagree
4. Strongly disagree
5. Don’t know
6. Refuse to answer
If I’m treated unfairly or disrespectfully because of my sexual orientation, I speak up and challenge the person’s actions or beliefs.
1. Strongly agree
2. Agree
3. Disagree
4. Strongly disagree
5. Don’t know
6. Refuse to answer
I keep my life private as a way to avoid others’ negative attitudes or prejudices based on sexual orientation.
1. Strongly agree
2. Agree
3. Disagree
4. Strongly disagree
5. Don’t know
6. Refuse to answer
When I hear others express negative attitudes or prejudices because of my sexual orientation, I just shrug it off.
1. Strongly agree
2. Agree
3. Disagree
4. Strongly disagree
5. Don’t know
6. Refuse to answer
When others express negative attitudes about my sexual orientation, I try to educate them.
1. Strongly agree
2. Agree
3. Disagree
4. Strongly disagree
5. Don’t know
6. Refuse to answer
I sometimes laugh at “fag” or “dyke” jokes to fit in with people I’m with.
1. Strongly agree
2. Agree
3. Disagree
4. Strongly disagree
5. Don’t know
6. Refuse to answer
When heterosexual friends and/or family start talking about things like dating or relationships, I usually avoid participating.
1. Strongly agree
2. Agree
3. Disagree
4. Strongly disagree
5. Don’t know
6. Refuse to answer
When a public figure, policy, or law is discriminatory to gays, bisexuals, and lesbians, I tell people what I think.
1. Strongly agree
2. Agree
3. Disagree
4. Strongly disagree
5. Don’t know
6. Refuse to answer
Letting people get to know me as a person is a good way to change their negative attitudes about my sexual orientation.
1. Strongly agree
2. Agree
3. Disagree
4. Strongly disagree
5. Don’t know
6. Refuse to answer
I have had to pretend I’m straight in order to be accepted.
1. Strongly agree
2. Agree
3. Disagree
4. Strongly disagree
5. Don’t know
6. Refuse to answer
I avoid actions, like holding hands with another man in public, that would reveal my sexual orientation.
1. Strongly agree
2. Agree
3. Disagree
4. Strongly disagree
5. Don’t know
6. Refuse to answer
I sometimes talk about past or made-up relationships with women, while avoiding mention of relationships with men.
1. Strongly agree
2. Agree
3. Disagree
4. Strongly disagree
5. Don’t know
6. Refuse to answer
When I’m asked about my sexual orientation, I usually answer in an honest and matter-of-fact way.
1. Strongly agree
2. Agree
3. Disagree
4. Strongly disagree
5. Don’t know
6. Refuse to answer
I am very careful about who I let know about my sexual orientation.
1. Strongly agree
2. Agree
3. Disagree
4. Strongly disagree
5. Don’t know
6. Refuse to answer
When people express negative stereotypes about homosexuality, I try to explain to them that there are more similarities than differences between male-male and heterosexual relationships.
1. Strongly agree
2. Agree
3. Disagree
4. Strongly disagree
5. Don’t know
6. Refuse to answer
I openly confront others when I hear a homophobic remark or joke.
1. Strongly agree
2. Agree
3. Disagree
4. Strongly disagree
5. Don’t know
6. Refuse to answer
Do you use a computer?
1. Yes
2. No
3. Don’t know
4. Refuse to answer
Do you use the Internet?
1. Yes
2. No
3. Don’t know
4. Refuse to answer
Where do you usually connect to the Internet?
1. Home
2. School
3. Work
4. Library
5. Friend’s house
6. Internet café
7. PDA or Blackberry
8. Cell phone
9. Other [Specify: ]
10. Don’t know
11. Refuse to answer
When you connect to the Internet, do you use…
1. Dial-up
2. DSL
3. Cable modem
4. PDA or Blackberry
5. Cell phone
6. Other [Specify: ]
7. Don’t know
8. Refuse to answer
How many hours per day do you use the Internet for reasons other than work or school?
_________________ hours per day
1. Don’t know
2. Refuse to answer
What do you do when you go online? [MARK ALL THAT APPLY.]
1. E-mail
2. Look up sports news/information
3. Look up news/current events
4. Instant message (IM)
5. Play games
6. Download music
7. Shop/make purchases
8. Look for employment
9. Watch video
10. Listen to online radio
11. Watch online TV
12. Look up health information
13. Visit chat rooms
14. Make travel plans
15. Use social networking Web sites (such as MySpace or Facebook)
16. Visit gay Web sites
17. Visit adult Web sites
18. Visit dating Web sites
19. Don’t know
20. Refuse to answer
Here are some ways people use the Internet. Some people have done these things, but other people have not. In the past [INSERT TIME FRAME], have you done the following things while using the Internet?
|
Yes |
No |
Don’t know |
Refuse to answer |
a. Looked up health-related topics. |
1 |
2 |
3 |
4 |
b. Looked up information about HIV. |
1 |
2 |
3 |
4 |
c. Bought medicine or vitamins online. |
1 |
2 |
3 |
4 |
d. Participated in an online support group for people with a similar health or medical issue. |
1 |
2 |
3 |
4 |
e. Used e-mail or the Internet to communicate with a doctor or a doctor’s office. |
1 |
2 |
3 |
4 |
f. Used a Web site to help you with your diet, weight, or physical activity. |
1 |
2 |
3 |
4 |
g. Looked for a health care provider. |
1 |
2 |
3 |
4 |
h. Downloaded to a portable device, such as an iPod, cell phone, or PDA. |
1 |
2 |
3 |
4 |
i. Visited a “social networking” site, such as “MySpace” or “Second Life.” |
1 |
2 |
3 |
4 |
j. Wrote in an online diary or “blog” (i.e., Web log). |
1 |
2 |
3 |
4 |
k. Kept track of personal health information, such as care received, test results, or upcoming medical appointments. |
1 |
2 |
3 |
4 |
Have you ever used the Internet to look up health-related topics?
1. Yes
2. No
3. Don’t know
4. Refuse to answer
Have you ever used the Internet to look up information about HIV?
1. Yes
2. No
3. Don’t know
4. Refuse to answer
I trust the information about HIV that I have found on the Internet.
1. Strongly agree
2. Agree
3. Disagree
4. Strongly disagree
5. Don’t know
6. Refuse to answer
How often do you go online to seek sexual partners?
1. Never
2. Less than once a month
3. Once a month
4. 2–3 times a month
5. 1–2 times a week
6. 3–6 times a week
7. About once a day
8. More than once a day
9. Don’t know
10. Refuse to answer
Which of the following Web sites do you visit regularly?
1. [INSERT SITES] EXAMPLE: Blackgaychat (www.BGCLive.com)
2. EXAMPLE: Whatstea (www.whatstea.com)
3. EXAMPLE: Walk4mewednesdays (www.walk4mewednesdays.com)
4. EXAMPLE: Keithboykin (www.keithboykin.com)
5. EXAMPLE: Adam4Adam (www.Adam4Adam.com)
6. EXAMPLE: Gay (www.gay.com)
7. EXAMPLE: Facebook (www.facebook.com)
8. EXAMPLE: MySpace (www.myspace.com)
9. Other: [Specify: ]
10. Don’t know
11. Refuse to answer
How often do you read banner ads on Web sites for [men seeking men]?
1. Always
2. Sometimes
3. Rarely
4. Never
5. Don’t know
6. Refuse to answer
How often do you click on banner ads on Web sites for [men seeking men]?
1. Always
2. Sometimes
3. Rarely
4. Never
5. Don’t know
6. Refuse to answer
How likely would you be to click on a banner ad about HIV testing?
1. Always
2. Sometimes
3. Rarely
4. Never
5. Don’t know
6. Refuse to answer
How worried would you be about your privacy if you got information about HIV testing online?
1. Very worried
2. Somewhat worried
3. A little bit worried
4. Not worried at all
5. Don’t know
6. Refuse to answer
How often do you read blogs about [INSERT TOPIC]?
1. Always
2. Sometimes
3. Rarely
4. Never
5. Don’t know
6. Refuse to answer
Do you use a cell phone?
1. Yes
2. No
3. Don’t know
4. Refuse to answer
Do you send/receive text messages on your cell phone?
1. Yes
2. No
3. Don’t know
4. Refuse to answer
I would be interested in getting information about HIV testing via text messaging.
1. Strongly agree
2. Agree
3. Disagree
4. Strongly disagree
5. Don’t know
6. Refuse to answer
How worried would you be about your privacy if you got information about HIV testing via text messaging?
1. Very worried
2. Somewhat worried
3. A little bit worried
4. Not worried at all
5. Don’t know
6. Refuse to answer
How many hours of TV do you watch per week?
____________ hours per week
1. Don’t know
2. Refuse to answer
Which of the following TV channels or networks do you regularly watch?
1. ABC
2. CBS
3. NBC
4. A&E
5. ESPN
6. Food Network
7. Fox News
8. Comedy Central
9. BET
10. HGTV
11. HBO
12. Bravo
13. MTV
14. VH1
15. Showtime
16. TV One
17. Other [Specify: ]
18. Don’t know
19. Refuse to answer
Which of the following do you subscribe to or read regularly in the print version?
1. [INSERT] EXAMPLE: Your local newspaper
2. EXAMPLE: Ebony
3. EXAMPLE: Essence
4. EXAMPLE: Jet
5. EXAMPLE: Vibe
6. EXAMPLE: The Source
7. Don’t know
8. Refuse to answer
What radio stations do you listen to most often?
_____________________________________________
1. Don’t know
2. Refuse to answer
What type of music or programming do you listen to on the radio?
1. Rhythm and blues (R&B)
2. Jazz
3. Talk
4. Gospel
5. Pop
6. Rock
7. Hip hop/rap
8. Country
9. Urban
10. Sports talk
11. Dance/techno
12. Latin
13. Other [Specify: ]
14. Don’t know
15. Refuse to answer
How many hours per week do you listen to an iPod or other MP3 player?
_________ hours per week
1. Don’t know
2. Refuse to answer
How likely would you be to listen to a podcast about HIV prevention or testing? (Podcasting is a form of audio broadcasting over the Internet.)
1. Very likely
2. Somewhat likely
3. Not at all likely
4. Don’t know
5. Refuse to answer
Do you ever use the Internet to...use a social networking site like MySpace, Facebook, or LinkedIn.com?
1. Yes
2. No
3. Don’t know
4. Refuse to answer
H.29a (If Yes, ask:) Did you do this yesterday?
1. Did yesterday
2. Have done this, but not yesterday
3. Have not done this
4. Don’t know
5. Refuse to answer
Have you ever created your own profile online that others can see, like on a social networking site like MySpace, Facebook, or LinkedIn.com?
1. Yes
2. No
3. Don’t know
4. Refuse to answer
H.30a You said you have a profile online at a social networking Web site such as MySpace, Facebook, or LinkedIn.com. How many social networking Web sites do you currently have a profile on?
1. One
2. Two
3. Three
4. Four or more
5. Don’t know
6. Refuse to answer
H.30b How many total profiles (on social networking Web sites) do you have online, counting all Web sites?
1. One
2. Two
3. Three
4. Four or more
5. Don’t know
6. Refuse to answer
H.30c Do you have a single profile (on social networking Web sites) on each site, or do you have multiple profiles on one Web site?
1. I only have a single profile on each site
2. Some are multiple profiles on same site
3. Don’t know
4. Refuse to answer
H.30d On which social networking Web site is your profile?
1. MySpace
2. Facebook
3. LinkedIn
4. Yahoo
5. YouTube
6. Classmates.com
7. Flickr
8. Other [Specify: ]
9. Don’t know
10. Refuse to answer
H.30e On which social networking Web site is the profile you use or update most often?
1. MySpace
2. Facebook
3. Linked In
4. Yahoo
5. YouTube
6. Classmates.com
7. Flickr
8. Other [Specify: ]
9. Don’t know
10. Refuse to answer
H.30f How often do you visit the social networking Web site where you have a profile/the social networking Web site with the profile you use most often—several times a day, about once a day, every few days, once a week, or less often?
1. Several times a day
2. About once a day
3. Every few days
4. Once a week
5. Less often
6. Don’t know
7. Refuse to answer
H.30g Thinking about the privacy protections you can set for your profile/the profile you use most often (on a social networking Web site)...Do you currently...restrict access to your full profile so that only your friends can view it?
1. Yes
2. No
3. Don’t know
4. Refuse to answer
H.30h Thinking about the privacy protections you can set for your profile/the profile you use most often (on a social networking Web site)...Do you currently...limit who can see certain information like photos or posts to your wall?
1. Yes
2. No
3. Don’t know
4. Refuse to answer
What are the different ways you use social networking sites? Do you ever use those sites to…
|
Yes |
No |
Don’t know |
Refuse to answer |
a. Make new friends? |
1 |
2 |
3 |
4 |
b. Stay in touch with friends? |
1 |
2 |
3 |
4 |
c. Flirt with someone? |
1 |
2 |
3 |
4 |
d. Make plans with your friends? |
1 |
2 |
3 |
4 |
e. Make new business or professional contacts? |
1 |
2 |
3 |
4 |
f. Promote yourself or your work? |
1 |
2 |
3 |
4 |
g. Organize with other people for an event, issue or cause? |
1 |
2 |
3 |
4 |
How easy do you think it would be for someone to find out who you are from your profile on a social networking Web site? Do you think...
1. It would be pretty easy
2. They would have to work at it but they could figure it out eventually
3. It would be very difficult for someone to find out who you are from your profile
4. Don’t know
5. Refuse to answer
Earlier you mentioned that you have more than one profile online (on social networking Web sites). Why do you have more than one profile?
1. My friends use many different Web sites, so I have more than one profile online to keep in touch with them
2. Some profiles are for professional or work relationships and other profiles are for friends
3. Just use different sites
4. I have an older profile from a site that I don’t really use anymore
5. I have a different profile for different parts of my personality
6. It’s fun
7. I have a profile so I can view content on the Web site
8. It was just something to do
9. Some profiles are specifically for gaming
10. Someone else told me to sign up on a particular site
11. Other [Specify: ]
12. Don’t know
13. Refuse to answer
Have you ever had an online profile in the past at a social networking (Web) site such as MySpace, Facebook, or LinkedIn.com that you have since deleted?
1. Yes
2. No
3. Don’t know
4. Refuse to answer
Why did you delete that (online) profile (that you ever had in the past at a social networking Web site)? (open-ended response)
Possible response categories:
1. Just stopped using it
2. I got bored with it
3. Didn’t like the site or I found another site I like better
4. Too much spam/unwanted contact on the profile
5. It took up too much time
6. Hacked or stolen password
7. My friends all moved to a different Web site
8. Did not want my personal information on the Web
9. My spouse/partner wanted me to delete it
10. It was too complicated/confusing
11. Needed something older/younger/more professional
12. I’m not allowed to have one anymore
13. Got married or met someone
14. Web site I was using changed
15. I was being stalked
16. Other [Specify: ]
17. Don’t know
18. Refuse to answer
Please tell me if you ever use the Internet to do any of the following things. Do you ever use the Internet to...send “instant messages” to someone who’s online at the same time? (If Yes, ask:) Did you do this yesterday?
1. Did yesterday
2. Have done this, but not yesterday
3. Have not done this
4. Don’t know
5. Refuse to answer
Please tell me if you ever use your cell phone or Blackberry or other device to do any of the following things. Do you ever use it to...send or receive “instant messages”? (If Yes, ask:) Did you do this yesterday?
1. Did yesterday
2. Have done this, but not yesterday
3. Have not done this
4. Don’t know
5. Refuse to answer
Have you ever posted comments, queries, or information about the economy or personal finances in any of these places online?...On a social networking site such as Facebook, MySpace, or LinkedIn—have you ever posted there about general economic or personal financial matters?
1. Yes
2. No
3. Don’t know
4. Refuse to answer
Please tell me if you ever use the Internet to do any of the following things. Do you ever use the Internet to...use a social networking site like MySpace, Facebook, or LinkedIn.com? Did you happen to do this yesterday, or not?
1. Did yesterday
2. Have done this, but not yesterday
3. Have not done this
4. Don’t know
5. Refuse to answer
Did you communicate with others about politics, the (election) campaign, or the 2008 elections using the Internet, whether by e-mail, text messaging, instant messaging, or using a social networking site? (If Yes, ask:) How often did you go online to do one or more of these activities related to the elections...more than once a day, every day, 3 to 5 days per week, 1 to 2 days per week, or less often?
1. Yes—more than once a day
2. Yes—every day
3. Yes—3 to 5 days per week
4. Yes—1 to 2 days per week
5. Yes—less often
6. No, never
7. Don’t know
8. Refuse to answer
Have you ever posted comments, queries, or information about the (2008 presidential election) campaign or the elections in any of these places online?...On a social networking site such as MySpace, Facebook, or LinkedIn...Have you ever posted there about the campaign or the elections?
1. Yes
2. No
3. Don’t know
4. Refuse to answer
Thinking about what you have done on social networking sites like Facebook and MySpace, have you...
|
Yes |
No |
Don’t know |
Refuse to answer |
a. Gotten any (election) campaign or candidate information on the sites? |
1 |
2 |
3 |
4 |
b. Started or joined a political group or group supporting a cause on a social networking site? |
1 |
2 |
3 |
4 |
c. Revealed on a social networking site which presidential candidate you voted for last year (2008)? |
1 |
2 |
3 |
4 |
d. Discovered on the sites which presidential candidate your friends voted for last year (2008)? |
1 |
2 |
3 |
4 |
e. Signed up as a “friend” of any candidates on a social networking site? |
1 |
2 |
3 |
4 |
After you voted in this fall’s (2008) elections, did you share with others your experiences casting your ballot by posting your experiences on a social networking site?
1. Yes
2. No
3. Don’t know
4. Refuse to answer
Have you ever posted comments, queries, or information about health or medical matters in any of these places online?...In an online discussion, a listserv, or other online group forum...Have you ever posted there about health or medical matters?
1. Yes
2. No
3. Don’t know
4. Refuse to answer
Have you ever posted comments, queries, or information about health or medical matters in any of these places online?...On a social networking site such as MySpace, Facebook, or LinkedIn...Have you ever posted there about health or medical matters?
1. Yes
2. No
3. Don’t know
4. Refuse to answer
Thinking about what you have done on social networking sites like Facebook and MySpace, have you gotten any health information on the sites?
1. Yes
2. No
3. Don’t know
4. Refuse to answer
Thinking about what you have done on social networking sites like Facebook and MySpace, have you started or joined a health-related group on a social networking site?
1. Yes
2. No
3. Don’t know
4. Refuse to answer
Thinking about what you have done on social networking sites like Facebook and MySpace, have you followed your friends’ personal health experiences or updates on the site?
1. Yes
2. No
3. Don’t know
4. Refuse to answer
Please tell me if you ever use the Internet to do any of the following things. Do you ever use the Internet to participate in an online discussion, a listserv, or other online group forum that helps people with personal issues or health problems? (If Yes, ask:) Did you do this yesterday?
1. Did yesterday
2. Have done this, but not yesterday
3. Have not done this
4. Don’t know
5. Refuse to answer
While you are at work, how often do you communicate with your colleagues at work using social networking sites like MySpace or Facebook...constantly, several times an hour, several times a day, about once a day, every few days, less often, or never?
1. Constantly
2. Several times an hour
3. Several times a day
4. About once a day
5. Every few days
6. Less often
7. Never
8. Don’t know
9. Refuse to answer
While you are at work, how often do you communicate with friends or family using social networking sites?
1. Constantly
2. Several times an hour
3. Several times a day
4. About once a day
5. Every few days
6. Less often
7. Never
8. Don’t know
9. Refuse to answer
Thinking about all the different ways you socialize or communicate with friends, about how often do you send messages through social networking sites like MySpace or Facebook?
1. Every day
2. Several times a week
3. At least once a week
4. Less that once a week
5. Never
6. Don’t know
7. Refuse to answer
Is your (online) profile (on a social networking site like MySpace or Facebook) currently visible?
1. Yes
2. No
3. Don’t know
4. Refuse to answer
Is your (online) profile (on a social network site like MySpace or Facebook) visible to anyone or visible only to your friends?
1. Visible to anyone
2. Visible only to friends
3. Don’t know
4. Refuse to answer
During the last [INSERT TIME FRAME], how much, if anything, have you personally seen, heard, or read about the problems of AIDS in the United States?
1. A lot
2. Some
3. Only a little
4. Nothing at all
5. Don’t know
6. Refuse to answer
Thinking about everything you know about HIV/AIDS, does this information mainly come from things you’ve seen and heard from…
1. The media, such as radio, television, newspapers, and the Internet
2. Your doctor or other health professional
3. School
4. Friends and family
5. Some other source
6. Don’t know
7. Refuse to answer
H.56a (If answered Media…) Would you say most of the information you have about HIV/AIDS comes from…
1. Television
2. Internet
3. Newspapers
4. Radio
5. Media, unspecified
6. Don’t know
7. Refuse to answer
Indicate how much you trust each of the following sources of HIV information.
|
Trust very much |
Trust somewhat |
Distrust somewhat |
Do not trust at all |
Don’t know |
Refuse to answer |
a. My doctor, nurse, or health care professional |
1 |
2 |
3 |
4 |
5 |
6 |
b. WebMD (Health Web site) |
1 |
2 |
3 |
4 |
5 |
6 |
1 |
2 |
3 |
4 |
5 |
6 |
|
d. AIDS organization in my local community |
1 |
2 |
3 |
4 |
5 |
6 |
e. Centers for Disease Control and Prevention (CDC) |
1 |
2 |
3 |
4 |
5 |
6 |
f. A major university medical center |
1 |
2 |
3 |
4 |
5 |
6 |
g. State or local health department |
1 |
2 |
3 |
4 |
5 |
6 |
h. A local hospital or health care system |
1 |
2 |
3 |
4 |
5 |
6 |
i. Other [Specify:_______________] |
1 |
2 |
3 |
4 |
5 |
6 |
Have you ever looked for information about HIV/AIDS from any source?
1. Yes
2. No
3. Don’t know
4. Refuse to answer
The most recent time you looked for information about HIV/AIDS, where did you go first? [IF MADE MORE THAN ONE SEARCH, PROBE FOR THE MOST RECENT SEARCH.]
1. Books
2. Brochures, pamphlets, etc.
3. Cancer organization
4. Family
5. Friend/coworker
6. Health care provider
7. Internet
8. Library
9. Magazines
10. Newspapers
11. Telephone information number (1-800 number)
12. Complementary or alternative practitioner
13. Other [Specify: ]
14. Don’t know
15. Refuse to answer
Did you look or go anywhere else [for information about HIV/AIDS]?
1. Yes
2. No
3. Don’t know
4. Refuse to answer
Where else did you look or go?
[MARK ALL THAT APPLY.]
[PROBE: Anywhere else?]
1. Books
2. Brochures, pamphlets, etc.
3. Cancer organization
4. Family
5. Friend/coworker
6. Health care provider
7. Internet
8. Library
9. Magazines
10. Newspapers
11. Telephone information number (1-800 number)
12. Complementary or alternative practitioner
13. Other [Specify: ]
14. Don’t know
15. Refuse to answer
Based on the results of your most recent search for information about HIV/AIDS, how much do you agree or disagree with the following statements?
|
Strongly agree |
Agree |
Disagree |
Strongly disagree |
Don’t know |
Refuse to answer |
a. It took a lot of effort to get the information you needed. |
1 |
2 |
3 |
4 |
5 |
6 |
b. You felt frustrated during your search for the information. |
1 |
2 |
3 |
4 |
5 |
6 |
c. You were concerned about the quality of the information. |
1 |
2 |
3 |
4 |
5 |
6 |
d. The information you found was hard to understand. |
1 |
2 |
3 |
4 |
5 |
6 |
Overall, how confident are you that you could get HIV/AIDS-related information if you needed it?
1. Completely confident
2. Very confident
3. Somewhat confident
4. A little confident
5. Not confident at all
6. Don’t know
7. Refuse to answer
In general, how much would you trust information about HIV/AIDS?
|
A lot |
Some |
A little |
Not at all |
Don’t know |
Refuse to answer |
a. From a doctor or other health care professional? |
1 |
2 |
3 |
4 |
5 |
6 |
b. From family or friends? |
1 |
2 |
3 |
4 |
5 |
6 |
c. In newspapers or magazines? |
1 |
2 |
3 |
4 |
5 |
6 |
d. On the radio? |
1 |
2 |
3 |
4 |
5 |
6 |
e. On the Internet? |
1 |
2 |
3 |
4 |
5 |
6 |
f. On television? |
1 |
2 |
3 |
4 |
5 |
6 |
g. From government health agencies? [IF NEEDED: Government health agencies include the National Institutes of Health, the Centers for Disease Control and Prevention, and state and local health departments.] |
1 |
2 |
3 |
4 |
5 |
6 |
h. From charitable organizations? |
1 |
2 |
3 |
4 |
5 |
6 |
i. From religious organizations and leaders? |
1 |
2 |
3 |
4 |
5 |
6 |
Please indicate whether you would like to have more information about…
|
Yes |
No |
Don’t know |
Refuse to answer |
a. The different kinds of HIV tests available |
1 |
2 |
3 |
4 |
b. How to know whether you should get tested for HIV or not |
1 |
2 |
3 |
4 |
c. How to bring up the topic of getting an HIV test with your partner |
1 |
2 |
3 |
4 |
d. Where to get tested for HIV |
1 |
2 |
3 |
4 |
e. How to ask your health care provider for an HIV test |
1 |
2 |
3 |
4 |
During the past [INSERT TIME FRAME], have you seen or heard any advertising, campaigns, or messages about….
|
Yes |
No |
Don’t know |
Refuse to answer |
a. Not using drugs |
1 |
2 |
3 |
4 |
b. Quitting smoking |
1 |
2 |
3 |
4 |
c. Not starting to smoke |
1 |
2 |
3 |
4 |
d. Getting an HIV test |
1 |
2 |
3 |
4 |
e. Using condoms to prevent AIDS or sexually transmitted diseases |
1 |
2 |
3 |
4 |
f. The importance of knowing whether you or your partner is HIV positive |
1 |
2 |
3 |
4 |
g. Not using alcohol |
1 |
2 |
3 |
4 |
h. Other [Specify:_________________________________] |
1 |
2 |
3 |
4 |
Have you ever seen or heard of any ads on/at [INSERT] called [or with the following themes or slogans]?
|
Yes |
No |
Don’t know |
Refuse to answer |
a. [INSERT NAMES] EXAMPLE: Know HIV/AIDS |
1 |
2 |
3 |
4 |
b. EXAMPLE: Rap it Up |
1 |
2 |
3 |
4 |
c. EXAMPLE: Get tested. Get the results. Get on with your life. |
1 |
2 |
3 |
4 |
d. EXAMPLE: With HIV, Knowledge Is Power |
1 |
2 |
3 |
4 |
e. EXAMPLE: 9 ½ minutes |
1 |
2 |
3 |
4 |
This is an ad in which [INSERT]. Have you ever seen [or heard] this ad?
1. Yes
2. No
3. Don’t know
4. Refuse to answer
In the last [INSERT TIME FRAME], about how often have you seen [or heard] HIV/AIDS-related ads on [INSERT MEDIUM]?
1. Not at all
2. Less than 1 time a month
3. 1 to 3 times a month
4. 1 to 3 times a week
5. Daily or almost daily
6. More than 1 time a day
7. Don’t know
8. Refuse to answer
In the last [INSERT TIME FRAME], how often have you noticed stories that dealt with HIV/AIDS among [INSERT GROUP]?
1. Not at all
2. Less than 1 time a month
3. 1 to 3 times a month
4. 1 to 3 times a week
5. Daily or almost daily
6. More than 1 time a day
7. Don’t know
8. Refuse to answer
In the last [INSERT TIME FRAME], about how often have you seen [or heard] HIV/AIDS-related ads in/on/at [INSERT]?
1. Not at all
2. Less than 1 time a month
3. 1 to 3 times a month
4. 1 to 3 times a week
5. Daily or almost daily
6. More than 1 time a day
7. Don’t know
8. Refuse to answer
In the last [INSERT TIME FRAME], how many times have you seen [or heard] this ad?
1. Not at all
2. Once
3. 1 to 5 times
4. 6 to 10 times
5. More than 10 times
7. Don’t know
8. Refuse to answer
Did you see or hear this ad yesterday?
1. Yes
2. No
3. Don’t know
4. Refuse to answer
Where did you see [or hear] this ad?
Ads that appear in separate boxes on Web pages are called banner ads. Have you ever seen this banner ad on a Web page? [Show banner ad.]
1. Yes
2. No
3. Don’t know
4. Refuse to answer
On what Web sites have you seen this ad?
Did you ever click on the banner ad to go to the linked Web site?
1. Yes
2. No
3. Don’t know
4. Refuse to answer
Have you ever called the CDC-INFO hotline, 1-800-CDC-INFO?
1. Yes
2. No
3. Don’t know
4. Refuse to answer
Have you ever visited the [INSERT SITE] Web site?
1. Yes
2. No
3. Don’t know
4. Refuse to answer
H.79a If yes, when did you first visit the Web site?
Other [Specify ]
H.79b What information were you looking for?
Other [Specify ]
H.79c Was this information easy to find on the Web site?
1. Yes
2. No
3. Don’t know
4. Refuse to answer
H.79d Have you been back to visit the Web site since that first time?
1. Yes
2. No
3. Don’t know
4. Refuse to answer
H.79d.i If yes, how often do you use the Web site?
Other [Specify ]
H.79e What information/resources/links do you access?
INSERT LIST
H.79f Have you downloaded, printed, or copied _________ materials from the Web site?
1. Yes
2. No
3. Don’t know
4. Refuse to answer
In the past [INSERT TIME FRAME] have you seen any materials for CDC’s _____ campaign?
1. Yes
2. No
3. Don’t know
4. Refuse to answer
Are you aware of any materials or campaigns specifically focused on _______?
1. Yes
2. No
3. Don’t know
4. Refuse to answer
H.81a If
Yes: Please select the key messages/elements present in the
materials.
[SELECT ALL THAT APPLY.]
1. A picture or graphic of _____________
2. Chart showing __________________
3. ________ logo/slogan
4. A list of frequently asked questions about…. patients living with HIV might ask about transmission
5. A checklist of ____________
6. Other [Specify: ]
7. Don’t know
8. Refuse to answer
Where did you hear about the campaign?
1. Saw poster in health care provider’s office
2. Heard about from health care provider
3. Received materials from doctor
4. Other [Specify: ]
5. Don’t know
6. Refuse to answer
Have you ever heard of the [INSERT CAMPAIGN]?
1. Yes
2. No
3. Don’t know
4. Refuse to answer
This is a campaign that encourages young adults to talk about HIV. Have you ever heard of this campaign?
1. Yes
2. No
3. Don’t know
4. Refuse to answer
In the past [INSERT TIME FRAME], have you visited the [INSERT CAMPAIGN] Web site?
1. Yes
2. No
3. Don’t know
4. Refuse to answer
Have you ever visited the [INSERT CAMPAIGN] Facebook fan page?
1. Yes
2. No
3. Don’t know
4. Refuse to answer
H.86a Are you currently or have you ever been a fan of the [INSERT CAMPAIGN] Facebook fan page?
1. Yes
2. No
3. Don’t know
4. Refuse to answer
H.86b In the past [INSERT TIME FRAME], how often have you visited the [INSERT CAMPAIGN] Facebook fan page?
1. Not at all
2. Once
3. 2 to 3 times
4. 4 to 5 times
5. 6 to 10 times
6. More than 10 times
7. Don’t know
8. Refuse to answer
In the past [INSERT TIME FRAME], have you received an SMS message about [INSERT]?
1. Yes
2. No
3. Don’t know
4. Refuse to answer
H.87a In the past [INSERT TIME FRAME], have you received an SMS message from the [INSERT CAMPAIGN]?
1. Yes
2. No
3. Don’t know
4. Refuse to answer
H.87b In the past [INSERT TIME FRAME], how often have you received an SMS message about [INSERT]?
1. Not at all
2. Once
3. 2 to 3 times
4. 4 to 5 times
5. 6 to 10 times
6. More than 10 times
7. Don’t know
8. Refuse to answer
H.87c In the past [INSERT TIME FRAME], how often have you received an SMS message from the [INSERT CAMPAIGN]?
1. Not at all
2. Once
3. 2 to 3 times
4. 4 to 5 times
5. 6 to 10 times
6. More than 10 times
7. Don’t know
8. Refuse to answer
In the past [INSERT TIME FRAME], have you read a blog post about [INSERT]?
1. Yes
2. No
3. Don’t know
4. Refuse to answer
H.88a In the past [INSERT TIME FRAME], how often have you read a blog about [INSERT]?
1. Not at all
2. Once
3. 2 to 3 times
4. 4 to 5 times
5. 6 to 10 times
6. More than 10 times
7. Don’t know
8. Refuse to answer
In the past [INSERT TIME FRAME], have you read a post on Twitter about [INSERT]?
1. Yes
2. No
3. Don’t know
4. Refuse to answer
H.89a In the past [INSERT TIME FRAME], how often have you read posts on Twitter about [INSERT]?
1. Not at all
2. Once
3. 2 to 3 times
4. 4 to 5 times
5. 6 to 10 times
6. More than 10 times
7. Don’t know
8. Refuse to answer
In the past [INSERT TIME FRAME], have you seen a video on [INSERT: YouTube/other] by [INSERT PERSON] about [INSERT, example: talking about HIV]?
1. Yes
2. No
3. Don’t know
4. Refuse to answer
H.90a In the past [INSERT TIME FRAME], how often have you watched a video on YouTube by [INSERT PERSON] about [INSERT]?
1. Not at all
2. Once
3. 2 to 3 times
4. 4 to 5 times
5. 6 to 10 times
6. More than 10 times
7. Don’t know
8. Refuse to answer
In the past [INSERT TIME FRAME], have you attended a(n) [INSERT CAMPAIGN] event?
1. Yes
2. No
3. Don’t know
4. Refuse to answer
H.91a In the past [INSERT TIME FRAME], how often have you attended a(n) [INSERT CAMPAIGN] event?
1. Not at all
2. Once
3. 2 to 3 times
4. 4 to 5 times
5. 6 to 10 times
6. More than 10 times
7. Don’t know
8. Refuse to answer
We want to ask you about some brief messages that might or might not have appeared on social media sites, as part of ads encouraging people to talk about HIV. In recent months, have you seen or heard either of the following phrases?
1. INSERT PHRASE 1
1. Yes
2. No
3. Don’t know
4. Refuse to answer
2. INSERT PHRASE 2
1. Yes
2. No
3. Don’t know
4. Refuse to answer
The following questions are about a [radio/TV/billboard] ad you [saw/heard] [earlier], entitled “_________________.” To refresh your memory of this ad, we would like to play/show it for you again.
[PLAY AUDIO 1/SHOW]:
Please indicate how much you agree or disagree with the following statements about this ad.
|
Strongly agree |
Agree |
Disagree |
Strongly disagree |
Don’t know |
Refuse to answer |
a. Overall, I liked this ad. |
1 |
2 |
3 |
4 |
5 |
6 |
b. I liked the people in this ad. |
1 |
2 |
3 |
4 |
5 |
6 |
c. I liked the voices in this ad. |
1 |
2 |
3 |
4 |
5 |
6 |
d. This ad was easy to listen to (to read). |
1 |
2 |
3 |
4 |
5 |
6 |
e. I learned something new by listening to (by reading) this ad. |
1 |
2 |
3 |
4 |
5 |
6 |
f. I was interested in listening to (reading) this ad. |
1 |
2 |
3 |
4 |
5 |
6 |
g. This ad was made (written) for a person like me. |
1 |
2 |
3 |
4 |
5 |
6 |
h. This ad was easy to understand. |
1 |
2 |
3 |
4 |
5 |
6 |
i. I liked the sound effects in this ad. |
1 |
2 |
3 |
4 |
5 |
6 |
j. I would look at (read) this ad if I saw it. |
1 |
2 |
3 |
4 |
5 |
6 |
k. I am interested in this ad’s topic. |
1 |
2 |
3 |
4 |
5 |
6 |
l. I like the way this ad looks. |
1 |
2 |
3 |
4 |
5 |
6 |
m. I liked the colors in this ad. |
1 |
2 |
3 |
4 |
5 |
6 |
n. I trust the information in this ad. |
1 |
2 |
3 |
4 |
5 |
6 |
o. I can do what this ad suggests. |
1 |
2 |
3 |
4 |
5 |
6 |
p. I will do what this ad suggests. |
1 |
2 |
3 |
4 |
5 |
6 |
q. I trust the information in this ad. |
1 |
2 |
3 |
4 |
5 |
6 |
r. This ad was believable. |
1 |
2 |
3 |
4 |
5 |
6 |
Please indicate how much you agree or disagree with the following statements about the (INSERT format—television ad, radio ad, print ad, brochure, video, etc.).
|
Strongly agree |
Agree |
Disagree |
Strongly disagree |
Don’t know |
Refuse to answer |
a. This [INSERT format] was convincing. |
1 |
2 |
3 |
4 |
5 |
6 |
b. This [INSERT format] said something important to me. |
1 |
2 |
3 |
4 |
5 |
6 |
c. I liked this [INSERT format] overall. |
1 |
2 |
3 |
4 |
5 |
6 |
d. This [INSERT format] grabbed my attention. |
1 |
2 |
3 |
4 |
5 |
6 |
e. This [INSERT format] told me something I didn’t already know. |
1 |
2 |
3 |
4 |
5 |
6 |
f. This [INSERT format] would be helpful in convincing my friends to [INSERT behavior] |
1 |
2 |
3 |
4 |
5 |
6 |
g. This ad made me feel confident that I could [INSERT behavior] |
1 |
2 |
3 |
4 |
5 |
6 |
h. This [INSERT format] gave me good reasons to get an HIV test. |
1 |
2 |
3 |
4 |
5 |
6 |
i. This [INSERT format] was confusing. |
1 |
2 |
3 |
4 |
5 |
6 |
j. This [INSERT format] spoke to me. |
1 |
2 |
3 |
4 |
5 |
6 |
k. I do not like this [INSERT format]. |
1 |
2 |
3 |
4 |
5 |
6 |
l. I learned something new from [INSERT format]. |
1 |
2 |
3 |
4 |
5 |
6 |
m. Real people would act (talk/look) the way the person(s) in this ad [INSERT] |
1 |
2 |
3 |
4 |
5 |
6 |
n. The person(s) in this ad were more similar to me than different. |
1 |
2 |
3 |
4 |
5 |
6 |
o. I could relate to what the person(s) in this ad were going through. |
1 |
2 |
3 |
4 |
5 |
6 |
p. I felt [INSERT emotion] while viewing (listening to) the ad. |
1 |
2 |
3 |
4 |
5 |
6 |
Please rate the persuasiveness of the [INSERT format—print ad, video, etc.] you just saw. Be honest, how persuasive was it?
1. The message that I saw about [INSERT] was compelling
2. The message about [INSERT] was persuasive
3. The message was dumb
4. The message was weak
5. Don’t know
6. Refuse to answer
My [INSERT] thinks I should [talk/tweet/post a status update or comment on Facebook/blog/send an SMS text message/etc.] about HIV.
1. Strongly agree
2. Agree
3. Disagree
4. Strongly disagree
5. Don’t know
6. Refuse to answer
Think about the people who are important to you. Do most of them think that you should, or should not, [talk/tweet/post a status update or comment on Facebook/blog/send an SMS text message/etc.] about HIV?
1. Definitely should not
2. Should not
3. Neither should nor should not
4. Should
5. Definitely should
How do you think [INSERT] would feel about you [talking/tweeting/posting status updates or commenting on Facebook/blogging/sending SMS text messages/etc.] about HIV?
1. Strongly disapprove
2. Disapprove
3. Neither approve nor disapprove
4. Approve
5. Strongly approve
How many of your [INSERT] do you think have [talked/tweeted/posted a status update or commented on Facebook/blogged/sent an SMS text message/etc.] about HIV in the last [INSERT TIME FRAME]?
1. None
2. A few
3. Some
4. Most
5. All
6. Don’t know
7. Refuse to answer
When it comes to [talking/tweeting/posting status updates or commenting on Facebook/ blogging/sending SMS text messages/etc.] about HIV, I want to do what my [INSERT] want(s) me to do.
1. Strongly disagree
2. Disagree
3. Neither agree nor disagree
4. Agree
5. Strongly agree
It is important to talk about HIV.
1. Strongly agree
2. Agree
3. Disagree
4. Strongly disagree
5. Don’t know
6. Refuse to answer
It is important to talk about HIV with [INSERT].
1. Strongly agree
2. Agree
3. Disagree
4. Strongly disagree
5. Don’t know
6. Refuse to answer
I am confident that I can talk to [INSERT] about [INSERT].
1. Strongly agree
2. Agree
3. Disagree
4. Strongly disagree
5. Don’t know
6. Refuse to answer
I am confident that I can [tweet/post a status update and/or comment on Facebook/blog/send an SMS text message] about [INSERT].
1. Strongly agree
2. Agree
3. Disagree
4. Strongly disagree
5. Don’t know
6. Refuse to answer
I plan on talking about HIV with [INSERT PERSON] in the next [INSERT TIME FRAME].
1. Strongly agree
2. Agree
3. Disagree
4. Strongly disagree
5. Don’t know
6. Refuse to answer
I plan on tweeting about HIV in the next [INSERT TIME FRAME].
1. Strongly agree
2. Agree
3. Disagree
4. Strongly disagree
5. Don’t know
6. Refuse to answer
I plan on posting a status update or comment on Facebook about HIV in the next [INSERT TIME FRAME].
1. Strongly agree
2. Agree
3. Disagree
4. Strongly disagree
5. Don’t know
6. Refuse to answer
I plan on sending an SMS text message about HIV in the next [INSERT TIME FRAME].
1. Strongly agree
2. Agree
3. Disagree
4. Strongly disagree
5. Don’t know
6. Refuse to answer
I plan on blogging about HIV in the next [INSERT TIME FRAME].
1. Strongly agree
2. Agree
3. Disagree
4. Strongly disagree
5. Don’t know
6. Refuse to answer
In the next [INSERT TIME FRAME], do you plan to talk to your partner about HIV?
1. Yes
2. No
3. Don’t know
4. Refuse to answer
H.110a If yes, do you plan to use any of the following methods to communicate with your partner? [SELECT ALL THAT APPLY.]
|
Yes |
No |
Don’t know |
Refuse to answer |
a. Face-to-face |
1 |
2 |
3 |
4 |
b. Facebook—personal page |
1 |
2 |
3 |
4 |
c. Facebook—[INSERT CAMPAIGN] fan page |
1 |
2 |
3 |
4 |
d. Twitter |
1 |
2 |
3 |
4 |
e. SMS text messages |
1 |
2 |
3 |
4 |
f. Blog |
1 |
2 |
3 |
4 |
In the next [INSERT TIME FRAME], do you plan to talk to your friends about HIV?
1. Yes
2. No
3. Don’t know
4. Refuse to answer
H.111a If yes, do you plan to use any of the following methods to communicate with your friends? [SELECT ALL THAT APPLY.]
|
Yes |
No |
Don’t know |
Refuse to answer |
a. Face-to-face |
1 |
2 |
3 |
4 |
b. Facebook—personal page |
1 |
2 |
3 |
4 |
c. Facebook—[INSERT CAMPAIGN] fan page |
1 |
2 |
3 |
4 |
d. Twitter |
1 |
2 |
3 |
4 |
e. SMS text messages |
1 |
2 |
3 |
4 |
f. Blog |
1 |
2 |
3 |
4 |
In the next [INSERT TIME FRAME], do you plan to talk to your family about HIV?
1. Yes
2. No
3. Don’t know
4. Refuse to answer
H.112a If yes, do you plan to use any of the following methods to communicate with your family? [SELECT ALL THAT APPLY.]
|
Yes |
No |
Don’t know |
Refuse to answer |
a. Face-to-face |
1 |
2 |
3 |
4 |
b. Facebook—personal page |
1 |
2 |
3 |
4 |
c. Facebook—[INSERT CAMPAIGN] fan page |
1 |
2 |
3 |
4 |
d. Twitter |
1 |
2 |
3 |
4 |
e. SMS text messages |
1 |
2 |
3 |
4 |
f. Blog |
1 |
2 |
3 |
4 |
In the past [INSERT TIME FRAME], with whom and how have you talked about HIV? [SELECT ALL THAT APPLY.]
|
Partner |
Friends |
Family |
a. Face-to-face |
1 |
2 |
3 |
b. Facebook—personal page |
1 |
2 |
3 |
c. Facebook—[INSERT CAMPAIGN] fan page |
1 |
2 |
3 |
d. Twitter |
1 |
2 |
3 |
e. SMS text messages |
1 |
2 |
3 |
f. Blog |
1 |
2 |
3 |
In the past [INSERT TIME FRAME], have you talked to [INSERT] about [INSERT]?
1. Yes
2. No
3. Don’t know
4. Refuse to answer
H.114a In the past [INSERT TIME FRAME], how often have you talked to [INSERT] about [INSERT]?
1. Never
2. Once
3. 2 to 3 times
4. 4 to 5 times
5. 6 to 10 times
6. More than 10 times
7. Don’t know
8. Refuse to answer
In the past [INSERT TIME FRAME], have you [tweeted/retweeted/replied to a tweet] about [INSERT]?
1. Yes
2. No
3. Don’t know
4. Refuse to answer
H.115a In
the past [INSERT TIME FRAME], how often have you
[tweeted
/retweeted/replied to a tweet] about [INSERT]?
1. Never
2. Once
3. 2 to 3 times
4. 4 to 5 times
5. 6 to 10 times
6. More than 10 times
7. Don’t know
8. Refuse to answer
H.115b In
the past [INSERT TIME FRAME], how often have you
[tweeted/
retweeted/replied to a tweet] about [INSERT]?
1. Never
2. Rarely
3. Often
4. Always
5. Don’t know
6. Refuse to answer
In the past [INSERT TIME FRAME], have you posted a Facebook status update or commented on Facebook about [INSERT]?
1. Yes
2. No
3. Don’t know
4. Refuse to answer
H.116a In the past [INSERT TIME FRAME], how often have you posted a Facebook update or commented on Facebook about [INSERT]?
1. Never
2. Once
3. 2 to 3 times
4. 4 to 5 times
5. 6 to 10 times
6. More than 10 times
7. Don’t know
8. Refuse to answer
Have you ever posted a comment on the [INSERT CAMPAIGN] Facebook fan page?
1. Yes
2. No
3. Don’t know
4. Refuse to answer
H.117a How often have you posted a comment on the [INSERT CAMPAIGN] Facebook fan page?
1. Never
2. Once
3. 2 to 3 times
4. 4 to 5 times
5. 6 to 10 times
6. More than 10 times
7. Don’t know
8. Refuse to answer
In the past [INSERT TIME FRAME], have you posted a blog or commented on a blog post about [INSERT]?
1. Yes
2. No
3. Don’t know
4. Refuse to answer
H.118a In the past [INSERT TIME FRAME], how often have you posted a blog or commented on a blog post about [INSERT]?
1. Never
2. Once
3. 2 to 3 times
4. 4 to 5 times
5. 6 to 10 times
6. More than 10 times
7. Don’t know
8. Refuse to answer
In the past [INSERT TIME FRAME], have you forwarded an SMS text message about [INSERT]?
1. Yes
2. No
3. Don’t know
4. Refuse to answer
H.119a In the past [INSERT TIME FRAME], how often have you forwarded an SMS text message about [INSERT]?
1. Never
2. Once
3. 2 to 3 times
4. 4 to 5 times
5. 6 to 10 times
6. More than 10 times
7. Don’t know
8. Refuse to answer
In the past [INSERT TIME FRAME], have you sent an SMS text message about [INSERT]?
1. Yes
2. No
3. Don’t know
4. Refuse to answer
H.120a In the past [INSERT TIME FRAME], how often have you sent SMS text messages about [INSERT]?
1. Never
2. Once
3. 2 to 3 times
4. 4 to 5 times
5. 6 to 10 times
6. More than 10 times
7. Don’t know
8. Refuse to answer
Have you ever talked to [INSERT] about [INSERT]?
1. Yes
2. No
3. Don’t know
4. Refuse to answer
Have you ever heard of [INSERT NAME]?
1. Yes
2. No
3. Don’t know
4. Refuse to answer
Is s/he a good source of information on [INSERT TOPIC]?
1. Yes
2. No
3. Don’t know
4. Refuse to answer
Is s/he believable?
1. Yes
2. No
3. Don’t know
4. Refuse to answer
Does s/he seem trustworthy?
1. Yes
2. No
3. Don’t know
4. Refuse to answer
Is [INSERT PERSON] a good source of information on [INSERT TOPIC]?
1. Yes
2. No
3. Don’t know
4. Refuse to answer
H.126a Is [INSERT PERSON] believable?
1. Yes
2. No
3. Don’t know
4. Refuse to answer
H.126b Does [INSERT PERSON] seem trustworthy?
1. Yes
2. No
3. Don’t know
4. Refuse to answer
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| File Title | Attachments |
| Author | snaauw |
| File Modified | 0000-00-00 |
| File Created | 2021-01-31 |