Zika Readiness Initiative Questionnaire - English

Form Approved

OMB No. 0920-1136

Expires 3/31/2017

Zika Readiness Initiative Questionnaire - English

SAMPLE READ-IN: FRAME

1. Landline

2. Cell Phone

S.1 [INTRODUCTION] Hello, my name is __________ and I am calling from Abt SRBI on behalf of the Centers for Disease Control and Prevention. We are conducting an important study about public knowledge and opinions concerning the Zika virus. The survey will only take about 12 minutes.

[CONTINUE IN ENGLISH]

[CONTINUE IN SPANISH]

[ASK ALL]

S.2 First, to ensure your safety I’d like to ask, are you driving a car right now?

1 Yes, driving or in another unsafe place [SCHEDULE CALLBACK]

2 No [ASK S.3]

S.3 Have I reached you on a cell phone?

1 Yes [CODE AS CELL PHONE MODE] [IF SAMPLE RECORD IS IN LANDLINE FRAME BUT TURNS OUT TO BE A CELL PHONE, GO TO TERMINATE]

2 No [CODE AS LANDLINE MODE]

9 Refused [GO TO TERMINATE]

S.4 Are you 18 years of age or older?

1 Yes [GO TO S.6]

2 No [ASK S.5]

9 Refused [GO TO TERMINATE]

[IF LANDLINE MODE (S.3=2), SKIP TO S.5.2]

S.5 Is this your own cell phone or does it belong to someone over 18?

1 Cell phone belongs to someone under 18 [GO TO TERMINATE]

2 Cell phone belongs to an Adult 18+ [SCHEDULE CALLBACK]

9 Refused [GO TO TERMINATE]

S.5.2 Is there an adult in the household that I can speak to (someone over 18)?

1. Yes [GO TO S.5.3 AFTER ADULT IS BROUGHT TO PHONE]

2. No adult at home right now [SCHEDULE CALLBACK]

Public reporting burden for this collection of information is estimated to average 12 minutes per response, including 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 current valid OMB control number.  Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing burden to:  CDC/ATSDR Information Collection Review Office, 1600 Clifton Road, MS D-74, Atlanta, GA 30333, ATTN:  PRA (0920-1136).

S.5.3 Hello, my name is __________ and I am calling from Abt SRBI on behalf of the Centers for Disease Control and Prevention. We are conducting an important study about public knowledge and opinions concerning the Zika virus. The survey will only take about 12 minutes.

[CONTINUE IN ENGLISH]

[CONTINUE IN SPANISH]

S.5.4 Are you 18 years of age or older?

1 Yes

2 No [ASK S.5.2]

9 Refused [GO TO TERMINATE]

[IF CELL PHONE MODE SURVEY (S.3 = 1), GO TO CONSENT SECTION (S.14a)]

[IF LANDLINE MODE SURVEY (S.3 = 2), GO TO RESPONDENT SELECTION (S.6)]

S.6 Now I need to select one adult who lives in your household to be interviewed. How many current members of your household (including yourself) are 18 years of age or older?

[READ IF NEEDED]: Household members are those who spend a majority of their time living in the household.

RECORD 88 FOR NOT A PRIVATE RESIDENCE

RECORD 99 FOR REFUSED/DK

_________ Number of adults [RANGE 0-20]

[IF NO ADULTS (S.6 = 0) OR NOT A PRIVATE RESIDENCE (S.6 = 88) OR REFUSED/DK (S.6 = 99), GO TO TERMINATE]

[IF ONLY 1 ADULT (S.6 = 1) ASK S.7, ELSE IF MORE THAN ONE ADULT (HH>1) ASK S.9]

S.7 And just to confirm, are you the one adult in this household?

1 Yes [GO TO S.14]

2 No [GO TO S.8]

9 Refused [GO TO TERMINATE]

[ASK S.8 IF S.7 = 2 (NOT THE ADULT)]

S.8 May I speak with the adult who lives in this household?

1 Yes - available [GO TO S.12]

2 No - not available [GO TO S.11]

9 Refused [TERMINATE]

[IF MORE THAN ONE ADULT (S.6 > 1) ASK S.9]

S.9 How many of these adults are men and how many are women?

[INTERVIEWER: RECORD 99 FOR REFUSED]

___ MEN

___ WOMEN

[If either NUMMEN or NUMWOMEN = 99 GO TO TERMINATE]

S.10 Could I please speak with ___________? [RANDOMLY PICKED GENDER/AGE ORDER]

1 Yes - available [GO TO S.12]

2 No - not available [GO TO S.11]

9 Refused [GO TO TERMINATE]

[PROGRAMMER’S NOTE: AFTER GENDER IS SELECTED, IF THERE IS ONLY ONE PERSON OF THE SELECTED GENDER, DROP “OLDEST” ADJECTIVE]

[IF PICKED PERSON IS NOT AVAILABLE]

S.11 [If S.8 = 2] May I please have the adult's name so we can ask for [him/her] when we call back?/[If S.10 = 2] May I please have the [PICKED PERSON’S] name so that we can ask for them when we call back?

1 Gave response [ENTER RESPONSE]

8 Don’t know [VOL] [SCHEDULE CALLBACK]

9 Refused [VOL] [SCHEDULE CALLBACK]

S.12 [INTERVIEWER: SELECT LANGUAGE]

1 English

2 Spanish

S.13 [INTRODUCTION FOR NEW RESPONDENT:]

Hello, my name is __________ and I am calling from Abt SRBI on behalf of the Centers for Disease Control and Prevention. We are conducting an important study about public knowledge and opinions concerning the Zika virus. The survey will only take about 12 minutes.

[GENDER BY OBSERVATION; READ ONLY IF NECESSARY]

S.14a What is your gender? Or what gender do you consider yourself to be? [INTERVIEWER: DO NOT READ CHOICES; IF RESPONDENT SAYS ‘TRANSGENDER’, ASK THEM WHAT GENDER THEY IDENTIFY WITH]

1. Male

2. Female

S.14b. Are you between 18 and 44 years of age, or are you older than 44 years of age?

1. Between 18 and 44 years of age

2. Older than 44 years of age

[CHECK QUOTAS TO ENSURE A 75% 18-44, 25% 45+ AGE BALANCE; IF OVERQUOTA, GO TO S.19]

[ASK S.14c IF IN MIAMI, HOUSTON, OR MISSISSIPPI MARKETS; IF PUERTO RICO MARKET, ASK S.14c2]

S.14c. What state do you currently reside in? [TERMINATE IF STATE IS NOT FL, TX OR MS, OR IF DK OR REF]

1. ___________ Gave Answer

8. [VOL] Don’t Know

9. [VOL] Refuse

S.14c2. Do you currently reside in Puerto Rico?

1. Yes

2. No

1. [VOL] Don’t Know

2. [VOL] Refuse

[TERMINATE IF ‘NO’, ‘Don’t Know’, OR ‘Refuse’]

[ASK IF IN MIAMI OR HOUSTON MARKETS, ELSE SKIP TO S.15]

S.14d. What county do you currently reside in? [TERMINATE IF COUNTY IS NOT ONE OF THE TARGETED COUNTIES IN FLORIDA OR TEXAS]

1. ___________ Gave Answer

1. [VOL] Don’t Know

2. [VOL] Refuse

[ASK IF S.14d = “Don’t Know” OR “Refuse”, ELSE SKIP TO S.15]

S.14e. In which zip code do you currently live? ENTER FIVE DIGIT ZIP CODE.

[TERMINATE IF ZIP CODE DOES NOT MATCH THE MIAMI OR HOUSTON DMA’S FRAME OF ZIP CODES]

1_________Gave Answer

8 [VOL] Don’t know

9 [VOL] Refuse

CONSENT

S.15 Now that we are ready to begin, I am required to read the following to you: There are no costs to you for being in this study and your participation is completely voluntary. This interview will take about 12 minutes to complete. The study is funded by the Center for Disease Control and Prevention. You may refuse to answer any questions and may choose to quit the study at any time. The risks to you for participating in this study are minimal. You may experience some discomfort when answering some of the more personal questions.

We can assure you that procedures to protect the confidentiality of your data will be strictly followed, with your answers kept in a secure database only accessible to the researchers working on this study.

May I continue with the interview?

1 Continue; R agrees to interview [GO TO S.17] [QUALIFIED LEVEL = 1]

2 R does not agree to interview after consent is read [ASK S.16]

S.16 Can you tell me why you don’t wish to participate in the interview?

_____________

[GO TO TERMINATE]

S.17 Are you in a place where you can speak freely?

1 Yes [GO TO A.1]

2 No [ASK S.18]

S.18 Would you like to move to a place where you are comfortable and can answer the interview questions?

1 Ready for interview [GO TO A.1] [QUALIFIED LEVEL=2]

2 Wants to move [WAIT FOR MOVE OR SCHEDULE CALLBACK]

3 Wants to be called back [SCHEDULE CALLBACK]

S.19 Thank you for your participation. These are all of the questions I have for you today. [IF ASKED WHY: “We need to speak to a certain number of people in each age group. We have spoken to the required number of people in your age group.”] [TERMINATE INTERVIEW]

[INSERT S SECTION SECTIONAL TIMING]

1. Zika Virus

Awareness

A.1 Have you heard about the Zika virus?

1. Yes

2 No [SKIP TO B.1]

8 [VOL] Don’t Know [SKIP TO B.1]

9 [VOL] Refuse [SKIP TO B.1]

A.2a How much information do you feel you know about Zika? [READ CHOICES]

1 A great deal of information

2 Some information

3 A little information

4 Almost no information

8 [VOL] Don’t Know

9 [VOL] Refuse

A.2b Thinking about the past 30 days, how often have you seen, read or heard information about how to protect yourself from Zika?

[READ CHOICES AS NEEDED]

1 Never

2 Twice a month or less

3 Once a week

4 2-5 days/week

5 Daily

6 Several times a day

8 [VOL] Don’t Know

9 [VOL] Refuse

Knowledge/Misinformation

A.3 To the best of your knowledge, which of the following are ways in which the Zika virus is spread? Please answer yes or no for each item.

[PROGRAMMER NOTE: RANDOMIZE AND ROTATE LIST. “Something else [SPECIFY]” SHOULD ALWAYS BE ASKED LAST]

	Yes	No	[VOL] Don’t Know	[VOL] Refused
A mosquito bite	1	2	8	9
Sex (vaginal, anal, or oral)	1	2	8	9
Breastfeeding	1	2	8	9
Receiving donated blood or other blood products	1	2	8	9
Coughing and sneezing	1	2	8	9
Drinking contaminated water	1	2	8	9
Something else [SPECIFY]	1	2	8	9

A.4 To the best of your knowledge, which of the following activities can protect someone from the Zika virus? Please answer yes or no for each item.

[PROGRAMMER NOTE: RANDOMIZE AND ROTATE LIST. “Something else [SPECIFY]” SHOULD ALWAYS BE ASKED LAST]

	Yes	No	[VOL] Don’t Know	[VOL] Refused
Avoid travel to areas where Zika virus is present	1	2	8	9
Wear insect repellant	1	2	8	9
Wear long sleeves and long pants when going outdoors	1	2	8	9
Use screens on open doors or windows, or use air conditioning	1	2	8	9
Consistently use condoms during sex	1	2	8	9
Avoid having sex	1	2	8	9
Wash hands	1	2	8	9
Wear a mask	1	2	8	9
Eliminate standing water from the house and yard	1	2	8	9
Avoid unpasteurized meat and milk products	1	2	8	9
Get vaccinated	1	2	8	9
Avoid people who are coughing and sneezing	1	2	8	9
Something else [SPECIFY]	1	2	8	9

A.5. In your opinion, which of the following activities are expected of individuals who’ve been in areas with Zika, in order to protect their loved ones or communities against Zika? Please answer yes or no for each item.

[PROGRAMMER NOTE: RANDOMIZE AND ROTATE LIST. “Something else [SPECIFY]” SHOULD ALWAYS BE ASKED LAST]

	Yes	No	[VOL] Don’t Know	[VOL] Refused
Wear insect repellant while in areas with Zika	1	2	8	9
Wear insect repellant for 3 weeks after returning from an area with Zika	1	2	8	9
Wear long sleeves and long pants when going outdoors in an area with Zika	1	2	8	9
Consistently use condoms during sex if partner is pregnant	1	2	8	9
Consistently use condoms during sex if partner is concerned about Zika	1	2	8	9
Get vaccinated	1	2	8	9

[INSERT A SECTION SECTIONAL TIMING]

2. Zika Readiness Campaign

B. Reach

B.1 Now I’m going to read a list of a few Zika public health campaign names you may or may not have heard about. Which of the following campaigns have you heard about? Please answer yes or no for each campaign. [READ CHOICES]

[PROGRAMMER NOTE: RANDOMIZE AND ROTATE LIST]

	Yes	No	[VOL] Don’t Know	[VOL] Refused
Zika No More!	1	2	8	9
Zap Zika	1	2	8	9
This is how we prevent Zika. This is why.	1	2	8	9

B.1.b Have you heard of any other Zika public health campaign names?

1 Yes [GO TO B.1c]

2 No [GO TO B.2]

8 [VOL] Don’t Know [GO TO B.2]

9 [VOL] Refuse [GO TO B.2]

B.1.c What were these other Zika public health campaign names called?

1 Gave Answer ___________

8 [VOL] Don’t Know

9 [VOL] Refuse

[ASK B.2 IF YES TO ANY ITEMS IN B.1 OR B.1b, OTHERWISE SKIP TO C.1]

B.2 Where have you heard information about a Zika prevention campaign? Please answer yes or no for each item. [READ CHOICES]

[PROGRAMMER NOTE: RANDOMIZE AND ROTATE LIST. “Somewhere else [SPECIFY]” SHOULD ALWAYS BE ASKED LAST]

	Yes	No	[VOL] Don’t Know	[VOL] Refused
Healthcare workers or private doctor	1	2	8	9
Community event	1	2	8	9
Radio	1	2	8	9
Television	1	2	8	9
Posters or Billboards	1	2	8	9
Newspapers	1	2	8	9
Internet	1	2	8	9
Social media (Facebook, Twitter, etc)	1	2	8	9
SMS, or text messages	1	2	8	9
Movies	1	2	8	9
Workplace	1	2	8	9
Shopping mall or other public venue	1	2	8	9

[ASK B.3 FOR EACH CAMPAIGN SAID YES TO IN B.1 AND B.1b]

B.3 Thinking about the past 30 days, how often have you seen, read or heard information about the [INSERT CAMPAIGN NAME] campaign?

[READ CHOICES AS NEEDED]

1 Never

2 Twice a month or less

3 Once a week

4 2-5 days/week

5 Daily

6 Several times a day

8 [VOL] Don’t Know

9 [VOL] Refuse

[INSERT B SECTION SECTIONAL TIMING]

C. Pregnancy/Relationship Status and Traveler status

[ASK C.1 IF GENDER IS FEMALE (S.14a = 2), OTHERWISE SKIP TO C.4]

C.1 Are you currently pregnant?

1 Yes [SKIP TO C.3]

2 No

8 [VOL] Don’t Know

9 [VOL] Refuse

C.2 Were you pregnant at any time since September 1, 2015?

1. Yes

2 No

8 [VOL] Don’t Know

9 [VOL] Refuse

C.3 Do you plan to become pregnant within the next two years?

1. Yes

2 No

8 [VOL] Don’t Know

9 [VOL] Refuse

C.4 Are you currently sexually active?

1. Yes

2 No

8 [VOL] Don’t Know

9 [VOL] Refuse

C.4b Are you in a marriage or committed relationship with a man or a woman?

1. Man

2. Woman

3. Neither [SKIP TO C.8]

8. [VOL] Don’t Know

9. [VOL] Refuse

[ASK C.5 IF GENDER IS MALE (S.14a = 1) AND C.4b = 2 OR IF GENDER IS FEMALE (S.14a = 2) AND C.4b = 2; OTHERWISE, SKIP TO C.8]

C.5 Is your wife or partner currently pregnant?

1 Yes [GO TO C.7]

2 No

8 [VOL] Don’t Know

9 [VOL] Refused

C.6 Was your wife or partner pregnant at any time since September 1, 2015?

1 Yes

2 No

8 [VOL] Don’t Know

9 [VOL] Refused

C.7 Is your wife or partner planning to become pregnant within the next two years?

1 Yes

2 No

8 [VOL] Don’t Know

9 [VOL] Refused

C.8 Have you traveled any place outside of the 50 U.S. states [IF PUERTO RICO SAMPLE, READ: “or Puerto Rico”] since September 1, 2015?

1 Yes [GO TO C.9]

2 No [SKIP TO C.12]

8 [VOL] Don’t Know [SKIP TO C.12]

9 [VOL] Refused [SKIP TO C.12]

[ASK C.9 IF C.1=YES OR C.5=YES, AND C.8=YES]

C.9 During ([IF C.1=YES] your) ([IF C.5 = YES] your partner’s) CURRENT pregnancy, which countries have you traveled to?

1 Gave Answer ___________

8 [VOL] Don’t Know

9 [VOL] Refuse

[ASK C.10 IF C.2 = YES OR C.6 = YES, AND C.8 = YES]

C.10 While ([IF C.2 = YES] you were) ([IF C.6 = YES] your partner was) pregnant with your most recent pregnancy, which countries have you traveled to?

[INTERVIEWER NOTE: IF RESPONDENT IS CONFUSED AS TO WHICH PREGNANCY IS BEING REFERRED TO AS THEY ARE CURRENTLY PREGNANT AND THEY HAD ANOTHER PREGNANCY BEFORE THE CURRENT ONE AND IT WAS SINCE AUGUST 1, 2015, PLEASE MAKE IT CLEAR THAT WE ARE REFERRING TO THE LAST PREGNANCY BEFORE THE CURRENT ONE]

1 Gave Answer ___________

8 [VOL] Don’t Know

9 [VOL] Refuse

[ASK C.11 IF C.8=YES]

C.11 During the last 6 months, which countries have you traveled to?

1 Gave Answer ___________

8 [VOL] Don’t Know

9 [VOL] Refuse

[ASK ALL]

C.12 Which countries are you planning to travel to in the next 6 months?

1 Gave Answer ___________

2 None

8 [VOL] Don’t Know

9 [VOL] Refuse

[INSERT C SECTION SECTIONAL TIMING]

D. Beliefs: Personal susceptibility/seriousness/concern

D.1 Have you heard of someone with the Zika virus in the [IF IN THE U.S.: state /IF IN PUERTO RICO: city or town ] where you live?

1 Yes

2 No

8 [VOL] Don’t Know

9 [VOL] Refuse

D.2 How concerned are you about the spread of Zika in [IF IN THE U.S.: the United States; IF IN PUERTO RICO: Puerto Rico]? [READ CHOICES]

1 Very concerned

2 Somewhat concerned

3 Not very concerned

4 Not at all concerned

8 [VOL] Don’t Know

9 [VOL] Refuse

D.3 Please answer yes or no for each of the following statements [READ CHOICES]

	Yes	No	[VOL] Don’t Know	[VOL] Refused
I believe that I am at risk of being infected with Zika.	1	2	8	9
I believe that Zika is a serious disease.	1	2	8	9
I believe I can protect myself from Zika.	1	2	8	9
I believe I can protect my partner from Zika.	1	2	8	9

D.4 How closely do you follow news stories about Zika? [READ CHOICES]

1 Very closely

2 Fairly closely

3 Not too closely

4 Not at all

8 [VOL] Don’t Know

9 [VOL] Refuse

D.5 Which of the following best describes how the news media reports the dangers of Zika? [READ CHOICES]

1 The news media reports the dangers as more serious than they really are

2 The news media reports the dangers as less serious than they really are

3 The news media reports the dangers about right

8 [VOL] Don’t Know

9 [VOL] Refuse

[INSERT D SECTION SECTIONAL TIMING]

3. Zika Actions

E. Benefits/Barriers to Action – Attitude toward action

The next several questions are about actions to reduce the risk of getting the Zika virus.

E.1 In warm weather, how often do you take action to cover up by using long sleeve shirts and pants to keep mosquitoes from biting you?

Always Usually Sometimes, Rarely Never

1 2 3 4 5 8 (DK) 9 (REF)

E.2 How often do you take action to use insect repellent to keep mosquitoes from biting you?

Always Usually Sometimes, Rarely Never

1 2 3 4 5 8 (DK) 9 (REF)

E.3 How often do you take action to remove standing water in and around your home, so mosquitoes can’t lay eggs there?

Always Usually Sometimes, Rarely Never

1 2 3 4 5 8 (DK) 9 (REF)

E.4 How often do you take action to keep mosquitoes out of your home?

Always Usually Sometimes, Rarely Never

1 2 3 4 5 8 (DK) 9 (REF)

E.5 In the last 6 months, how often have you used condoms to avoid giving or getting Zika?

Always Usually Sometimes, Rarely Never

1 2 3 4 5 8 (DK) 9 (REF)

E.6 H In the last 6 months, how often have you abstained from sex to avoid giving or getting Zika?

Always Usually Sometimes, Rarely Never

1 2 3 4 5 8 (DK) 9 (REF)

[ASK E.7 and E.8 IF C.1 = YES OR C.2 = YES OR C.5=YES OR C.6=YES]

E.7 During pregnancy, how often do (or did) you use condoms to protect the unborn baby from ZIka?

Always Usually Sometimes, Rarely Never

1 2 3 4 5 8 (DK) 9 (REF)

E.8 During pregnancy, how often do (or did) you avoid sex to protect the unborn baby from Zika?

Always Usually Sometimes, Rarely Never

1 2 3 4 5 8 (DK) 9 (REF)

[INSERT E.1-E.6 SECTIONAL TIMING]

4. CDC Response to Zika

As you may know, the Centers for Disease Control and Prevention, or CDC, has been working to stop the spread of the Zika virus through a health education initiative.

G.1 How would you rate the CDC’s response to the Zika outbreak so far? [READ CHOICES]

1 Excellent

2 Good

3 Fair

4 Poor

5 Don’t know/Not sure

[INSERT G SECTION SECTIONAL TIMING]

[QUALIFIED LEVEL = 3]

5. Screener/Demographic Questions (HBM MODIFYING FACTORS)

H.1 In what year were you born?

1 _________ [RECORD YEAR OF BIRTH] [RANGE = 1900-1997]

8888 [VOL] Don’t Know

9999 [VOL] Refused

H.2 Are you of Hispanic or Latino origin?

1 Yes

2 No

8 [VOL] Don’t Know

9 [VOL] Refuse

H.3 Please tell me your race. Do you consider yourself…? [READ CHOICES] [MULTIPLE SELECTIONS ALLOWED] You can choose more than one race.

1. White/Caucasian

2. Black or African-American

3. American Indian or Alaska Native

4. Native Hawaiian or Other Pacific Islander

5. Asian

8. [VOL] Don’t Know

9. [VOL] Refused

H.4. Are you currently married, divorced, separated, widowed, or have you never been married?

[IF RESPONDENT SAYS THEY ARE “SINGLE” OR “ENGAGED”, PLEASE PROBE FURTHER TO FIND OUT WHICH OF THE LISTED CATEGORIES IS CORRECT: “You stated you are single/engaged, but which of these categories best describes your status.”]

1. Married

2. Divorced

3. Separated

4. Widowed

5. Never Married

8. [VOL] Don’t Know

9. [VOL] Refuse

H.5 Within the past 6 months, who have you primarily had sex with? [READ LIST]

1. A male

2. A female

3. Haven’t had sex in the last 6 months [SKIP TO H.7]

8. [VOL] Don’t Know

9. [VOL] Refused

H.6 Within the past 6 months, have you had unprotected sex? By “unprotected sex” we mean having sex without a condom.

1 Yes

2 No

8 [VOL] Don’t Know

9 [VOL] Refuse

[ASK H.7 IF CELL PHONE SAMPLE]

H.7      How many people in your household, including yourself, are adults, age 18 and older?

______            Enter number 1-7

8          8 or more

9          [VOL]Don’t know/Refused

[ASK H.8a AND H.8b IF LANDLINE SAMPLE]

H.8a Now thinking about your telephone use… How many telephone numbers do you have in your household that are used for talking? DO NOT COUNT cell phones or telephone lines that are used only for machines like fax machines and computers.

____________ [RANGE 1-5]

99 [VOL] Don’t Know/Refused

H.8b       Do you have a working cell phone?

1          Yes, have cell phone

2          No, do not

9          [VOL] Don't know/Refused

[ASK H.9 IF H.8b = 2 AND S.6 > 1]

H.9      Does anyone in your household have a working cell phone?

1          Yes, someone in household has cell phone

2          No

9          [VOL] Don't know/Refused

[ASK H.10a AND H.10b OF ALL CELL PHONE SAMPLE]

H.10a Now thinking about your telephone use… Including this one, how many working cell phones do you have?

____________ [RANGE 1-9]

99 [VOL] Don’t Know/Refused

H.10b    Is there at least one telephone INSIDE your home that is currently working and is not a cell phone?

1. Yes, home telephone

2. No, home telephone

9 [VOL] Don’t Know /Refuse

[ SKIP IF S14.e WAS ASKED AND ASK H.12]

H.11 In which zip code do you currently live? ENTER FIVE DIGIT ZIP CODE.

1. Gave Response ___________

8. [VOL] Don’t Know

9. [VOL] Refuse

H.12 What is the highest level of education you have completed?

[READ CHOICES IF NECESSARY]

1. Grade school

2. Less than high school graduate/some high school

3. High school graduate or completed GED

4. Some college or technical school

5. Received four-year college degree

6. Some post graduate studies

7. Received advanced degree

8. Other: _____________________

98 [VOL] Don’t Know

99 [VOL] Refuse

H.13 What is your current employment status? Would you say…? [READ CHOICES]

1. Employed full time

2. Employed part time

3. Unemployed

4. Homemaker

5. Student

6. Retired, or

7. Disabled

8. Other:_______________

98. [VOL] Don’t Know

99. [VOL] Refuse

H.14 Which of the following categories best describe your total, annual household income?

1. Under $20,000/year

2. $20,001 - $30,000/year

3. $30,001 - $40,000/year

4. $40,001 - $50,000/year

5. $50,001 - $60,000/year

6. $60,001 - $80,000/year

7. $80,001 - $100,000/year

8. Over $100,000/year

98. [VOL] Don’t Know

99. [VOL] Refuse

Thank you for your help with our survey today. These are all of the questions we have for you today. Have a great day/evening.

[INSERT H SECTION SECTIONAL TIMING]

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