SAMPLE READ-IN: FRAME
Landline
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 14 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)?
Yes [GO TO S.5.3 AFTER ADULT IS BROUGHT TO PHONE]
No adult at home right now [SCHEDULE CALLBACK]
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 14 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 14 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]
Male
Female
S.14b. Are you between 18 and 44 years of age, or are you older than 44 years of age?
Between 18 and 44 years of age
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]
___________ Gave Answer
[VOL] Don’t Know
[VOL] Refuse
S.14c2. Do you currently reside in Puerto Rico?
Yes
No
[VOL] Don’t Know
[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]
___________ Gave Answer
[VOL] Don’t Know
[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 14 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 privacy 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]
Zika Virus
Awareness
A.1 Have you heard about the Zika virus?
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 |
|
1 |
2 |
8 |
9 |
|
1 |
2 |
8 |
9 |
|
1 |
2 |
8 |
9 |
|
1 |
2 |
8 |
9 |
|
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 |
|
1 |
2 |
8 |
9 |
|
1 |
2 |
8 |
9 |
|
1 |
2 |
8 |
9 |
|
1 |
2 |
8 |
9 |
|
1 |
2 |
8 |
9 |
|
1 |
2 |
8 |
9 |
|
1 |
2 |
8 |
9 |
|
1 |
2 |
8 |
9 |
|
1 |
2 |
8 |
9 |
|
1 |
2 |
8 |
9 |
|
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.]
|
Yes |
No |
[VOL] Don’t Know |
[VOL] Refused |
|
1 |
2 |
8 |
9 |
|
1 |
2 |
8 |
9 |
|
1 |
2 |
8 |
9 |
|
1 |
2 |
8 |
9 |
[INSERT A SECTION SECTIONAL TIMING]
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 |
|
1 |
2 |
8 |
9 |
|
1 |
2 |
8 |
9 |
|
1 |
2 |
8 |
9 |
[ASK B.2 B.3, and B.4 IF YES TO B1.c “This is how we prevent Zika. This is why”, OTHERWISE SKIP TO C.1]
B.2 Where have you heard information about the Zika prevention campaign “This is how we prevent Zika. This is why”? Please answer yes or no for each item. [READ CHOICES]
[PROGRAMMER NOTE: RANDOMIZE AND ROTATE LIST.]
|
Yes |
No |
[VOL] Don’t Know |
[VOL] Refused |
|
1 |
2 |
8 |
9 |
|
1 |
2 |
8 |
9 |
|
1 |
2 |
8 |
9 |
|
1 |
2 |
8 |
9 |
|
1 |
2 |
8 |
9 |
|
1 |
2 |
8 |
9 |
|
1 |
2 |
8 |
9 |
|
1 |
2 |
8 |
9 |
|
1 |
2 |
8 |
9 |
|
1 |
2 |
8 |
9 |
|
1 |
2 |
8 |
9 |
|
1 |
2 |
8 |
9 |
B.3 After hearing about or receiving information for the “This is how we prevent Zika. This is why” campaign, did you talk with anyone about using condoms to prevent the spread of Zika?
1 Yes
2 No (SKIP to B.4)
8 [VOL] Don’t Know (SKIP to B.4)
9 [VOL] Refuse (SKIP to B.4)
B.3.1 Did you talk about using condoms to prevent the spread of Zika with any of the following? Please answer yes or no for each item. [READ CHOICES]
|
Yes |
No |
[VOL] Don’t Know |
[VOL] Refused |
|
1 |
2 |
8 |
9 |
|
1 |
2 |
8 |
9 |
|
1 |
2 |
8 |
9 |
|
1 |
2 |
8 |
9 |
|
1 |
2 |
8 |
9 |
B.4 How much do you trust the information you received from the “This is how we prevent Zika. This is why” campaign? [READ CHOICES]
1 Trust a great deal
2 Trust somewhat
3 Trust very little
4 Don’t trust at all
8 [VOL] Don’t Know
9 [VOL] Refuse
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
2 No
8 [VOL] Don’t Know
9 [VOL] Refuse
C.1.1 Is anyone else in your household currently pregnant?
Yes
No
[VOL] Don’t Know
[VOL] Refuse
[IF C.1=Yes, SKIP TO C.3]
C.2 Were you pregnant at any time since September 1, 2015?
Yes
2 No (Skip to C.3)
8 [VOL] Don’t Know (Skip to C.3)
9 [VOL] Refuse (Skip to C.3)
C.2a. And were you pregnant at any time since January 1, 2016?
Yes
2 No
8 [VOL] Don’t Know
9 [VOL] Refuse
C.3 Do you plan to become pregnant within the next two years?
Yes
2 No
8 [VOL] Don’t Know
9 [VOL] Refuse
C.4 Are you currently sexually active?
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?
[INTERVIEWER INSTRUCTION: IF RESPONDENT SIMPLY SAYS ‘YES’, PROBE FURTHER TO HAVE THEM SPECIFY IF THE MARRIAGE OR COMMITTED RELATIONSHIP IS WITH A MAN OR A WOMAN, OR IF THEY’RE NOT IN A MARRIAGE OR COMMITTED RELATIONSHIP WITH A MAN OR A WOMAN]
Man [SKIP TO C.5.1 IF S.14a=1 (MALE)]
Woman
Not in a marriage or committed relationship with a man or a woman [SKIP TO C.8 [IF S.14a=2 (FEMALE); SKIP TO C.5.1 IF S.14a=1 (MALE)]
[VOL] Don’t Know [SKIP C.8 IF S.14a=2 (FEMALE); SKIP TO C.5.1 IF S.14a=1 (MALE)]
[VOL] Refuse [SKIP TO C.8 IF S.14a=2 (FEMALE); SKIP TO C.5.1 IF S.14a=1 (MALE)]
[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
2 No
8 [VOL] Don’t Know
9 [VOL] Refused
[ASK C.5.1 IF S.14a=1 (MALE), SKIP TO C.6 IF S.14a=2 (FEMALE)]
C.5.1 Is anyone else in your household currently pregnant?
[PROGRAMMER’S NOTE: IF S.14a=1 (MALE) AND C.4b=1 (MAN), 3 (NEITHER), 8 (DK), OR 9 (REF) , DROP THE WORD ‘ELSE’ FROM QUESTION]
Yes
No
[VOL] Don’t Know
[VOL] Refuse
[IF C.4b=3, 8, or 9, OR IF C.4b=1 AND S.14a=1, SKIP TO C.8]
[IF C.5=YES, SKIP TO C.7]
C.6 Was your wife or partner pregnant at any time since September 1, 2015?
1 Yes
2 No (Skip to C.7)
8 [VOL] Don’t Know (Skip to C.7)
9 [VOL] Refused (Skip to C.7)
C.6a. And was your wife or partner pregnant at any time since January 1, 2016?
Yes
2 No
8 [VOL] Don’t Know
9 [VOL] Refuse
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
2 No [SKIP TO C.12]
8 [VOL] Don’t Know [SKIP TO C.12]
9 [VOL] Refused [SKIP TO C.12]
C.8a And have you traveled any place outside of the 50 U.S. states [IF PUERTO RICO SAMPLE, READ: “or Puerto Rico”] since January 1, 2016?
1 Yes
2 No
8 [VOL] Don’t Know
9 [VOL] Refused
[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 SEPTEMBER 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
[ASK C.13 IF S14a=1 (“male”) AND IF C.5, C.6 OR C.7=1 AND
IF those respondents traveled to a country with Zika – SEE LIST OF 30 COUNTRIES AND TERRITORIES USED IN C.9-C.11]
C.13 After traveling to [FILL IN COUNTRIES IF THEY ARE ON THE LIST USED IN C.9-C.11], how often did you use a condom to avoid giving or getting Zika?
[READ CHOICES]
Always Usually Sometimes, Rarely Never
1 2 3 4 5 8 (DK) 9 (REF)
[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
|
Yes |
No |
[VOL] Don’t Know |
[VOL] Refused |
|
1 |
2 |
8 |
9 |
|
1 |
2 |
8 |
9 |
|
1 |
2 |
8 |
9 |
|
1 |
2 |
8 |
9 |
|
1 |
2 |
8 |
9 |
|
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
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? [READ CHOICES]
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? [READ CHOICES]
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? [READ CHOICES]
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? [READ CHOICES]
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? [READ CHOICES]
[VOL]
Not sexually
Active in the last
Always Usually Sometimes Rarely Never 6 months
1 2 3 4 5 6 8 (DK) 9 (REF)
E.6 In the last 6 months, how often have you abstained from sex to avoid giving or getting Zika? [READ CHOICES]
[VOL]
Not sexually
Active in the last
Always Usually Sometimes Rarely Never 6 months
1 2 3 4 5 6 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? [READ CHOICES]
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? [READ CHOICES]
Always Usually Sometimes Rarely Never
1 2 3 4 5 8 (DK) 9 (REF)
[INSERT E.1-E.6 SECTIONAL TIMING]
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]
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.
White/Caucasian
Black or African-American
American Indian or Alaska Native
Native Hawaiian or Other Pacific Islander
Asian
[VOL] Don’t Know
[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.”]
Married
Divorced
Separated
Widowed
Never Married
[VOL] Don’t Know
[VOL] Refuse
H.5 Within the past 6 months, who have you primarily had sex with? [READ LIST]
A male
A female
Haven’t had sex in the last 6 months
[VOL] Don’t Know
[VOL] Refused
[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-H.10c 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?
Yes, home telephone
No, home telephone
9 [VOL] Don’t Know /Refuse
H.10c Thinking about this cell phone (phone number). Are you the only adult (18+) who uses this phone or do you share it with another adult in your household?
Respondent is the only adult user
Cell phone is shared with another adult
[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.
Gave Response ___________
[VOL] Don’t Know
[VOL] Refuse
H.12 What is the highest level of education you have completed?
[READ CHOICES IF NECESSARY]
Grade school
Less than high school graduate/some high school
High school graduate or completed GED
Some college or technical school
Received four-year college degree
Some post graduate studies
Received advanced degree
Other: _____________________
98 [VOL] Don’t Know
99 [VOL] Refuse
H.13 What is your current employment status? Would you say…? [READ CHOICES]
Employed full time
Employed part time
Unemployed
Homemaker
Student
Retired, or
Disabled
Other:_______________
[VOL] Don’t Know
[VOL] Refuse
H.14 Which of the following categories best describe your total, annual household income?
[READ CHOICES]
Under $20,000/year
$20,001 - $30,000/year
$30,001 - $40,000/year
$40,001 - $50,000/year
$50,001 - $60,000/year
$60,001 - $80,000/year
$80,001 - $100,000/year
Over $100,000/year
[VOL] Don’t Know
[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]
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| File Modified | 0000-00-00 |
| File Created | 2021-01-22 |