0920-0840 Attachment 5_Eligibility Screener

Form Approved

OMB No. 0920-0840

Exp. Date: 2/29/2016

ATTACHMENT 5

ELIGIBILITY SCREENER

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Public reporting burden of this collection of information is estimated to average 5 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number.  Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to: CDC, Project Clearance Officer, 1600 Clifton Road, MS D-74, Atlanta, GA 30333, ATTN: PRA (0920-0840).  Do not send the completed form to this address.

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Variables from prior section(s) used in this section of the questionnaire
Section	Question #	Variable name	Variable label
Preloaded variables	INT3b	METHOD	YMSM Method
Preloaded variables	--	IDATE	Interview date
Interviewer Entered Information	INT2	CITY	City
Interviewer Entered Information	INT4	PEA	VBS: Is this interview a Post Event Appointment?
Interviewer Entered Information	INT10	ISEED	RDS: Respondent is a seed

INTRO_ES.

“READ: I'd like to thank you again for your interest in this health survey. Remember that all information you give me will be kept private. First, I will ask you a few questions about yourself and then the computer will determine if you have been selected to participate in the health survey.”

CALC_BEGSCR.
BEGSCR	Time at beginning of screener	BEGSCR = Current time

FlowCheck_CALC_RDATE.

If INT3b EQ 1 (VBS), go to CALC_RDATE. Else, go to ES1a.

CALC_RDATE.
RDATE	Recruitment Date	RDATE = Shortdate(IF(PEA=0, IDATE, IF(PEA=1,DATEYMD(PEARDTEY,PEARDTEM, PEARDTED), 0)))

ES1a.		How old are you?
R_AGE		Requested Age
		__ __
		Range	1-99
		Don't Know	99
		Refuse to Answer	77

ES1b.		What is your date of birth?
DOB		date of birth
		__ __ / __ __ / __ __ __ __ (MM/DD/YYYY)	Unlimited - Unlimited
		Don't Know (Year)	9999
		Refuse to Answer (Year)	7777

FlowCheck_CALC_AGE.

If ES1b EQ DK or REF, go to CALC_EL_AGE. Else, go to HardEditCheck_ES1b.

HardEditCheck_ES1b.

If ES1b After or EQ IDATE, DISPLAY: “Date of Birth cannot be TODAY or later.” Then, go back to ES1b. Else, go to CALC_AGE_1.

CALC_AGE_1.
AGE	QDS calculated age today	AGE = AGE(DOB,IDATE)

FlowCheck_ES1_C_AGE.

If the day and month of ES1b EQ the day and month of IDATE, DISPLAY: "Happy Birthday!" Else, go to CALC_AGE_2.

HardEditCheck_ES2.

If R_AGE NE DK and R_AGE NE REF and R_AGE NE AGE, DISPLAY: “You said that you are &[R_AGE] but based on your date of birth you are &[AGE]. It is important that you provide honest answers so that the information that you provide can be used to help the community.”. Then, go back to ES1a. Else, go to CALC_E_AGE.

CALC_EL_AGE.
E_AGE	Age eligibility calculation	If (ES1a EQ DK or ES1a EQ REF) and (ES1b EQ DK or ES1b EQ REF), E_AGE=0. Else, if ES1a < 13 or ES1a > 17 or AGE < 13 or AGE >= 18, E_AGE=0. Else, E_AGE=1.

CALC_AGE_2.
AGE	QDS calculated age today	If ES1a NE DK and ES1a NE REF and (ES1b EQ DK or REF), AGE = R_AGE. Else, AGE=AGE.

ES2.		Did you already complete at least part of the health survey that [Insert Project Name] is conducting? It could have been here or at another location.
E_PART		Eligibility, previous participant
		No	0
		Yes	1
		Known previous participant	2
		Don't Know	9
		Refuse to Answer	7

ES3.		Do you consider yourself to be Hispanic or Latino? [Interviewer: If necessary, say "Just tell me Yes or No."]
HISPANIC		consider Hispanic, Latino
		No	0
		Yes	1
		Don't Know	9
		Refuse to Answer	7

FlowCheck_ES3a.

If ES3 NE 1, go to ES4. Else, go to ES3a.

ES3a.		What best describes your Hispanic or Latino ancestry? (READ CHOICES. CHECK ALL THAT APPLY)
HISPTYP		Hispanic Ancestry
	HISPTYPA	Mexican
	HISPTYPB	Puerto Rican
	HISPTYPC	Cuban
	HISPTYPD	Dominican
	HISPTYPE	Some other ancestry
		Don't Know	9
		Refuse to Answer	7

FlowCheck_ES3spec.

If HISPTYPE NE 1, go to ES4. Else, go to ES3spec.

ES3spec.		Specify other ancestry:
SPECHISP		specify other ancestry
		__ __ __ __ __ __ __ __ __ ____ __ __ __ ____ __ __ __ ____ __ __ __ __ ____ __ __ __ ____ __ __ __ ____ __ __ __
		{text response; max length = 50 characters}
		Don't Know	9
		Refuse to Answer	7

ES4.		[GIVE RESPONDENT FLASHCARD A.] Which racial group or groups do you consider yourself to be in? You may choose more than one option. [READ CHOICES. CHECK ALL THAT APPLY]
RACE		racial group
	RACEA	American Indian or Alaska Native
	RACEB	Asian
	RACEC	Black or African American
	RACED	Native Hawaiian or Other Pacific Islander
	RACEE	White
		Don't Know	9
		Refuse to Answer	7
		Not Applicable	8

FlowCheck_County of Residence.

If INT2 EQ 1, go to ES5_CHI. If INT2 EQ 2, go to ES5_NYC. If INT2 EQ 3, go to ES5_PHL.

County of Residence

ES5_CHI.		What county do you currently live in?
CHICTY		Eligibility, Chicago county of residence
		Cook County	1
		DeKalb County	2
		DuPage County	3
		Grundy County	4
		Kane County	5
		Kendall County	6
		McHenry County	7
		Will County	8
		Other	88
		Don't Know	99
		Refuse to Answer	77

CALC_CHIEL.
CHIEL		CHIEL = if ((CHICTY=1 OR CHICTY=2 OR CHICTY=3 OR CHICTY=4 OR CHICTY=5 OR CHICTY=6 OR CHICTY=7 OR CHICTY=8), 1,0)

FlowCheck_ES5spec_CHI.

If ES5_CHI EQ 88, go to ES5spec. Else, go to CALC_E_CITY.

ES5_NYC.		What county do you currently live in?
NYCCTY		Eligibility, New York City county of residence
		Bronx County, NY	1
		Kings County, NY	2
		New York County, NY	3
		Putnam County, NY	4
		Queens County, NY	5
		Richmond County, NY	6
		Rockland County, NY	7
		Westchester County, NY	8
		Bergen County, NJ	9
		Hudson County, NJ	10
		Passaic County, NJ	11
		Other	88
		Don't Know	99
		Refuse to Answer	77

CALC_NYCEL.
NYCEL		NYCEL = if ((NYCCTY=1 OR NYCCTY=2 OR NYCCTY=3 OR NYCCTY=4 OR NYCCTY=5 OR NYCCTY=6 OR NYCCTY=7 OR NYCCTY=8 OR NYCCTY=9 OR NYCCTY=10 OR NYCCTY=11), 1,0)

FlowCheck_ES5spec_NYC.

If ES5_NYC EQ 88, go to ES5spec. Else, go to CALC_E_CITY.

ES5_PHL.		What county do you currently live in?
PHLCTY		Eligibility, Philadelphia county of residence
		Bucks County	1
		Chester County	2
		Delaware County	3
		Montgomery County	4
		Philadelphia County	5
		Other	88
		Don't Know	99
		Refuse to Answer	77

CALC_PHLEL.
PHLEL		PHLEL = if ((PHLCTY=1 OR PHLCTY=2 OR PHLCTY=3 OR PHLCTY=4 OR PHLCTY=5), 1,0)

FlowCheck_ES5spec.

If ES5_PHL EQ 88, go to ES5spec. Else, go to CALC_E_CITY.

ES5spec.			Specify other county:
SPECCNTY			Specify other county
		__ __ __ __ __ __ __ __ __ ____ __ __ __ ____ __ __ __ ____ __ __ __ __ ____ __ __ __ ____ __ __ __ ____ __ __ __
			{text response; max length = 20 characters}
			Don't Know		9
			Refuse to Answer		7

CALC_E_CITY.
E_CITY	Eligible city	E_CITY = if ((CHIEL=1 or NYCEL=1 or PHLEL=1),1,0)

ES5a.		How long have you been living in &[CITY]? [Interviewer: If response is in months, enter 0 below and then enter the number of months in the next screen.]
RESY		Length of time living in city—years
		__ __ __	0 - 100
		Don't Know	999
		Refuse to Answer	777

FlowCheck_ES5b_1.

If ES1b EQ DK or REF, go to FlowCheck_ES5b_2. Else, go to HardEditCheck_ES5a.

HardEditCheck_ES5a.

If ES5a GT AGE, DISPLAY: "Interviewer: The respondent's age is less than the number of years living in the MSA." Then, go back to ES5a. Else, go to FlowCheck_ES5b_2.

FlowCheck_ES5b_2.

If ES5a LT 1, go to ES5b. Else, go to ES6.

ES5b.		Number of months:
RESM		Number of months:
		__ __	0 - 11
		Don't Know	99
		Refuse to Answer	77

ES6.		What was your sex at birth? [CHECK only ONE]
BIRTHSEX		Sex at birth
		Male	1
		Female	2
		Intersex/ambiguous	3
		Don't Know	9
		Refuse to Answer	7

ES7.		Do you consider yourself to be male, female or transgender? [CHECK only ONE]
GENDER		Gender
		Male	1
		Female	2
		Transgender	3
		Don't Know	9
		Refuse to Answer	7

NHBS-YMSM Behavioral Eligibility

INTRO_ES7b.

“READ: Now I’m going to ask you some questions about sexual behavior.”

ES7b.		Are you sexually attracted to other males?
E_EVRMAT		Eligibility: Sexually attracted to other males
		No	0
		Yes	1
		Don't Know	9
		Refuse to Answer	7

ES7c.		Do you identify as gay, bisexual, queer, or same gender loving? [INTERVIEWER: Tell respondent they can simply respond yes or no]
E_EVRGBQ		Eligibility: identify as gay or bisexual
		No	0
		Yes	1
		Don't Know	9
		Refuse to Answer	7

ES7d.		Have you ever had oral or anal sex with a male?
E_EVROAN		Eligibility: MSM, Ever had sex with man
		No	0
		Yes	1
		Don't Know	9
		Refuse to Answer	7

ES7e.		Have you ever had any other type of sexual contact with a male?
E_EVRMSX		Eligibility: MSM, Ever had other type of sex with male
		No	0
		Yes	1
		Don't Know	9
		Refuse to Answer	7

CALC_E_SEX.
E_SEX	YMSM Male attraction/sex eligibility	E_SEX=if(E_EVRMAT=1 or E_EVRGBQ=1 or E_EVROAN=1 or E_EVRMSX=1,1,0)

INTRO_ES8.

“READ: We've finished the first series of questions. Now the computer will determine whether you've been selected to participate in the survey.”

ES8.		Interviewer: Is this person alert and able to complete the survey in English?
E_ABLE		Eligibility: able to complete
		No	0
		Yes	1

FlowCheck_ES8a.

If ES8 EQ 0 go to ES8a. Else, go to CALC_EL_YMSM.

ES8a.		Interviewer: Specify reason person not able to complete the interview: [CHECK ALL THAT APPLY.]
E_ABLEA		Eligibility: Reason not able to complete
	E_ABLEAA	Not Alert
	E_ABLEAB	Not able to complete in English
	E_ABLEAC	Thought to be too young
	E_ABLEAD	Thought to be too old
	E_ABLEAE	Known to be previous participant
	E_ABLEAF	Other

FlowCheck_ES8asp_1.

If E_ABLEAF EQ 1, go to ES8asp. Else, go to CALC_EL_YMSM.

ES8asp.		Interviewer: Specify the other reason person was not able to complete the interview.
SPECABLA		Specify reason not able to complete
		__ __ __ __ __ __ __ __ __ ____ __ __ __ ____ __ __ __ ______ __ __ __ ____ __ __ __ ____ __ __ __ ____ __ __ __
		{text response; max characters = 20}

Cycle Eligibility Calculation

CALC_EL_YMSM.
EL_YMSM	Eligible: YMSM cycle	EL_YMSM = if((E_AGE=1 AND E_PART=0 AND E_CITY=1 AND BIRTHSEX=1 AND GENDER=1 AND E_SEX=1 AND E_ABLE=1),1,0)

CALC_ENDSCR.
ENDSCR	Time eligibility screener ended	ENDSCR = Current time

FlowCheck_Eligibility.

If EL_YMSM EQ 0, go to INTRO_END6. Else, DISPLAY: “READ: Congratulations! The computer has selected you to participate in the health survey. Let me tell you about it. [Interviewer: Proceed with the consent process.]” Then go to CN1.