Attachment 1: Proposed ACASI questions (including sexual identity questions) to be tested and respondent debriefing questions administered following full NHIS
Note to reviewers: The “Green Arrow Key” refers to the Enter key. A green arrow sticker is placed on the Enter key. The “Red Circle Key” refers to the Space Bar. A red circle sticker is placed on the Space Bar. Finally, the “Blue Arrow Key” is the Tab key. A blue arrow sticker is placed on the Tab key.
INSTRUCTIONS AND PRACTICE SESSION QUESTIONS
ACASINTR. READ TO RESPONDENT: Now I will ask you to do an important part of this interview on your own, using the computer and headphones. You will hear questions through the headphones and see them on the computer screen.
FR INSTRUCTION: TURN COMPUTER AND HAND HEADPHONES TO RESPONDENT.
Before you start, you will go through a short practice session. Let me first show you the keys you will use. The practice session that follows will go through what each key does also.
FR INSTRUCTION: WHEN THE RESPONDENT IS READY, ASK THEM TO PRESS “1” TO CONTINUE.
ACIHEAD. First I want to make sure you can hear me. I will ask you questions at this level. If you want to change the level of my voice, use the knob that the interviewer showed you. If you have difficulty, ask the interviewer for help. When you are comfortable with the volume, press the Green Arrow Key once.
ACIINTR1. We want you to be able to answer the remaining questions in complete privacy. The first questions are for practice. When you are ready to go to the next screen, press the Green Arrow Key.
ACIINTR2. You can read the questions on the computer screen and hear them read through the headphones. If you would like to just see the questions on the screen without sound, you can turn off the voice using the knob on the cord. Now press the Green Arrow Key.
ACIDLIC. After you hear or read this question, press the Red Circle Key until the circle is on the answer you want, then press the Green Arrow Key.
Did you watch TV in the past 24 hours?
Yes
No
ACIDOAGN. You can tell the computer to repeat a question by pressing the Red Circle Key until you are at the question again. Try this now. Then press the Red Circle Key to pick your answer, then press the Green Arrow Key.
Do you own a bicycle?
Yes
No
ACIBACK. If you want to change or see your answer to a previous question, you can back up using the Blue Arrow Key. Each time you press this key, the computer will go back one question. Press the Green Arrow Key to continue. Pressing the Green Arrow Key will take you to the next question.
ACISTART. You have now completed the practice questions. For the remaining questions, if you are unsure about your answer, please give us your best estimate. If you have any questions, ask your interviewer now. If not, press the Green Arrow Key to begin the questions.
ACASI QUESTIONS TO BE TESTED
1. These questions are about you and your neighborhood.
How often do you use a computer?
Never or almost never
Some days
Most days
Every day
[If no answer is selected]
1a.You did not enter an answer for the question. That is because you:
Made a mistake and would like to have another chance
Are not sure how to answer
Do not want to answer
2. In general, how satisfied are you with the health care you received in the past 12 months?
Very satisfied
Somewhat satisfied
Somewhat dissatisfied
Very dissatisfied
I haven’t had health care in the past 12 months
[If no answer is selected]
2a.You did not enter an answer for the question. That is because you:
Made a mistake and would like to have another chance
Are not sure how to answer
Do not want to answer
3. About how long have you lived in your present neighborhood?
Less than one year
One to three years
Four to ten years
Eleven to twenty years
More than twenty years
[If no answer is selected]
3a.You did not enter an answer for the question. That is because you:
Made a mistake and would like to have another chance
Are not sure how to answer
Do not want to answer
4. Please tell us how much you agree or disagree with the following statements about your neighborhood. “People in this neighborhood help each other out.” Would you say:
Definitely agree
Somewhat agree
Somewhat disagree
Definitely disagree
[If no answer is selected]
4a.You did not enter an answer for the question. That is because you:
Made a mistake and would like to have another chance
Are not sure how to answer
Do not want to answer
5. “There are people I can count on in this neighborhood.” Would you say:
Definitely agree
Somewhat agree
Somewhat disagree
Definitely disagree
[If no answer is selected]
5a.You did not enter an answer for the question. That is because you:
Made a mistake and would like to have another chance
Are not sure how to answer
Do not want to answer
6. “People in this neighborhood can be trusted.” Would you say:
Definitely agree
Somewhat agree
Somewhat disagree
Definitely disagree
[If no answer is selected]
6a.You did not enter an answer for the question. That is because you:
Made a mistake and would like to have another chance
Are not sure how to answer
Do not want to answer
7. “This is a close-knit neighborhood.” Would you say:
Definitely agree
Somewhat agree
Somewhat disagree
Definitely disagree
[If no answer is selected]
7a.You did not enter an answer for the question. That is because you:
Made a mistake and would like to have another chance
Are not sure how to answer
Do not want to answer
(For men)
8a. Do you think of yourself as
Gay
Straight, that is, not gay
Bisexual
Something else
I don’t know the answer
[If “Something else” is selected]
By something else, do you mean that…
You are not straight, but identify with another label such as queer, trisexual, omnisexual or pan-sexual
You are transgender, transsexual or gender variant
You have not figured out or are in the process of figuring out your sexuality
You do not think of yourself as having sexuality
You do not use labels to identify yourself
You made a mistake and did not mean to pick this answer
You mean something else
[If “You mean something else” is selected]
What do you mean by something else? Please type in your answer and then press the Green Arrow Key.
[If “I don’t know the answer” is selected]
By Don’t Know, do you mean that…
You don’t understand the words
You understand the words, but you have not figured out or are in the process of figuring out your sexuality
You mean something else
[If “You mean something else” is selected]
What do you mean by something else? Please type in your answer and then press the Green Arrow Key.
[If no answer is selected]
You did not enter an answer for the question. That is because you:
Made a mistake and would like to have another chance
Are not sure how to answer
Do not want to answer
(For women:)
8b. Do you think of yourself as
Lesbian or Gay
Straight, that is, not gay
Bisexual
Something Else
I don’t know the answer
[If “Something else” is selected]
By something else, do you mean that…
You are not straight, but identify with another label such as queer, trisexual, omnisexual or pan-sexual
You are transgender, transsexual or gender variant
You have not figured out or are in the process of figuring out your sexuality
You do not think of yourself as having sexuality
You do not use labels to identify yourself
You made a mistake and did not mean to pick this answer
You mean something else
[If “You mean something else” is selected]
What do you mean by something else? Please type in your answer and then press the Green Arrow Key.
[If “I don’t know the answer” is selected]
By Don’t Know, do you mean that…
You don’t understand the words
You understand the words, but you have not figured out or are in the process of figuring out your sexuality
You mean something else
[If “You mean something else” is selected]
What do you mean by something else? Please type in your answer and then press the Green Arrow Key.
[If no answer is selected]
You did not enter an answer for the question. That is because you:
Made a mistake and would like to have another chance
Are not sure how to answer
Do not want to answer
9. The next questions ask how worried you are right now about financial matters. How worried are you right now about not having enough money for retirement? Are you…
Very worried
Moderately worried
Not too worried
Not worried at all
[If no answer is selected]
9a.You did not enter an answer for the question. That is because you:
Made a mistake and would like to have another chance
Are not sure how to answer
Do not want to answer
10. How worried are you right now about not being able to pay medical costs of a serious illness or accident? Are you…
Very worried
Moderately worried
Not too worried
Not worried at all
[If no answer is selected]
10a.You did not enter an answer for the question. That is because you:
Made a mistake and would like to have another chance
Are not sure how to answer
Do not want to answer
11. How worried are you right now about not being able to maintain the standard of living you enjoy? Are you…
Very worried
Moderately worried
Not too worried
Not worried at all
[If no answer is selected]
11a.You did not enter an answer for the question. That is because you:
Made a mistake and would like to have another chance
Are not sure how to answer
Do not want to answer
12. How worried are you right now about not being able to pay medical costs for normal healthcare? Are you…
Very worried
Moderately worried
Not too worried
Not worried at all
[If no answer is selected]
12a.You did not enter an answer for the question. That is because you:
Made a mistake and would like to have another chance
Are not sure how to answer
Do not want to answer
13. How worried are you right now about not having enough money to pay for your children's college? Are you…
Very worried
Moderately worried
Not too worried
Not worried at all
This does not apply to me
[If no answer is selected]
13a.You did not enter an answer for the question. That is because you:
Made a mistake and would like to have another chance
Are not sure how to answer
Do not want to answer
14. How worried are you right now about not having enough to pay your normal monthly bills? Are you…
Very worried
Moderately worried
Not too worried
Not worried at all
[If no answer is selected]
14a.You did not enter an answer for the question. That is because you:
Made a mistake and would like to have another chance
Are not sure how to answer
Do not want to answer
15. How worried are you right now about not being able to pay your rent, mortgage, or other housing costs? Are you…
Very worried
Moderately worried
Not too worried
Not worried at all
[If no answer is selected]
15a.You did not enter an answer for the question. That is because you:
Made a mistake and would like to have another chance
Are not sure how to answer
Do not want to answer
16. How worried are you right now about not being able to make the minimum payments on your credit cards? Are you…
Very worried
Moderately worried
Not too worried
Not worried at all
I don’t have credit cards
[If no answer is selected]
16a.You did not enter an answer for the question. That is because you:
Made a mistake and would like to have another chance
Are not sure how to answer
Do not want to answer
17. On average, how many hours of sleep do you get in a 24-hour period?
Four hours or less
Five hours
Six hours
Seven hours
Eight hours
Nine hours
Ten hours or more
[If no answer is selected]
17a.You did not enter an answer for the question. That is because you:
Made a mistake and would like to have another chance
Are not sure how to answer
Do not want to answer
18. In the past week, how often did you have trouble falling asleep?
I didn’t have trouble falling asleep in the past week
One time
Two times
Three times
Four times
Five times
Six times
Seven or more times
[If no answer is selected]
18a.You did not enter an answer for the question. That is because you:
Made a mistake and would like to have another chance
Are not sure how to answer
Do not want to answer
19. In the past week, how many times did you have trouble staying asleep?
I didn’t have trouble staying asleep in the past week
One time
Two times
Three times
Four times
Five times
Six times
Seven or more times
[If no answer is selected]
19a.You did not enter an answer for the question. That is because you:
Made a mistake and would like to have another chance
Are not sure how to answer
Do not want to answer
20. In the past week, how many times did you take medication to help you fall asleep or stay asleep?
I did not take medication to help me sleep in the past week
One time
Two times
Three times
Four times
Five times
Six times
Seven or more times
[If no answer is selected]
20a.You did not enter an answer for the question. That is because you:
Made a mistake and would like to have another chance
Are not sure how to answer
Do not want to answer
21. In the past week, on how many days did you wake up feeling well rested?
I never felt rested
One time
Two times
Three times
Four times
Five times
Six times
Seven or more times
[If no answer is selected]
21a.You did not enter an answer for the question. That is because you:
Made a mistake and would like to have another chance
Are not sure how to answer
Do not want to answer
22. Now I am going to ask you some questions about feelings you may have experienced over the PAST 30 DAYS.
DURING THE PAST 30 DAYS, how often did you feel
... So sad that nothing could cheer you up?
ALL of the time
MOST of the time
SOME of the time
A LITTLE of the time
NONE of the time
[If no answer is selected]
22a.You did not enter an answer for the question. That is because you:
Made a mistake and would like to have another chance
Are not sure how to answer
Do not want to answer
23. During the PAST 30 DAYS, how often did you feel
... Nervous?
ALL of the time
MOST of the time
SOME of the time
A LITTLE of the time
NONE of the time
[If no answer is selected]
23a.You did not enter an answer for the question. That is because you:
Made a mistake and would like to have another chance
Are not sure how to answer
Do not want to answer
24. During the PAST 30 DAYS, how often did you feel
... Restless or fidgety?
ALL of the time
MOST of the time
SOME of the time
A LITTLE of the time
NONE of the time
[If no answer is selected]
24a.You did not enter an answer for the question. That is because you:
Made a mistake and would like to have another chance
Are not sure how to answer
Do not want to answer
25. During the PAST 30 DAYS, how often did you feel
... Hopeless?
ALL of the time
MOST of the time
SOME of the time
A LITTLE of the time
NONE of the time
[If no answer is selected]
25a.You did not enter an answer for the question. That is because you:
Made a mistake and would like to have another chance
Are not sure how to answer
Do not want to answer
26. During the PAST 30 DAYS, how often did you feel
...That everything was an effort?
ALL of the time
MOST of the time
SOME of the time
A LITTLE of the time
NONE of the time
[If no answer is selected]
26a.You did not enter an answer for the question. That is because you:
Made a mistake and would like to have another chance
Are not sure how to answer
Do not want to answer
27. During the PAST 30 DAYS, how often did you feel
...Worthless?
ALL of the time
MOST of the time
SOME of the time
A LITTLE of the time
NONE of the time
[If no answer is selected]
27a.You did not enter an answer for the question. That is because you:
Made a mistake and would like to have another chance
Are not sure how to answer
Do not want to answer
Universe statement: Sample adults 18+ who at least some of the time have felt sad, nervous, restless or fidgety, hopeless, that everything was an effort, or worthless, in the past 30 days.
28. We just talked about a number of feelings you had during the past 30 days. Altogether, how much did these feelings interfere with your life or activities: a lot, some, a little, or not at all?
A lot
Some
A little
Not at all
[If no answer is selected]
28a.You did not enter an answer for the question. That is because you:
Made a mistake and would like to have another chance
Are not sure how to answer
Do not want to answer
29. The next question is about the test for HIV, the virus that causes AIDS. Except for tests you may have had as part of blood donations, have you ever been tested for HIV?
Yes
No
[If no answer is selected]
29a.You did not enter an answer for the question. That is because you:
Made a mistake and would like to have another chance
Are not sure how to answer
Do not want to answer
RESPONDENT DEBRIEFING QUESTIONS
1. Answering questions on your own using a recorded voice is one way we can collect data. To help us improve this process, the next few questions ask about your experience using this computer.
Did the interviewer explain how to use this computer?
Yes
No
2. Did you have any difficulty using the keys to choose your answers?
Yes
No
3. Including the practice questions, did you listen to the recorded voice for all of the questions, some of the questions, or none of the questions?
All of the questions
Some of the questions
None of the questions
(Listened to all or some of the questions):
4. Was the recorded voice too slow, too fast, or about the right speed?
Too slow
Too fast
About the right speed
(Listened to all or some of the questions):
5. Did you have any difficulty adjusting the volume?
Yes
No
6. Do you think it was important for this part of the interview to be private?
Yes
No
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | Centers for Disease Control & Prevention |
| File Modified | 0000-00-00 |
| File Created | 2021-01-30 |