0920-0840 Attachment 9_Enumeration Interview

Form Approved

OMB No. 0920-0840

Exp. Date: 2/29/2016

Attachment 9

Enumeration Interview

____________________________________________________________________________________

Public reporting burden of this collection of information is estimated to average 2 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.

Section 1: For Type 1 and Type 2 Enumerations

Venue: __________________________________

Counter: ______________________________

Enumeration Type: 1 2

Date: _____ / _____ / _____

Start Time: _____ : _____ AM PM

End Time: _____ : _____ AM PM

Elapsed Time: _______ minutes

Count: _______

Standardized Count: _______

Section 2: For Type 2 Enumerations

Number Interviewed: _______

Number Eligible: _______

Eligible Percent: _______

Eligible Count: _______

Calculations

1. Elapsed Time in Hours= Elapsed Time in Minutes / 60

2. Standardized Count= ( 4 X Count ) / Elapsed Time in Hours

3. Eligible Percent= Number Eligible / Number Interviewed

4. Eligible Count= Standardized Count X Eligible Percent

Overview

The Count Form for Type 1 and 2 Enumerations may be used as is or modified to meet local needs. Count forms should be completed by the counter during Type 1 and Type 2 enumerations. The following instructions apply to each of the variables (noted in capital letters) included on the form.

Section 1: For Type 1 and Type 2 Enumerations

During all enumerations (Type 1 or 2), section 1 should be completed.

Venue. Name of the venue where the enumeration is being conducted.

Counter. Name of the staff member responsible for counting men who appear to be 13-17 years of age who enter the counting area.

Enumeration Type: Record whether Type 1 or Type 2 enumeration is being conducted.

Date. DATE is the date the enumeration was conducted in month/day/year format.

Time. START TIME is the time when counting begins and END TIME is the time when counting ends. Time is written in hours/minutes and a.m. or p.m. is cir­cled. ELAPSED TIME is the difference in minutes between START TIME and END TIME. Note: ELAPSED TIME should be between 30 and 60 minutes, the recommended duration of an enumeration period.

Count. COUNT is the total number of men who appear to be 13-17 years of age who are "clicked" by the counter from the start of the enumeration period (START TIME) to the end (END TIME).

Standardized Count. The product of the number of persons counted and 4, divided by the time in hours.

Section 2: For Type 2 Enumerations

Data from brief eligibility interviews conducted with participants during Type 2 enumerations are recorded in this section. Information from the Enumeration Interview (Attachment 10) can be used to complete this section.

Number Interviewed. Total number of men who completed brief eligibility interviews during Type 2 enumerations.

Number Eligible. Number of men determined to be eligible following brief eligibility interviews.

Eligible Percent. Number of eligible men divided by the number of men interviewed.

Eligible Count. Standardized count multiplied by the eligible percent.

Venue: ________________________________ Interviewer: ______________________________ Date: _____ / _____ / _____

#

Accepted Intercept

Gender

Age

Race/Ethnicity

MSA Resident

Sex in Past Year

Type of Sex Partners

Eligible

1

Y

N

M

F

U

W

B

H

A

N

U

Y

N

U

Y

N

U

M

W

B

U

Y

N

U

2

Y

N

M

F

U

W

B

H

A

N

U

Y

N

U

Y

N

U

M

W

B

U

Y

N

U

3

Y

N

M

F

U

W

B

H

A

N

U

Y

N

U

Y

N

U

M

W

B

U

Y

N

U

4

Y

N

M

F

U

W

B

H

A

N

U

Y

N

U

Y

N

U

M

W

B

U

Y

N

U

5

Y

N

M

F

U

W

B

H

A

N

U

Y

N

U

Y

N

U

M

W

B

U

Y

N

U

6

Y

N

M

F

U

W

B

H

A

N

U

Y

N

U

Y

N

U

M

W

B

U

Y

N

U

7

Y

N

M

F

U

W

B

H

A

N

U

Y

N

U

Y

N

U

M

W

B

U

Y

N

U

8

Y

N

M

F

U

W

B

H

A

N

U

Y

N

U

Y

N

U

M

W

B

U

Y

N

U

9

Y

N

M

F

U

W

B

H

A

N

U

Y

N

U

Y

N

U

M

W

B

U

Y

N

U

10

Y

N

M

F

U

W

B

H

A

N

U

Y

N

U

Y

N

U

M

W

B

U

Y

N

U

Page (circle one): 1 2 3 4 5

Overview

The model Interview Form for Type 2 Enumerations may be used as is or modified to meet local needs. Modified forms should collect all the data elements included on the model form. Interview forms should be completed during brief eligibility interviews. The following instructions apply to each of the variables (noted in capital letters) included on the form. Listed below the respective variables are the questions staff should ask participants during the brief eligibility interview. Note: not all variables have a corresponding question.

Enumeration Variables

Data that characterize the Type 2 enumeration, such as the venue, the counter, dates, times of the enumeration, count and standardized count, should collected on the Count Form for Type 1 and 2 Enumerations. The interviewer conducting the brief eligibility interview should complete the following fields on the interview form:

Venue. Name of the venue where the Type 2 enumeration is being conducted.

Interviewer. Name of the staff member who intercepts men who have been counted.

Date. DATE is the date the Type 2 enumeration was conducted.

Page #. PAGE is used to identify individual records when multiple forms are used during an enumeration event. Code PAGE sequentially beginning with “1” for the first form used, “2” for the second form used, and so forth for all forms that are used during the event.

Participant Records

Data on participants should be recorded in the table below the enumeration variables. Each row of the table represents a record of an attempted intercept and, if the intercept is successful, a brief eligibility interview. Each record has 9 variables that head the columns of the table. Six of these variables are asked of participants. Instructions for completing all 9 variables are listed below.

Accepted Intercept. ACCEPTED INTERCEPT is coded by the interviewer based on whether sufficient information is obtained to determine NHBS-MSM3 eligibility. Code ACCEPTED INTERCEPT as "Y" (yes) for venue attendees who stop and answer at least AGE, RESIDENCE, and TYPE OF SEX PARTNERS. Code ACCEPTED INTERCEPT as “N” (no) for venue attendees who do not stop, refuse the brief interview outright, or do not answer all three questions listed above. If a venue attendee does not stop or refuses to answer any of the questions, the remaining variables should be coded as “U” (unknown) or in the case of AGE, “99”.

Age. Ask venue attendee their current age and record their responses in the space provided. Code AGE as “99” for attendees who refuse to provide their age, or if the question was accidentally skipped.

Question: What is your age?

Race/Ethnicity. Ask venue attendees their race/ethnicity. Circle one or more of the codes: A = Asian/Native Hawaiian/Pacific Islander; B = Black; H = Hispanic or Latino; N = American Indian/Alaskan Native; W = White. Circle U (unknown) if an attendee refuses to answer the question or if it was accidentally skipped.

Question: What is your race or ethnicity?

MSA Resident. Ask whether attendees currently live in the local area. Circle “Y” if the attendee lives in the MSA and “N” if they don’t. Circle “U” if an attendee refuses to answer this question or if the question was accidentally skipped.

Question: Do you live in the (project city) area?

Sex in the past year. Ask venue attendees whether they have had sex in the past 12 months. Circle “Y” if they have and “N” if they haven’t. Circle “U” if an attendee refuses to answer the question or if the question was accidentally skipped. If an attendee responds no to this question, end the interview and code ELIGIBLE “N” (no). If the response is “unknown,” end the interview and code both SEX PARTNERS and ELIGIBLE as “U” (unknown).

Question: Have you had sex in the past 12 months?

Type of sex partners. For only those venue attendees who have had sex, ask whether they have had sex with men, women, or both in the past 12 months. Circle only one response. Circle “M” if they only had sex with men, “W” if they only had sex with women, and “B” if they had sex with both men and women. Circle “U” if a venue attendee refuses to answer this question or if the question was accidentally skipped.

Question: In the past 12 months, have you had sex with men only, with women only, or with both men and women?

Eligible. ELIGIBLE is coded by the interviewer based on an attendee’s responses to AGE, MSA RESIDENT, and TYPE OF SEX PARTNERS. Circle "Y" for men 13-17 years of age who are residents of the MSA and report having sex with another man in the past 12 months. Circle "N" for attendees who do not meet these criteria. Circle “U” if data were not obtained on AGE, MSA RESIDENT, or TYPE OF SEX PARTNERS.