Assessment - English word

Form Approved

OMB No. 0920-0840

Expiration Date: 02/29/2016

Testing Brief Messages for Black and Latino MSM

Attachment 14

Assessment in English

Public reporting burden of this collection of information is estimated to average 1 hour 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/ATSDR Reports Clearance Officer; 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; Attn: OMB-PRA (0920-0840)

Testing Brief Messages for Black and Latino MSM:

Emerging HIV Prevention Information

AA1. Site ID (Choose one) 1 1

2 2

3 3

AA2. Computer number

__

PAST90D = LongDate(BTODAY - 90)

PAST365D = LongDate(BTODAY - 365)

Funding for this study is provided by the Centers for Disease Control and Prevention.

Practice Questions

READ: Practice Questions

So that you are comfortable answering these questions using the computer, the first few questions will be for practice. These will give you an idea of the different types of questions you will see during the interview, and will give you a chance to ask the staff any questions before you get started. Now, use the mouse to click on the "Next Question" button to begin.

PRA1. Some of the questions will ask you to answer either YES or NO. For example, "Are you wearing blue today?"

1 Yes

0 No

8 Refuse to Answer

PRA2. Some of the questions will ask you to pick one answer from a list, such as, how much do you agree with this statement? Blue is my favorite color. (Choose one)

1 Strongly Disagree

2 Disagree

3 Neither Disagree nor Agree

4 Agree

5 Strongly Agree

8 Refuse to Answer

PRA3. Some of the questions will ask you to indicate how important something is to you. Answer on a scale from 1 to 9 where '1' indicates 'Not at all Important' and '9' indicates 'Very Important.' How important is TV to you?

1 Not at all Important

2

3

4

5

6

7

8

9 Very Important

98 Refuse to Answer

PRA4. Some of the questions will ask you to pick one or more answers from a list of choices, such as, what colors do you like the most? Please check all that apply, then click on the "NEXT QUESTION" button. (Check all that apply)

__ Red

__ Blue

__ Green

__ Yellow

__ Purple

__ Refuse to Answer

PRA5. Some of the questions will ask you to enter a number, such as, how many colors did you choose on the previous question? After entering the number, click on the "NEXT QUESTION" button.

__ __

98 Refuse to Answer

READ: Sometimes the computer will tell you that the number that you have entered is not a possible response, and that you have to go back and give another answer. For example, on the previous question if you entered the number 6, the computer would tell you that the highest number you could have chosen is 5 since there were only 5 colors listed. Please click on the "NEXT QUESTION" button.

PRA6. So that you see what this screen looks like, enter a number higher than 5 and press "Next Question." A box will appear saying, Number too big. Click OK and then click on the "Clear" button and enter the correct number.

__

8 Refuse to Answer

If PRA6 is not greater than or equal to 6 then READ: "Today's date is &[BTODAY]. You will need this for the next question."

If not, then skip to instruction before PRA7.

PRA7. A few questions will ask you to enter a date. In this practice question, please enter today's date, indicating the year, month, and day. Use the arrow keys on either side of the boxes to indicate today's year, today's month and today's day. After entering the date, please click the "NEXT QUESTION" button.

__ __ / __ __ / __ __ __ __ mm / dd / yyyy

2098 Refuse to Answer (Year)

If PRA7 is not equal to BTODAY then READ: "You have entered the date other than today's date. Please re-answer this question." Go Back to PRA7.

PRA8. Finally, some of the questions will ask you to spell out your answer using your keyboard. Now you try it by answering the question, "My mother's name is." After entering the name, please click "NEXT QUESTION."

__ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __

PRA9. Has this been enough practice using the computer? If it has been, click YES and you can get started. If not, click NO and you will get a few more practice questions.

1 Yes Skip to instruction before Q1

0 No

8 Refuse to Answer

READ: Try a few more questions for you to practice getting used to the computer...

PRA10. Do you like watching TV?

1 Yes

0 No

8 Refuse to Answer

PRA11. My favorite thing about TV is sports. (Choose one)

0 Strongly Disagree

1 Disagree

2 Neither Disagree or Agree

3 Agree

4 Strongly Agree

8 Refuse to Answer

PRA12. The things I don't like about living in a big city are. Please check all that apply, and then click "NEXT QUESTION." (Check all that apply)

__ Crowds

__ Weather

__ Cars

__ Cost

__ Other things not listed here

__ Refuse to Answer

PRA13. How many things that you don't like about the city did you choose from the list in the previous question? After entering the number, please click on the "NEXT QUESTION" button.

__ __

98 Refuse to Answer

PRA14. So that you see again what the screen looks like when you enter an answer that is too high or low, try to enter a number greater than 5 for the question. A box will appear saying, Number too big. Click OK and then click on the "Clear" button and enter the correct number.

__

8 Refuse to Answer

PRA15. What is your favorite month and year? After entering the date, please click on the "NEXT QUESTION" button.

__ __ / __ __ __ __ mm / yyyy

2098 Refuse to Answer (Year)

PRA16. My favorite actor's first name is? After entering the name, please click on the "NEXT QUESTION" button.

__ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __

PRA17. Is that enough practice on the computer? If so, just select READY TO GET STARTED and the assessment will begin. If you would like some more help with the computer, just ask staff to help you. (Choose one)

0 Ready to get started

8 Refuse to Answer

READ: Great. Now you will answer questions on your own. Remember that your answers are private. If you need help, ask a staff person. Please click on the "NEXT QUESTION" button.

SOCIO-DEMOGRAPHIC INFORMATION

READ: The next section will cover demographic information.

Q1. What month and year were you born?

__ __ / __ __ __ __ mm / yyyy

2098 Refuse to Answer (Year)

AGE = UnknownFunction (Q1, BTODAY)

If AGE is greater than 18 or AGE is equal to 18, then skip to instruction before Q2.

If AGE is less than 18 then READ: "I'm sorry, but you have to be at least 18 years old to be in the study. Thank you for your interest.
Please see a staff person to end the assessment." .

READ: Participant is [AGE] years old.

If AGE is less than 18, then skip to G153.

Q2. Are you currently employed? (Choose one)

0 No

1 Yes, full-time

2 Yes, part-time

8 Refuse to Answer

If Q2 is equal to 1 or Q2 is equal to 2, then skip to Q4.

Q3. If you are not employed, are you: (Choose one)

1 Unemployed or between jobs

2 On disability

3 Retired

4 Student

5 Other

8 Refuse to Answer

Q4. Are you currently enrolled in school? (Choose one)

0 No

1 Yes, full-time

2 Yes, part-time

8 Refuse to Answer

Q5. What is the highest level of education that you have completed? (Choose one)

1 Less than high school graduate

2 High school graduate

3 High school equivalency (GED)

4 Some college or 2-year college degree (Associate degree)

5 Bachelor degree / College degree

6 Some graduate school or more

8 Refuse to Answer

Q6. At any point in the last three months, have you considered yourself homeless?

1 Yes

0 No

8 Refuse to Answer

Q7. Which best describes your total personal income from all sources in the last year? (Choose one)

01 No income

02 $1 - $9999

03 $10,000 - $19,999

04 $20,000 - $29,999

05 $30,000 - $39,999

06 $40,000 - $49,999

07 $50,000 - $59,999

08 $60,000 - $100,000

09 More than $100,000

98 Refuse to Answer

Q8. What is your primary type of health insurance coverage, if any? (Choose one)

1 No health insurance

2 Private or work health insurance (Blue Cross, Kaiser, HMO, PPO)

3 Student plan

4 Medicare / Medicaid /

5 Other

9 Don't Know

8 Refuse to Answer

Q9. Have you ever been in jail or prison?

1 Yes

0 No

8 Refuse to Answer

Q10. Are you Hispanic, Latino, or of Spanish origin (Check all that apply)

1 No, not of Hispanic, Latino, or Spanish origin

2 Yes, Mexican, Mexican American, Chicano/a

3 Yes, Puerto Rican

4 Yes, Cuban

5 Other Hispanic, Latino/a or Spanish origin (Identify)

If Q11 is not equal to 5, skip to Q13.

Q11. In the previous question you selected other.  Please specify your Hispanic, Latino, or Spanish origin ­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­______________________________

Q12. What is your race? (Check all that apply.)

1 White

2 Black or African American

3 American Indian or Alaska Native

4 Asian

5 Native Hawaiian or Other Pacific Islander

Q13. How well do you speak English?

Very well

Well

Not well

Not at all

Q14. Do you speak a language other than English at home?

1 Yes

2 No

If Q15 is not equal to 1, skip to Q17.

Q15. What is the language other than English that you speak at home?

1. Spanish

2. Portuguese

3 Other Language (specify: __________________________)

Q16. Where were you born? (Choose one)

01 Africa

02 Asia

03 Canada

04 Caribbean

05 Central America

06 Europe (including Eastern Europe, Russia, etc.)

07 Mexico

08 Middle East

09 South America

10 United States

11 Other

98 Refuse to Answer

Q17. How would you describe your sexual orientation? (Choose one)

1 Straight / Heterosexual

2 Gay / Homosexual

3 Bisexual

4 Other

8 Refuse to Answer

If Q18is not equal to 4, then skip to Q20.

Q18. In the previous question you selected other. How would you describe your sexual orientation?

__ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __

Q19. What is your HIV status? (Choose one)

1 Positive

2 Negative

3 Don't know / not sure

8 Refuse to Answer

If Q20 is not equal to 1, then skip to Q28.

Q20. Have you ever had a CD4 count? CD4 is also known as T-cells.

1 Yes

0 No Skip to 24

8 Refuse to Answer Skip to Q24

Q21. When was the last time you had a CD4 or T-cell count? (Choose one)

1 In the last month

2 In the last 3 months

3 In the last 6 months

4 In the last year

5 More than a year ago

8 Refuse to Answer

Q22. Indicate what the count was the last time you had your T-cells measured. (Choose one)

1 Less than 50

2 50 to 200

3 201 to 350

4 351 to 500

5 Over 500

7 Don't Know

8 Refuse to Answer

Q23. Have you ever had a VIRAL LOAD test?

1 Yes

0 No Skip to Q27

8 Refuse to Answer Skip to Q27

Q24. When was the last time you had your VIRAL LOAD measured? (Choose one)

1 In the last month

2 In the last 3 months

3 In the last 6 months

4 In the last year

5 More than a year ago

8 Refuse to Answer

Q25. Indicate your VIRAL LOAD the last time it was measured. (Choose one)

1 Undetectable

2 Detectable but less than 5000

3 5,001 - 10,000

4 10,001 - 30,000

5 30,001 or more

7 Don't Know

8 Refuse to Answer

Q26. Are you taking any medications that a doctor has prescribed to treat HIV?

1 Yes

0 No

8 Refuse to Answer

Q27. Please indicate if you have had any of the following sexually transmitted diseases (STD) in the past 12 months. (Check all that apply)

__ Chlamydia

__ Gonorrhea

__ Syphilis

__ Urethritis, a burning or discharge from the penis

__ Other

__ Have had an STD, but don't know the name

__ None

__ Don't Know

__ Refuse to Answer

If Q28G is equal to 1 and (Q28A is equal to 1 or Q28B is equal to 1 or Q28C is equal to 1 or Q28D is equal to 1 or Q28E is equal to 1 or Q28F is equal to 1) then READ: "You indicated that you had an STD listed here AND you checked "None." Please re-answer this question." Go Back to Q28.

Q28. In the past 3 months, have you had any partners with whom you had sex in exchange for things you needed, like food, shelter, transportation, drugs, or money?

1 Yes

0 No

8 Refuse to Answer

SEX WITH MEN

READ: SEXUAL BEHAVIOR WITH MEN

The following questions ask about your sexual behavior in the last three months. Some questions ask about all your partners, and others ask only about certain partners.

READ: When we ask about the times you were a top, we mean a top during anal sex (insertive anal sex, you fucked, your penis was in a man's rectum). When we ask about the times you were a bottom, we mean a bottom during anal sex (receptive anal sex, getting fucked, a man's penis was in your rectum). Some questions refer to condom use. Include the times you used a male condom or an anal condom (Reality condom). Sex with a condom means that the condom was put on before you began having anal sex and the condom was not taken off until you were done.

READ: First, we want to ask you about all of the men you have had any anal sex with in the past 3 months.

A1. How many men did you have any anal sex with (top or bottom) in the last three months? This includes times when you were a top or bottom, used or didn't use a condom, and whether or not there was ejaculation.

__ __ __ __

9998 Refuse to Answer

READ: Now we want to ask you if you have had a primary male partner over the last 3 months. That is since approximately [PAST90D]. By "Primary" partner we mean a man you have lived with or have seen a lot, and to whom you have felt a special emotional commitment for at least three months.

A2. Have you had a primary male partner in the last three months?

1 Yes

0 No

9 Don't Know

8 Refuse to Answer

If A2 is equal to 0 or A2 is equal to 8, then skip to instruction before B1.

READ: Now we want to ask you about all of the other men you have had any anal sex with in the past 3 months other than your primary partner.

A2a. How many men did you have any anal sex with (top or bottom) in the last three months other than your most recent primary partner? This includes times when you were a top or bottom, used or didn't use a condom, and whether or not there was ejaculation.

__ __ __ __

9999 Don't Know

9998 Refuse to Answer

MOST RECENT MALE PRIMARY PARTNER

READ: Now we are going to ask you some questions about your sex behavior with your most recent male primary partner in the past 3 months.

A3. Throughout this next group of questions, your recent male primary partner will be referred to by his initials. Please put his initials here. Use AA if you do not know his name.

_ _

A3a. What is his HIV status? (Choose one)

1 Positive

2 Negative

3 Not sure or don't know

8 Refuse to Answer

A3b. How old is [Response to A3]? If you are not sure, give it your best guess.

__ __ __

998 Refuse to Answer

A3c. What is [Response to A3] primary race/ethnicity? If you are not sure, give it your best guess.

1 African American or Black

2 Asian American or Pacific Islander

3 Latino, Hispanic, or Chicano

4 Native American, American Indian, or Alaska Native

5 White or European American

6 Mixed

7 Other

8 Refuse to Answer

If A3c is not equal to 6, then skip to A3f.

A3d. In the previous question you selected mixed. Please select all applicable race/ethnicities. (Check all that apply)

__ African American / Black

__ Asian / Asian American / Pacific Islander

__ Latino / Hispanic / Chicano

__ Middle Eastern

__ Native American / American Indian / Alaskan Native

__ White / European American

__ Other

__ Refuse to Answer

If A3d7 (other) is not equal to 1, then skip to A3f.

A3e. In the previous question you selected other. Please specify his race/ethnicity

_ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ ____ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ _

A3f. Where did you first meet [Response to A3]? (Choose one)

01 Circuit party

02 Party

03 Work

04 School

05 Friend

06 Gay bar, night club, or dance club

07 Straight bar, night club, or dance club

08 Internet

09 Health club or gym

10 Sex club or bathhouse

11 Porn theater/video arcade

12 Other public place, such as beach, park

13 Street festival, pride parade, etc.

14 Other

98 Refuse to Answer

A3g. When was the first time you had any anal sex with [Response to A3]? That is, where you were a top or bottom, with or without a condom, and with or without ejaculation. (Choose one)

1 Less than a week ago

2 More than a week but less than a month ago

3 One to three months ago

4 Four to six months ago

5 Seven to twelve months ago

6 More than a year ago

8 Refuse to Answer

A4. In the last three months, how many times were you the top with [Response to A3]? This would be with or without a condom, and whether or not you ejaculated.

__ __ __ __ __

00000 zero Skip to A5

99998 Refuse to Answer Skip to A5

A4a. How many of these [Response to A4] times was a condom used from start to finish?

__ __ __ __

9998 Refuse to Answer

If A4a is greater than A4 then READ: "You cannot enter a number that is greater than [Response to A4], which is the number of times you were the top with your most recent partner. Please re-answer this question." Go back to A4a.

UNPRO = A4 - A4a

If UNPRO is equal to 0, then skip to A5.

A4b. Think of the [UNPRO] times you were the top and did not use a condom from start to finish with [Response to A3]. How many of these times were you drunk or buzzed on alcohol within 2 hours before or during sex?

__ __ __ __

9998 Refuse to Answer

If A4b is greater than UNPRO then READ: "You cannot enter a number that is greater than [UNPRO], which is the number of times you were the top and did not use a condom with your most recent partner. Please re-answer this question." Go back A4b.

A4c. Think of the [UNPRO] times you were the top and did not use a condom from start to finish with [Response to A3]. How many of these times did you use non-prescription drugs within 2 hours before or during sex?

__ __ __ __

0000 zero Skip to A5

9998 Refuse to Answer Skip to A5

If A4c is greater than UNPRO then READ: "You cannot enter a number that is greater than [UNPRO], which is the number of times you were the top and did not use a condom with your most recent partner. Please re-answer this question." Go back to A4c.

A5. In the last three months, how many times were you the bottom with [Response to A3]? This would be with or without a condom and with or without ejaculation.

__ __ __ __

0000 zero Skip to instruction before B1

9998 Refuse to Answer Skip to instruction before B1

A5a. How many of these [Response to A5] times was a condom used from start to finish?

__ __ __ __

9998 Refuse to Answer

If A5a is greater than A5 then READ: "You cannot enter a number that is greater than [Response to A5], which is the number of times you were the bottom with your most recent partner. Please re-answer this question." Go back to A5a.

UNPRO1 = A5 - A5a

If UNPRO1 is equal to 0, then skip to instruction before B1.

A5b. Think of the [UNPRO1] times you were the bottom and did not use a condom from start to finish with [Response to A3]. How many of these times were you drunk or buzzed on alcohol within 2 hours before or during sex?

__ __ __ __

9998 Refuse to Answer

If A5b is greater than UNPRO1 then READ: "You cannot enter a number that is greater than [UNPRO1], which is the number of times you were the bottom and did not use a condom with your most recent partner. Please re-answer this question." Go back to A5b.

A5c. Think of the [UNPRO1] times you were the bottom and did not use a condom from start to finish with your [Response to A3]. How many of these times did you use non-prescription drugs within 2 hours before or during sex?

__ __ __ __

0000 zero Skip to instruction before B1

9998 Refuse to Answer Skip to instruction before B1

If A5c is greater than UNPRO1 then READ: "You cannot enter a number that is greater than [UNPRO1], which is the number of times you were the bottom and did not use a condom with your most recent partner. Please re-answer this question." Go back to A5c.

SEX WITH OTHER MALE PARTNERS

If A2a is equal to 0 or A2a is equal to 9998, then skip to instruction before D1.

READ: SEXUAL BEHAVIOR WITH ALL OTHER PARTNERS

Now I would like to ask you about the HIV status of these [Response to A2a] male partners in the past three months, other than your most recent male partner.

B1. Of these [Response to A2a] men, how many did you believe were HIV positive and had no reason to doubt it?

__ __ __ __

9998 Refuse to Answer

If B1 is greater than A2a then READ: "You cannot enter a number that is greater than [Response to A2a], which is the number of men, other than your most recent primary partner, with whom you've had anal sex. Please re-answer this question." Go back to B1.

If B1 is equal to 9998, then skip to instruction before D1.

TOT_P = A2a - B1

If TOT_P is equal to 0, then skip to B4.

B2. Of the remaining [TOT_P] men, how many did you believe were HIV negative and had no reason to doubt it?

__ __ __ __

9998 Refuse to Answer

If B1 is equal to 0 or B1 is equal to 9998, then skip to instruction before B5.

B3. Of the [Response to B1] HIV positive men, how many actually TOLD you they were HIV positive and you had no reason to doubt it?

__ __ __ __

9998 Refuse to Answer

If B4 is greater than B1 then READ: "You cannot enter a number that is greater than [Response to B1], which is the number of partners you believe to be HIV positive. Please re-answer this question." Go back to B4.

If B2 is equal to 0, then skip to instruction before C1.

If TOT_P is equal to 0, then skip to instruction before C1.

B4. Of the [Response to B2] HIV negative men, how many actually TOLD you they were HIV negative and you had no reason to doubt it?

__ __ __ __

9998 Refuse to Answer

If B5 is greater than B2 then READ: "You cannot enter a number that is greater than [Response to B2], which is the number of partners you believe to be HIV negative. Please re-answer this question." Go back to B5.

SEX WITH HIV-POSITIVE MALE PARTNERS

If B1 is equal to 0 or B1 is equal to 9998, then skip to instruction before C4.

READ: SEXUAL BEHAVIOR WITH HIV-POSITIVE PARTNERS

These next questions ask about your [Response to B1] HIV-positive partners who were NOT your most recent male primary partner(s). So, please think about all of the men, other than your primary partner, you had any anal sex with in the last three months who were HIV-positive.

C1. How many of your [Response to B1] HIV-positive partners who were NOT your primary partner did you have ANY unprotected anal sex with?

__ __ __ __

9998 Refuse to Answer Skip to instruction before C2

If C1 is greater than B1 then READ: "You cannot enter a number that is greater than [Response to B1], which is the number of partners you believe to be HIV positive. Please re-answer this question." Go back to C1.

C1a. Of these [Response to C1] men, with how many did you have any unprotected anal sex with while you were drunk or buzzed on alcohol within 2 hours before or during sex?

__ __ __ __

9998 Refuse to Answer

If C1a is greater than C1 then READ: "You cannot enter a number that is greater than [Response to C1], which is the number of HIV+ partners with whom you've had unprotected anal sex. Please re-answer this question." Go back to C1a.

C1b. Of these [Response to C1] men, with how many did you have any unprotected anal sex with after using non-prescribed drugs within 2 hours before or during sex?

__ __ __ __

9998 Refuse to Answer

If C1b is greater than C1 then READ: "You cannot enter a number that is greater than [Response to C1], which is the number of HIV+ partners with whom you've had unprotected anal sex. Please re-answer this question." Go back to C1b.

READ: Now we are going to ask you some more questions about the [Response to B1] HIV-positive men with whom you had anal sex in the last 3 months. For these remaining questions, we are going to ask you about the number of times you had anal sex with these men.

C2. In the last three months, how many times were you the top (you had insertive anal sex) with your [Response to B1] HIV-positive male partners? This would be with or without a condom, and whether or not you ejaculated.

__ __ __ __

9998 Refuse to Answer Skip to C3

C2a. How many of these [Response to C2] times was a condom used from start to finish?

__ __ __ __

9998 Refuse to Answer

If C2a is greater than C2 then READ: "You cannot enter a number that is greater than [Response to C2], which is the number of times you were the top with your HIV positive male partners. Please re-answer this question." Go back to C2a.

UNPRO2 = C2 - C2a

If UNPRO2 is equal to 0, then skip to C3.

C2b. Think of the [UNPRO2] times you were the top (you had insertive anal sex) and did not use a condom from start to finish with your [Response to B1] HIV-positive male partners. How many of these times were you drunk or buzzed on alcohol within 2 hours before or during sex?

__ __ __ __

9998 Refuse to Answer

If C2b is greater than UNPRO2 then READ: "You cannot enter a number that is greater than [UNPRO2], which is the number of times you were the top and did not use condoms with your HIV+ partners. Please re-answer this question." Go back to C2b.

C2c. Think of the [UNPRO2] times you were the top (you had insertive anal sex) and did not use a condom from start to finish with your [Response to B1] HIV-positive male partners. How many of these times did you use non-prescription drugs within 2 hours before or during sex?

__ __ __ __

9998 Refuse to Answer

If C2c is greater than UNPRO2 then READ: "You cannot enter a number that is greater than [UNPRO2], which is the number of times you were the top and did not use condoms with your HIV+ partners. Please re-answer this question." Go back to C2c.

C3. In the last three months, how many times were you the bottom (you had receptive anal sex) with your [Response to B1] HIV-positive male partners? This would be with or without a condom, and with or without ejaculation.

__ __ __ __

9998 Refuse to Answer Skip to instruction before C4

C3a. How many of these [Response to C3] times was a condom used from start to finish?

__ __ __ __

9998 Refuse to Answer

If C3a is greater than C3 then READ: "You cannot enter a number that is greater than [Response to C3], which is the number of times you were the bottom with your HIV positive male partners. Please re-answer this question." Go back to C3a.

UNPRO3 = C3 - C3a

If UNPRO3 is equal to 0, then skip to instruction before C4.

C3b. Think of the [UNPRO3] times you were the bottom (you had receptive anal sex) and did not use a condom from start to finish with your [Response to B1] HIV-positive male partners. How many of these times were you drunk or buzzed on alcohol within 2 hours before or during sex?

__ __ __ __

9998 Refuse to Answer

If C3b is greater than UNPRO3 then READ: "You cannot enter a number that is greater than [UNPRO3], which is the number of times you were the bottom and did not use condoms with your HIV positive male partners. Please re-answer this question." Go back to C3b.

C3c. Think of the [UNPRO3] times you were the bottom (you had receptive anal sex) and did not use a condom from start to finish with your [Response to B1] HIV-positive male partners. How many of these times did you use non-prescription drugs within 2 hours before or during sex?

__ __ __ __

9998 Refuse to Answer

If C3c is greater than UNPRO3 then READ: "You cannot enter a number that is greater than [UNPRO3], which is the number of times you were the bottom and did not use condoms with your HIV positive male partners. Please re-answer this question." Go back to C3c.

SEX WITH HIV-NEGATIVE MALE NONPRIMARY PARTNERS

If TOT_P is equal to 0, then skip to instruction before D1.

If B2 is equal to 0 or B2 is equal to 9998, then skip to instruction before C7.

READ: SEXUAL BEHAVIOR WITH HIV-NEGATIVE PARTNERS

These next questions ask about your [Response to B2] HIV-negative partners who were NOT your most recent primary partner(s). So, please think about all of the men you had anal sex with in the last three months who were HIV-negative.

READ: REMEMBER...

When we ask about the times you were a top, we mean a top during anal sex (insertive anal sex, you fucked, your penis was in a man's rectum). When we ask about the times you were a bottom, we mean a bottom during anal sex (receptive anal sex, getting fucked, a man's penis was in your rectum). Some questions refer to condom use. Include the times you used a male condom or an anal condom (Reality condom). Sex with a condom means that the condom was put on before you began having anal sex and the condom was not taken off until you were done.

C4. How many of your [Response to B2] HIV-negative partners who were NOT your primary partner did you have ANY unprotected anal sex with?

__ __ __ __

9998 Refuse to Answer Skip to instruction before C5

If C4 is greater than B2 then READ: "You cannot enter a number that is greater than [Response to B2], which is the number of partners believed to be HIV negative. Please re-answer this question." Go back to C4.

C4a. Of these [Response to C4] men, with how many did you have any unprotected anal sex with while you were drunk or buzzed on alcohol within 2 hours before or during sex?

__ __ __ __

9998 Refuse to Answer

If C4a is greater than C4 then READ: "You cannot enter a number that is greater than [Response to C4], which is the number of HIV- partners with whom you've had unprotected anal sex. Please re-answer this question." Go back to C4a.

C4b. Of these [Response to C4] men, with how many did you have any unprotected anal sex with after using non-prescribed drugs within 2 hours before or during sex?

__ __ __ __

9998 Refuse to Answer

If C4b is greater than C4 then READ: "You cannot enter a number that is greater than &[BC4], which is the number of HIV- partners with whom you had unprotected sex. Please re-answer this question." Go back to C4b.

READ: Now we are going to ask you some more questions about the [Response to B2] HIV-negative men with whom you had anal sex in the last 3 months. For these remaining questions, we are going to ask you about the number of times you had anal sex with these men.

C5. In the last three months, how many times were you the top (did you have insertive anal sex) with your [Response to B2] HIV-negative male partners? This would be with or without a condom, and whether or not you ejaculated.

__ __ __ __

9998 Refuse to Answer Skip to C6

C5a. How many of these [Response to C5] times was a condom used from start to finish?

__ __ __ __

9998 Refuse to Answer

If C5a is greater than C5 then READ: "You cannot enter a number that is greater than [Response to C5], which is the number of times you were the top with your HIV negative male partners. Please re-answer this question." Go back to C5a.

UNPRO4 = C5 - C5a

If UNPRO4 is equal to 0, then skip to C6.

C5b. Think of the [UNPRO4] times you were the top (you had insertive anal sex) and did not use a condom from start to finish with your [Response to B2] HIV-negative male partners. How many of these times were you drunk or buzzed on alcohol within 2 hours before or during sex?

__ __ __ __

9998 Refuse to Answer

If C5b is greater than UNPRO4 then READ: "You cannot enter a number that is greater than [UNPRO4], which is the number of times you were the top and did not use a condom with your HIV- partners. Please re-answer this question." Go back to C5b.

C5c. Think of the [UNPRO4] times you were the top (you had insertive anal sex) and did not use a condom from start to finish with your [Response to B2] HIV-negative male partners. How many of these times did you use non-prescription drugs within 2 hours before or during sex?

__ __ __ __

9998 Refuse to Answer

If C5c is greater than UNPRO4 then READ: "You cannot enter a number that is greater than [UNPRO4], which is the number of times you were the top and did not use a condom with your HIV- partners. Please re-answer this question." Go back to C5c.

C6. In the last three months, how many times were you the bottom (did you have receptive anal sex) with your [Response to B2] HIV-negative male partners? This would be with or without a condom, and with or without ejaculation.

__ __ __ __

9998 Refuse to Answer Skip to instruction before C7

C6a. How many of these [Response to C6] times was a condom used from start to finish?

__ __ __ __

9998 Refuse to Answer

If C6a is greater than C6 then READ: "You cannot enter a number that is greater than [Response to C6], which is the number of times you were the bottom with your HIV negative male partners. Please re-answer this question." Go back to C6a.

UNPRO5 = C6 - C6a

If UNPRO5 is equal to 0, then skip to instruction before C7.

C6b. Think of the [UNPRO5] times you were the bottom (you had receptive anal sex) and did not use a condom from start to finish with your [Response to B2] HIV-negative male partners. How many of these times were you drunk or buzzed on alcohol within 2 hours before or during sex?

__ __ __ __

9998 Refuse to Answer

If C6b is greater than UNPRO5 then READ: "You cannot enter a number that is greater than [UNPRO5], which is the number of times you were the bottom and did not use a condom with your HIV negative male partners. Please re-answer this question." Go back to C6b.

C6c. Think of the [UNPRO5] times you were the bottom (you had receptive anal sex) and did not use a condom from start to finish with your [Response to B2] HIV-negative male partners. How many of these times did you use non-prescription drugs within 2 hours before or during sex?

__ __ __ __

9998 Refuse to Answer

If C6c is greater than UNPRO5 then READ: "You cannot enter a number that is greater than [UNPRO5], which is the number of times you were the bottom and did not use a condom with your HIV positive male partners. Please re-answer this question." Go back to C6c.

SEX WITH MALE PARTNERS OF UNKNOWN HIV STATUS

If TOT_P is equal to 0, then skip to instruction before D1.

If TOT_PN is equal to 0 and B3 is equal to 1, then skip to instruction before D1.

If B2 is equal to 9998, then skip to instruction before D1.

If B3 is equal to 8, then skip to instruction before D1.

READ: SEXUAL BEHAVIOR WITH PARTNERS WITH UNKNOWN HIV STATUS

These next questions ask about your [TOT_PN] partners whose HIV status you did not know who were NOT your most recent primary partner(s). So, please think about all of the men you had anal sex with in the last three months whose HIV status you did not know.

C7. How many of your [TOT_PN] partners who were NOT your primary partner and whose HIV status you did not know did you have ANY unprotected anal sex with?

__ __ __ __

9998 Refuse to Answer Skip to instruction before C8

If C7 is greater than TOT_PN then READ: "You cannot enter a number that is greater than [TOT_PN], which is the number of partners whose HIV status you did not know. Please re-answer this question." Go back to C7.

C7a. Of these [Response to C7] men, with how many did you have any unprotected anal sex with while you were drunk or buzzed on alcohol within 2 hours before or during sex?

__ __ __ __

9998 Refuse to Answer

If C7a is greater than C7 then READ: "You cannot enter a number that is greater than [Response to C7] which is the number of men with whom you had unprotected anal sex. Please re-answer this question." Go back to C7a.

C7b. Of these [Response to C7] men, how many did you have any unprotected anal sex with after using non-prescribed drugs within 2 hours before or during sex?

__ __ __ __

9998 Refuse to Answer

If C7b is greater than C7 then READ: "You cannot enter a number that is greater than [Response to C7] which is the number of men with whom you had unprotected anal sex. Please re-answer this question." Go back to C7b.

READ: Now we are going to ask you some more questions about the [TOT_PN] partners in the last 3 months whose HIV status you did not know. For these remaining questions, we are going to ask you about the number of times you had anal sex with these men.

READ: REMEMBER...

When we ask about the times you were a top, we mean a top during anal sex (insertive anal sex, you fucked, your penis was in a man's rectum). When we ask about the times you were a bottom, we mean a bottom during anal sex (receptive anal sex, getting fucked, a man's penis was in your rectum). Some questions refer to condom use. Include the times you used a male condom or an anal condom (Reality condom). Sex with a condom means that the condom was put on before you began having anal sex and the condom was not taken off until you were done.

C8. In the last three months, how many times were you the top (did you have insertive anal sex) with your [TOT_PN] partners whose HIV status you did not know? This would be with or without a condom, and whether or not you ejaculated.

__ __ __ __

0000 zero Skip to C9

9998 Refuse to Answer Skip to C9

C8a. How many of these [Response to C8] times was a condom used from start to finish?

__ __ __ __

9998 Refuse to Answer

If C8a is greater than C8 then READ: "You cannot enter a number that is greater than [Response to C8], which is the number of times you were the top with your partners whose HIV status you did not know. Please re-answer this question." Go back to C8a.

UNPRO6 = C8 - C8a

If UNPRO6 is equal to 0, then skip to C9.

C8b. Think of the [UNPRO6] times you were the top (you had insertive anal sex) and did not use a condom from start to finish with your [TOT_PN] partners whose HIV status you did not know. How many of these times were you drunk or buzzed on alcohol within 2 hours before or during sex?

__ __ __ __

9998 Refuse to Answer

If C8b is greater than UNPRO6 then READ: "You cannot enter a number that is greater than [UNPRO6], which is the number of times you were the top and did not use a condom with your unknown HIV status partners. Please re-answer this question." Go back to C8b.

C8c. Think of the [UNPRO6] times you were the top (you had insertive anal sex) and did not use a condom from start to finish with your [TOT_PN] partners whose HIV status you did not know. How many of these times did you use non-prescription drugs within 2 hours before or during sex?

__ __ __ __

9998 Refuse to Answer

If C8c is greater than UNPRO6 then READ: "You cannot enter a number that is greater than [UNPRO6], which is the number of times you were the top and did not use a condom with your unknown HIV status partners. Please re-answer this question." Go back to C8c.

C9. In the last three months, how many times were you the bottom (did you have receptive anal sex) with your [TOT_PN] partners whose HIV status you did not know? This would be with or without a condom, and whether or not you ejaculated.

__ __ __ __

9998 Refuse to Answer Skip to instruction before D1

C9a. How many of these [Response to C9] times was a condom used from start to finish?

__ __ __ __

9998 Refuse to Answer

If C9a is greater than C9 then READ: "You cannot enter a number that is greater than &[BC9], which is the number of times you were the bottom with your partners whose HIV status you did not know. Please re-answer this question." Go back to C9a.

UNPRO7 = C9 - C9a

If UNPRO7 is equal to 0, then skip to instruction before D1.

C9b. Think of the [UNPRO7] times you were the bottom (you had receptive anal sex) and did not use a condom from start to finish with your [TOT_PN] partners whose HIV status you did not know. How many of these times were you drunk or buzzed on alcohol within 2 hours before or during sex?

__ __ __ __

9998 Refuse to Answer

If C9b is greater than UNPRO7 then READ: "You cannot enter a number that is greater than [UNPRO7], which is the number of times you were the bottom and did not use a condom with your unknown HIV status partners. Please re-answer this question." Go back to C9b.

C9c. Think of the [UNPRO7] times you were the bottom (you had receptive anal sex) and did not use a condom from start to finish with your [TOT_PN] partners whose HIV status you did not know. How many of these times did you use non-prescription drugs within 2 hours before or during sex?

__ __ __ __

9998 Refuse to Answer

If C9c is greater than UNPRO7 then READ: "You cannot enter a number that is greater than [UNPRO7], which is the number of times you were the bottom and did not use a condom with your unknown HIV status partners. Please re-answer this question." Go back to C9c.

SEX WITH WOMEN

READ: SEXUAL BEHAVIOR WITH WOMEN

The following questions ask about any women with whom you have had sex in the last 3 months.

D1. How many women have you had sex with in the last three months? Include only women with whom you had vaginal or anal sex, with or without a condom, and with or without ejaculation.

__ __ __ __

9998 Refuse to Answer Skip to instruction before E1a

D2. Of the [Response to D1] women you have had sex with in the past three months, with how many did you ever NOT use a condom?

__ __ __ __

9998 Refuse to Answer

If D2 is greater than D1 then READ: "You cannot enter a number that is greater than [Response to D1], which is the number of women with whom you've had sex. Please re-answer this question." Go back to D2.

D3. Have you been in a primary relationship with a woman in the last three months? This would be a woman you have lived with or have seen a lot, and to whom you have felt a special emotional commitment in the last three months.

1 Yes

0 No Skip to instruction before E1a

8 Refuse to Answer Skip to instruction before E1a

READ: If you have more than one female primary partner in the last 3 months, please think only about your most recent female partner when answering these next two questions.

D4. Are you still in this primary relationship with your most recent primary female partner?

1 Yes

0 No Skip to instruction before E1a

8 Refuse to Answer Skip to instruction before E1a

D5. What is your most recent primary female partner's HIV status? (Choose one)

1 You believe she was HIV positive and had no reason to doubt it.

2 You believe she was HIV negative and had no reason to doubt it.

3 You did not know or were unsure about her HIV status.

8 Refuse to Answer

COVARIATES

READ: In the remaining questions, the time frame you will be asked to think about before you answer will change from section to section. Please keep this in mind and pay close attention to the instructions on the screen.

READ: Please rate the following statements on how true they are to you, on a scale from 1 (not true at all) to 5 (true nearly all the time).

	1	2	3	4	5
	Never true	Rarely true	Neutral	Sometimes true	Nearly always true
E1. I am able to adapt to change.
E2. I can deal with whatever comes.
E3. I try to see the humorous side of problems.
E4. Coping with stress can strengthen me.

Resiliency B

	1	2	3	4	5
	Never true	Rarely true	Neutral	Sometimes true	Nearly always true
E5. I tend to bounce back after illness or hardship.
E6. I can achieve goals despite obstacles.
E7. I can stay focused under pressure.
E8. I am not easily discouraged by failure.
E9. I think of myself as strong person.
E10. I can handle unpleasant feelings.

READ: Think about how well the following statements describe your behavior and actions on a scale from 1 to 5, where 1 means the statement does not describe you at all and 5 means it describes you very well.

	1	2	3	4	5
	Not at all like me	Slightly like me	Neutral	Mainly like me	Very much like me
E11. I actively look for ways to replace the losses I encounter in life.
E12. I believe that I can grow in positive ways by dealing with difficult situations.
E13. I look for creative ways to alter difficult situations.
E14. Regardless of what happens to me, I believe I can control my reaction to it.

READ: For each of the statements below, please indicate whether or not the statement is characteristic of you. If the statement is extremely uncharacteristic of you (not at all like you) please select "1 Extremely uncharacteristic”; if the statement is extremely characteristic of you (very much like you) select "5 Extremely characteristic". And, of course, use the numbers in the middle if you fall between the extremes. Please keep the following scale in mind as you rate each of the statements below.

	1	2	3	4	5
	Extremely uncharacteristic	Somewhat uncharacteristic	Uncertain	Somewhat characteristic	Extremely characteristic
E15. Often I engage in a particular behavior in order to achieve outcomes that may not result for many years.
E16. I only act to satisfy immediate concerns, figuring the future will take care of itself.
E17. My behavior is only influenced by the immediate (i.e., a matter of days or weeks) outcomes of my actions.
E18. My convenience is a big factor in the decisions I make or the actions I take.
E18a. For this question, please select “Somewhat uncharacteristic”
E19. I generally ignore warnings about possible future problems because I think the problems will be resolved before they reach crisis level.
E20. I think that sacrificing now is usually unnecessary since future outcomes can be dealt with at a later time.
E21. I only act to satisfy immediate concerns, figuring that I will take care of future problems that may occur at a later date.
E22. Since my day to day work has specific outcomes, it is more important to me than behavior that has distant outcomes.

READ: Please answer the next questions by indicating how much you agree with each statement. Answer on a scale from 1 to 5 where '1' indicates you do not agree at all and '5' indicates that you strongly agree.

	1	2	3	4	5	8
	Strongly Disagree	Somewhat Disagree	Neither	Somewhat Agree	Strongly Agree	Refuse to Answer
E23. Because of combination drug treatment for HIV, I am less concerned about becoming HIV+. (Choose one)

READ: Please answer the next questions by indicating how much you agree with each statement. Answer on a scale from 1 to 5 where '1' indicates you do not agree at all and '5' indicates that you strongly agree.

	1	2	3	4	5	8
	Strongly Disagree	Somewhat Disagree	Neither	Somewhat Agree	Strongly Agree	Refuse to Answer
E24. Because of combination drug treatment for HIV, I am less concerned about infecting someone. (Choose one)
E25. A lot of my friends use condoms. (Choose one)
E26. I can choose safer sex with a man I have sex with regularly. (Choose one)
E27. Someone can talk me out of safer sex by persuading me they are the same HIV status as me. (Choose one)
E28. If I ever did something risky, I am confident that I would go back to having safer sex right away. (Choose one)
E29. I am confident that I can have safer sex even if my partner really doesn't want to. (Choose one)
E30. Most gay men do not really use condoms anymore. (Choose one)
E31. Most gay men I meet only have safer sex practices. (Choose one)
E32. A lot of gay men just will not have sex with you if you insist on a condom. (Choose one)

READ: Please answer the next questions by indicating how much you agree with each statement. Answer on a scale from 1 to 5 where '1' indicates you do not agree at all and '5' indicates that you strongly agree.

	1	2	3	4	5	8
	Strongly Disagree	Somewhat Disagree	Neither	Somewhat Agree	Strongly Agree	Refuse to Answer
E33. HIV is a manmade virus.
E34. AIDS was produced in a government laboratory.
E35. There is a cure for AIDS, but it is being withheld from the poor.
E36. AIDS was created by the government to control the Black or Latino population.
E37. AIDS is a form of genocide, or planned destruction, against Blacks or Latinos.
E38. HIV was created and spread by the CIA.
E38a. For the question, please select “Neither”
E39. People who take the new medications for HIV are human guinea pigs for the government.
E40. The medication used to treat HIV causes people to get AIDS.

READ: For the next two items, please indicate how important each thing is to you - from "Not at all Important" to "Extremely Important".

	01	02	03	04	05	06	07	08	09	98
	Not at all Important								Extremely Important	Refuse to Answer
E41. How important is your race and ethnicity to your sense of who you are?
E42. How important is being gay / bisexual to your sense of who you are?

E43. How connected do you feel to the community of gay / bisexual men of your race and ethnicity?

01 Not at all Connected

02

03

04

05

06

07

08

09 Extremely Connected

98 Refuse to Answer

READ: For the following items, select the percentage that best represents you or your situation.

E44. What percent (%) of your friends and people you socialize with are the same race and ethnicity?

00 0%

01 10

02 20

03 30

04 40

05 50

06 60

07 70

08 80

09 90

10 100%

98 Refuse to Answer

E45. What percent of your friends and people you socialize with are gay / bisexual?

00 0%

01 10

02 20

03 30

04 40

05 50

06 60

07 70

08 80

09 90

10 100%

98 Refuse to Answer

E46. Do you feel that there is a community of gay / bisexual men of your race and ethnicity in your city?

1 Yes

0 No

8 Refuse to Answer

E47. What percent of your time do you spend with the community of gay / bisexual men or your race and ethnicity?

00 0%

01 10

02 20

03 30

04 40

05 50

06 60

07 70

08 80

09 90

10 100%

98 Refuse to Answer

READ: For the next four questions, you will be asked about your visits with your doctor. Please indicate how much you AGREE or DISAGREE with the following statements.

	1	2	3	4	8
	Agree a lot	Agree a little	Disagree a little	Disagree a lot	Refuse to Answer
E48. It is easy for me to ask my doctor questions.
E49. It is easy for me to ask for help if I don’t understand something.
E50. It is easy for me to understand my doctor’s instructions.
E51. It is easy for me to remember my doctor’s instructions.

E52. For the next 4 questions, think about times when you were prescribed medicine by a doctor when you were sick or for a chronic condition.

E52A. Do you ever forget to take your medicine?

1 Yes

2 No

8 Refused to answer

E52B. Do you ever have problems taking your medicine?

1 Yes

2 No

8 Refused to answer

E52C. When you feel better, do you sometimes stop taking your medicine before you should?

1 Yes

2 No

8 Refused to answer

E52D. Sometimes if you feel worse when you take your medicine, do you stop taking it?

1 Yes

2 No

8 Refused to answer

Technology Use

READ: The following questions are about your use of the internet and mobile phones.

E53. Do you have access to the internet when you want or need to use it?

___ yes

___no

E54. What do you use the internet for mostly? [check/confirm the following options in Formative Research]

___ email

____Facebook

____Twitter

___ Dating or hookup sites (M4M, etc)

___ Information and news

___ Skyping or other live video communications

___ other (specify) _____________________

E55. Do you own a mobile phone?

___Yes

___No

E56. What do you use your mobile phone for mostly? [check/confirm the following options in Formative Research]

___ Phone calls

____Texting

____Facebook

____Twitter

___ Dating or hookup sites (M4M, etc)

___ Information and news

___ Skyping or other live video communications

___ other (specify) _____________________

READ: The next set of items is more about your use of the internet.

E57. Which of the following have you used the internet for in the past 12 months? (check all that apply)

__ Information

__ To chat with men

__ To make friends

__ To find a long-term partner

__ To meet men for casual sex

__ For online sex (cyber sex)

__ Other (specify_____________)

__ Don't Know

__ Refuse to Answer

E58. How often have you used the internet to meet other gay men in the past 12 months? (Pull down)

__ Never

__ Once a month

__ 2-3 times a month

__ About once a week

__ 2-6 times a week

__ About once a day

__ More than once a day

__ Don't Know

__ Refuse to Answer

E59. How many sex partners have you met through the internet in the last 12 months? (text box) _____

E60. How frequently do you use the Internet to meet sexual partners? (Choose only one)

__ Never

__ Once a month or less

__ 2-3 times a month

__ About once a week

__ 2-6 times a week

__ About once a day

__ More than once a day

__ Don't Know

__ Refuse to Answer

If E60 is Never, skip to E62

E61. Which of the following Internet sites have you used to meet sexual partners in the past 12 months? [Check all that apply] [check/confirm the following options in Formative Research]

___ adam4adam.com

___ AOL.com

___ bareback.com

___ barebacksex.com

___ Bear411.com

___ cruisetool.com

___ cruisingforsex.com

___ cupid.com

___ gay.com

___ gaydar.co.uk

___ ICQ.com

___ m4m4sex.com

___ manhunt.net

___ match.com

___ men4now.com

___ men4sexnow.com

___ ultimatebareback.com

___ yahoo.com

___ Other (specify) _______________

___ Other (specify) _______________

E62. How frequently do you use the Internet to meet friends? (Choose only one)

__ Never

__ Once a month or less

__ 2-3 times a month

__ About once a week

__ 2-6 times a week

__ About once a day

__ More than once a day

__ Don't Know

__ Refuse to Answer

If E62 is Never, skip to End

E63. Which of the following Internet sites have you used to meet friends in the past 12 months?

[Check all that apply] [check/confirm the following options in Formative Research]

___ adam4adam.com

___ AOL.com

___ bareback.com

___ barebacksex.com

___ Bear411.com

___ cruisetool.com

___ cruisingforsex.com

___ cupid.com

___ gay.com

___ gaydar.co.uk

___ ICQ.com

___ m4m4sex.com

___ manhunt.net

___ match.com

___ men4now.com

___ men4sexnow.com

___ ultimatebareback.com

___ yahoo.com

___ Other (specify) _______________

READ: You have reached the end of this survey. Please tell the Study Coordinator that you are done.

Please do nothing else to the computer. DO NOT close the survey or the web browser.

The Study Coordinator will help you with the final steps of this study, including giving you the gift card as a token of appreciation.

Thank you for taking part in this important study.

E64. What happened on this baseline assessment? (Choose one)

1 Participant completed assessment

2 Participant did not finish assessment

If E64 is not equal to 2, then skip to end of questionnaire.

E65. Please type in why the participant was unable to finish.

__ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __

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