Form 3 Household Screening Questionnaire

NSFG 2009-2012 Attachment G4 OMB No. 0920-0314

ATTACHMENT G4: Household Screening Questionnaire

HOUSEHOLD ROSTER; DEMOGRAPHIC CHARACTERISTICS;

WITHIN HOUSEHOLD SELECTION PROTOCOL

This first section of the screener will be on a laminated hard copy. The computerized portion begins after a household member has been confirmed or selected to be the informant.

------------------------ HARD COPY BEGINS HERE ---------------------------

{ RULES FOR WHO CAN PROVIDE THE SCREENER INFORMATION:

{ a. You should complete the screener with an adult, 18 years or older.

{ b. If an emancipated minor lives with another adult, that adult

{ should complete the screener.

{ c. If the household consists only of married teens 15-17 years old OR

{ if it consists only of an emancipated minor (15-17 years old), you

{ may conduct the screener with this individual, after asking if

{ she/he is Aemancipated@ (relying on self-report).

INTRO

SC-1. I am (INTERVIEWER=S NAME) from the University of Michigan. Here is my identification card. We are conducting the National Survey of Family Growth for the National Center for Health Statistics, which is part of the US Department of Health and Human Services.

This letter explains all about this survey. You may remember receiving this letter and a brochure in the mail recently. Please take some time to read this important information.

{ IF NECESSARY, YOU MAY READ THE LETTER TO THE HOUSEHOLD MEMBER.

Do you have any questions about anything (you have read/I have read to you) about the National Survey of Family Growth?

INTRO2

SC-1b. I have a few questions that tell us whether anyone living here can take part in our study. These questions take about 5 minutes. I have to ask these questions only of an adult member of the household. Are you 18 or over?

{IF PERSON IS NOT AGE 18 OR OLDER

May I please speak to someone in the household who is age 18 or older?

{IF NO ADULTS LIVE IN THE HOUSEHOLD, ASK:

Are you married? (IF NO:) Are you legally emancipated?

{IF YES, CONTINUE WITH SC-1c INTRO3

{IF NO, ATTEMPT TO SCHEDULE ANOTHER VISIT WHEN AN ADULT WILL BE HOME

INTRO3

SC-1bc This interview is completely voluntary and confidential. If there is any question that you do not wish to answer, please let me know and we can move on to the next question.

May I ask you these questions now?

Yes ...........1 (CONTINUE WITH HOUSEHOLD SCREENER)

No ............5 (ATTEMPT TO SCHEDULE ANOTHER TIME)

-------------- HARD COPY ENDS HERE ------------------------------------------

{ VARIABLE IS CREATED THAT HOLDS THE DATE OF ADMINISTRATION OF THE SCREENER

{ A grid is displayed for entry of the demographic characteristics of the

{ household members. Household members' names or initials are entered in the

{ first column which prompts the member-by-member characteristics loop.

TABLE HHL APPEARS...

	Name	Sex	Age	Race	Hisp	DormRes
HHL[1]
HHL[2]
HHL[3]
HHL[4]
HHL[5]
HHL[6]
HHL[7]
HHL[8]
HHL[9]
HHL[10]
HHL[11]
HHL[12]
HHL[13]
HHL[14]
HHL[15]

NAME[X]

SC-2 Can you give me the name (or initial) of the people who usually live here? Please include any unmarried children away from home living in a dormitory, fraternity or sorority.

ENTER Name.

{ Begin member characteristics loop -- from SEX[X] through DORMRES[X].

{ Demographic data will be collected for each household member.

SEX[X]

SC-3 If necessary ASK: (Is (NAME[X]) male or female?)

Male ................1

Female ..............2

AGE[X]

SC-4 How old (is (NAME[X] / are you)?

If necessary, ASK: (How old was(NAME[X]) on (his/her) last birthday?)

ENTER age in years as of last birthday.

ENTER [0] if less than 1 year.

HISP[X]

SC-5 (Does (NAME[X] / Do you) consider (himself/ herself / yourself) to be Hispanic or Latino?

Yes.....................1

No......................5

RACE[X]

SC-6 What race (does (NAME[X) / do you) consider (himself/ herself / yourself) to be?

READ list:

American Indian or Alaska Native.........1

Asian....................................2

Native Hawaiian or

other Pacific Islanded.............3

Black or African-American................4

White....................................5

{ ASKED IF HOUSEHOLD MEMBER X IS BETWEEN 17 AND 22 YEARS OLD

DORMRES[X]

SC-7 (Does (NAME[X]) live in a college or university dormitory, fraternity, or sorority during the school year?

Yes.....................1

No......................5

ENDROSTER

SC-8a Before we finish, are there any other members of this household who are currently living in a college or university, dormitory, fraternity, or sorority?

{ If there are additional members of the household who reside in a dormitory,

{ then member is added to household grid and demographic characteristics

{ questions are asked for this member.

VERROSTER

SC-8b DISPLAYED FOR ALL:

PLEASE REVIEW THE ROSTER WITH THE SCREENER INFORMANT:

{Roster information is displayed and informant verifies accuracy and corrects

{information if needed.

{ computer determines whether any member of the household is age-eligible

( READ IF ALL HOUSEHOLD MEMBERS' AGES ARE UNDER 15 OR OVER 44

EXITAGE

SC-9 Thank you. In this study, we are only interviewing men and women between the ages of 15 and 44. So, these are all the questions I have for you now. On behalf of the University of Michigan, the US Public Health Service, and the Department of Health and Human Services, I thank you for taking time to help with this survey.

( ASKED IF ANY HOUSEHOLD MEMBER'S AGE IS BETWEEN 15 AND 44

INFORMANT

SC-10 ASK if necessary: Who am I talking to now?

NAME[1]....................1

NAME[2]....................2

NAME[3]....................3

...

NAME[15]..................15

Informant is not in HH....96

{ Computer selects one person using the within-household selection protocol

( ASKED IF SELECTED RESPONDENT LIVES IN A DORMITORY

EXITSCR1

SC-11 Thank you for your time. (RNAME) has been selected to provide additional information for this study. Is (RNAME) currently away at school or college?

Yes.....................1

No......................5

( ASKED IF SELECTED RESPONDENT DOES NOT LIVE IN A DORMITORY

EXITSCR2

SC-12 If selected Respondent is older than 17 and the above question EXITSCR1 was just read, and the answer was "no", ASK:

May I speak to (RNAME) now?

If selected Respondent is older than 17, ASK:

Thank you for your time. (RNAME) has been selected to provide additional information for this study. May I speak to (RNAME) now?

If selected Respondent is 17 or younger, ASK:

Thank you for your time. (RNAME) has been selected to provide additional information for this study. May I speak to a parent or guardian of (RNAME) now?

If selected Respondent is 17 or younger and the above question EXITSCR1 was just read (regardless of answer), ASK:

May I speak to a parent or guardian of (RNAME) now?

Yes.....................1

No......................5

{ ASKED IF IF SELECTED RESPONDENT LIVES IN A DORMITORY:

STDORMCON

SC-13 May I have a telephone number to contact (RNAME)?

LANG

SC-14 INTERVIEWER:

Please code the likely interview language.

English.................1

Spanish.................2

Unknown.................3

Other...................4

{ exit screener

5