OMB No. 2127-XXXX
Expiration Date: X/XX/2017
Questionnaire – Version A
Intro/Vehicle Use
First, for some general background, we have a few questions about your living arrangement.
Right now, are you living in a………..
_______ House
________Townhouse
________Condo
_______ Apartment
_______ Dormitory
_______ or something else?
2. At this residence, with whom do you live?
a. Both parents
b. One parent – mother
c. One parent – father
d. A guardian (either a legal guardian, or a guardian who cares for you but hasn’t been appointed by the courts)
e. Others, but not with parent(s) or guardian(s)
f. I live alone.
Do you live there ………….
_______ All of the year
_______ More than 6 months, but less than a year
_______ About 6 months of the year
_______ Less than 6 months of the year
NHTSA Form 1199(a)
If Q3is less than all of the year CONTINUE, OTHERWISE GO TO Q7
During the rest of the year, do you live in a……..
_______ House
_______Townhouse
_______Condo
_______ Apartment
_______ Dormitory
_______ or something else
5. Who do you live with during those other times of the year?
a. Both parents
b. One parent – mother
c. One parent – father
d. Guardian (either a legal guardian, or a guardian who cares for you but hasn’t been appointed by the courts)
e. Others, but not with parent(s) or guardian(s)
f. Alone.
6. Do you tend to drive more while living at the place you are living at right now, or do you tend to drive more while living at the place(s) where you live the rest of the year?
_______ Drive more while living at current residence
_______ Drive more while living at the place(s) I live the rest of the year
_______ Neither, it’s about the same
[IF Q3 is less than all of the year > For the next set of questions, please think about the place where you drive the most.] Every week can be a little different, but we would like you to think about how much you drive and ride in a typical driving week. [Have a link to provide greater clarification. Also how to respond if there is no typical week.]
7. In a typical driving week, on how many days do you drive a motor vehicle?
_______ days
____ Never drive [SKIP TO Q14]
9. Is the vehicle you drive most often a car, SUV, van or minivan, pickup truck, motorcycle, or something else? (If you drive multiple vehicles about the same amount and can’t determine which of them you drive most often, select the one you drove most recently)
Car
SUV/Sport utility vehicle
Van or minivan
Pickup truck
Motorcycle
Other (including other kinds of trucks)—specify: ______________________
10. Who owns the vehicle that you drive most often? [mark all that apply]
□ I do Yes__ No__
□ My parent(s) Yes__ No__
□ Family member other than parent Yes__ No__
□ Someone else who is not a family member Yes__ No__
Again, if you live at different places during the course of the year, please base your response on the location where you drive the most.
In a typical driving week, how many days do you drive a motor vehicle at night, after 10:00 PM?
_______ days [DROPDOWN LIST]
12. In a typical driving week, how often do you drive by yourself?
All of the time
Most of the time
Some of the time
Rarely
Never
13. In a typical driving week, how many days do you drive with passengers in the vehicle who are under the age of 21?
_______ days per week
_______ less than once a week
_______ never drive with passengers in the vehicle who are under 21
14. In a typical week, how many days do you ride as a passenger in a motor vehicle with a driver who is under the age of 21? [Add link to define typical week]
_______ days per week
_______ less than once a week
_______ never ride as a passenger with a driver who is under 21
If Q7 = never drive SKIP TO Q22
15. Are there rules you are supposed to follow that restrict the following?
How late you are allowed to stay out with a motor vehicle □yes □no □n/a
The number of passengers that you are allowed to drive □yes □no □n/a
The age of the passengers that you are allowed to drive □yes □no □n/a
Your use of a cell phone while driving □yes □no □n/a
[FOR EACH YES IN 15 a., b., c., OR d., ASK #16, #17 And #18. IF NO TO ALL, GO TO #19.]
Who is requiring you to follow the rule? [Check all that apply.]
□ The law YES__ NO__
□ My School YES__ NO__
□ My Employer(s) YES__ NO__
□ My parent(s) YES__ NO__
□ Myself YES__ NO__
□ A family member other than parent YES__ NO__
□ Someone else who is not a family member (specify _____) YES__ NO__
If you broke the rule, how likely is it that you would be reprimanded by a parent (for example, being told not to do it again)?
Very likely
Somewhat likely
Not at all likely
Not applicable
18. If you broke the rule, how likely is it that you would be punished by a parent, where a privilege is taken away (for example, being grounded or having the keys taken)?
Very likely
Somewhat likely
Not at all likely
Not applicable
There are devices that parents can use to monitor how their children drive. The devices are installed in the car and may record specific actions such as quick stops or lane changes, seat belt use, driver speed, driving locations, or sound in the vehicle.
Are you driving a vehicle that has a monitoring device that your (parents/guardians) use to check your driving?
yes
no (Skip to Q21)
Don’t know (skip to Q21)
Not applicable (skip to Q21)
20 What is being recorded by the monitoring device that your (parents/guardians) are using to check your driving? (Check all that apply)
_____ Speed
_____ Driving maneuvers (such as lane changes or quick stops)
_____ Seat belt use
_____ Alcohol use
_____ Locations where the driver has driven
_____ Sound in the vehicle
_____ Crashes or accidents if they occur
_____ A video of driving activity
_____Other (specify)
21. In general, do you approve or disapprove of parents using devices such as these to monitor the driving of their children?
Strongly approve
Approve
Neither approve nor disapprove
Both approve and disapprove
Disapprove
Strongly disapprove
Driver Licensing
22. Which of the following describes your own license for driving (Check all that apply):
a) a Full Driver’s License, with no provisions
b) a Provisional Driver’s License
c) a Learner’s Permit
d) a Farm Permit or License
e) a Motorcycle License
f) a Suspended or Revoked License
g) I do not have a Learner’s Permit or any kind of driver’s license [go to Q34]
[PROVIDE A HYPERLINK WITH CLARIFICATION UNDER CATEGORY b: A provisional license has special rules that a driver must follow. Some States require that new drivers receive a provisional license before they can receive a full, unrestricted driver’s license
[DROPDOWN LIST WITH ALL THE 50 STATES]
23. What State did you get your driver’s license in? _________ [STATE]
Cell Phone Use
When you drive a motor vehicle, do you usually have a cell phone in the vehicle with you?
Yes
No
25 When you are driving, how often do you keep the cell phone within arm’s length? Arm’s length is when you don’t have to move to reach it.
On all driving trips
On most driving trips
On some driving trips
On almost no driving trips
Never
26. How often do you talk on the phone while you are driving?
On all driving trips
On most driving trips
On some driving trips
On almost no driving trips
Never (skip to #28)
27. When you talk on the phone while driving, which do you do most often:
______ Hold the phone
______ Use a hands-free set
______ Use a speakerphone
______ Half and half between holding the phone and using a hands-free set
_______ Half and half between holding the phone and using a speakerphone
28. If you are driving and your phone rings, what do you do most often:
_____ Answer the phone
_____ Look to see who is calling, then decide whether to answer the phone
_____ Look to see who is calling, but always delay answering until no longer driving
_____ I ignore it until later
_____ Never rings while driving/I turn it off
29. How often do you read text messages while you are driving and the vehicle is moving?
a) On all driving trips
b) On most driving trips
c) On some driving trips
d) On almost no driving trips
e) Never
30. How often do you send text messages while you are driving and the vehicle is moving?
a) On all driving trips
b) On most driving trips
c) On some driving trips
d) On almost no driving trips
e) Never
When you’re the driver of a car, how much do you think each of the following things would reduce the quality of your driving? (RANDOMIZE)
using a hands-free cell phone while driving
does not reduce quality of driving
somewhat reduces the quality of driving
greatly reduces the quality of driving
using a hand-held cell phone while driving
does not reduce quality of driving
somewhat reduces the quality of driving
greatly reduces the quality of driving
reading text messages while driving
does not reduce quality of driving
somewhat reduces the quality of driving
greatly reduces the quality of driving
sending text messages while driving
does not reduce quality of driving
somewhat reduces the quality of driving
greatly reduces the quality of driving
eating snack foods while driving, such as chips or candy
does not reduce quality of driving
somewhat reduces the quality of driving
greatly reduces the quality of driving
drinking a beverage while driving
does not reduce quality of driving
somewhat reduces the quality of driving
greatly reduces the quality of driving
talking to passengers while driving
does not reduce quality of driving
somewhat reduces the quality of driving
greatly reduces the quality of driving
operating the radio or entertainment system while driving
does not reduce quality of driving
somewhat reduces the quality of driving
greatly reduces the quality of driving
33. When you take your eyes off the road for more than a few seconds at a time while driving, is it usually because you are……..?
Looking around to see what’s in the area
Checking something in the vehicle
______ Looking at a passenger
______ Eating or drinking
______ Using a mobile electronic device such as a cell phone or iPod
______ Reading
______ Touching or adjusting the entertainment system
______ Grooming yourself, such as putting on makeup, shaving, or looking at yourself in the mirror
Or something else (specify )
34. How many seconds do you believe a driver can take his or her eyes off the road before driving becomes significantly more dangerous?
Seconds Range 0-60
35. In the past 30 days, how many days, if any, have you been a passenger in a motor vehicle when you had concerns for your safety because the driver was not paying enough attention to his or her driving?
_____ DAYS Range 0-30
Belts
IF Q7=never drive SKIP TO Q40
When you are driving a motor vehicle, how often do you wear a seatbelt?
37. When was the last time that you did not wear a seat belt while driving—was it
a) within the past week
b) within the past month
c) within the past year
d) more than a year ago [go to #40]
e) never [go to #40]
38. Who was in the vehicle with you the last time you were driving without wearing a seat belt? (check all that apply).
___ Nobody, was driving alone
___ Friends about your age
___ Brother(s) or sister(s)
___ Your parent(s)
___ Adult(s) other than your parent(s)
___ Someone else (specify) ___________
39. Do you agree or disagree with the following statements.
“Sometimes I do not wear my seat belt while driving because…
a. I’m only driving a short distance ___agree ___ disagree
b. I’m in a rush ___ agree ___ disagree
c. The seat belt is uncomfortable ___ agree ___ disagree
d. I forgot to put it on ___ agree ___ disagree
e. My passengers aren’t wearing them ___ agree ___ disagree
f. I just don’t feel like it ___ agree ___ disagree
40. When you are a passenger in the front seat of a motor vehicle, how often do you wear a seat belt?
a) all of the time [go to #43}
b) most of the time
c) some of the time
d) rarely
e) never
f) never ride as a passenger in the front seat of a motor vehicle [go to #43]
41.The last time that you were a passenger in the front seat and were not wearing a seat belt, who was driving the motor vehicle?
a) a friend about your age
b) a brother or sister
c) one of your parents
d) an adult other than your parent
e) someone else (specify) ___________
42. Do you agree or disagree with the following statements.
“Sometimes I do not wear my seat belt while riding as a passenger in the front seat because…
a. I’m only riding a short distance ___agree ___ disagree
b. I’m in a rush ___ agree ___ disagree
c. The seat belt is uncomfortable ___ agree ___ disagree
d. I forgot to put it on ___ agree ___ disagree
e. The driver isn’t wearing one ___ agree ___ disagree
f. I just don’t feel like it ___ agree ___ disagree
g. It might insult the driver ___ agree ___ disagree
43. When you are a passenger in the back seat of a motor vehicle, how often do you wear a seatbelt?
a) all of the time [go to #46]
b) most of the time
c) some of the time
d) rarely
e) never
f) I never ride as a passenger in the back seat of a motor vehicle [go to #46]
44. The last time that you were a passenger in the back seat and were not wearing a seat belt, who was driving the motor vehicle?
a) a friend about your age
b) a brother or sister
c) one of your parents
d) an adult other than your parent
e) someone else (specify) ___________
45. Do you agree or disagree with the following statements?
“Sometimes I do not wear my seat belt while riding as a passenger in the back seat because…
a. I’m only riding a short distance ___agree ___ disagree
b. I’m in a rush ___ agree ___ disagree
c. The seat belt is uncomfortable ___ agree ___ disagree
d. I forgot to put it on ___ agree ___ disagree
e. The driver isn’t wearing one ___ agree ___ disagree
f. I just don’t feel like it ___ agree ___ disagree
g. It might insult the driver ___ agree ___ disagree
h. I can’t find the seat belt ___ agree ___ disagree
i. It’s not necessary to wear a belt in the back seat ___ agree ___ disagree
46. How often [does your parent, do your parents] usually wear their seat belts when driving a motor vehicle? [If answer differs by parent, please answer according to the parent you ride with most often.]
all of the time
most of the time
some of the time
rarely
never
Not applicable
47. In general, how often do friends about your age wear their seat belts when they’re driving?
a) all of the time
b) most of the time
c) some of the time
d) rarely
e) never
48. Do you ever ask passengers to fasten their seat belt when you’re driving?
Yes, I ask every time I see a passenger not buckling up
Yes, I sometimes ask
c) No, I never drive with passengers
d) No, my passengers always buckle up
e) No, I never ask unbuckled passengers to buckle up
f) Not applicable
Police Stops/Enforcement
IF Q7=never drive SKIP TO Q52
49. In the past 12 months, how many times have you been stopped by the police while driving a motor vehicle? [Provide link for definition of stop]
_____ [NUMBER] {If zero, go to question #52}
50. Of the times you were stopped, how many times did you receive a ticket?
_____ [NUMBER] {If zero, go to question #52}
51. What was/were the violation(s) that were marked on the ticket(s)?
[check all that apply]
_____ Speeding
_____ Running a red or yellow light
_____ Driving without a seat belt
_____ failure to use a turn signal
_____ careless or reckless driving
_____ failure to stop at a stop sign
_____ using a cell phone while driving
______ minor in possession
______ violation of zero tolerance
___________________________ other (specify)
52. How much attention do you pay to messages in the media about police enforcement of traffic safety laws?
I pay a lot of attention
I pay some attention
I pay almost no attention
I never see or hear enforcement messages
Crash Experience
The next questions are about crashes and accidents where there was moderate or greater damage to a vehicle. Do not include crashes that resulted only in small scratches or small dents.
Regardless of who was at fault, have you ever been the driver of a vehicle involved in a crash or accident?
____ Yes
____ No [Skip to Q58]
____ Never been a driver [skip to Q58]
How many times have you been the driver of a vehicle that was involved in a crash or accident? Again, do not include crashes that resulted only in small scratches or small dents. [DROPDOWN LIST]
____ times [if Q54=0 skip to Q58]
In how many of these crashes or accidents where you were driving were you wearing a seat belt?
____ times
In how many of these crashes or accidents where you were driving were you injured seriously enough that you received medical attention?
____ times
How long ago was the most recent time you were involved in a crash or accident as a driver?
a. Less than one year ago
b. Between one and two years ago
c. Between two and three years ago
d. More than 3 years ago
58. Have you ever been a passenger in a vehicle involved in a crash or accident where the driver was under 21 years of age? Again, do not include crashes that resulted only in small scratches or small dents.
____ Yes
____ No [go to Q63]
59. How many times have you been a passenger in a vehicle that was involved in a crash or accident where the driver was under 21 years of age? [DROPDOWN LIST]
____ times [If Q59=0 skip to Q63]
60. In how many of these crashes or accidents where you were a passenger were you wearing a seat belt?
____ times
61. In how many of these crashes or accidents where you were a passenger were you injured seriously enough that you received medical attention?
____ times
How long ago was the most recent time you were involved in a crash or accident as a passenger where the driver was under 21 years of age?
a. Less than one year ago
b. Between one and two years ago
c. Between two and three years ago
d. More than 3 years ago
IF Q7=never drive SKIP TO Q67
63. Near misses occur when a driver has to suddenly brake or rapidly steer the vehicle to avoid a crash or accident.
In the past 30 days, how many near misses have you been involved in as a driver? [dropdown list]
____ times
Alcohol/Substance Use
The next questions ask about driving after drinking alcohol.
64. In the past 30 days, how many days, if any, have you driven a motor vehicle within 2 hours after drinking alcoholic beverages? [dropdown list] [pop-up message (enter digits) Q64 to Q70]
_____ DAYS [IF ZERO, GO TO #67]
65. In the past 30 days, how many days, if any, have you driven a motor vehicle within 2 hours of having 5 or more drinks of alcohol?
_____ DAYS
66. In the past 30 days, how many days, if any, have you driven a motor vehicle while feeling buzzed from drinking alcohol?
_____ DAYS
67. In the past 30 days, how many days, if any, have you been a passenger in a motor vehicle when you think the driver was buzzed from drinking alcohol?
_____ DAYS
68. In the past 30 days, how many days, if any, have you been a passenger in a motor vehicle when you had concerns for your safety because of the amount of alcohol the driver had been drinking?
_____ DAYS
IF Q7=never drive SKIP TO Q70
69. In the past 30 days, how many days, if any, have you driven a motor vehicle while you were feeling buzzed, sleepy, or disoriented from using a drug other than alcohol? This could be a prescription or non-prescription drug.
_____ DAYS
70. In the past 30 days, how many days, if any, have you been a passenger in a motor vehicle when you think the driver was high on some drug or substance other than alcohol?
_____ DAYS
IF Q7=never drive SKIP TO Q79
Drowsy Driving
71. Have you ever fallen asleep or nodded off even for a moment while driving?
____ Yes
____ No
72. If you feel sleepy while driving, what if anything do you do to stop it? (Check all that apply)
____Pull over and take a nap
____Eat
____ Get coffee/soda/caffeine
____Take a stimulant (such as No-Doz)
____Turn the radio on loud
____Shake your head
____Open the widow
____Make a call on your cell phone
____ Sing or talk to yourself
____Change drivers
____Nothing
Speed
73. Which statement best describes your driving?
______ I tend to pass other cars more often than other cars pass me
______ other cars tend to pass me more often than I pass them
______ It’s about equal – I pass other cars as often as other cars pass me
74. How often do you drive 20 or more miles faster than most other vehicles are going?
____ All the time
____ Most of the time
____ Some of the time, or
____ Never
75. To what extent do you agree or disagree with the following statements:
“I like driving fast.”
____ Strongly agree
____ Somewhat agree
____ Neither agree nor disagree
____ Somewhat disagree
____ Strongly disagree
“Slow drivers make me angry.”
____ Strongly agree
____ Somewhat agree
____ Neither agree nor disagree
____ Somewhat disagree
____ Strongly disagree
“The faster I drive, the more alert I am.”
____ Strongly agree
____ Somewhat agree
____ Neither agree nor disagree
____ Somewhat disagree
____ Strongly disagree
“I try to get where I am going as fast as I can.”
____ Strongly agree
____ Somewhat agree
____ Neither agree nor disagree
____ Somewhat disagree
____ Strongly disagree
The next questions are about racing. By racing, we mean any time that two or more drivers are trying to go faster than each other. Racing may occur on public roads, private roads, parking lots, official or non-official racetracks, or in other locations. Racing can be for short or long distances and have an end point.
76. In the past 12 months, have you ever raced while driving a motor vehicle? Check all that apply.
____ Yes, on public roads [provide link to define]
____ Yes, on private roads [provide link to define]
____ Yes, in parking lots
____ Yes, on sanctioned or official racetracks
____ Yes, on non-sanctioned or non-official racetracks
____ Yes, other location (specify______)
____ No [go to #79]
77. In the past 12 months, how many times have you raced while driving a motor vehicle.
______ times
78.The last time you raced while driving a motor vehicle, how many people were in the vehicle with you? [dropdown list]
______ [NUMBER]
79. In the past 12 months, have you ever been a passenger in a motor vehicle that was racing another motor vehicle? Check all that apply.
____ Yes, on public roads [provide link to define]
____ Yes, on private roads [provide link to define]
____ Yes, in parking lots
____ Yes, on sanctioned or official racetracks
____ Yes, on non-sanctioned or non-official racetracks
____ Yes, other location (specify______)
____ No [go to #78]
80. In the past 12 months, how many times have you been a passenger in a motor vehicle that was racing another motor vehicle?
_____ [NUMBER]
The next questions are about your opinions about racing.
81. Do you think racing another vehicle is…
_____ Very dangerous
_____ Somewhat dangerous
_____ A little dangerous
_____ Not at all dangerous
82. Do you think the idea of racing another vehicle sounds…
_____ Very exciting
_____ Somewhat exciting
_____ A little exciting
_____ Not at all exciting
The next questions collect some basic information about you, and are the final questions in the survey.
83 What is your age?
_____ Years old (RANGE=16-21)
84 Are you a male or a female?
1 Male
2 Female
85 Do you consider yourself to be Hispanic or Latino?
1 Yes
2 No
86 Which of the following racial categories describes you? You may select more than one. READ LIST AND MULTIPLE RECORD.
1 American Indian or Alaskan Native
2 Asian
3 Black or African‑American
4 Native Hawaiian or Other Pacific Islander
5 White
87 Are you currently attending school full time or part time?
1 Yes, attending school full time
2 Yes, attending school part time
3 No
88 Are you currently working for pay, either full time or part time?
1 Yes, working full time
2 Yes, working part time
3 No
That completes the survey. Thank you very much for your time and cooperation.
| File Type | application/msword |
| File Title | Vehicle Use |
| Author | Kristen Miller |
| Last Modified By | alan.block |
| File Modified | 2014-05-05 |
| File Created | 2014-03-28 |