2017 NHANES Health Behaviors Cognitive Interviewing Study

Attachment 1a: Questions to be cognitively tested – English version

The Public Health Service Act provides us with the authority to do this research (42 United States Code 242k). All information which would permit identification of any individual, a practice, or an establishment will be held confidential, will be used for statistical purposes only by NCHS staff, contractors, and agents only when required and with necessary controls, and will not be disclosed or released to other persons without the consent of the individual or the establishment in accordance with section 308(d) of the Public Health Service Act (42 USC 242m) and the Confidential Information Protection and Statistical Efficiency Act (PL-107-347).

Public reporting burden for this collection of information is estimated to average 60 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/ATSDR Information Collection Review Office; 1600 Clifton Road, MS D-74, Atlanta, GA 30333, ATTN: PRA (0920-0222).

Form Approved OMB #0920-0222; Expiration Date: 07/31/2018

E-Cigarettes	Electronic nicotine delivery systems, or ENDS, are battery-operated systems that heat a solution containing nicotine and produce a vapor or aerosol instead of smoke.  People use them in a manner that simulates smoking.  Examples of ENDs are e-cigarettes, e-hookahs and vape pens.
NEW SMQ.1	During the last 7 days, were you in a place where someone was using an e-cigarette, e-hookah, vape-pen or other similar electronic product indoors?	Yes No
NEW SMQ.2	During the last 7 days, did you breathe the vapor from someone else who was using an e-cigarette, e-hookah, vape-pen or other similar electronic product indoors?	Yes No
	INTERVIEWER: “indoors” refers to any public or private space. Questions refer to being around OTHERS using e-cigarettes not use of e-cigarettes by the respondent.
Alcohol	The following questions ask about alcohol use. This includes beer, wine, wine coolers, and liquor such as rum, gin, vodka, or whiskey.
ALQ.NEW1	[Show hand card ALQ1] In your entire life, have you had at least 1 drink of any kind of alcohol, not counting small tastes or sips? By a drink, I mean a 12 oz. beer, a 5 oz. glass of wine, or one and a half ounces of liquor.	Yes No
ALQ.120	In the past 12 months, how often did you drink any type of alcoholic beverage?	_____/Day _____/Week _____/Year
	PROBE: How many days per week, per month, or per year did {you/Sample Person} drink?
Skip	IF ALQ.120=0, GO TO ALQ.151. OTHERWISE, CONTINUE WITH ALQ.130.
ALQ.130	[Show hand card ALQ1] In the past 12 months, on those days that you drank alcoholic beverages, on average, how many drinks did {you/he/she} have? (By a drink, I mean a 12 oz. beer, a 5 oz. glass of wine, or one and a half ounces of liquor.)	________#
ALQ.141	In the past 12 months, how often did {you/Sample Person} have {DISPLAY NUMBER} or more drinks of any alcoholic beverage?	_____/Day _____/Week _____/Year
Skip	IF ALQ.141Q = 0, GO TO ALQ.151. OTHERWISE, CONTINUE.
ALQ.NEW2	[HAND CARD ALQ2] In the past 12 months, about how often did {you/Sample Person} have {DISPLAY NUMBER} or more drinks in a period of TWO HOURS OR LESS?	Every Day Nearly Every Day 3-4 Times/week 2 Times/week Once a week 2-3 Times/Month One/Month 7-11 times/last year 3-6 times/last year 1-2 times/last year Never/last year
ALQ.NEW3	[HAND CARD ALQ2] In the past 12 months, about how often did {you/Sample Person} have 8 or more drinks in a single day?	Every Day Nearly Every Day 3-4 Times/week 2 Times/week Once a week 2-3 Times/Month One/Month 7-11 times/last year 3-6 times/last year 1-2 times/last year Never/last year

ALQ.NEW4	[HAND CARD ALQ2] In the past 12 months, about how often did {you/Sample Person} have 12 or more drinks in a single day?	Every Day Nearly Every Day 3-4 Times/week 2 Times/week Once a week 2-3 Times/Month One/Month 7-11 times/last year 3-6 times/last year 1-2 times/last year Never/last year
ALQ.151	Was there ever a time or times in {your/Sample Person’s} life when {you/he/she} drank {DISPLAY NUMBER} or more drinks of any kind of alcoholic beverage almost every day?	Yes No
NEWALQ.160	Considering all types of alcoholic beverages, during the past 30 days, how many times did {you/Sample Person} have [4 female/5 male] or more drinks on an occasion?	________# Times
ALCLIFE	In your ENTIRE LIFE, have you had at least 12 drinks of any type of alcoholic beverage?	Yes No
Skip	If ALCLIFE= 1, ask AL06, otherwise, END
AL06	During the past 30 days, on how many days did you drink one or more drinks of an alcoholic beverage?	________# Days
Skip	If AL06=0, ask ALC12MNO2
ALC12MNO2	In the past year, have you had one or more drinks of an alcoholic beverage?	Yes No
Skip	If AL06 is between 1-30, ask AL07 and AL08
AL07	During the past 30 days, on the days that you drank, about how many drinks did you drink on the average?	________# Drinks
ALC5UPNO2	During the past 30 days, on how many days did you have [5 or more/4 or more] drinks?	________# Days

HAND CARD #ALQ1

See Attachment 2a - Adobe file

HAND CARD #ALQ2

• Every Day

• Nearly Every Day

• 3-4 Times/week

• 2 Times/week

• Once a week

• 2-3 Times/Month

• One/Month

• 7-11 times/last year

• 3-6 times/last year

• 1-2 times/last year

Attachment 1b: Questions to be cognitively tested – Spanish version

The Public Health Service Act provides us with the authority to do this research (42 United States Code 242k). All information which would permit identification of any individual, a practice, or an establishment will be held confidential, will be used for statistical purposes only by NCHS staff, contractors, and agents only when required and with necessary controls, and will not be disclosed or released to other persons without the consent of the individual or the establishment in accordance with section 308(d) of the Public Health Service Act (42 USC 242m) and the Confidential Information Protection and Statistical Efficiency Act (PL-107-347).

Public reporting burden for this collection of information is estimated to average 60 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/ATSDR Information Collection Review Office; 1600 Clifton Road, MS D-74, Atlanta, GA 30333, ATTN: PRA (0920-0222).

Form Approved OMB #0920-0222; Expiration Date: 07/31/2018

E-Cigarettes - Los sistemas electrónicos de administración de nicotina son sistemas operadas por baterías que calientan una solución conteniendo nicotina y producen un vapor o aerosol en lugar de humo. La gente los usa en manera de simular fumar. Ejemplos de sistemas electrónicos de administración de nicotina son cigarrillos electrónicos, hookahs electrónicas, y pluma estilo de fumar electrónica.

1. Durante los úlimos 7 días, ¿{estuvo usted/estuvo SP} en un lugar donde alguien estaba usando un cigarrillo electrónico, hookah electrónica, pluma estilo de fumar electrónica, u otro producto electrónico parecido?

YES.......................................................................    1

NO.........................................................................    2

REFUSED............................................................     7

DON'T KNOW......................................................    9

2. Durante los últimos 7 días, ¿{estuvo usted/estuvo SP} en un automóvil o vehiculó de motor donde alguien estaba usando un cigarrillo electrónico, hookah electrónica, pluma estilo de fumar electrónica, u otro producto electrónico parecido?

YES.......................................................................    1

NO.........................................................................    2

REFUSED............................................................     7

DON'T KNOW......................................................    9

ALCOHOL

Las siguientes preguntas son acerca de tomar bebidas alcohólicas. Están incluídos licores (tales como wiskey o ginebra), cerveza, vino, sangría y cualquier otro tipo de bebida alcohólica.

Las siguientes preguntas son acerca del consumo de bebidas alcohólicas, las cuales incluyen cerveza, vino, sangría y licores como ron, ginebra, vodka o wiskey.

ALQ.NEW1 [Show hand card ALQ1]. En toda su vida, ¿se ha tomado al menos 1 bebida de cualquier tipo de alcohol, sin incluir probaditas o sorbos? Por bebida, quiero decir una cerveza de 12 onzas, una copa de vino de 5 onzas o una onza y media de licor.

YES 1

NO 2 (END OF SECTION)

REFUSED 7

DON'T KNOW 9

ALQ.120 En los últimos 12 meses, ¿con qué frecuencia se tomó {usted/SP} algún tipo de bebida alcohólica?

Q/U

PROBE: ¿Cuántos días por semana, por mes o por año tomó {usted/SP}?

|___|___|___|

ENTER QUANTITY

REFUSED 777

DON'T KNOW 999

ENTER UNIT

WEEK 1

MONTH 2

YEAR 3

ALQ.130 [Show hand card ALQ1]. En los últimos 12 meses, en aquellos días en que {usted/SP} se tomó algún tipo de bebida alcohólica, , ¿cuántas bebidas se tomó {usted(SE)/él(MPR)/ella(FPR)} en promedio? (Por bebida, quiero decir una cerveza de 12 onzas, una copa de vino de 5 onzas o una onza y media de licor.)

|___|___|___|

ENTER # OF DRINKS

REFUSED 777

DON'T KNOW 999

ALQ.141 Q/U

En los últimos 12 meses, ¿con qué frecuencia se tomó {usted/SP} {DISPLAY NUMBER} o más bebidas alcohólicas de cualquier tipo?

PROBE: ¿Cuántos días por semana, por mes o por año tomó {usted/SP} {DISPLAY NUMBER} o más bebidas alcóholicas en un solo día?

Skip: IF QUANTITY CODED ‘0’, GO TO ALQ.151

|___|___|___|

ENTER QUANTITY

REFUSED 777

DON'T KNOW 999

ENTER UNIT

WEEK 1

MONTH 2

YEAR 3

ALQ.NEW2

[HAND CARD ALQ2]. En los últimos 12 meses, ¿aproximadamente con qué frecuencia se tomó {usted/SP} {4/5} o más bebidas en un periodo de DOS HORAS O MENOS?

ALQ.NEW3

[HAND CARD ALQ2]. En los últimos 12 meses, ¿aproximadamente con qué frecuencia se tomó {usted/SP} 8 o más bebidas en un solo día?

ALQ.NEW4

[HAND CARD ALQ2]. En los últimos 12 meses, ¿aproximadamente con qué frecuencia se tomó {usted/SP} 12 o más bebidas en un solo día?

ALQ.151 ¿Hubo alguna vez un tiempo o tiempos en {su vida/la vida de SP} cuando {usted(SE)/él(MPR)/ella(FPR)} se tomó {4/5} o más bebidas alcóholicas de cualquier tipo, casi todos los días?

YES 1

NO 2

REFUSED 7

DON'T KNOW 9

NEWALQ.160 Piense en todos los tipos de bebidas alcohólicas. En los últimos 30 días, ¿cuántas veces se tomó {usted/SP} {4/5} o más bebidas alcóholicas en una ocasión?

|___|___|

ENTER QUANTITY

REFUSED 777

DON'T KNOW 999

ALCLIFE In your ENTIRE LIFE, have you had at least 12 drinks of any type of alcoholic beverage?

Durante TODA SU VIDA, ¿ha consumido por lo menos 12 tragos de cualquier tipo de bebida alcohólica?

1 Yes

2 No

DK/REF

If ALCLIFE= 1, ask AL06, otherwise, END:

AL06 During the past 30 days, on how many days did you drink one or more drinks of an alcoholic beverage?

En los últimos 30 días, ¿cuántos días bebió al menos un trago de cualquier tipo de bebida alcohólica?

# of DAYS ______ [RANGE: 0-30]

DK/REF

Enter ‘0’ if no drinks in past 30 days (Ningún trago en los últimos 30 días)

If AL06=0, ask ALC12MNO2:

ALC12MNO2 In the past year, have you had one or more drinks of an alcoholic beverage?

En CUALQUIER AÑO, ¿ha consumido por lo menos un trago de cualquier tipo de bebida alcohólica?

1 Yes

2 No

DK/REF

Regardless of answer to ALC12MNO2, go to END.

If AL06 is between 1-30, ask AL07 and AL08:

AL07 During the past 30 days, on the days that you drank, about how many drinks did you drink on the average?

En los últimos 30 días, en los días que bebió, ¿aproximadamente cuántos tragos tomó en promedio?

# OF DRINKS: _____ [RANGE: 1-90]

DK/REF

Enter ‘1’ if part of one drink

ALC5UPNO2 During the past 30 days, on how many days did you have [fill: 5 or more/4 or more] drinks?

DURANTE LOS ÚLTIMOS 30 DÍAS, ¿cuántas veces tuvo [fill: 5 o más / 4 o más] bebidas?

# DAYS __________ [0-30]

DK/REF

Enter ‘0’ for never

If respondent is male, fill 5 or more

If respondent is female, fill 4 or more

NEWALQ.160 Considering all types of alcoholic beverages. during the past 30 days, how many times did you have {DISPLAY NUMBER} or more drinks on an occasion?

Teniendo en cuenta todos los tipos de bebidas alcohólicas, DURANTE LOS ÚLTIMOS 30 DÍAS, ¿cuántas veces tuvo [fill: 5 o más / 4 o más] bebidas en una sola ocasión?

|___|___|

ENTER QUANTITY

REFUSED 777

DON'T KNOW 999

HAND CARD #ALQ1

See Attachment 2a - Adobe file

HAND CARD #ALQ2

• Todos los días

• Casi todos los días

• 3 a 4 veces por semana

• 2 veces por semana

• Una vez por semana

• 2 a 3 veces por mes

• Una vez por mes

• 7 a 11 veces en el último año

• 3 a 6 veces en el último año

• 1 a 2 veces en el último año

12 | Page