NHTSA Form 1159 Evaluation Survey for Impaired Riding Interventions

OMB Control No. 2127-xxxx

Expiration Date xx-xx-xxxx

Hello, I'm conducting a study of motorcycle riders for the U.S. Department of Transportation.

If you take about 5 minutes to answer my questions, I can offer you [incentive] for your participation. Your participation is voluntary and your responses are anonymous. Could we begin now?

OMB Burden Statement (to be handed out with incentive): Please note a federal agency may not conduct or sponsor, and a person is not required to respond to, nor shall a person be subject to a penalty for failure to comply with a collection of information subject to the requirements of the Paperwork Reduction Act unless that collection of information displays a current valid OMB Control Number. The OMB Control Number for this information collection is xxxx-xxxx. Public reporting for this collection of information is estimated to be approximately 5 minutes per response, including the time for reviewing instructions, completing and reviewing the collection of information. All responses to this collection of information are voluntary. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to: Information Collection Clearance Officer, National Highway Traffic Safety Administration, 1200 New Jersey Ave, S.E., Washington, DC, 20590.

All of the following questions refer to your motorcycle riding on the road.

1. Have you operated a motorcycle on the road in the past 30 days?

   1. Yes

   2. No [TERMINATE]

1a. Are you attending [name of event]? Question will only be asked if HVE is in conjunction with a special event and if event attendance is not obvious.

1. Yes

2. No [TERMINATE]

2. What type of motorcycle do you operate most often on the road?

   1. Sportbike

   2. Cruiser

   3. Touring

   4. Dual Purpose (On/Off-road)

   5. Scooter

   6. Three-wheeled

   7. Other (name) ___________

   8. Refused

3. Who is the manufacturer?________

4. How many miles did you operate a motorcycle in the past year?

   1. 100 miles or less

   2. 101-1,000 miles

   3. 1,001-2,000 miles

   4. 2,001-3,000 miles

   5. 3,001-5,000 miles

   6. over 5,000 miles

   7. Don’t know

   8. Refused

5. Do you operate your motorcycle mostly for transportation (that is, you use your motorcycle primarily for things like commuting and errands) or do you ride mostly for recreation?

   1. Mostly transportation

   2. Mostly recreation

   3. Equal amounts transportation and recreation

   4. Don’t know

   5. Refused

6. How often do you operate a motorcycle?

   1. Monthly or less

   2. 2 to 4 times a month

   3. 2 to 3 times a week

   4. 4 or more times a week

   5. Don’t know

   6. Refused

7. How often do you operate a motorcycle after 8:00 o’clock at night?

   1. Never

   2. Monthly or less

   3. 2 to 4 times a month

   4. 2 to 3 times a week

   5. 4 or more times a week

   6. Don’t know

   7. Refused

8. How often do you have a drink containing alcohol, including liquor, beer, wine, or wine cooler?

   1. Never [Skip to Q 12]

   2. Monthly or less

   3. 2 to 4 times a month

   4. 2 to 3 times a week

   5. 4 or more times a week

   6. Don’t know

   7. Refused

9. In the past 30 days have you operated a motorcycle within two hours of drinking any alcoholic beverage?

   1. Yes –If so, about how many times? ___________

   2. No

   3. Don’t know

   4. Refused

10. In the past 30 days have you operated a motorcycle when you thought you had too much to drink?

    1. Yes—If so, about how many times? __________

    2. No

    3. Don’t know

    4. Refused

11. In the past 30 days, have you ever deliberately avoided operating a motorcycle because you felt you had too much to drink to ride safely?

    1. Yes — If so, about how many times? __________

    2. No

    3. Don’t know

    4. Refused

12. In the past 30 days, have you seen or heard any media messages that warn riders not to ride a motorcycle after drinking?

    1. Yes

    2. No

    3. Don’t know

    4. Refused

13. In the past 30 days, have you seen or heard any publicity about special efforts by police in this area to reduce motorcycle riding under the influence of alcohol or drunk riding?

    1. Yes

    2. No

    3. Don’t know

    4. Refused

14. In the past 30 days, have you seen or heard anything about police setting up checkpoints or special DWI patrols in this area to catch drinking drivers and motorcyclists?

    1. Yes

    2. No

    3. Don’t know

    4. Refused

15. In the past 30 days have you personally seen or been stopped during any of these checkpoints or DWI patrols?

    1. Yes, saw and was stopped

    2. Yes, saw but was not stopped

    3. No, I didn’t see any

    4. Don’t know

    5. Refused

16. Have you seen [heard] this [these] ad(s) in the past 30 days? [Show or play examples]

    1. Yes

    2. No

    3. Don’t know

    4. Refused

17. Do you recall hearing or seeing the following slogans in the past 30 days? [Check all that apply—Responses will be added to survey when campaign slogans are created]

18. How likely is it that the police in this area will catch a motorcycle rider who is riding after drinking more alcohol than the law allows?

    1. Very Likely

    2. Somewhat Likely

    3. Not Likely

    4. Don’t know

    5. Refused

19. If HVE is NOT held in conjunction with an event, ask Q19
    In the past 30 days, has police enforcement in this area to catch riders who are riding under the influence of alcohol or riding drunk:

    1. Gone up

    2. Gone down

    3. Stayed the same

    4. Don’t know

    5. Refused

19a. If HVE is held in conjunction with an event, ask Q19a instead of Q19

Since [the previous time this event was held], has police enforcement [during this event] to catch riders who are riding under the influence of alcohol or riding drunk:

1. Gone up

2. Gone down

3. Stayed the same

4. I wasn’t at [this event] last time

5. Don’t know

6. Refused

OK, we’re almost done... Gender (Record by observation): M F

20. Can I ask which age group best describes you?

    1. 20 or younger

    2. 21-34

    3. 35-44

    4. 45-54

    5. 55-64

    6. 65+

    7. Refused

21. About how many miles away from here do you live?

    1. 0-10 miles

    2. 11-50 miles

    3. 51-100 miles

    4. 101-500 miles

    5. More than 500 miles

    6. Don’t know

    7. Refused

22. Do you consider yourself to be Hispanic or Latino?

    1. Yes

    2. No

    3. Refused

23. Which of the following racial categories describes you? You may select more than one.

    1. American Indian or Alaska Native

    2. Asian

    3. Black or African American

    4. Native Hawaiian or other Pacific Islander

    5. White

    6. Refused

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NHTSA Form 1159