2 Appendix C

Appendix C - Focus Group Screening Questionnaires by Audience

ENGLISH-SPEAKING FOCUS GROUPS

First Name, Last Initial
Unique ID
Address
City, State, Zip
Phone (H/C/W)
Reason for Termination (IF TERMINATED)

SECTION 1: WILLINGNESS

Hello, my name is ______ and I’m from ______, a focus group facility working on behalf of the U.S. Census Bureau to help improve communications to communities across the country.

The focus group will take about 90 minutes, and you will receive $75 for your time. If you are still interested in participating and if you are available the evening of [DATE], I will ask you a few questions to see if you qualify. The questions I will ask on this call will take about 5 minutes.

1a. May we proceed?

Yes
No	2	> Terminate

1b. If you are eligible, are you available on [DATE] at [TIME] to participate in a focus group? The focus group will be held in [PLACE].

Yes
No		> Terminate

Before we start, I want to tell you a few things about the focus group and the questions I will be asking you now. Your participation is voluntary, but your responses are important. You can choose not to answer any or all questions. The questions I am about to ask you, and those asked during the focus group itself, have been authorized for collection by U.S. Office of Management and Budget, approval number 0607-0987, expiring on 08/31/2020.

1c. Are you willing to participate?

Yes
No		> Terminate

SECTION 2: MARKET RESEARCH EXPERIENCE

Great, I have a few questions to see if you qualify for this study.

2a. When, if ever, was the last time you participated in a marketing research study, such as a consumer interview or a group discussion?

Within the past three months		> hold
Over three months ago
Never

2b. Do you or an immediate family member work in any of the following fields? RANDOMIZE LIST

Advertising or public relations		> terminate
Marketing or market research		> terminate
Federal government		> terminate
Journalism		> terminate
Education
Medicine
Engineering
Service Industry
Other (specify: )

SECTION 3: AUDIENCE SPECIFIC CRITERIA

AMERICAN INDIAN

3a. How old are you?

17 or under		> ask for someone in household ages 18+
18 – 24		> Check Quotas
25 – 34		> Check Quotas
35 – 44		> Check Quotas
45 – 54		> Check Quotas
55+		> Check Quotas

3b. Are you…

Male		> Check Quotas
Female		> Check Quotas
Other (specify: )

3c. Do you consider yourself to be of Latino or Hispanic origin?

Yes		> TERMINATE
No

3d. What is your race? You may provide more than one group. MUST RESPOND AMERICAN INDIAN ONLY

White		> TERMINATE
Black or African American		> TERMINATE
Asian		> TERMINATE
American Indian
Alaska Native		> TERMINATE
Native Hawaiian or Pacific Islander		> TERMINATE
Some other race (specify: )		> TERMINATE

3e-h. Please respond yes or no to the following. MUST ANSWER YES TO 2 OF 4 TO QUALIFY. RANDOMIZE LIST:

3e.	Are you a member of a Tribe?	Yes	No
3f.	Do you consider yourself knowledgeable about your native culture?	Yes	No
3g.	Do you participate in traditional native cultural events or ceremonies?	Yes	No
3h.	Do you live in or regularly communicate with people from your home village or tribe?	Yes	No

TOTAL # OF YES: _____________________ MUST ANSWER YES TO 2 OF 4 TO QUALIFY

3i. What is your tribe? For example, Navajo Nation, Blackfeet Tribe, Bay Mills, Klamath, etc. MULTIPLE RESPONSES PERMITTED. RECRUIT A MIX.

Navajo Nation
Blackfeet Tribeg
Bay Mills
Klamath
Other (specify: )
Not a member of any Tribe (federal or state recognized)		> TERMINATE

ALASKA NATIVE

3a. How old are you?

17 or under		> ask for someone in household ages 18+
18 – 24		> Check Quotas
25 – 34		> Check Quotas
35 – 44		> Check Quotas
45 – 54		> Check Quotas
55+		> Check Quotas

3b. Are you…

Male		> Check Quotas
Female		> Check Quotas
Other (specify: )

3c. Do you consider yourself to be of Latino or Hispanic origin?

Yes		> TERMINATE
No

3d. What is your race? You may provide more than one group. MUST RESPOND ALASKA NATIVE ONLY

White		> TERMINATE
Black or African American		> TERMINATE
Asian		> TERMINATE
American Indian		> TERMINATE
Alaska Native
Native Hawaiian or Pacific Islander		> TERMINATE
Some other race (specify: )		> TERMINATE

3e-h. Please respond yes or no to the following. MUST ANSWER YES TO 2 OF 4 TO QUALIFY. RANDOMIZE LIST:

3e.	Are you a Shareholder of an Alaska Native Corporation?	Yes	No
3f.	Do you consider yourself knowledgeable about your native culture?	Yes	No
3g.	Do you participate in traditional native cultural events or ceremonies?	Yes	No
3h.	Do you live in or regularly communicate with people from your home village or tribe?	Yes	No

TOTAL # OF YES: _____________________ MUST ANSWER YES TO 2 OF 4 TO QUALIFY

3i. What is your Alaska Native Corporation? For example, Native Village of Barrow, Arctic Slope Corporation, Tlingit, etc. MULTIPLE RESPONSES PERMITTED. RECRUIT A MIX.

Native Village of Barrow
Arctic Slope Corporation
Tlingit
Other (specify: )
Not a member of an Alaska Native Corporation		> TERMINATE

BLACK OR AFRICAN AMERICAN

3a. How old are you?

17 or under		> ask for someone in household ages 18+
18 – 24
25 – 34
35 – 44
45 – 54
55+

3b. Are you…

Male
Female
Other (specify: )

3c. Do you consider yourself to be of Latino or Hispanic origin?

Yes		> TERMINATE
No

3d. What is your race or ethnicity? You may provide more than one group. MUST RESPOND BLACK/AFRICAN AMERICAN ONLY.

White		> Terminate
Black or African American
Asian		> Terminate
American Indian		> Terminate
Alaska Native		> Terminate
Middle Eastern or North African		> Terminate
Native Hawaiian or Pacific Islander		> Terminate
Some other race (specify: )		> Terminate

3e. What is the highest grade or year of schooling you have completed?

Less than High school
High School graduate or equivalent
Some college
College graduate or postgraduate degree		> Terminate

3f. What is your total annual household income?

Less than $14,999
$15,000 to $29,999
$30,000 to $34,999
$35,000 to $74,999		> Terminate
$75,000 to $149,999		> Terminate
More than $150,000		> Terminate

3g. In what country were you born?

United States
Other		> TERMINATE

ENGLISH-DOMINANT LATINOS, U.S. MAINLAND

3a. How old are you?

17 or under		> ask for someone in household ages 18+
18 – 24
25 – 34
35 – 44
45 – 54
55+		> TERMINATE

3b. Are you…

Male
Female
Other (specify: )

3c. Do you consider yourself to be of Latino or Hispanic origin?

Yes
No		> TERMINATE

3d. What is your race? You may provide more than one group.

White
Black or African American
Asian
American Indian
Alaska Native
Native Hawaiian or Pacific Islander
Some other race (specify: _____)

3e. What languages do you speak at home? DO NOT READ RESPONSE OPTIONS / MULTIPLE RESPONSES PERMITTED / MUST SPEAK ENGLISH AND SPANISH

English only		>TERMINATE
Spanish only		>TERMINATE
Spanish and English
Other (specify: )		> TERMINATE

3f. How well do you speak English?

Very well
Well		> Terminate
Not well		> TERMINATE
Not at all		> TERMINATE

3g. How well do you speak Spanish?

Very well
Well
Not well
Not at all		> TERMINATE

3g1. In what language do you consume most TV, magazines, newspapers, music and/or radio?

Spanish only		> Terminate > Terminate
More Spanish than English
Spanish and English about equally		> RECRUIT A MIX
More English than Spanish		> RECRUIT A MIX
English only		> RECRUIT A MIX
Some other language		> Terminate

3h. What is your country of origin? RECRUIT A MIX.

Mexico		> mexican check quotas
El Salvador, Guatemala, Honduras, or other Central American country		> central american check quotas
Puerto Rico, Cuba, Dominican Republic		> Caribbean check quotas
Colombia, Venezuela, Argentina, or other South American country		> south american check quotas
Puerto Rican		> Puerto rican check quotas
Cuban		> Cuban check quotas

3i. In what country or territory were you born?

United States		> 2nd GenerATION
Other (specify: _______)		> ask Q3j

ONLY ASKED IF OTHER (C2 @ Q3I)

3j. How old were you when you first came to the United States?

IF ASKED, THIS INFORMATION IS BEING ASKED TO ENSURE A BROAD RANGE OF EXPERIENCES ARE REPRESENTED IN THE DISCUSSION. ANSWERS WILL NOT BE SHARED FOR MARKETING OR ANY OTHER PURPOSE.

Record Verbatim: ________ [please capture age]

17 or older		> TERMINATE
16 or younger		> 1.5 GENERATION

3k. In what country or territory were your parents born?

Both parents were born in the U.S.		> Terminate
One parent was born in the U.S.; the other was born outside of the U.S.		> Terminate
Both parents were born outside of the U.S.
Don’t know		> Terminate

READ TO ALL

Next, I’d like to ask you a question about the U.S. census. The U.S. census is the count of all the people who live in the United States. It happens every 10 years, and the next census is in 2020. The Census plans to ask questions such as how many people live at your address or place and their age, gender, race, ethnicity, relationships, and citizenship.

3l. If the census were held today, how likely would you be to complete the census form?

Not at all likely
Not too likely
Somewhat likely		>HOLD
Very likely		> Terminate
Extremely likely		> Terminate
Unsure/Have not decided yet		> HOLD

MIDDLE EASTERN OR NORTH AFRICAN (MENA)

3a. How old are you?

17 or under		> ask for someone in household ages 18+
18 – 24
25 – 34
35 – 44
45 – 54
55+

3b. Are you…

Male
Female
Other (specify: )

3c. Do you consider yourself to be of Latino or Hispanic origin?

Yes		> TERMINATE
No

3d. What is your race or ethnicity? You may provide more than one group. MUST RESPOND MENA ONLY.

White		> TERMINATE
Black or African American		> TERMINATE
Asian		> TERMINATE
American Indian		> TERMINATE
Alaska Native		> TERMINATE
Middle Eastern or North African
Native Hawaiian or Pacific Islander		> TERMINATE
Some other race (specify: )		> TERMINATE

3e. Earlier, you reported you were MIDDLE EASTERN OR NORTH AFRICAN. What are your detailed MIDDLE EASTERN OR NORTH AFRICAN ethnicities? For example, Lebanese, Iranian, Egyptian, Syrian, Moroccan, Israeli, etc. MULTIPLE RESPONSES PERMITTED. TERMINATE IF THEY PROVIDE “OTHER” RESPONSE.

Lebanese
Iranian
Egyptian
Moroccan
Iraqi
Yemeni
Other (specify: )		> TERMINATE

3f. How well do you speak English?

Very well
Well
Not well		> TERMINATE
Not at all		> TERMINATE

3g. In what country or territory were you born?

In the United States		> skip to SECTION 4
Outside of the United States (specify: )		> ask q3h

ONLY ASK IF NOT BORN IN THE UNITEd STATES

3h. How old were you when you first came to the United States?

IF ASKED, THIS INFORMATION IS BEING ASKED TO ENSURE A BROAD RANGE OF EXPERIENCES ARE REPRESENTED IN THE DISCUSSION. ANSWERS WILL NOT BE SHARED FOR MARKETING OR ANY OTHER PURPOSE.

17 or older
16 or younger

NATIVE HAWAIIAN OR PACIFIC ISLANDER (NHPI)

3a. How old are you?

17 or under	1	> ask for someone in household ages 18+
18 – 24	2
25 – 34	3
35 – 44	4
45 – 54	5
55+	6

3b. Are you…

Male
Female
Other (specify: )

3c. Do you consider yourself to be of Latino or Hispanic origin?

Yes		> TERMINATE
No

3d. What is your race? You may provide more than one group. MUST RESPOND NHPI ONLY.

White		> TERMINATE
Black or African American		> TERMINATE
Asian		> TERMINATE
American Indian		> TERMINATE
Alaska Native		> TERMINATE
Native Hawaiian or Pacific Islander
Some other race (specify: )		> TERMINATE

3e. Earlier, you reported you were NATIVE HAWAIIAN OR PACIFIC ISLANDER. What are your NATIVE HAWAIIAN OR PACIFIC ISLANDER ethnicities? For example, Native Hawaiian, Samoan, Chamorro, Tongan, Fijian, Marshallese, etc. MULTIPLE RESPONSES PERMITTED. RECRUIT A MIX.

Native Hawaiian		> native hawaiian
Samoan		> Polynesian/ melanesian
Chamorro		> micronesian
Fijian		> Polynesian/ melanesian
Tongan		> Polynesian/ melanesian
Marshallese		> micronesian
Other (specify: )

3f. How well do you speak English?

Very well
Well
Not well		> TERMINATE
Not at all		> TERMINATE

3g. In what country or territory were you born?

In the continental United States, Alaska, or Hawaii		> skip to SECTION 4
Outside of the United States (specify: )		> ask q3h

ASK IF NOT BORN IN THE UNITEd STATES (INCLUDING HAWAII):

3h. How old were you when you first came to the United States? IF ASKED, THIS INFORMATION IS BEING ASKED TO ENSURE A BROAD RANGE OF EXPERIENCES ARE REPRESENTED IN THE DISCUSSION. ANSWERS WILL NOT BE SHARED FOR MARKETING OR ANY OTHER PURPOSE.

17 or older
16 or younger

3i. Is there a language besides English that you are fluent in? RECRUIT A MIX.

Yes (specify: )
Native Hawaiian
Micronesian
Polynesian/Melanesian
No		> IF Micronesian OR Polynesian/ MELANESIAN, TERMINATE. > IF Native Hawaiian, skip to section 4

3j. How many hours of media in [OTHER] language do you consume per week? This can include TV, print, radio, digital media, and social media.

HOURS: ________________________________________

PEOPLE LIVING IN RURAL LOCATIONS

3a. How old are you?

17 or under	1	> ask for someone in household ages 18+
18 – 24	2
25 – 34	3
35 – 44	4
45 – 54	5
55+	6

3b. Are you…

Male
Female
Other (specify: )

3c. Do you consider yourself to be of Latino or Hispanic origin?

Yes		> TERMINATE
No

3d. What is your race or ethnicity? You may provide more than one group.

White
Black or African American		> TERMINATE
Asian		> TERMINATE
American Indian		> TERMINATE
Alaska Native		> TERMINATE
Native Hawaiian or Pacific Islander		> TERMINATE
Some other race or ethnicity (specify: )		> TERMINATE

3e. What is your ZIP code? RECRUIT FROM A LIST OF ZIP CODES PROVIDED BY TEAM Y&R. IF ZIP CODE DOES NOT MATCH LIST, TERMINATE.

RECORD ZIP CODE:_______________________

PEOPLE WITH YOUNG CHILDREN LIVING IN HOUSEHOLD

3a. How old are you?

17 or under		> ask for someone in household ages 18+
18 – 24
25 – 34
35 – 44
45 – 54
55+

3b. Are you…

Male
Female
Other (specify: )

3c. Do you consider yourself to be of Latino or Hispanic origin?

Yes
No

3d. What is your race? You may provide more than one group.

White		> terminate
Black or African American
Asian
American Indian
Alaska Native
Native Hawaiian or Pacific Islander
Some other race (specify: )

3e. Are there any children under the age of 18 currently live in your household?

Yes
No		> terminate

3f. What are the ages of each child currently living in your home? ONLY PROCEED IF AT LEAST 1 CHILD IS 4 YEARS OLD OR YOUNGER

Child 1
Child 2
Child 3
Child 4
Child 5

3g. Thinking about the [child/children] who are four years or younger, what is your relationship with [the child/each child]? MULTIPLE RESPONSES PERMITTED.

Parent
Grandparent
Other relative (specify: )
Not related

3h. Besides yourself, how many adults live in your home?

None, just myself
One other person
Two other people
Three other people
Four other people
Five or more other people

3i. What is your total annual household income?

Less than $14,999
$15,000 to $29,999
$30,000 to $34,999
$35,000 to $74,999
$75,000 to $149,999
More than $150,000

ONLY PROCEED IF LIVING IN A LARGE HOUSEHOLD (C4 @ Q3H) OR HAVING LOW INCOME (C1-C3 @ Q3I)

SECTION 4: HARD-TO-COUNT DEMOGRAPHICS

NOTE: MUST MEET AT LEAST TWO OF THE FOLLOWING CRITERIA:

• Renters

• Living in a large household (with 6 or more people)

• Less than high school diploma

• Female householder, no husband present

• Low income (less than $35,000 per year)

• Move within the past year

• Household with young children (0-4 years old)

• Multi-unit or mobile home structure

4a. What is the highest grade or year of schooling you have completed?

Less than High school		1 point Check quotas
High School graduate or equivalent
Some college
College graduate or postgraduate degree		> Terminate

4b. What is your marital status?

Married
Widowed
Divorced
Separated
Never married

4c. Are there any children currently living in your household?

Yes (specify number of children: )		> ask q4d
No		> skip to q4e

4d. What is the age of the youngest child in your home?

0–4 years old		YOUNG children	1 point
5–9 years old
10–17 years old

ASK ALL PARTICIPANTS

4e. Besides yourself, how many adults live in your home?

RECORD NUMBER: ______________________________________

FEMALE HOUSEHOLDER

1 Point IF ALL OF FOLLOWING:

• Female (Code 2 @ Q3B)

• Unmarried (Code 2-5 @ Q4B)

• Lives with another adult (Q4E > 0)

LARGE HOUSEHOLD:

CODE NUMBER OF PEOPLE IN HOUSEHOLD = nUMBER OF CHILDREN (4C) + NUMBER OF ADULTS (4E)

None, just myself
One other person
Two other people
Three other people
Four other people
Five or more other people		1 point

4f. Do you rent or own your own house or apartment?

Rent		1 point
Own
Other (specify:_________________________________ _)

4g. Which describes the building of your primary residence?

A mobile home		1 point
A one-family house detached from any other house
A one-family house attached from any other house		1 point
A building with 2 or more apartments		1 point
Boat, RV, van, etc.		1 point

4h. How many years ago did you move into the home you are currently living in?

Moved within the past year		1 point
Moved more than a year ago

4i. What is your total annual household income?

Less than $14,999		1 point
$15,000 to $29,999		1 poinT
$30,000 to $34,999		1 point
$35,000 to $74,999
$75,000 to $149,999
More than $150,000

record TOTAL POINTS ALLOCATED THROUGHOUT SCREEneR: _________ (enter number here)

2 OR MORE POINTS
LESS THAN 2 POINTS		> TERMINATE

SECTION 5: INVITATION TO PARTICIPATE

READ TO ALL QUALIFYING PARTICIPANTS

Thank you! You are eligible to participate in the focus group on [DATE] starting at [TIME] taking place at [LOCATION]. If you have any questions or comments about this study, you may send them to [email protected]. May we schedule you to participate?

Yes
No		> Terminate

CONFIRM DETAILS & SCHEDULE PARTICIPANT

READ TO ALL NON-QUALIFYING PARTICIPANTS

Thank you! It’s important we include a variety of backgrounds in our discussions, at this time we have reached our quota for individuals who match your characteristics, so you are not eligible to participate in this study. If you have any questions or comments about this study, you may send them to [email protected].

NON-ENGLISH-SPEAKING FOCUS GROUPS: NON-ENGLISH

First Name, Last Initial
Unique ID
Address
City, State, Zip
Phone (H/C/W)
Reason for Termination (IF TERMINATED)

SECTION 1: WILLINGNESS

Hello, my name is ______ and I’m from ______, a focus group facility working on behalf of the U.S. Census Bureau to help improve communications to communities across the country.

The focus group will take about 90 minutes, and you will receive $75 for your time. If you are still interested in participating and if you are available the evening of [DATE], I will ask you a few questions to see if you qualify. The questions I will ask on this call will take about 5 minutes.

1a. May we proceed?

Yes
No		> Terminate

1b. If you are eligible, are you available on [DATE] at [TIME] to participate in a focus group? The focus group will be held in [PLACE].

Yes
No		> Terminate

Before we start, I want to tell you a few things about the focus group and the questions I will be asking you now. Your participation is voluntary, but your responses are important. You can choose not to answer any or all questions. The questions I am about to ask you, and those asked during the focus group itself, have been authorized for collection by U.S. Office of Management and Budget, approval number 0607-0987, expiring on 08/31/2020.

1c. Are you willing to participate?

Yes
No		> Terminate

SECTION 2: MARKET RESEARCH EXPERIENCE

Great, I have a few questions to see if you qualify for this study.

2a. When, if ever, was the last time you participated in a marketing research study, such as a consumer interview or a group discussion?

Within the past three months		> hold
Over three months ago
Never

2b. Do you or an immediate family member work in any of the following fields? RANDOMIZE LIST

Advertising or public relations		> terminate
Marketing or market research		> terminate
Federal government		> terminate
Journalism		> terminate
Education
Medicine
Engineering
Service Industry
Other (specify: )

SECTION 3: AUDIENCE SPECIFIC CRITERIA

3a. How old are you?

17 or under		> ask for someone in household ages 18+
18 – 24
25 – 34
35 – 54
55+

3b. Are you…

Male
Female
Other (specify: )

ARABIC

3c. Do you consider yourself to be of Latino or Hispanic origin?

Yes		> TERMINATE
No

3d. What is your race or ethnicity? You may provide more than one group. MUST RESPOND MENA ONLY.

White		> TERMINATE
Black or African American		> TERMINATE
Asian		> TERMINATE
American Indian		> TERMINATE
Alaska Native		> TERMINATE
Middle Eastern or North African
Native Hawaiian or Pacific Islander		> TERMINATE
Some other race or ethnicity (specify: )		> TERMINATE

3e. Earlier, you reported you were MIDDLE EASTERN OR NORTH AFRICAN. What are your detailed MIDDLE EASTERN OR NORTH AFRICAN ethnicities? For example, Lebanese, Iranian, Egyptian, Syrian, Moroccan, Israeli, etc. MULTIPLE RESPONSES PERMITTED. TERMINATE IF THEY RESPOND OTHER.

Lebanese
Iranian
Egyptian
Moroccan
Iraqi
Yemeni
Other (specify: )		> TERMINATE

3f. What languages do you speak at home? You may provide more than one language. MULTIPLE RESPONSES PERMITTED / MUST SPEAK ARABIC

English
Arabic
French
Other (specify: )		> TERMINATE

3g. How well do you speak English?

Very well		> TERMINATE
Well
Not well
Not at all

3h. How well do you speak Arabic?

Very well
Well
Not well		> TERMINATE
Not at all		> TERMINATE

CHINESE, CANTONESE

3c. Do you consider yourself to be of Latino or Hispanic origin?

Yes		> TERMINATE
No

3d. What is your race or ethnicity? You may provide more than one group. MUST RESPOND ASIAN ONLY.

White		> TERMINATE
Black or African American		> TERMINATE
Asian
American Indian		> TERMINATE
Alaska Native		> TERMINATE
Middle Eastern or North African		> TERMINATE
Native Hawaiian or Pacific Islander		> TERMINATE
Some other race or ethnicity (specify: )		> TERMINATE

3e. Earlier, you reported you were ASIAN. What are your detailed ASIAN ethnicities? For example, Chinese, Filipino, Asian Indian, Vietnamese, Korean, Japanese, etc. MUST BE CHINESE

Chinese
Filipino/Tagalog		> TERMINATE
Asian Indian		> TERMINATE
Vietnamese		> TERMINATE
Korean		> TERMINATE
Japanese		> TERMINATE
Other (specify: )		> TERMINATE

3f. In what country or territory were you born?

In the United States		> TERMINATE
Outside of the United States (specify: )		> ask q3G

3g. What languages do you speak at home? You may provide more than one language. MULTIPLE RESPONSES PERMITTED / MUST SPEAK CHINESE

English
Chinese (Cantonese)
Other (specify: )		> TERMINATE

3h. How well do you speak English?

Very well		> TERMINATE
Well
Not well
Not at all

3i. How well do you speak Chinese (Cantonese)?

Very well
Well
Not well		> TERMINATE
Not at all		> TERMINATE

CHINESE, MANDARIN

3c. Do you consider yourself to be of Latino or Hispanic origin?

Yes		> TERMINATE
No

3d. What is your race or ethnicity? You may provide more than one group. MUST RESPOND ASIAN ONLY.

White		> TERMINATE
Black or African American		> TERMINATE
Asian
American Indian		> TERMINATE
Alaska Native		> TERMINATE
Middle Eastern or North African		> TERMINATE
Native Hawaiian or Pacific Islander		> TERMINATE
Some other race or ethnicity (specify: )		> TERMINATE

3e. Earlier, you reported you were ASIAN. What are your detailed ASIAN ethnicities? For example, Chinese, Filipino, Asian Indian, Vietnamese, Korean, Japanese, etc. MUST BE CHINESE

Chinese
Filipino		> TERMINATE
Asian Indian		> TERMINATE
Vietnamese		> TERMINATE
Korean		> TERMINATE
Japanese		> TERMINATE
Other (specify: )		> TERMINATE

3f. In what country or territory were you born?

In the United States		> TERMINATE
Outside of the United States (specify: )		> ask q3G

3g. What languages do you speak at home? You may provide more than one language. MULTIPLE RESPONSES PERMITTED / MUST SPEAK CHINESE

English
Chinese (Mandarin)
Other (specify: )		> TERMINATE

3h. How well do you speak English?

Very well		> TERMINATE
Well
Not well
Not at all

3i. How well do you speak Chinese (Mandarin)?

Very well
Well
Not well		> TERMINATE
Not at all		> TERMINATE

FILIPINO (TAGALOG)

3c. Do you consider yourself to be of Latino or Hispanic origin?

Yes		> TERMINATE
No

3d. What is your race or ethnicity? You may provide more than one group. MUST RESPOND ASIAN ONLY.

White		> TERMINATE
Black or African American		> TERMINATE
Asian
American Indian		> TERMINATE
Alaska Native		> TERMINATE
Middle Eastern or North African		> TERMINATE
Native Hawaiian or Pacific Islander		> TERMINATE
Some other race or ethnicity (specify: )		> TERMINATE

3e. Earlier, you reported you were ASIAN. What are your detailed ASIAN ethnicities? For example, Chinese, Filipino, Asian Indian, Vietnamese, Korean, Japanese, etc. MUST BE FILIPINO

Chinese		> TERMINATE
Filipino
Asian Indian		> TERMINATE
Vietnamese		> TERMINATE
Korean		> TERMINATE
Japanese		> TERMINATE
Other (specify: )		> TERMINATE

3f. In what country or territory were you born?

In the United States		> TERMINATE
Outside of the United States (specify: )		> ask q3G

3g. What languages do you speak at home? You may provide more than one language. MULTIPLE RESPONSES PERMITTED / MUST SPEAK FILIPINO/TAGALOG

English
Tagalog
Other (specify: )

3h. How well do you speak English?

Very well
Well
Not well
Not at all

3i. How well do you speak Filipino/Tagalog?

Very well
Well
Not well		> TERMINATE
Not at all		> TERMINATE

HAITIAN CREOLE

3a. How old are you?

17 or under		> ask for someone in household ages 18+
18 – 24
25 – 34
35 – 44
45 – 54
55+

3b. Are you…

Male
Female
Other (specify: )

3c. Do you consider yourself to be of Latino or Hispanic origin?

Yes		> TERMINATE
No

3d. What is your race or ethnicity? You may provide more than one group. MUST RESPOND BLACK/AFRICAN AMERICAN ONLY.

White		> Terminate
Black or African American
Asian		> Terminate
American Indian		> Terminate
Alaska Native		> Terminate
Middle Eastern or North African		> Terminate
Native Hawaiian or Pacific Islander		> Terminate
Some other race (specify: )		> Terminate

3e. In what country or territory were you born?

United States		> Terminate
Haiti
Other		> Terminate

3f. How old were you when you first came to the United States?

IF ASKED, THIS INFORMATION IS BEING ASKED TO ENSURE A BROAD RANGE OF EXPERIENCES ARE REPRESENTED IN THE DISCUSSION. ANSWERS WILL NOT BE SHARED FOR MARKETING OR ANY OTHER PURPOSE.

17 or older		> 1ST GENERATION
16 or younger		> 1.5 GENERATION

3g. In what country or territory were your parents born?

Both parents were born in the U.S.		> Terminate
One parent was born in the U.S.; the other was born outside of the U.S.		> Terminate
Both parents were born outside of the U.S.
Don’t know		> Terminate

3h. What languages do you speak at home? MULTIPLE RESPONSES PERMITTED / MUST SPEAK HAITIAN CREOLE

English
Haitian Creole
Other (specify: )		> TERMINATE

3i. How well do you speak English?

Very well		> TERMINATE
Well
Not well
Not at all

3j. How well do you speak Haitian Creole?

Very well
Well
Not well		> TERMINATE
Not at all		> TERMINATE

JAPANESE

3c. Do you consider yourself to be of Latino or Hispanic origin?

Yes		> TERMINATE
No

3d. What is your race or ethnicity? You may provide more than one group. MUST RESPOND ASIAN ONLY.

White		> TERMINATE
Black or African American		> TERMINATE
Asian
American Indian		> TERMINATE
Alaska Native		> TERMINATE
Middle Eastern or North African		> TERMINATE
Native Hawaiian or Pacific Islander		> TERMINATE
Some other race or ethnicity (specify: )		> TERMINATE

3e. Earlier, you reported you were ASIAN. What are your detailed ASIAN ethnicities? For example, Chinese, Filipino, Asian Indian, Vietnamese, Korean, Japanese, etc. MUST BE JAPANESE

Chinese		> TERMINATE
Filipino/Tagalog		> TERMINATE
Asian Indian		> TERMINATE
Vietnamese		> TERMINATE
Korean		> TERMINATE
Japanese
Other (specify: )		> TERMINATE

3f. In what country or territory were you born?

In the United States		> TERMINATE
Outside of the United States (specify: )		> ask q3G

3g. What languages do you speak at home? You may provide more than one language. MULTIPLE RESPONSES PERMITTED / MUST SPEAK JAPANESE

English
Japanese
Other (specify: )		> TERMINATE

3h. How well do you speak English?

Very well		> TERMINATE
Well
Not well
Not at all

3i. How well do you speak Japanese?

Very well
Well
Not well		> TERMINATE
Not at all		> TERMINATE

KOREAN

3c. Do you consider yourself to be of Latino or Hispanic origin?

Yes		> TERMINATE
No

3d. What is your race or ethnicity? You may provide more than one group. MUST RESPOND ASIAN ONLY.

White		> TERMINATE
Black or African American		> TERMINATE
Asian
American Indian		> TERMINATE
Alaska Native		> TERMINATE
Middle Eastern or North African		> TERMINATE
Native Hawaiian or Pacific Islander		> TERMINATE
Some other race or ethnicity (specify: )		> TERMINATE

3e. Earlier, you reported you were ASIAN. What are your detailed ASIAN ethnicities? For example, Chinese, Filipino, Asian Indian, Vietnamese, Korean, Japanese, etc. MUST BE KOREAN

Chinese		> TERMINATE
Filipino/Tagalog		> TERMINATE
Asian Indian		> TERMINATE
Vietnamese		> TERMINATE
Korean
Japanese		> TERMINATE
Other (specify: )		> TERMINATE

3f. In what country or territory were you born?

In the United States		> TERMINATE
Outside of the United States (specify: )		> ask q3G

3g. What languages do you speak at home? You may provide more than one language. MULTIPLE RESPONSES PERMITTED / MUST SPEAK KOREAN

English
Korean
Other (specify: )		> TERMINATE

3h. How well do you speak English?

Very well		> TERMINATE
Well
Not well
Not at all

3i. How well do you speak Korean?

Very well
Well
Not well		> TERMINATE
Not at all		> TERMINATE

POLISH

3c. Do you consider yourself to be of Latino or Hispanic origin?

Yes		> TERMINATE
No

3d. What is your race or ethnicity? You may provide more than one group. MUST RESPOND White ONLY.

White
Black or African American		> TERMINATE
Asian		> TERMINATE
American Indian		> TERMINATE
Alaska Native		> TERMINATE
Middle Eastern or North African		> TERMINATE
Native Hawaiian or Pacific Islander		> TERMINATE
Some other race or ethnicity (specify: )		> TERMINATE

3e. What is your ancestry or ethnic origin? DO NOT READ RESPONSE OPTIONS. MUST BE POLISH.

Poland / Polish
Other

3f. What languages do you speak at home? You may provide more than one language. MULTIPLE RESPONSES PERMITTED / MUST SPEAK POLISH

English
Polish
Other (specify: )		> TERMINATE

3g. How well do you speak English?

Very well		> TERMINATE
Well
Not well
Not at all

3h. How well do you speak Polish?

Very well
Well
Not well		> TERMINATE
Not at all		> TERMINATE

PORTUGUESE (BRAZILIAN)

3c. Do you consider yourself to be of Latino or Hispanic origin?

Yes
No

3d. What is your race or ethnicity? You may provide more than one group.

White
Black or African American
Asian
American Indian
Alaska Native
Middle Eastern or North African
Native Hawaiian or Pacific Islander
Some other race or ethnicity (specify: )

3e. What is your country of origin? DO NOT READ RESPONSE OPTIONS. MUST BE BRAZILIAN.

Brazil
Other

3f. What languages do you speak at home? You may provide more than one language. MUST SPEAK PORTUGUESE

English		> TERMINATE
Portuguese
Other (specify: )		> TERMINATE

3g. How well do you speak English?

Very well		> TERMINATE
Well
Not well
Not at all

3h. How well do you speak Portuguese?

Very well
Well
Not well		> TERMINATE
Not at all		> TERMINATE

RUSSIAN

3c. Do you consider yourself to be of Latino or Hispanic origin?

Yes		> TERMINATE
No

3d. What is your race or ethnicity? You may provide more than one group. MUST RESPOND White ONLY.

White
Black or African American		> TERMINATE
Asian		> TERMINATE
American Indian		> TERMINATE
Alaska Native		> TERMINATE
Middle Eastern or North African		> TERMINATE
Native Hawaiian or Pacific Islander		> TERMINATE
Some other race or ethnicity (specify: )		> TERMINATE

3e. What is your ancestry or ethnic origin? DO NOT READ RESPONSE OPTIONS. MUST BE RUSSIAN.

Russia / Russian
Other

3f. What languages do you speak at home? You may provide more than one language. MULTIPLE RESPONSES PERMITTED / MUST SPEAK RUSSIAN

English
Russian
Other (specify: )

3g. How well do you speak English?

Very well		> TERMINATE
Well
Not well
Not at all

3h. How well do you speak Russian?

Very well
Well
Not well		> TERMINATE
Not at all		> TERMINATE

SPANISH, PUERTO RICO

3a. How old are you?

17 or under		> ask for someone in household ages 18+
18 – 24
25 – 34
35 – 44
45 – 54
55+

3b. Are you…

Male
Female
Other (specify: )

3c. Do you consider yourself to be of Latino or Hispanic origin?

Yes
No		> TERMINATE

3d. What is your race? You may provide more than one group.

White
Black or African American
Asian
American Indian
Alaska Native
Native Hawaiian or Pacific Islander
Some other race (specify: _____)

3e. FOR NON-DOMINCAN GROUPS: Earlier, you reported you were HISPANIC OR LATINO. What are your detailed HISPANIC OR LATINO ethnicities? For example, Mexican or Mexican American, Puerto Rican, Cuban, Salvadoran, Dominican, Colombian, etc.? MULTIPLE RESPONSES PERMITTED / MUST RESPOND PUERTO RICAN

Mexican or Mexican American		> TERMINATE
Central American		> TERMINATE
Puerto Rican
Dominican		> TERMINATE
Cuban		> TERMINATE
South American		> TERMINATE
Other (specify: )		> TERMINATE

3f. FOR NON-DOMINCAN GROUPS: In what country or territory were you born?

In the United States
Outside of the United States (specify: )

3g. FOR DOMINICAN GROUPS ONLY In what country or territory were you born?

Dominican Republic
Outside of the United States (specify: )		> TERMINATE

3h. FOR DOMINICAN GROUPS ONLY: How long have you been living in Puerto Rico?

Since 2011 (8 years)
Before 2011 (9+ years)

3ij. What languages do you speak at home? MULTIPLE RESPONSES PERMITTED / MUST SPEAK SPANISH

Spanish
Other (specify: )		> TERMINATE

3j. How well do you speak English?

Very well		> TERMINATE
Well
Not well
Not at all

3k. How well do you speak Spanish?

Very well
Well
Not well		> TERMINATE
Not at all		> TERMINATE

3l. Do you rent or own your house or apartment?

Owned or being bought by you or someone in your household
Rented by you or someone in your household
Occupied without payment of rent

3m. FOR HOMEOWNER GROUPS ONLY Do you live in a gated community or condominium, that is, a collection of homes accessible only to residents and their guests?

Yes
No

3n. FOR UTUADO GROUPS ONLY What part of Utuado do you live in?

Rural (Bario)
Neighborhood (Urbanización)
Downtown (El pueblo)

SPANISH, U.S. MAINLAND

3a. How old are you?

17 or under		> ask for someone in household ages 18+
18 – 24
25 – 34
35 – 44
45 – 54
55+

3b. Are you…

Male
Female
Other (specify: )

3c. Do you consider yourself to be of Latino or Hispanic origin?

Yes
No		> TERMINATE

3d. What is your race? You may provide more than one group.

White
Black or African American
Asian
American Indian
Alaska Native
Native Hawaiian or Pacific Islander
Some other race (specify: _____)

3e. What languages do you speak at home? MULTIPLE RESPONSES PERMITTED / MUST SPEAK SPANISH

Spanish
Other (specify: )		> TERMINATE

3f. How well do you speak English?

Very well		> TERMINATE
Well
Not well
Not at all

3g. How well do you speak Spanish?

Very well
Well
Not well		> TERMINATE
Not at all		> TERMINATE

3h. What is your country of origin? RECRUIT A MIX.

Mexico		> mexican check quotas
El Salvador, Guatemala, Honduras, or other Central American country		> central american check quotas
Puerto Rico, Cuba, Dominican Republic		> Caribbean
Colombia, Venezuela, Argentina, or other South American country		> south american
Puerto Rican		> Puerto rican
Cuban		> Cuban

3i. In what country or territory were you born?

United States		> Terminate
Other		> ask Q3j

ONLY ASKED IF OTHER (C2 @ Q3I)

3j. How old were you when you first came to the United States?

IF ASKED, THIS INFORMATION IS BEING ASKED TO ENSURE A BROAD RANGE OF EXPERIENCES ARE REPRESENTED IN THE DISCUSSION. ANSWERS WILL NOT BE SHARED FOR MARKETING OR ANY OTHER PURPOSE.

17 or older		> 1ST GENERATION
16 or younger		> 1.5 GENERATION

3k. In what country or territory were your parents born?

Both parents were born in the U.S.		> Terminate
One parent was born in the U.S.; the other was born outside of the U.S.		> Terminate
Both parents were born outside of the U.S.
Don’t know		> Terminate

3l. FOR YAKIMA GROUPS ONLY. What best describes your primary field of work? OPEN ENDED RESPONSE - DO NOT READ ANSWER CHOICES.

Agriculture or farming
Other		> Terminate

SUB-SAHARAN AFRICA DIASPORA (FRENCH SPEAKING)

3a. How old are you?

17 or under		> ask for someone in household ages 18+
18 – 24
25 – 34
35 – 44
45 – 54
55+

3b. Are you…

Male
Female
Other (specify: )

3c. Do you consider yourself to be of Latino or Hispanic origin?

Yes		> TERMINATE
No

3d. What is your race or ethnicity? You may provide more than one group. MUST RESPOND BLACK/AFRICAN AMERICAN ONLY.

White		> Terminate
Black or African American
Asian		> Terminate
American Indian		> Terminate
Alaska Native		> Terminate
Middle Eastern or North African		> Terminate
Native Hawaiian or Pacific Islander		> Terminate
Some other race (specify: )		> Terminate

3e. In what country or territory were you born? RECRUIT A MIX.

Benin
Burkina Faso
Burundi
Cameroon
Central African Republic
Chad
Comoros
Republic of Congo
Democratic Republic of Congo (D.R.C)
Cote d’Ivoire
Djibouti
Gabon
Guinea
Madagascar
Mali
Niger
Senegal
Togo
Other		> TERMINATE

3f. What languages do you speak at home? MULTIPLE RESPONSES PERMITTED / MUST SPEAK FRENCH

English
French
Other (specify: )		> TERMINATE

3g. How well do you speak English?

Very well
Well
Not well
Not at all

3h. How well do you speak French?

Very well
Well
Not well		> TERMINATE
Not at all		> TERMINATE

3i. How old were you when you first came to the United States?

IF ASKED, THIS INFORMATION IS BEING ASKED TO ENSURE A BROAD RANGE OF EXPERIENCES ARE REPRESENTED IN THE DISCUSSION. ANSWERS WILL NOT BE SHARED FOR MARKETING OR ANY OTHER PURPOSE.

17 or older		> 1ST GENERATION
16 or younger		> 1.5 GENERATION

3j. In what country or territory were your parents born?

Both parents were born in the U.S.		> Terminate
One parent was born in the U.S.; the other was born outside of the U.S.		> Terminate
Both parents were born outside of the U.S.
Don’t know		> Terminate

VIETNAMESE

3c. Do you consider yourself to be of Latino or Hispanic origin?

Yes		> TERMINATE
No

3d. What is your race or ethnicity? You may provide more than one group. MUST RESPOND ASIAN ONLY.

White		> TERMINATE
Black or African American		> TERMINATE
Asian
American Indian		> TERMINATE
Alaska Native		> TERMINATE
Middle Eastern or North African		> TERMINATE
Native Hawaiian or Pacific Islander		> TERMINATE
Some other race or ethnicity (specify: )		> TERMINATE

3e. Earlier, you reported you were ASIAN. What are your detailed ASIAN ethnicities? For example, Chinese, Filipino, Asian Indian, Vietnamese, Korean, Japanese, etc. MUST BE Vietnamese

Chinese		> TERMINATE
Filipino/Tagalog		> TERMINATE
Asian Indian		> TERMINATE
Vietnamese
Korean		> TERMINATE
Japanese		> TERMINATE
Other (specify: )		> TERMINATE

3f. In what country or territory were you born?

In the United States		> TERMINATE
Outside of the United States (specify: )		> ask q3G

3g. What languages do you speak at home? You may provide more than one language. MULTIPLE RESPONSES PERMITTED / MUST SPEAK VIETNAMESE

English
Vietnamese
Other (specify: )		> TERMINATE

3h. How well do you speak English?

Very well		> TERMINATE
Well
Not well
Not at all

3i. How well do you speak Vietnamese?

Very well
Well
Not well		> TERMINATE
Not at all		> TERMINATE

SECTION 4: HARD-TO-COUNT DEMOGRAPHICS

NOTE: MUST MEET AT LEAST TWO OF THE FOLLOWING CRITERIA:

• Renters

• Living in a large household (with 6 or more people)

• Less than high school diploma

• Female householder, no husband present

• Low income (less than $35,000 per year)

• Move within the past year

• Household with young children (0-4 years old)

• Multi-unit or mobile home structure

4a. What is the highest grade or year of schooling you have completed?

Less than high school		1 point Check quotas for group
High school graduate or equivalent
Some college
College graduate or postgraduate degree		> Terminate

4b. What is your marital status?

Married
Widowed
Divorced
Separated
Never married

4c. Are there any children currently living in your household?

Yes (specify number of children: )		> ask q4d
No		> skip to q4e

4d. What is the age of the youngest child in your home?

0–4 years old		YOUNG children	1 point
5–9 years old
10–17 years old

ASK ALL PARTICIPANTS

4e. Besides yourself, how many adults live in your home?

RECORD NUMBER: ______________________________________

FEMALE HOUSEHOLDER

1 Point IF ALL OF FOLLOWING:

• Female (Code 2 @ Q3B)

• Unmarried (Code 2-5 @ Q4B)

• Lives with another adult (Q4E > 0)

LARGE HOUSEHOLD:

CODE NUMBER OF PEOPLE IN HOUSEHOLD = nUMBER OF CHILDREN (4C) + NUMBER OF ADULTS (4E)

None, just myself
One other person
Two other people
Three other people
Four other people
Five or more other people		1 point

4f. Do you rent or own your own house or apartment?

Rent		1 point
Own
Other (specify:_________________________________ _)

4g. Which describes the building of your primary residence?

A mobile home		1 point
A one-family house detached from any other house
A one-family house attached from any other house		1 point
A building with 2 or more apartments		1 point
Boat, RV, van, etc.		1 point

4h. How many years ago did you move into the home you are currently living in?

Moved within the past year		1 point
Moved more than a year ago

4i. What is your total annual household income?

Less than $14,999		1 point
$15,000 to $29,999		1 poinT
$30,000 to $34,999		1 point
$35,000 to $74,999
$75,000 to $149,999
More than $150,000

record TOTAL POINTS ALLOCATED THROUGHOUT SCREEneR: _________ (enter number here)

2 OR MORE POINTS
LESS THAN 2 POINTS		> TERMINATE

SECTION 5: INVITATION TO PARTICIPATE

READ TO ALL QUALIFYING PARTICIPANTS

Thank you! You are eligible to participate in the focus group on [DATE] starting at [TIME] taking place at [LOCATION]. If you have any questions or comments about this study, you may send them to [email protected]. May we schedule you to participate?

Yes
No		> Terminate

CONFIRM DETAILS & SCHEDULE PARTICIPANT

READ TO ALL NON-QUALIFYING PARTICIPANTS

Thank you! It’s important we include a variety of backgrounds in our discussions, at this time we have reached our quota for individuals who match your characteristics, so you are not eligible to participate in this study. If you have any questions or comments about this study, you may send them to [email protected]