Form 1 Current Population Instrument Survey Instrument

November 2011

Civic Engagement Supplement

Items Booklet

NOVEMBER 2011CIVIC ENGAGEMENT

SUPPLEMENT TO THE CURRENT

POPULATION SURVEY

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PRESUP 2 The next set of questions are about people’s involvement and communication within their communities.

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NXTPR I (also) need to talk to (fill name/Read list of needed persons). Is he/she at home now/Are either of them at home now/Are any of them at home now?

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S1 The first question is about LOCAL elections, such as for mayor or a school board. (Do you/Does NAME) always vote in local elections, (do you/does he/does she) sometimes vote, (do you/does he/does she) rarely vote, or (do you/does he/does she) never vote?

(1) Always vote

(2) Sometimes vote

(3) Rarely vote

(4) Never vote

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S2 I am going to read a list of some things people have done to express their views. Please tell me whether or not (you have/NAME has) done any of the following in the last 12 months, that is since November 2010:

1. Contacted or visited a public official – at any level of government – to express (your/his/her) opinion?

(1) Yes

(2) No

2. Bought or boycotted a certain product or service because of the social or political values of the company that provides it?

1. Yes

2. No

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S3 How often, if at all, (have you/has NAME) used the Internet to express (your/his/her) opinions about POLITICAL or COMMUNITY issues within the last 12 months – basically every day, a few times a week, a few times a month, once a month, less than once a month, or not at all?

(1) Basically every day

(2) A few times a week

(3) A few times a month

(4) Once a month

(5) Less than once a month

(6) Not at all

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S5 Next, I will give you a list of types of groups or organizations in which people sometimes participate. (Have you/Has NAME) participated in any of these groups during the last 12 months, that is since November 2010:

1. A school group, neighborhood, or community association such as PTA or neighborhood watch group?

1. Yes

2. No

2. A service or civic organization such as American Legion or Lions Club?

1. Yes

2. No

3. A sports or recreation organization such as a soccer club or tennis club?

1. Yes

2. No

4. A church, synagogue, mosque, or other religious institution or organization, NOT COUNTING (your/his/her) attendance at religious services?

1. Yes

2. No

5. Any other type of organization that I have not mentioned?

1. Yes

2. No

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S6s What type of organization is that?

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S7 In the last 12 months, that is since November 2010, (have you/has NAME) served on a committee or as an officer of any group or organization?

(1) Yes

(2) No

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S11 These next questions ask how often (you/NAME) did something during a TYPICAL MONTH in the last 12 months, that is since November 2010. How often did (you/NAME) discuss politics with family or friends – basically every day, a few times a week, a few times a month, once a month, less than once a month, or not at all?

(1) Basically every day

(2) A few times a week

1. A few times a month

2. Once a month

(5) Less than once a month

(6) Not at all

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DO NOT ASK OF 1 PERSON HOUSEHOLDS

S12 How often did (you/NAME) eat dinner with any of the other members of (your/his/her) household – basically every day, a few times a week, a few times a month, once a month, less than once a month, or not at all?

(1) Basically every day

(2) A few times a week

(3) A few times a month

(4) Once a month

(5) Less than once a month

(6) Not at all

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S13 This next question is about friends and family (you do/NAME does) not live with.

During the last twelve months, how often did (you/NAME) see or hear from friends or family, whether in-person or not – basically every day, a few times a week, a few times a month, once a month, less than once a month, or not at all?

(1) Basically every day

(2) A few times a week

(3) A few times a month

(4) Once a month

(5) Less than once a month

(6) Not at all

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S15 How often did (you/NAME) talk with any or (your/his/her) neighbors – basically every day, a few times a week, a few times a month, once a month, less than once a month, or not at all?

1. Basically every day

2. A few times a week

3. A few times a month

4. Once a month

5. Less than once a month

6. Not at all

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S16 How often did (you/NAME) and (your/his/her) neighbors do favors for each other? By favors we mean such things as watching each others children, helping with shopping, house sitting, lending garden or house tools and other small things to help each other – basically every day, a few times a week, a few times a month, less than once a month, or not at all?

1. Basically every day

2. A few times a week

3. A few times a month

4. Once a month

5. Less than once a month

6. Not at all

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NOTE: Do not ask of proxy respondents.

S18 We’d like to know how much you trust people in your neighborhood. Generally speaking, would you say that you can trust all the people, most of the people, some of the people, or none of the people in your neighborhood?

1. All the people

2. Most of the people

3. Some of the people

4. None of the people

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NOTE: Do not ask of proxy respondents.

S21 I am going to name some institutions in this country. For each of these institutions, would you say you have a great deal of confidence, only some confidence, hardly any confidence, or no confidence at all in them to do what is right?

1. Corporations

(1) A great deal of confidence

(2) Some confidence

1. Hardly any confidence

2. No confidence at all

2. The media

1. A great deal of confidence

2. Some confidence

3. Hardly any confidence

4. No confidence at all

3. Public schools

1. A great deal of confidence

2. Some confidence

3. Hardly and confidence

4. No confidence at all

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S22 How would you describe (your/NAME’s) overall state of health these days: Would you say it is excellent, very good, good, fair, or poor?

(1) Excellent

(2) Very Good

1. Good

2. Fair

(5) Poor

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NOTE: Do not ask of proxy respondents.

S23 On the following scale, how would you describe the quality of your life overall? Excellent, good, fair, poor, or very poor?

(1) Excellent

(2) Good

1. Fair

2. Poor

(5) Very poor

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SCK5 ***DO NOT READ TO RESPONDENT***

Who reported for this person?

(1) Self

(2) Other------------------

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