Adult Questionnaire

The Center for Substance Abuse Prevention (CSAP) strongly recommends that grantees designate program or evaluation staff to conduct data collection. Program staff should not be responsible for administering questionnaires to participants to whom they provide direct services. Grantees may designate survey administrators (proctors) if this occurs or if data collection staff cannot administer the questionnaires.

Proctors should be present at the survey administration to explain the process of filling out the questionnaire and to answer any questions that may arise. Additional involvement of the proctor may be required for respondents with limited reading and/or English language ability.

Sections of the Questionnaire and Administration Time

The Adult Questionnaire is divided into three sections:

Section One: Facts About You
Section Two: Attitudes & Knowledge
Section Three: Behavior & Relationships

The number of sections an individual respondent is required to complete depends on the duration of the intervention he or she receives. This should be determined by the program staff responsible for data collection prior to survey administration. If you are unsure which sections of the questionnaire to administer, please ask the person in charge of data collection at your organization.

The following table shows which sections of the questionnaire to administer based on the intervention duration:

Intervention Duration	Sections of Survey To be Administered	Amount of Time To Complete*
Single Session Intervention	Pages 1-7 Section One: Facts about You 3 to 5 items from Section Two: Attitudes & Knowledge	5 minutes
Multiple Session Brief Intervention (less than 30 days duration)	Pages 1-7 Section One: Facts about You Section Two: Attitudes & Knowledge	30 minutes
Multiple Session Long Intervention (30 days or longer duration)	Pages 1-15 Section One: Facts about You Section Two: Attitudes & Knowledge Section Three: Behavior & Knowledge	50 minutes

*Does not include administrative time; respondents with limited reading and/or English ability may require extra time

Sections of the questionnaire that are not applicable to an individual respondent should be torn off and discarded prior to survey administration (see Pre-Administration Tasks Section below).

Respondents taking the survey at the second or third time point (exit or followup) should receive the same sections of the questionnaire that they received at the first time point (baseline).

Please allow extra time for the distribution of the questionnaires, reading of the instructions, collection of completed questionnaires, and any local administration activities (e.g. distributing incentives, collecting tracking information). The Adult Questionnaire is rated at an 8^th grade reading level based on the Flesch-Kincaid scale.

Full Proctoring of the Questionnaire

Respondents with limited reading ability (those with a reading level less than 8^th grade), or those with limited English language capabilities, may require full proctoring (having the entire questionnaire read aloud to them). If the questionnaire is read aloud, it is important to instruct respondents not to answer the questions out loud, but simply to mark their answers in the questionnaire. In all cases, respondents should fill out their own questionnaires.

Administration Setting

The questionnaire is designed to be administered in individual or group settings. The administration should be conducted in a quiet room with sufficient lighting and space, and with desks or tables to seat respondents. Some of the questions are sensitive, so the seating arrangement should maximize privacy for each respondent.

Pre-Administration Tasks

Before questionnaires are distributed, they must be prepared according to the following steps. This should be done prior to the time that is set aside to administer the questionnaire to respondents. The program staff responsible for data collection should prepare the questionnaires, not the proctor (although in some cases staff responsible for data collection may also serve as proctors):

Write the name of each survey respondent and his or her assigned 5 digit numeric Participant ID number on the front of the questionnaire
Tear off and discard any section of the questionnaire that is not applicable to a respondent. The section the respondent receives is based on the duration of the intervention he or she will receive/has received:
1. Respondents receiving a single session intervention should receive Section One (pages 1-3) and 3 to 5 items from Section Two (pages 4-7) that should be selected by the staff responsible for data collection prior to delivery of the intervention;
2. Respondents receiving multiple sessions lasting less than 30 days should receive only Sections One and Two (pages 1-7);
3. Respondents receiving multiple sessions lasting 30 days or longer should receive the entire questionnaire (Pages 1-15).
Complete the Record Management Section on page 2 of each questionnaire

Preparing each questionnaire in advance will help reduce tracking and data processing errors. Sections of the questionnaire that are not applicable to an individual respondent may be thrown away, shredded or recycled.

Administration Materials

In addition to the prepared questionnaires, the following materials are needed for each administration session:

No. 2 Pencils: A No. 2 pencil must be used to mark responses on the questionnaire. Bring enough pencils for everyone who will be in the session and a few extras in case they are needed.

Two Large Envelopes or Folders: One envelope or folder should be used to store the front tear-off pages of the questionnaires. These pages will have the individual’s name and unique 5-digit ID recorded on them. Respondents should be asked to tear off the front page of their questionnaire after confirming that their name is on it and the correct 5-digit ID is entered at the top of page 2. The tear-off pages should then be sealed in an envelope for use in record-keeping and tracking by qualified project staff. After a record has been made in the roster of the respondent’s date and type of survey, the face sheets should be shredded or destroyed. The second envelope or folder should be used to store the completed questionnaires until they are entered or uploaded online via the Prevention Management Reporting and Training System (PMRTS) Portal.

Roster: It is helpful to have a roster available with the participants’ names and 5 digit ID number. This roster serves as a crosswalk between the study participants’ names and ID number. Once the face sheet is separated from the questionnaire, the roster will be the only way to link the completed survey with the respondent. The roster should also include any other numbers the grantee uses to identify respondents; however, the same unique participant identification number should be used on all CSAP data collection instruments. To ensure confidentiality, the roster must be kept separate from the completed questionnaires at all times.

Administration Guide: When administering the questionnaire, be sure to have a copy of this Administration Guide on hand. Section II provides detailed instructions for addressing potential issues and answering questions that may arise from respondents.

Incentive Materials: Incentives are not required, and if used, should be approved by your CSAP Project Officer. Procedures for documenting the distribution of incentives are the responsibility of the grantees.

Questionnaire Introduction

Introduce the questionnaire with a statement similar to the following:

This questionnaire is being used to gather information on how to prevent substance abuse and HIV infection. The questions are being asked of hundreds of other individuals throughout the United States. The findings will be used to help our country learn more about how to keep people from abusing drugs or alcohol and getting infected with HIV.

This questionnaire is voluntary. If you do not want to answer any of the questions, you do not have to. However, your answers are very important to us. Please answer the questions honestly, based on what you really do, think, and feel. Your answers will not be told to anyone in your family or community.

Questionnaire Instructions

Read the following instructions to the survey respondents:

1. Check to make sure that the questionnaire has your name on the front page and an ID number written in below your name. Now check to make sure that the ID number marked at the top of the second page is the same number as the one on the first page. If the Date of Administration has not been marked, please mark today’s date, which is (today’s date) .

2. Please tear off the front page of your questionnaire and pass it to me. Do not write your name anywhere else on this questionnaire.

3. To answer each question, you should mark one of the answer circles by filling the circle completely. Some questions allow you to mark more than one answer. If you don’t find an answer that fits exactly, choose the one that comes closest.

4. Mark your answers carefully so your answer is obvious. Make heavy dark marks that fill the circle completely. Do not mark between the circles.

5. We would like you to work fairly quickly so that you can finish. Please work quietly by yourself. Raise your hand to let me know if you have a question or don’t understand something.

6. We think you will find the questionnaire to be interesting and that you will like filling it out. Before we begin, do you have any questions?

7. Thank you very much for being an important part of this effort!

Responses to Questions During the Administration

The questionnaire is designed to be self-administered, meaning respondents should fill out their own questionnaire privately. However, questions about certain items may arise that require clarification from the proctor. Section II of this guide provides instructions on how to respond to potential issues/questions for each item in the survey, including definitions of words. Please refer to this guide when answering questions from respondents. If a respondent asks a question about the meaning or intent of an item for which an answer is not provided in Section II, instruct the respondent to answer according to “what it means to you.”

If respondents at your site have serious problems understanding items in the questionnaire, please inform the staff responsible for data collection and contact your assigned CSAP Project Officer.

Administration Conclusion

When completed, collect questionnaires from each respondent, making sure that the face sheet containing respondents’ name and ID number has been removed. Place the questionnaires in an envelope or folder.

Thank respondents for taking the time to help with the survey.

Conclude with this debriefing statement:

Some of the questions on this survey may have been troubling for some of you. If there is anyone who feels they would like to talk to someone about any concern or problem, please see . S/he will be glad to listen to you and provide whatever help s/he can.

Makeup Administrations

When scheduled administrations of the instrument are complete, check the intervention and comparison group (if any) roster to determine if any scheduled respondents missed the session. If there are missing respondents, take the following steps:

Arrange to attend the next program session to speak to the respondent(s) who did not attend the questionnaire administration session.

Arrange a makeup session that is convenient for respondents; this can be done in person, by phone, or in writing.

If a respondent still misses a makeup session, or if a group makeup cannot be arranged, make reasonable efforts to administer the questionnaire individually.

II. Review of Questionnaire Items

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This section provides a detailed review of the items in each section of the questionnaire. For each item or group of items, potential issues are identified and one or more recommended solutions are provided. The potential issues focus on common questions that may be asked by respondents. The recommended solutions are appropriate responses to these questions. Following the recommended solutions will allow for consistency in the way the questionnaire is administered across settings and sites.

S ection One: Facts About You

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General Section Comments: The section asks sixteen basic questions about the respondent, such as gender, age, race, sexual orientation, primary language, place of origin, length of time in the United States, grade level, drug and alcohol use and repercussions and experience with the penal system. Respondents’ answers will not be used to identify them. Their answers will help us to understand how different groups (like men or women or people of similar ages) feel about substance abuse and HIV prevention.

1. How would you describe yourself? (Gender)

Potential Issue #1: Respondents are unsure what to answer (especially for transgendered individuals).

Recommended Response: Remind them that there are no right or wrong answers. Instruct respondents to answer based on which gender they most closely identify with.

Potential Issue #2: Respondents may not understand the Transgender category.

Recommended Response: If respondents consider themselves to be transgendered, they should select the Transgender category regardless of whether or not they have undergone medical or surgical procedures. We are interested in knowing whether they were born biologically male and now identify as female, or born biologically female and now identify as male.

Comments on Item 2-4: These questions are asked to determine respondents’ ages.

2. In what year were you born? (Enter all four digits of the year in the boxes below)

3. In what month were you born?

4. On what day of the month were you born?

Potential Issue #1: Respondents are confused about how to complete this question.

Recommended Response: Instruct the respondents to provide their best estimate. For question 2, the 4-digit year of birth should be entered in the boxes, and the corresponding bubbles filled in below.

Potential Issue #2: Respondents are reluctant to answer because of concern this information will be used to identifying them.

Recommended Response: Assure respondents that these questions are asked to determine their exact age so that evaluators can analyze the information accurately. This information will not be used to identify them.

5. Are you Hispanic or Latino?

Potential Issue: Respondents may not understand the question.

Recommended Solution: The intent of the question is to determine if respondents identify as Hispanic/Latino(a). Also, included in the category are those whose origins are from Spanish-speaking nations in Spain and Latin America, the Caribbean, or people who identify generally as Spanish, Spanish-American, Hispanic, Hispano, etc. Individuals from non-Spanish speaking countries, such as Brazil and Haiti, may also identify as Latino or Hispanic.

6. What is your race? (Select one or more)

Potential Issue #1: Respondents are multiracial.

Recommended Solution: Instruct respondents to mark the major racial group that they feel best describes them. Respondents may mark more than one group if they identifies with multiple groups represented on the list. For example, if a respondent identifies as half Asian and half African-American, he or she should fill in the bubbles for both Asian and African American.

Potential Issue #2: Respondents are Hispanic or Latino and do not know which category to mark.

Recommended Solution: The intent of the question is to determine which the race respondents best identify. For respondents that marked “yes” to the Hispanic ethnicity in Question 5, ask them to also mark any of the races that apply to them. If none of the races apply, ask respondents to select “Other.”

7. How would you describe yourself? (Sexual orientation)

Potential Issue: Respondents may be uncomfortable answering this question or may express confusion over which response option to choose.

Recommended Solution: Remind respondents that all answers will be kept private. Ask them to choose the response that best describes them as an individual- there are no right or wrong answers.

8. What is your primary spoken language?

Potential Issue: Respondents may indicate they speak more than one language and are unsure how to respond.

Recommended Solution: Ask respondents to bubble in the language they are most comfortable with, or the language they speak and read most often.

9. How long have you lived in the United States?

Potential Issue: Respondents are unsure how long they have been in the U.S.

Recommended Solution: Ask respondents to provide their best estimate. If they have left the United States or frequently visit their home country for extended periods of time, ask them to give the total time they have lived in the U.S. Do not include short trips or summer vacations abroad as time not living in the U.S.

10. What is the highest level of education you have finished, whether or not you received a degree? (Mark the highest grade you have completed.)

Potential Issue: Respondents may not know what grade to select.

Recommended Solution: We are interested in the highest grade respondents completed. If it is the middle of the school year, have respondents mark the grade/level they were in last year. If the respondents were homeschooled, they should select the grade that is equivalent to the highest grade level they have completed.

11. If less than 12 years of education, do you have a GED (General Equivalency Diploma)?

Potential Issue: Respondents may be unsure about what a GED is.

Recommended Solution: Explain that if someone doesn’t graduate from high school, that person can take a test, and if he or she passes, it is considered to be the same as completing school through twelfth grade.

12. Have you completed a technical or trade school program (such as beautician, cosmetology, business, appliance repair, computer etc.)?

Potential Issue: Confusion over what constitutes a “program.”

Recommended Solution: A program is a training for which the respondent received a certificate, license, or passed a test upon completion.

13. Which of the following best describes you? (Mark the one that fits best.)

Potential Issue: None of the employment statuses fit.

Recommended Solution: Ask the respondent to select “Unemployed (Other Reason)”.

14. During the past 12 months, have you driven a vehicle while you were under the influence of alcohol?

Potential Issue: Respondents may not understand what constitutes being “under the influence.”

Recommended Solution: Explain that “under the influence” means having had enough alcohol to feel the effects, thus impairing the ability to drive.

15. Have you ever been in juvenile/adult detention, jail, or prison for more than 3 days?

Potential Issue: Respondents are uncomfortable answering and find this question intrusive.

Recommended Response: Explain that this question is asked of everyone and there are no expectations about them, their past, or how they behave. If respondents are still reluctant to answer, please indicate that their answers are voluntary and they do not have to answer. If the Respondent indicates they have not been in jail or prison for more than 3 days, have them mark “No.”

16. If YES to question 15, how long has it been since you last got out of juvenile/adult detention, jail, or prison?

Potential Issue: Respondents do not remember how long ago it was, or have never been in juvenile/adult detention, jail or prison for more than three days.

Recommended Response: The question is asking if respondents have ever been in detention, jail or prison for more than three days, how long ago was the most recent time. Ask respondents to provide their best estimate. If they have not, they can check the corresponding circle for “never in juvenile/adult detention, jail, or prison for more than 3 days”.

S ection Two: Attitudes & Knowledge

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This section asks respondents how they feel about substance abuse and sexual behavior as well as what they know about HIV/AIDS. If respondents are concerned about any of the questions, please remind them that their answers are private and will not be used to identify them.

Comments on Items 17-19: These questions ask respondents how much they think people risk harming themselves physically or in other ways by using alcohol, tobacco, and drugs. There are no wrong or right answers. Also we are not implying that they do any of these things. We are only interested in what they think about these actions.

For these questions, possible answers include:

No risk You think nothing bad will happen if people do this.

Slight risk You think something bad MIGHT happen if people do this.

Moderate risk You are pretty sure something bad will happen if people do this.

Great risk You really think something bad will happen if people do this.

Don’t know or can’t say You really don’t know about this substance or don’t know how risky it is to use it.

17. How much do people risk harming themselves physically or in other ways when they smoke one or more packs of cigarettes per day?

18. How much do people risk harming themselves physically or in other ways when they smoke marijuana once or twice a week?

19. How much do people risk harming themselves physically or in other ways when they have five or more drinks of an alcoholic beverage once or twice a week?

Potential Issue #1: Respondents are unsure how to answer the question because they do not smoke, use marijuana, or drink alcohol.

Recommended Solution: Explain that we would like their thoughts or opinions about adults who smoke cigarettes, use marijuana or drink alcohol regardless of their own behavior.

Potential Issue #2: Respondents may be confused about what five drinks means in question 19.

Recommended Solution: Explain that this means having five or more drinks in one sitting and doing this once or twice a week. One drink is equivalent to:

12-ounces of beer or one regular bottle or can of beer.
8-ounces of malt liquor.
5-ounces of wine.
1.5-ounces or a “shot” of 80-proof distilled spirits or liquor (e.g., gin, rum, vodka, or whiskey).

Comments on Items 20-36: The next set of questions asks about the respondents’ beliefs and attitudes toward SEX, sexual relationships and substance use. The following definitions are used for the items:

Sex or Sexual Activity -- a situation where two partners get sexually excited or aroused (turned on) by touching each other’s genitals (penis or vagina) or anus (butt) with their own genitals, hands, or mouths
Vaginal Sex -- a male inserts his penis into his female partner’s vagina
Oral Sex -- when one partner’s mouth is in contact with the other partner’s genitals (penis or vagina) or anus during sex
Anal Sex -- when a male’s penis is inserted into his male or female partner’s anus
Sexual Partners – with whom you have sex, that is, engage in sexual activity
Protected Sex -- when a latex or polyurethane condom (rubber) is used to cover the penis; a female condom is used to cover the vagina; or a dental dam is used to cover the anus
Unprotected Sex -- vaginal, oral, or anal sex without a barrier such as a condom or dental dam

The following group of questions asks respondents’ opinions concerning certain activities. They should mark the answer that best describes what they think.

The possible response categories include:

No risk You think nothing bad will happen if people do this.

Slight Risk You think something bad MIGHT happen if people do this.

Moderate Risk You are pretty sure something bad will happen if people do this.

Great Risk You really think something bad will happen if people do this.

How much do you think people risk harming themselves physically:

20. If they have oral sex without a condom or dental dam?

21. If they have vaginal sex without a condom?

22. If they have anal sex without a condom?

23. If they have sex under the influence of alcohol?

24. If they have sex while high on drugs?

25. If they share nonsanitized needles or works when using drugs? (Works refers to supplies used for injecting drugs)

Potential Issue: Respondents ask if they must have a personal experience to answer.

Recommended Solution: No, respondents do not need personal experience to hold any opinion or belief. Ask them to read each question and mark the answer that best describes what they think. Remember there are no right or wrong answers.

Comments Items 26-31: These questions ask how confident respondents are in their ability to do certain activities in their relationship with their MAIN partner.

For these next few questions, possible answers include:

Not at all You could not do the action described.

A little This only describes you a little. You might be able to carry out the action but are very unsure.

Somewhat You would probably be able to carry out the action but have some doubts.

Very much You would be able to carry out the action.

In your relationship with your PRIMARY (MAIN) partner, how confident are you that you could:

26. Refuse to have sex with your partner because you weren’t in the mood?

27. Ask your partner to wait while you got a condom or dental dam?

28. Tell your partner how to treat you sexually?

29. Refuse to engage in sexual practices you didn’t like?

30. Ask your partner to use a condom or dental dam?

31. Refuse to have sex because your partner did not want to use a condom or dental dam?

Potential Issue: Respondents may indicate that they do not have a MAIN partner.

Recommended Solution: Tell respondents to answer the way they think they would if they had a primary partner.

Comments on Items 32-36: The following set of questions asks respondents how likely they are to do something in the next 6 months. The possible response categories are:

Not at all likely I am certain I will not do this.

A little likely There is a chance I will do this, but probably not. (For example, there is a 25% chance that this might happen.)

Somewhat likely There is a good chance I will do this. (For example, there is a 50% chance that this might happen.)

Very likely There is a very strong chance this will happen.

(For example, there is a 75% chance that this might happen.)

Potential Issue: There may be items that respondents do not feel are relevant for them.

Recommended Solution: Choose the ‘not at all likely’ category.

In the next 6 months, how likely are you…

32. To drink five or more alcoholic drinks in one sitting?

Potential Issue #1: Respondents may question the definition of “alcoholic drinks.”

Recommended Solution: Alcoholic drinks include beer, wine, wine coolers, malt liquor and hard liquor.

Potential Issue #2: Respondents may question what one drink is equivalent to.

Recommended Solution: One drink is equivalent to:

12-ounces of beer or one regular bottle or can of beer.
8-ounces of malt liquor.
5-ounces of wine.
1.5-ounces or a “shot” of 80-proof distilled spirits or liquor (e.g., gin, rum, vodka, or whiskey).

33. To use any illegal drugs (including prescription drugs) to get high?

Potential Issue: Respondents may question the definition of illegal drug.

Recommended Solution: Illegal drugs are substances that are controlled or prohibited. Illegal drugs can also include prescription drugs taken without the advice of a doctor, or which are used other than for the intended purpose. Examples of illegal drugs include, but are not limited to:

Marijuana - ‘Marijuana - pot, weed, blunt, whether prescribed or not. Marinol which also contains THC is a legal drug and should only be counted if the client is using it in an unprescribed manner.

Hashish -Hash, junk, chive.

Cocaine/crack—Cocaine crystal, free-base cocaine, crack, or rock cocaine

Nonprescription methadone—Dolophine, LAAM

Hallucinogens/psychedelics, PCP, MDMA, LSD, Mushrooms, or Mescaline— Psilocybin, peyote, green

Methamphetamine or other amphetamines—Monster, amp, Benzedrine, Dexedrine, Ritalin, preludin

Benzodiazepines—Ativan, Librium

Barbiturates—Amytal, seconal, phenobarbital

Ketamine—Ketalar, cat valium

Other tranquilizers, downers, sedatives, or hypnotics—Dalmane, haldol, quaaludes

Inhalants—Nitrous oxide, amyl nitrate, glue, solvents, gasoline, toluene, aerosols (hair spray, Lysol, air freshener)

34. To use injection drugs without a doctor’s orders, just to feel good or to get high?

Potential Issue: Respondents may be unsure what is meant by injection drugs.

Recommended Solution: Injected drugs are drugs administered with a needle. They can be either intravenous (i.e. into the vein) or non-intravenous (i.e., into a muscle or under the skin). Do not count injection of legal and prescribed medications (i.e. insulin, hormones). However, include injection drugs taken without the advice of a doctor, including steroids and hormones.

35. To use clean needles when injecting drugs?

Potential Issue: Respondents may not be clear on the definition of clean needles.

Recommended Solution: By clean needles, we mean needles that have been cleaned or sterilized with bleach before use.

36. To practice safe sex?

Potential Issue: Respondents may not be clear on the definition of safe sex.

Recommended Solution: By safe sex, we mean sex using a latex condom or other barrier method, such as the female condom, dental dam or finger cot.

Comments on Items 37-42: These questions test respondents’ knowledge about HIV/AIDS and the risk of certain actions for contracting the HIV virus. This section asks respondents what they THINK about the given statements. Respondents are asked if each statement is true or false. If they are unsure, they should mark “Don’t know” and continue to the next statement.

37. Only people who look sick can spread the HIV/AIDS virus.

Potential Issue: None

38. Only people who have sexual intercourse with gay (homosexual) people get HIV/AIDS.

Potential Issue: None

39. Birth control pills protect women from getting the HIV/AIDS virus.

Potential Issue: Respondents may not know what birth control pills are.

Recommended Solution: Birth control pills, or “the Pill,” are common names for oral contraception—pills that can be taken by women to prevent pregnancies.

40. There are drugs available to treat HIV that can lengthen the life of a person infected with the virus.

Potential Issue: Respondents may not understand the use of the word “drugs.”

Recommended Solution: Explain that “drugs” refers to medication given by a doctor that is meant to help the person with HIV to live longer.

41. There is no cure for AIDS.

Potential Issue: Respondents do not understand the use of the word “cure.”

Recommended Solution: Explain that “cure” refers to a way of eliminating AIDS from a person’s body forever.

42. Young people under age 18 need their parents’ permission to get an HIV test.

Potential Issue: None.

Comments on items 43-47: These questions ask respondents about health care services.

43. Would you know where to go in your neighborhood to see a health care professional regarding HIV/AIDS or other sexually transmitted health issues?

Potential Issue: Respondents do not know what a health care professional is.

Recommended Solution: A health care professional is someone who provides health care to individuals in a community after attending school for their area of specialty and attaining certification. Some common examples are doctors, nurses, counselors, therapists etc.

44. Would you know where to go in your neighborhood to see a health care professional regarding a drug or alcohol problem?

Potential Issue: Respondents do not know what a health care professional is.

45. Have you ever been tested for the HIV virus that causes AIDS?

Potential Issue #1: Respondents may interpret this as asking for their HIV status.

Recommended Solution: We are only interested in whether they have been tested or not.

Potential Issue #2: Respondents are confused by the wording of this question.

Recommended Solution: Explain that the question is asking whether or not respondents have ever been tested for HIV. Although it might seem to imply that some forms of the HIV virus do not cause AIDS, clarify that all strains of HIV cause AIDS. We are interested in whether respondents have ever been tested.

46. If YES to question 45, what type of HIV test was it?

Potential Issue #1: Respondents do not know what kind of test was taken.

Recommended Solution: Have them select “Don’t know”.

Potential Issue #2: Respondents may not know the difference between the test types.

Recommended Solution: Explain to the respondent that each type requires a different bodily fluid: saliva can be tested with a swab to the mouth, urine can be tested by urinating in a cup, or blood can be taken with a needle. If they are still unsure of which test they took, have them select “Don’t know” and continue to Item 47.

47. If YES to question 45, did you receive or go back to get your results?

Potential Issue: Respondents may interpret this as asking for their HIV status.

Recommended Solution: We are only interested in whether they have been tested and received their results. We do not want to know the results of their HIV test. If they indicate that they received their results, they should also indicate that they have been tested in item 45.

Comments on Items 48-51: These questions ask about the people in respondents’ lives and the amount of social support they receive. The possible response categories are:

Yes, there are people I can talk with

No, there is no one I can talk with

Thinking about all the people you know…

48. Are there any people you could go to when you want to talk about things having to do with your own health?

49. Are there any people you could talk with about personal issues having to do with sex?

50. Are there any people you could talk with about personal issues having to do with alcohol or drug use?

51. Are there certain people you could go to if you need to talk about other personal matters that you wouldn’t tell just anyone?

Comments on Items 52-54: These questions ask about respondents’ religious or spiritual beliefs and how they may affect their daily life.

52. In general, how important are religious or spiritual beliefs in your day-to-day life?

The possible response categories are:

Not at all important Religion or spirituality are not important.

Not too important Somewhat important, but not fairly important.

Fairly important Important, but not very important.

Very important Religious or spiritual beliefs guide my day-to-day life.

Potential Issue: Respondents may be unsure of what is meant by “religious or spiritual beliefs.”

Recommended Solution: Have them answer the question according to what “religious or spiritual beliefs” mean to them. In general, a spiritual belief is a belief system based on something sacred, the belief in a spirit or soul, or a belief in a god or other deity.

53. When you have problems or difficulties with your school (education), work, family, friends, or personal life, how often do you seek spiritual guidance and support?

Possible response categories are:

Never I never seek spiritual guidance and/or support.

Rarely I hardly ever seek spiritual guidance and/or support.

Sometimes From time to time—occasionally.

Often I frequently seek spiritual guidance and/or support.

Almost always Most of the time.

Potential Issue #1: Respondents may be unsure as to what we mean by “spiritual guidance and/or support.”

Recommended Solution: Spiritual guidance and/or support may include going to church, temple or other place of worship, faith-based meetings, or retreats. It may also include speaking to a clergy or other faith representative.

Potential Issue #2: Does it include prayer or meditation?

Recommended Solution: No, we are interested in knowing if you sought guidance from a clergy-member or other spiritual leader.

54. How spiritual or religious would you say you are?

Possible response categories are:

Not spiritual/religious at all I am not religious or spiritual.

Not too spiritual/religious I am somewhat religious or spiritual.

Fairly spiritual/religious I am religious or spiritual but not very religious or spiritual.

Very spiritual/religious I am really spiritual or religious.

Potential Issue: Respondents may be unsure of what is meant by “religious or spiritual beliefs.”

Recommended Solution: Have them answer the question according to what it means to them. Ask, “What do the words ‘spiritual’ or ‘religious’ mean to you?”

Section Three: Behavior & Relationships

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Comments on Items 55-56: These items ask respondents about use of cigarettes or other tobacco products over the past 30 days. The specific definition of each substance is provided within the question.

55. During the past 30 days, on how many days did you smoke part or all of a cigarette? (Includes menthol and regular cigarettes and loose tobacco rolled into cigarettes.)

Potential Issue: Question may be unclear to respondents.

Recommended Solution: Explain that we are interested in the number of days during the past 30 days on which they smoked all or part of a cigarette. Respondents should be instructed not to indicate the number of cigarettes, drags, puffs or the number of occasions they smoked all or part of a cigarette.

56. During the past 30 days, on how many days did you use other tobacco products? (Includes any tobacco product other than cigarettes such as snuff, chewing tobacco, and smoking tobacco from a pipe)

Potential Issue: Question may be unclear to respondents.

Recommended Solution: Explain that we are interested in the number of days they used other tobacco products, not the amount or the number of times or occasions they used other tobacco products.

Comments on Items 57-58: These questions are about alcohol. By alcohol, we mean BEER, WINE, WINE COOLERS, MALT LIQUOR or HARD LIQUOR. Different groups of people in the United States may use alcohol for religious reasons. However, this may not be true for other religious, cultural, or ethnic group. For example, some churches serve wine during a church service. Wine consumed at church or for some other religious reason do not count in response to these questions.

57. During the past 30 days, on how many days did you drink one or more drinks of an alcoholic beverage?

Potential Issue: Question may be unclear to respondents.

Recommended Solution: Tell them to indicate the number of days on which they consumed alcohol, not the amount of sips or occasions they used alcohol. One drink is equivalent to:

12-ounces of beer or one regular bottle or can of beer.
8-ounces of malt liquor.
5-ounces of wine.
1.5-ounces or a “shot” of 80-proof distilled spirits or liquor (e.g., gin, rum, vodka, or whiskey).

58. Female only: during the past 30 days, on how many days did you have 4 or more drinks on the same occasion? [By 'occasion,' we mean at the same time or within a couple of hours of each other].

Potential Issue: Question may be unclear to respondents.

Recommended Solution: If they identify as female, tell them to indicate the number of days on which they consumed alcohol, not the occasions they used alcohol. One drink is equivalent to:

12-ounces of beer or one regular bottle or can of beer.
8-ounces of malt liquor.
5-ounces of wine.
1.5-ounces or a “shot” of 80-proof distilled spirits or liquor (e.g., gin, rum, vodka, or whiskey).

59. Male only: during the past 30 days, on how many days did you have 5 or more drinks on the same occasion? [By 'occasion,' we mean at the same time or within a couple of hours of each other].

Potential Issue: Question may be unclear to respondents.

Recommended Solution: If they identify as male, tell them to indicate the number of days on which they consumed alcohol, not the occasions they used alcohol. One drink is equivalent to:

12-ounces of beer or one regular bottle or can of beer.
8-ounces of malt liquor.
5-ounces of wine.
1.5-ounces or a “shot” of 80-proof distilled spirits or liquor (e.g., gin, rum, vodka, or whiskey).

60. During the past 30 days, on how many days have you been drunk or very high from drinking alcoholic beverages?

Potential Issue: Question may be unclear to respondents.

Recommended Solution: Tell them to indicate the number of days they have been drunk or high from alcohol, not the number of drinks or occasions.

Comments on Item 61: This question is about MARIJUANA or HASHISH. Marijuana is sometimes called weed, blunt, hydro, grass, or pot. Hashish is sometimes called hash or hash oil.

61. During the past 30 days, on how many days did you use marijuana or hashish?

Potential Issue: Question may be unclear to respondents.

Recommended Solution: Tell them to indicate the number of days on which they smoked or consumed marijuana or hashish, not the number of puffs, joints or the number of occasions.

Comments on Items 62-66: These questions are about OTHER ILLEGAL DRUGS, excluding marijuana or hashish. They include substances like inhalants or sniffed substances such as glue, gasoline, paint thinner, cleaning fluid, or shoe polish (used to feel good or to get high); heroin, crack or cocaine, methamphetamine; hallucinogens (drugs that cause people to see or experience things that are not real) such as LSD (sometimes called acid), Ecstasy (MDMA), PCP, peyote (sometimes called angel dust); and prescription drugs used without a doctor’s orders, just to feel good or to get high.

62. During the past 30 days, on how many days did you use any other illegal drug?

Potential Issue #1: Question may be unclear to respondents.

Recommended Solution: Tell them to indicate the number of days on which they used any illegal drug, not the number of illegal drugs, or the number of occasions they used. If they used more than one illegal drug on any given day, tell them to count this as only one day, not by the number of illegal drugs they used on each day.

Potential Issue #2: Respondents may not know what other illegal drugs are.

Recommended Solution: Remind them that the question is not asking about marijuana since that was asked about in a previous question. Explain that other illegal drugs are substances used to alter how a person feels or thinks and are taken without a doctor’s orders, just to feel good or get high. Tell them that this does not include substances like ibuprofen taken for headaches. Refer them to definition given in survey above item 60.

Comments on Items 63-66: These questions are about respondents’ use of several specific drugs. The definition of each drug is included in the question.

63. During the past 30 days, on how many days did you use cocaine or crack?

Potential Issue #1: Question may be unclear to respondents.

Recommended Solution: Tell them we are interested in the number of days they used crack or cocaine, not the number of occasions.

Potential Issue #2: Respondents may not know what cocaine or crack is.

Recommended Solution: Common street terms for crack include: 151, badrock, base, basing, cloud, crunch, dice, dime, glo, ice cube, patico, piedra, roca, topo, and basa. Common street terms for cocaine include: aspirin, C, candy sugar, basuco, bazulco, and blanco/a.

64. During the past 30 days, on how many days did you use methamphetamine? (Also called meth, crystal meth, crank, go, and speed)

Potential Issue: Question may be unclear to respondents.

Recommended Solution: Tell them we are interested in the number of days they used meth, not the number of occasions.

65. During the past 30 days, on how many days have you used prescription drugs without a doctor’s orders, in order to feel good or to get high?

Potential Issue #1: Question may be unclear to respondents.

Recommended Solution: Tell them we are interested in the number of days they used prescription drugs without a doctor’s orders, not the number of occasions.

Potential Issue #2: Respondents may not know what a prescription drug is.

Recommended Solution: Prescription drugs are given to individuals after a doctor or nurse has approved that the patient can use the drug, usually to cure or manage an illness. Prescription drugs do not include over-the-counter drugs. Over-the-counter drugs are medicine a person can buy at a pharmacy in the United States without a doctor’s permission. Some of the common prescription drugs that are used by people to get high or feel good without a doctor’s order include pain relievers like codeine, OxyContin, Percocet and morphine, muscle relaxers like Valium, and other drugs like Vicodin, Adderall and Ritalin. Steroids that athletes sometimes take to improve their performance also count in this category if they are not prescribed by a doctor to treat an illness.

66. During the last 30 days, on how many days have you injected any drugs? (Count only injections without a doctor’s orders you used to feel good or to get high)

Potential Issue: Respondents are unclear as to what “injected any drugs” means.

Recommended Solution: Explain that the intent of this question is to determine whether they have used a needle to inject any illegal substances, such as heroin (this includes prescription medications obtained without a doctor’s order, including steroids and/or hormones). Injections can be done either directly into a vein or the muscle or under the skin.

Comments on Items 67-68: These items are about how substance abuse may have affected a respondents’ personal lives.

67. During the past 30 days, how stressful have things been for you because of your use of alcohol or drugs?

Potential Issue: Respondents may not understand the meaning of this question.

Recommended Solution: Ask if their alcohol or drug use has caused them problems in their personal lives (such as financial difficulties) or in their personal or professional relationships with others.

68. During the past 30 days, has your use of alcohol or other drugs caused you to have emotional problems?

Potential Issue: Respondents may not understand the meaning of this question.

Recommended Solution: Explain that the question is asking if their alcohol or illegal drug use has made them feel bad or caused them to have depression, confusion, mood swings, anxiety, etc.

Comments on Items 69-73: These items ask respondents about the FIRST TIME they used tobacco, alcohol, marijuana, and other illegal and specific drugs. The specific definition of each substance is defined within the question.

69. How old were you the first time you smoked part or all of a cigarette? (Includes menthol and regular cigarettes and loose tobacco rolled into cigarettes)

Potential Issue: Respondents are unsure how to respond based on the term “part or all.”

Recommended Solution: This question is interested in the age of first use regardless of the amount, even if it was just a few puffs from someone else’s cigarette.

70. How old were you the first time you used any other tobacco product? (Includes any tobacco product other then cigarettes such as snuff, chewing tobacco, and smoking tobacco from a pipe)

Potential Issue: Respondents may be confused about which bubble to fill in.

Recommended Solution: This question is interested in the age of first use regardless of the amount, even if it was just a few puffs or a small amount of chew.

71. How old were you the first time you had a drink of an alcoholic beverage? (Includes beer, wine, wine coolers, malt beverages, and liquor)- DO NOT include any time when you only had a sip or two from a drink.

Potential Issue: Respondents may not remember exactly when they first had a drink of an alcoholic beverage.

Recommended Solution: Ask them to mark their best guess as to what age they were the first time they had an alcoholic beverage. Remind them that a sip or drink of alcohol for religious purposes (i.e., first communion, Sabbath dinner, etc.) is NOT what we are asking about here. We are interested in their first drink for nonreligious purposes.

72. How old were you the first time you used marijuana or hashish? (Also known as weed, grass, pot, hash, or hash oil)

Potential Issue: Respondents may not remember exactly when they first tried marijuana or hashish.

Recommended Solution: Have them mark their best guess as to what age they were the first time they tried marijuana or hashish, even if it was one or two puffs or consumed a small amount.

73. How old were you the first time you used any other illegal drug?

Potential Issue #1: Respondents may not remember exactly how old they were the first time they used other illegal drugs.

Recommended Solution: Have them make their best guess as to what age they were the first time they tried an illegal drug.

Potential Issue #2: Respondents may not know what the term “other illegal drug” includes.

Recommended Solution: Remind them that the question does NOT include marijuana or hashish. Refer them back to the definition above item 62.

General Comments on Items 74-101: This section asks a number of questions about respondents’ sexual behaviors and their attitudes about certain sexual behaviors. Many of these questions are of a sensitive, personal nature. The questions do not assume that respondents have engaged in any of the sexual behaviors stated in the questions. The following definitions are used for the items:

Sex or Sexual Activity -- a situation where two partners get sexually excited or aroused (turned on) by touching each other’s genitals (penis or vagina) or anus (butt) with their own genitals, hands, or mouths
Vaginal Sex -- a male inserts his penis into his female partner’s vagina
Oral Sex -- when one partner’s mouth is in contact with the other partner’s genitals (penis or vagina) or anus during sex
Anal Sex -- when a male’s penis is inserted into his male or female partner’s anus
Sexual Partners – with whom you have sex, that is, engage in sexual activity
Protected Sex -- when a latex or polyurethane condom (rubber) is used to cover the penis; a female condom is used to cover the vagina; or a dental dam is used to cover the anus
Unprotected Sex -- vaginal, oral, or anal sex without a barrier such as a condom or dental dam

Potential Issue: Respondents may be uncomfortable answering these types of questions.

Recommended Solution: Remind them that these questions are voluntary and their answers will be kept private—the page with the respondent’s name was taken off the survey. Also explain that these questions are being asked of everyone, and there are no expectations or judgments made about them or certain individual behaviors.

74. Have you ever had sex (either vaginal, oral, or anal)?

Potential Issue: Respondents may not understand the question.

Recommended Solution: Definitions for the terms are provided above. Have them answer the question as best they can with the information provided.

75. Have you had oral sex in the past 30 days?

Potential Issue: Respondents may not understand the question.

Recommended Solution: Definitions for the terms are provided above. Have them answer the question as best they can with the information provided.

76. The last time you had oral sex, was it protected or unprotected?

Potential Issue #1: Respondents may not understand the difference between protected and unprotected sex.

Recommended Solution: Protected oral sex is when a latex condom (rubber) or a dental dam is used in sexual intercourse. A dental dam is a piece of latex that is placed on the vulva or anus. By unprotected oral sex, we mean oral sex without the use of a latex condom or other barrier (i.e. female condom, dental dam, Saran Wrap).

Potential Issue #2: They have never had this type of sex.

Recommended Solution: Tell respondents that if they have never had the type of sex being asked about, they can fill in the bubble indicating that they have never had this type of sex.

77. Have you had vaginal sex in the past 30 days?

Potential Issue: See Question 75.

78. The last time you had vaginal sex, was it protected or unprotected?

Potential Issue: See Question 76.

79. Have you had anal sex in the past 30 days?

Potential Issue: See Question 75.

80. The last time you had anal sex, was it protected or unprotected?

Potential Issue: See Question 76.

81. In the past 3 months, have you had sex with any men?

Potential Issue: Unclear as to the meaning of “men”—someone who identifies as male or biological male?

Recommended Solution: Explain that we are interested in knowing if they had sex with someone whom they identify as a man.

82. Are you a woman who has sex with men?

Potential Issue: Respondents may be unclear as to how it relates to sexual orientation.

Recommended Solution: Indicate that we are interested in whether or not they consider themselves to be someone who has sex with individuals whom they identify as men, regardless of the sexual orientation they marked on question 7.

Potential Issue #2: Respondent does not identify as a woman.

Recommended Solution: If the respondent does not identify as a woman, have the respondent fill in the “No” bubble.

83. Are you a man who has sex with men?

Potential Issue #1: Respondent may be unclear as to how it relates to their sexual orientation.

Potential Issue #2: Respondent does not identify as a man.

Recommended Solution: If the respondent does not identify as a man, have the respondent fill in the “No” bubble.

84. In the past 3 months, have you had sex with any women?

Potential Issue: Unclear as to the meaning of “women”—sexually oriented female or biological female?

Recommended Solution: Explain that we are interested in knowing if they had sex with someone whom they identify as a woman.

85. Are you a man who has sex with women?

Potential Issue #1: Respondents may be unclear as to the meaning of the question.

Recommended Solution: Indicate that we are interested in whether or not they consider themselves to be someone who has sex with individuals whom they identify as women, regardless of the sexual orientation they marked on question 7.

Potential Issue #2: Respondent does not identify as a man.

Recommended Solution: If the respondent does not identify as a man, have the respondent fill in the “No” bubble.

86. Are you a woman who has sex with women?

Potential Issue#1: Respondents may be unclear as to the meaning of the question.

Potential Issue #2: Respondent does not identify as a woman.

Recommended Solution: If the respondent does not identify as a woman, have the respondent fill in the “No” bubble.

87. During the past 3 months, how many sexual partners have you had?

Potential Issue #1: Respondents may be unclear about the meaning of sexual partners.

Recommended Solution: Explain that a sexual partner is someone with whom you have vaginal, oral, or anal sex. This question includes sexual contact with any sexual partners.

Potential Issue #2: Respondents may not know their number of sexual partners.

Recommended Solution: Tell them to estimate the actual number of sexual partners, not the number of contacts or days in the last 3 months that they have had vaginal, anal or oral sex. For respondents who have a large number of partners, start by estimating daily, then weekly, then the monthly number of sexual partners.

Comments on Items 88-97: These questions ask about having unprotected sex under certain types of conditions.

Potential Issue: There may be some confusion between similar questions. Some questions ask about ever doing something, and other questions ask about doing the same thing during the past 3 months.

Recommended Solution: Explain that this pattern of questioning is repeated throughout this section, and that the respondents should think about the time frames. The questions asking if they have ever done an activity apply to one’s entire life, and the “past 3 month” questions focus on what they have done during the last 3 months only.

88. Have you ever had unprotected sex (vaginal, anal or oral) with someone in exchange for money, drugs, or shelter?

Potential Issue: Respondents may not understand the phrase “in exchange for money, drugs, or shelter.”

Recommended Solution: Explain that we are interested in times when they traded, or were given money, drugs, or a place to stay in return for sex.

89. In the past 3 months, have you had unprotected sex (vaginal, anal or oral) with someone in exchange for money, drugs, or shelter?

Potential Issue: Respondents may be unsure of the difference between this question, and question 86.

Recommended Solution: Explain that now we are interested in times when they were given money, drugs, or a place to stay in return for sex during the past 3 months.

90. Have you ever had unprotected sex (vaginal, anal or oral) with a partner you know had, or suspected of having a sexually transmitted disease (STD)?

Potential Issue #1: Respondent has never had unprotected sexual contact.

Recommended Solution: Have the respondent mark “No” and continue to the next question.

Potential Issue #2: Respondents may be unsure as to which partner this question applies.

Recommended Solution: Tell them we are interested in any instance of unprotected sex. The question includes any person with whom they have been sexually active.

Potential Issue #3: Respondents are unaware whether or not their partner has an STD.

Recommended Solution: If they are unaware and do not suspect their partner of having an STD, tell them to mark “No.”

Potential Issue #4: Does STD include HIV or AIDS?

Recommended Solution: Yes, STD does include HIV or AIDS.

91. In the past 3 months, have you had unprotected sex (vaginal, anal or oral) with a partner you know had, or suspected of having a sexually transmitted disease (STD)?

Potential Issue #1: Respondent has never had unprotected sexual contact.

Recommended Solution: Have the respondent mark “No” and continue to the next question.

Potential Issue #2: Respondent has had unprotected sexual contact, but not within the last 3 months.

Recommended Solution: This question is concerned with recent unprotected sexual intercourse. We are only interested in unprotected sex that occurred in the past 3 months. Have the respondent mark “No” and continue to the next question.

Potential Issue #3: Respondents may be unaware whether or not any of their partners in the past three months had an STD.

Recommended Solution: If they are unsure of the STD status of their sexual partner(s) in the past 3 months, have them give the best answer they can based upon their knowledge.

92. Have you ever had unprotected sex (vaginal, anal or oral) with a partner you know had, or suspected of having HIV/AIDS?

Potential Issue #1: Respondent is unsure as to which partner this question applies.

Recommended Solution: Tell the respondent we are interested in any instance of unprotected sex. The question includes sexual contact with the main partner or other partners.

Potential Issue #2: Respondents are unaware or unsure whether or not their partner has HIV/AIDS.

Recommended Solution: If they are unsure of the status of their sexual partner(s), have them give the best answer they can based upon their knowledge.

93. In the past 3 months, have you had unprotected sex (vaginal, anal or oral) with a partner you know had, or suspected of having HIV/AIDS?

Potential Issue: Respondents may be unsure as to how to respond to this question.

Recommended Solution #1: Tell them we are interested in any instance of unprotected sex that may have occurred in the past 3 months. The question includes sexual contact with the main partner or other partners.

Recommended Solution #2: If respondents are unsure of the HIV status of their sexual partner(s), have them give the best answer they can based upon their knowledge.

94. Have you ever had unprotected sex (vaginal, anal or oral) with someone whom you knew was, or suspected of being an injected drug user?

Potential Issue #1: Respondent may not know what an injected drug user is.

Recommended Solution: Explain that an injected drug user is someone who uses a needle to inject any illegal substances (this includes prescription medications obtained without a doctor’s order, including steroids and/or hormones). Injections can be done either directly into a vein or into the muscle or under the skin.

Potential Issue #2: Respondents may not know whether their partner was someone who injected drugs.

Recommended Solution #1: Tell them we are interested in any instance of unprotected sex with someone they knew was or who they suspected of being an injection drug user. The question includes sexual contact with the main partner or other partners.

Recommended Solution #2: If they cannot remember, or are unsure of their sexual partner’s injection drug use, have them give the best answer they can based upon their knowledge.

95. In the past 3 months, have you had unprotected sex (vaginal, anal or oral) with someone you knew was, or suspected of being an injected drug user?

Potential Issue #1: The respondent may not know what an injected drug user is.

Recommended Solution: See item #94 potential issue #1.

Potential Issue #2: Respondents may be unsure as to how to respond to this question.

Recommended Solution #1: Tell them we are interested in any instance of unprotected sex that may have occurred in the past 3 months with someone whom they suspected of being an injected drug user. The question includes sexual contact with the main partner or other partners.

Recommended Solution #2: If they cannot remember, or are unsure of their sexual partner’s injection drug use, have them give the best answer they can based upon their knowledge.

Comments on Items 96-97: These questions ask respondents about sexual activity while under the influence of drugs or alcohol.

96. Have you ever had sex while you were under the influence of drugs or alcohol?

Potential Issue: Respondents may be unsure of the meaning of influence of drugs or alcohol.

Recommended Solution: Indicate that we are interested in knowing if they have had sex while feeling high or intoxicated, or immediately after drinking alcohol or doing any illegal drugs.

97. In the past 3 months, have you had sex while you were under the influence of drugs or alcohol?

Potential Issue: See question 96, and note the time difference.

Comments Items on 98-101: The following items are about things that may or may not have been done to the respondent in the past 3 months.

For these next few questions, possible answers include:

Never: This never happened to you.

Rarely: This hardly ever happened to you. (For example, it only happened about 25% of the time.)

Sometimes: This happened occasionally, or some of the time. (For example, this happened about half (or 50%) of the time.)

Often: This happened to you most of the time. (For example, this happened 75% of the time)

Very Often: This happened to you almost all of the time (For example, this happened 90% or more of the time).

In the past 3 months, how often has anyone with whom you had an intimate relation, sexual or not...

98. Emotionally abused you (swore at you, called you negative names, kept you from seeing family or friends)?

99. Physically abused you (slapped, beat, kicked, or choked you; threatened you with a knife or a gun)?

100. Sexually abused you (forced you to have sex, physically hurt the sexual parts of your body)?

101. Forced you to use drugs or alcohol?

Potential Issue: Respondents may find the questions too personal or difficult to answer.

Recommended Solution: Remind them that their name is not on the survey, their answers will be kept private, and that they do not have to answer these questions.

Comments on Items 102-116: This set of questions ask respondents about their relationships.

102. Describe your current relationship status.

Potential Issue #1: Respondents may not want to provide information.

Recommended Solution: Explain that the people who analyze this survey will not know who they are, and that their names will not be associated with any responses.

Potential Issue: Respondents do not know what informally married means.

Recommended Solution: Explain that “informally married” means that they live together with their partner “as if married” and consider themselves married but did not obtain an official marriage certificate.

103. With whom do you live? (Mark all that apply)

Potential Issue: Respondent confusion about which bubble to fill in.

Recommended Solution: Respondents should mark all the people with whom they are currently living. If their current living situation is not represented by the categories (i.e. if respondents are currently living in a group home), have them select “other.”

104. Describe where you live.

Potential Issue: Respondent is in a residential treatment facility.

Recommended Response: Explain that he or she can mark “Other.”

105. At what age did you have your first child?

Potential Issue: Respondents may not remember how old they were when they had their first child.

Recommended Solution: Tell them to select the age that is closest to when they think they had their first child.

106. How many children under the age of 18 are living with you?

Potential Issue: Respondents have children that occasionally live with them.

Recommended Solution: Tell them to select the number of children under the age of 18 that live with them at least half of the time.

107. If you have children, during the past 12 months, how many times have you talked with your children about the dangers or problems associated with the use of tobacco, alcohol, or other drugs?

Potential Issue: Respondents may be confused by the question.

Recommended Solution: Explain that this question is asking if they currently have any children, how many times they have discussed the topics of tobacco, alcohol, or drug use. If they cannot recall how many times, have them estimate the number to their best ability. If they do not have any children, they should indicate that they have no children in the response options.

108. Think about the household members that live with you right now. About how much income have you and/or your family members made in the last year before taxes? (Include child support and/or cash payments from the government, for example, welfare (TANF), SSI, or unemployment compensation)

Potential Issue #1: Respondents may be uncomfortable answering this question; they may find it intrusive.

Recommended Response: Remind them that their name is not on the survey, their answers will be kept private, and the information is very important to the study. The information will not be reported to a welfare office or local government authorities. If respondents are still reluctant to answer, please indicate that their answers are voluntary and they do not have to answer these questions.

For sites where surveys are administered via face-to-face interviewing or full or partial proctoring, it may be helpful to have a card with each response option on it and respondent pick their income range from a list. Oftentimes, respondents are more comfortable saying “number 4" from the list, than stating their exact income. Just be sure that the responses are recorded correctly if this method is used.

Potential Issue #2: Term “household member” not clear.

Recommended Response: Explain that we are looking for any individual who currently lives with them; doesn’t necessarily need to be a family member. Instruct them that a tenant, or someone who rents a room from them is not considered a household member.

Potential Issue #3: Respondents may be living in a residential treatment facility or homeless.

Recommended Response: Ask them to answer based on their income and/or that of a household member (see potential issue #2) in the past year.

109. Do you have health care or medical insurance?

Potential Issue: Respondents may not know if they have health insurance.

Recommended Solution: Tell them that it includes Medicare and Medicaid. Ask them to give their best response based upon their experiences and knowledge.

110. Would you be more or less likely to want to work for an employer that tests its employees for drug or alcohol use on a random basis? Would you say more likely, less likely, or would it make no difference to you? (Mark one)

Potential Issue #1: Respondents may not have been in the work force and not know how to answer.

Recommended Solution #1: Ask them to think about getting a job in the future. Would they want to work for an employer that randomly tests its employees for drugs or alcohol?

Potential Issue #2: Respondents may not know what a drug test is.

Recommended Solution #2: Explain that a drug test is when a person’s blood, urine, or hair is tested to see if they have used drugs or alcohol.

Comments on Items 111-116: These questions ask about respondents’ relationship with their family. For these questions, the response categories are:

I don’t have any family

Not true This is NEVER true.

Sometimes true This is true some of the time (this is true 50% or less of the time).

Usually true This is true ALMOST all the time (this is true about 75% of the time).

Always true This is ALWAYS true (this is true 90% or more of the time).

111. I am available when others in my family want to talk to me.

112. I listen to what other family members have to say, even when I disagree.

113. Members of my family ask each other for help.

114. Members of my family like to spend free time with each other.

115. Members of my family feel very close to each other.

116. We can easily think of things to do together as a family.

Potential Issue: Respondents may be estranged from their family.

Recommended Solution: Ask them to answer the question as best as they can, as it applies to their relationship with their family.

Comments on Items 117-118: This next set of questions asks about classes or programs respondents may have participated in recently.

117. In the past 30 days, have you been in any classes or programs where they talked about the prevention of drug or alcohol abuse?

Potential Issue: Does class mean classroom?

Recommended Solution: No. A class is a group of people who study or learn about a subject, such as health or sex education in school or at a local community center, church, or other location.

118. In the past 30 days, have you been in any classes or programs where they talked about preventing HIV/AIDS?

Potential Issue: See Question 117.

Comments on Items 119-120: These questions ask about respondents’ experience taking the survey.

119. How comfortable was it for you to answer the questions in this survey?

Potential Issue: Respondents question the purpose of this question.

Recommended Solution: If they wonder why they are being asked this question, say that this question is often asked to help the researchers determine how much confidence they can have in the overall study findings.

120. How truthful were you when answering the questions?

Potential Issue: Respondents question the purpose of this question.

CSAP HIV Adult Questionnaire Administration Guide

Updated 3/2011

File Type	application/vnd.openxmlformats-officedocument.wordprocessingml.document
File Title	HIV Cohort 6 Adult Administrative Guide
Author	mcarmody
File Modified	0000-00-00
File Created	2021-01-31