OMB No: 0920-0770
OMB Exp. Date: X/XX/XXXX
Eligibility Screener (English)
Form Approved:
OMB No. 0920-0770
Expiration Date: XX/XX/XXXX
National HIV Behavioral Surveillance System: Eligibility Screener
Public reporting burden of this collection of information is estimated to average 5 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, Project Clearance Officer, 1600 Clifton Road, MS D-74, Atlanta, GA 30333, ATTN: PRA (0920-0770). Do not send the completed form to this address
NHBS Round 6 CAPI REFERENCE QUESTIONNAIRE (CRQ)
Order in CAPI |
Abbreviation |
Domain |
Other topics included |
00 |
Overview |
Overview |
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0 |
CalcVars |
Pre-set & calculated variables |
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1 |
IE |
Interviewer-entered information |
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2 |
ES |
Eligibility screener |
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3 |
CN |
Consent |
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4 |
CI |
OMB Statement & Core Introductory Statement |
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5 |
NS |
Network size (RDS cycles only) |
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6 |
DM |
Demographics |
General health care access & utilization |
7 |
SO |
Social experiences (MSM cycle only) |
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8 |
SX |
Sexual behavior |
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9 |
AL |
Alcohol use |
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10 |
ID |
Injection drug use |
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11 |
ND |
Non-injection drug use |
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12 |
TX |
Drug overdose and drug treatment |
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13 |
HT |
HIV testing & care |
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14 |
HC |
Health conditions (STIs, hepatitis, mental health) |
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15 |
PA |
Prevention activities |
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16 |
JT |
Justice system experiences |
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17 |
VE |
Violence |
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CAPI |
Computer-Assisted Personal Interview |
CRQ |
CAPI Reference Questionnaire |
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R |
Respondent |
P |
Partner |
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DK |
Don't know |
REF |
Refused to answer |
NA |
Not applicable (question asked of R but this is a codable response option) |
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EQ |
Equal to |
GT |
Greater than |
GE |
Greater than or equal to |
LE |
Less than or equal to |
LT |
Less than |
NE |
Not equal to |
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VS, UVS |
Vaginal sex, unprotected vaginal sex (i.e., without a condom) |
AS, UAS |
Anal sex, unprotected anal sex (i.e., without a condom) |
IAS |
Insertive anal sex |
RAS |
Receptive anal sex |
Term |
Prefix / format |
Definition |
Calculated variable |
CALC_ |
Item identifier (not prefix for variable name) for variables calculated by the CAPI program that appear in the CRQ. |
Century Month |
_C |
A century month is an integer value that represents the number of months since January 1900. These calculations are used to compare dates and facilitate routing where respondents are asked to only provide the month and year in which an event took place. These types of questions occur in every date item within the CRQ, with the exception of DOB (ES1). As an example, January 2014 is represented by the integer 1369. The higher the integer, the closer the event is to the current date, and the lower the integer, the farther it is in the past. |
Message |
INTERVIEWER: |
Message displayed to the interviewer that is not to be read to R. May be triggered by an edit check. Distinct from Interviewer Instruction. |
Filter question |
|
A question that determines whether the respondent should receive subsequent question or set of questions, typically on a related topic. |
Logic Check |
Check_ |
Logic that must be checked (by the CAPI program) in order to determine proper routing to the next item in the CAPI programmed questionnaire. |
Hard Edit Check |
HardEdit_ |
A check to determine whether the response entered is logically inconsistent with specific previously entered response. If so, CAPI program displays message to interviewer. Hard edit checks cannot be suppressed, i.e., program will not advance until interviewer has changed at least one of the inconsistent values. |
Interviewer instruction |
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Instruction to interviewer regarding survey administration. Standard instructions are ‘Give Respondent Flashcard {letter}', ‘READ choices', ‘DO NOT read choices', & ‘CHECK ALL that apply'. |
Introductory statement |
INTRO_ |
Transitional statement read to R at the beginning of a new topic (e.g., Section, set of questions, etc.). Prefix is followed by section abbreviation, series, or first item in set to which it applies. |
Range |
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Range of valid response values for items collecting or computing numeric data. E.g., the valid range of responses to number of sex partners in past 12 months is 0 to 7000. |
Section |
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Section of the Questionnaire. Each section has a unique two letter abbreviation. |
Series |
…Series. |
A group of questions on a given topic that share a general universe. Most but not all series have a parallel series elsewhere (e.g. Male-Female, Male-Male, and Female-Male series). |
Soft Edit Check |
SoftEdit_ |
A check to determine whether the response entered is implausible. If yes, CAPI program displays message to interviewer; program may advance after closing the error message dialog box. |
Universe |
Universe_ |
A specific group of respondents to receive a section, series, question, etc. E.g., the universe for the Consent Section is respondents who were eligible for the cycle in which they completed the eligibility screener. |
NHBS ROUND 6 QUESTIONNAIRE
PRE-SET AND CALCULATED VARIABLES
Variables with pre-set values |
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ROUND |
NHBS Round |
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ROUND = "NHBS Round 6" |
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CYCLE |
NHBS Cycle |
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CYCLE = 1 (MSM) If MSM cycle CYCLE = 2 (IDU) If IDU cycle CYCLE = 3 (HET) If HET cycle |
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LANGUAGE |
Language |
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LANGUAGE = 1 IF ENGLISH LANGUAGE = 2 IF SPANISH |
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VERSION |
Questionnaire Version |
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If CYCLE=1 & LANGUAGE=1, VERSION=‘NHBS-MSM6 – ENGLISH, V1, [BUILD DATE]' If CYCLE=1 & LANGUAGE=2, VERSION = ‘NHBS-MSM6 – SPANISH, V1, [BUILD DATE]' If CYCLE=2 & LANGUAGE=1, VERSION=‘NHBS-IDU6 – ENGLISH, V1, [BUILD DATE]' If CYCLE=2 & LANGUAGE=2, VERSION = ‘NHBS-IDU6 – SPANISH, V1, [BUILD DATE]' If CYCLE=3 & LANGUAGE=1, VERSION=‘’NHBS-HET6 – ENGLISH, V1, [BUILD DATE]' If CYCLE=3 & LANGUAGE=2, VERSION = ‘NHBS-HET6 – SPANISH, V1, [BUILD DATE]' |
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IDATE |
Interview date |
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IDATE = Today's date {system date on device} |
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IDATEMN |
Interview date: Numeric month |
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IDATEMN = if(idatem="01", 01, if(idatem="02", 02, if(idatem="03", 03, if(idatem="04", 04, if(idatem="05", 05, if(idatem="06", 06, if(idatem="07", 07, if(idatem="08", 08, if(idatem="09", 09, if(idatem="10", 10, if(idatem="11", 11, if(idatem="12", 12, 0)))))))))))) |
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IDATEY |
Interview date: Year |
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IDATEY = If(P_IYEAR="2020", 2020,If(P_IYEAR="2021", 2021,If(P_IYEAR="2022", 2022, 0))) |
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START |
Start Time |
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START = Current time {system time on device} |
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DATETIME |
Date and time identifier |
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DATETIME= CONCAT(IDATE, START) |
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DATAFILE |
Data file name |
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DATAFILE = Data file name |
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QYR |
Current Questionnaire Year |
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QYR = if ((CYCLE=1), 2020, if ((CYCLE=2), 2021, if ((CYCLE=3), 2022, 0))) |
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MSM6_IMP |
MSM6 data collection start date |
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MSM6_IMP = June 1, 2020 |
Computed date and duration variables used throughout the interview |
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IDATE_C |
Interview date: Century Month |
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IDATE_C= (IDATEY-1900) *12 + (IDATEMN) |
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AGO2Y_C |
2 yrs before interview: Century Month |
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AGO2Y_C= IDATE_C-24 |
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AGO12M_C |
12 mos before interview: Century Month |
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AGO12M_C= IDATE_C -12 |
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AGO6M_C |
6 mos before interview: Century Month |
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AGO6M_C= IDATE_C -6 |
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AGO3M_C |
3 mos before interview: Century Month |
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AGO3M_C= IDATE_C -3 |
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NHBS ROUND 6 QUESTIONNAIRE
INTERVIEWER ENTERED INFORMATION (IE)
Variables from prior section(s) used in this section of the questionnaire |
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Section |
Question # |
Variable name |
Variable label |
Preloaded Variables |
-- |
CYCLE |
NHBS Cycle |
Preloaded Variables |
-- |
VERSION |
Questionnaire Version |
Preloaded Variables |
-- |
MSM6_IMP |
MSM6 data collection start date |
Preloaded Variables |
-- |
QYR |
Current Questionnaire Year |
Preloaded Variables |
-- |
IDATE |
Interview Date |
Preloaded Variables |
-- |
IDATEY |
Interview Date: Year |
Universe_IE. |
All Rs. |
INTRO_DATETIME. |
DISPLAY: "The current date recorded on this device is [fill with current date, formatted as “Month date, year”] and the time is [fill with current time, formatted as “Hour: minute”]. If this is not correct, please close this interview and correct the date on the device." |
INTRO_VERSION. |
DISPLAY: "This is questionnaire version [fill with value for VERSION]." |
INTRO_OMB. |
DISPLAY: "Public reporting burden of this collection of information is estimated to average 5 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, Project Clearance Officer, 1600 Clifton Road, MS D-74, Atlanta, GA 30333, ATTN: PRA (0920-0770). Do not send the completed form to this address." |
IE1. |
Interviewer ID: |
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ICODE |
Interviewer ID |
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---- ---- |
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Range |
1-99 |
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IE2. |
City: |
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CITY |
City (List of eligible cities on computer) |
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IE3. |
Survey ID: |
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SURID |
Survey ID |
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---- ---- ---- ---- Must be 4 digits |
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Range |
1-9999 |
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HardEdit_IE3. |
If IE3 not 4 digits long, DISPLAY: "INTERVIEWER: The Survey ID must be four digits long." Then, go back to IE3. Else, go to IE3conf1. |
IE3conf1. |
INTERVIEWER: The Survey ID that you entered was [fill with value entered for IE3]. Is this correct? |
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C_SURID |
Survey ID confirmation |
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No |
0 |
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Yes |
1 |
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HardEdit_IE3conf1. |
If value entered for IE3 is not correct (IE3conf1 EQ 0), DISPLAY: "INTERVIEWER: Enter the correct Survey ID number in the next screen." Then, go back to IE3. Else, go to Check_VBSSeries. |
Check_VBSSeries. |
If MSM cycle (CYCLE EQ 1), go to VBS Recruitment (VBS) Series. Else, go to RDS Recruitment (RDS) Series. |
Universe_VBSSeries. |
All Rs in MSM Cycle (CYCLE EQ 1). |
IE4. |
INTERVIEWER: Is this interview a Post Event Appointment? |
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PEA |
Post Event Appointment |
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No |
0 |
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Yes |
1 |
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IE5. |
Venue Code: |
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VENUE |
Venue Code |
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__ __ __ __ |
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Range |
1-9900 |
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IE6. |
Event Number: |
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VBS_EVNT |
Event number |
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---- ---- ---- |
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Range |
1-999 |
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Don't Know |
9999 |
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Check_IE7. |
If interview is Post Event Appointment, (IE4 EQ 1), go to IE7. Else, go to END_IE. |
IE7. |
Enter the field site ID for the location of the interview: (If unknown, select "Don't Know".) |
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PEASITE |
PEA Field site ID |
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---- ---- ---- ---- |
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{4 alphanumeric characters} |
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Don't Know |
9 |
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Check_HardEdit_IE7. |
If PEA field site is unknown (IE7 EQ DK), go to IE8. Else, go to HardEdit_IE7. |
HardEdit_IE7. |
If IE7 is NOT 4 digits long, DISPLAY: "INTERVIEWER: The PEA Field Site ID must be four alphanumeric characters long." Then, go back to IE7. Else, go to IE8. |
IE8. |
Enter the date of the recruitment event: (If unknown, select "Don't Know".) |
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PEARDTE |
PEA recruitment event date |
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__ __ / __ __ / __ __ __ __ (MM/DD/YYYY) |
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Range (Year) |
1900-2100 |
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Don't know (Year) |
9999 |
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HardEdit_IE8. |
If PEA recruitment event date known & after interview date (IE8 NE DK & IE8 GT IDATE), DISPLAY: " INTERVIEWER: The date of the recruitment event cannot be after today's date. Please correct on next screen." Then return to IE8. Else, go to SoftEditIE8. |
SoftEdit_IE8. |
If PEA recruitment event date known & before MSM cycle implementation date (IE8 NE DK & IE8 LT MSM5_IMP), DISPLAY: "INTERVIEWER: The date of the recruitment event is before June 1, [fill with current questionnaire year (QYR)]. If this is incorrect, go back to the previous screen and re-enter the date of the recruitment event.” Else, go to END_IE. |
Universe_RDSSeries. |
All Rs in IDU & HET Cycle (CYCLE EQ 2 or 3). |
IE9. |
Field Site ID: |
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FLDSTEID |
RDS Field site ID |
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---- ---- {Must be 2 digits} |
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Range |
0-99 |
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HardEdit_IE9. |
If IE9 is not 2 digits long, DISPLAY: "INTERVIEWER: The Field Site ID must be two digits long. Please correct on next screen." Then return to IE9. Else, go to IE10. |
IE10. |
INTERVIEWER: Is the respondent a seed? |
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ISEED |
Respondent is a seed |
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No |
0 |
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Yes |
1 |
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HardEdit_IE10. |
If Survey ID in non-seed range & R is a seed (IE3 GE 1000 &IE10 EQ 1), DISPLAY: "INTERVIEWER: You indicated that the respondent is a seed but earlier, recorded a non-seed Survey ID. One of these is incorrect." Then return to IE10. If Survey ID in seed range & R NOT a seed (IE3 LT 1000 & IE10 EQ 0), DISPLAY: "INTERVIEWER: You indicated that the respondent is NOT a seed but earlier, recorded a seed Survey ID. One of these is incorrect." Then return to IE3. Else, go to END_IE. |
END_IE. |
Go to Eligibility Screener Section (ES). |
NHBS ROUND 6 QUESTIONNAIRE
Variables from prior section(s) used in this section of the questionnaire |
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Section |
Question # |
Variable name |
Variable label |
Preloaded variables |
-- |
CYCLE |
NHBS Cycle |
Preloaded variables |
-- |
IDATE |
Interview date |
Preloaded variables |
-- |
QYR |
Current Questionnaire Year |
Interviewer Entered Information |
IE2 |
CITY |
City |
Interviewer Entered Information |
IE4 |
PEA |
Post Event Appointment |
Interviewer Entered Information |
IE8 |
PEARDTE |
PEA recruitment event date |
Interviewer Entered Information |
IE10 |
ISEED |
Respondent is a seed |
Universe_ES. |
All Rs. |
INTRO_ES. |
DISPLAY: "READ: I'd like to thank you again for your interest in this health survey. Remember that all information you give me will be kept private and I will not ask for your name. First, I will ask you a few questions about yourself and then the computer will determine if you have been selected to participate in the health survey." |
CALC_BEGSCR. |
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BEGSCR |
Time at beginning of screener |
BEGSCR = Current time |
Check_CALC_RDATE. |
If MSM cycle (CYCLE EQ 1), go to CALC_RDATE. Else, go to ES1. |
CALC_RDATE. |
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RDATE |
Recruitment Date |
If interview is NOT a Post Event Appointment (IE4 EQ 0): RDATE=IDATE
If interview is Post Event Appointment (IE4 EQ 1): RDATE=PEARDTE |
ES1. |
What is your date of birth? |
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DOB |
Date of birth |
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__ __ / __ __ / __ __ __ __ (MM/DD/YYYY) |
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Range (Year) |
1900-2100 |
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Don't Know (Year) |
9999 |
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Refuse to Answer (Year) |
7777 |
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Check_CALC_AGE. |
If R did not provide date of birth (ES1 EQ DK or REF), go to ES2. Else, go to HardEdit_ES1. |
HardEdit_ES1. |
If date of birth is on or after interview date (ES1 GE IDATE), DISPLAY: "INTERVIEWER: Date of birth cannot be TODAY or later." Then, go back to ES1. Else, go to CALC_AGE. |
CALC_AGE. |
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AGE |
QDS calculated age today |
Calculate age from date of birth (DOB) |
ES1a. |
So, you are [fill with calculated age (AGE)] years old. Is that correct? |
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C_AGE |
Confirm age |
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No |
0 |
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Yes |
1 |
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HardEdit_ES1a. |
If calculated age NOT correct (ES1a EQ 0), DISPLAY: "INTERVIEWER: Please hit ok to re-enter the date of birth." Then, go back to ES1. Else, go to Check_ES2. |
Check_ES2. |
If R LT 18 years old (AGE LT 18), go to Check_CALC_EL. Else, go to ES2. |
ES2. |
During [fill with current questionnaire year (QYR)], did you already complete at least part of the health survey that (Insert Project Name) is conducting? It could have been here or at another location. |
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E_PART |
Eligibility, previous participant |
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No |
0 |
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Yes |
1 |
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Don't Know |
9 |
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Refuse to Answer |
7 |
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ES3. |
Do you consider yourself to be of Hispanic, Latino/a, or Spanish origin?
[INTERVIEWER: If necessary, say "Just tell me Yes or No."] |
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HISPANIC |
Latino ethnicity |
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No |
0 |
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Yes |
1 |
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Don't Know |
9 |
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Refuse to Answer |
7 |
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Check_ES3a. |
If R is Latino (ES3 EQ 1), go to ES3a. Else, go to ES4. |
ES3a. |
Which of the following describes your Hispanic, Latino/a, or Spanish origin? You may choose more than one option.
[READ choices. CHECK ALL that apply.] |
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HSPTYP |
Hispanic Ancestry (number reported) |
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HSPTYPA |
Mexican |
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HSPTYPB |
Puerto Rican |
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HSPTYPC |
Cuban |
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HSPTYPD |
Dominican |
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HSPTYPE |
Another Hispanic, Latino/a, or Spanish origin |
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Don't Know |
9 |
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Refuse to Answer |
7 |
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Check_ES3spec. |
If R reports ‘Another' Hispanic origin (HSPTYPE EQ 1), go to ES3spec. Else, go to ES4. |
ES3spec. |
What is your Hispanic, Latino/a, or Spanish origin? |
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SPECHSP |
Other specified Latino origin |
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__ __ __ __ __ __ __ __ __ ____ __ __ __ ____ __ __ __ ____ __ __ __ __ ____ __ __ __ ____ __ __ __ ____ __ __ __ |
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{text response; max length = 100 characters} |
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Don't Know |
9 |
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Refuse to Answer |
7 |
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ES4. |
[Give Respondent Flashcard A.]
Which racial group or groups do you consider yourself to be in? You may choose more than one option.
[READ choices. CHECK ALL that apply.] |
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RACE |
Racial group (number reported) |
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RACEA |
American Indian or Alaska Native |
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RACEB |
Asian |
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RACEC |
Black or African American |
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RACED |
Native Hawaiian or Other Pacific Islander |
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RACEE |
White |
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Don't Know |
9 |
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Refuse to Answer |
7 |
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Not Applicable |
8 |
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ES5 |
What county do you currently live in?
[DO NOT read choices.] (List of eligible counties on computer) |
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CALC_E_CITY. |
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E_CITY |
Eligible city resident |
E_CITY = if ((ATLELR5=1 or BLTELR5=1 or BSTELR5=1 or CHIELR5=1 or DALELR5=1 or DENELR5=1 or DETELR5=1 or HOUELR5=1 or LAXELR5=1 or MEMELR5=1 or MIAELR5=1 or NAUELR5=1 or NEWELR5=1 or NOLELR5=1 or NORELR5=1 or NYCELR5=1 or PHLELR5=1 or PTLELR5=1 or SDGELR5=1 or SFOELR5=1 or SJNELR5=1 or SEAELR5=1 or WDCELR5=1),1,0) |
Check_ES5spec. |
If R is resident of ‘other' county (ES5_ATL1 EQ 88 or ES5_BLT EQ 88 or ES5_BOS EQ 88 or ES5_CHI. EQ 88 or ES5_DAL. EQ 88 or ES5_DEN. EQ 88 or ES5_DET. EQ 88 or ES5_HOU. EQ 88 or ES5_LAX. EQ 88 or ES5_MEM. EQ 88 or ES5_MIA. EQ 88 or ES5_NAU. EQ 88 or ES5_NEW. EQ 88 or ES5_NOL. EQ 88 or ES5_NOR. EQ 88 or ES5_NYC. EQ 88 or ES5_PHL. EQ 88 or ES5_PTL. EQ 88 or ES5_SDG. EQ 88 or ES5_SFO. EQ 88 or ES5_SJN1. EQ 88 or ES5_SEA.EQ 88 or ES5_WDC. EQ 88), go to ES5spec. Else, go to Check_ES6. |
ES5spec. |
INTERVIEWER: Specify other county: |
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SPECCNTY |
Specify other county |
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__ __ __ __ __ __ __ __ __ ____ __ __ __ ____ __ __ __ ____ __ __ __ __ ____ __ __ __ ____ __ __ __ ____ __ __ __ |
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{text response; max length = 100 characters} |
Check_ES8. |
If MSM cycle (CYCLE EQ 1), go to ES8. Else, go to ES9. |
ES8. |
What was your sex at birth?
[DO NOT read choices.] |
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BIRTHSEX |
Sex at birth |
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Male |
1 |
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Female |
2 |
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Intersex/ambiguous |
3 |
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Don't Know |
9 |
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Refuse to Answer |
7 |
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ES9. |
Do you consider yourself to be male, female or transgender? |
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GENDER |
Gender |
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Male |
1 |
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Female |
2 |
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Transgender |
3 |
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Don't Know |
9 |
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Refuse to Answer |
7 |
|
Check_ES9a. |
If MSM cycle (CYCLE EQ 1), go to ES9a. If IDU cycle (CYCLE EQ 2), go to ES10. If HET cycle (CYCLE EQ 3), go to Check_INTRO_ES17. |
ES9a. |
Have you ever had vaginal or anal sex with a woman? |
||
E_EVRMSW |
Eligibility: MSM, Ever had sex with woman |
|
|
|
No |
0 |
|
|
Yes |
1 |
|
|
Don't Know |
9 |
|
|
Refuse to Answer |
7 |
|
ES9b. |
Have you ever had oral or anal sex with a man? |
||
E_EVRMSM |
Eligibility: MSM, Ever had sex with man |
|
|
|
No |
0 |
|
|
Yes |
1 |
|
|
Don't Know |
9 |
|
|
Refuse to Answer |
7 |
|
ES9c. |
In the past 30 days, how many times have you gone to a place where gay men hang out, meet, or socialize? These could include bars, clubs, social organizations, parks, gay businesses, bookstores, sex clubs, etc. Do not include places where you are employed. |
||
ATTEND30 |
Venue attendance, 30 days |
|
|
|
__ __ __ |
|
|
|
Range |
0 - 700 |
|
|
Don't Know |
999 |
|
|
Refuse to Answer |
777 |
|
Check_ES10. |
Go to INTRO_ES18. |
ES10. |
Have you ever in your life shot up or injected any drugs other than those prescribed for you? By shooting up, I mean any time you might have used drugs with a needle, either by mainlining, skin popping, or muscling. |
||
E_EVRINJ |
Eligibility: ever injected |
|
|
|
No |
0 |
|
|
Yes |
1 |
|
|
Don't Know |
9 |
|
|
Refuse to Answer |
7 |
|
Check_ES11. |
If R ever injected (ES10 EQ 1), go to ES11. Else (ES10 NE 1), go to INTRO_ES18. |
ES11. |
When was the last time you injected any drug? That is, how many days or months or years ago did you last inject?
[INTERVIEWER: If today, enter "0"] |
||
E_LINJN |
IDU ES: When last injected, number |
|
|
|
__ __ __ |
|
|
|
Range |
0 - 365 |
|
|
Don't Know |
999 |
|
|
Refuse to Answer |
777 |
|
Check_ES11a. |
If R last injected today or did not report the last time they injected (ES11 EQ 0, DK, or REF), go to CALC_E_INJ12. Else, go to ES11a. |
ES11a. |
[INTERVIEWER: Was this days or months or years?] |
||
E_LINJU |
IDU ES : When last injected, unit |
|
|
|
Days |
0 |
|
|
Months |
1 |
|
|
Years |
2 |
|
CALC_E_INJ12. |
|
|
E_INJ12 |
injected in last 12 months |
E_INJ12 = if ((E_LINJN=0), 1, if (E_LINJU=0 and E_LINJN<=365), 1, if ((E_LINJU=1 and E_LINJN<=12), 1, if ((E_LINJU=2 and E_LINJN <=1), 1, 0))) |
ES12. |
[Give Respondent Flashcard B.]
Which drug do you inject most often?
[READ choices.] |
||
E_USINJ |
Eligibility, drug usually injected |
|
|
|
Speedball, which is heroin and cocaine together |
1 |
|
|
Heroin, by itself |
2 |
|
|
Powder cocaine, by itself |
3 |
|
|
Crack cocaine, by itself |
4 |
|
|
Methamphetamine, also known as meth, crystal meth, speed, or crank |
5 |
|
|
Painkillers, such as Oxycontin, Dilaudid, morphine, Percocet, or Demerol |
6 |
|
|
Something else |
7 |
|
|
Don't Know |
99 |
|
|
Refuse to Answer |
77 |
|
Check_ES12spec. |
If R most often injects ‘something else' (ES12 EQ 7), go to ES12spec. Else, go to ES13. |
ES12spec. |
INTERVIEWER: Specify other injection drug |
|
||
SPECE_ID |
Specify other injection drug |
|
||
|
__ __ __ __ __ __ __ __ __ ____ __ __ __ ____ __ __ __ ____ __ __ __ __ ____ __ __ __ ____ __ __ __ ____ __ __ __ |
|
||
|
{text response; max characters = 100} |
|
|
ES13. |
Where on your body do you usually inject?
[INTERVIEWER: Have respondent show ALL injection areas on body. Check for physical signs of injection.]
[DO NOT read choices. CHECK ALL that apply.] |
||
E_INJBD |
Part of body injected |
|
|
E_INJBDA |
Fresh track marks |
|
|
E_INJBDB |
Needle-sized scabs |
|
|
E_INJBDC |
Abscesses |
|
|
E_INJBDD |
Old track marks or scars |
|
|
E_INJBDE |
Injects in covered area |
|
|
E_INJBDF |
Showed injection area(s) but NO physical signs |
|
|
|
Refuse to Answer |
7 |
|
HardEdit_ES13. |
If interviewer records both physical signs & ‘no physical signs' of injection (E_INJBDA EQ 1 or E_INJBDB EQ 1 or E_INJBDC EQ 1 or E_INJBDD EQ 1) & E_INJBDF EQ 1, DISPLAY: "INTERVIEWER: You indicated that the respondent had both physical signs and no physical signs of injection. Clarify and re-enter response to current or prior item as needed." Then go back to ES13. Else, go to CALC_E_INJSGN. |
CALC_E_INJSIG. |
|
|
E_INJSIG |
Eligible: Phy Sign Recent Injection |
If R has fresh track marks, needle-sized scabs, or abcesses (E_INJBDA=1 OR E_INJBDB=1 OR E_INJBDC=1), E_INJSIG EQ 1. If R has old track marks or scars, has no physical signs of injection, or has no physical signs of injection and injects in a covered area (E_INJBDD=1 OR E_INJBDF=1 OR (E_INJBDE=1 and E_INJBDF=1)), E_INJSIG EQ 2. If R refused to answer (E_INJBD= REF) or only injected in a covered area (E_INJBDE=1 and E_INJBDA – E_INJBDF=0), E_INJSIG EQ 0. |
Check_ES14. |
If R has only non-recent signs of injection, no physical signs of injection, or has no physical signs of injection and injects in a covered area (E_INJSIG EQ 2), go to ES14. Else, go to CALC_E_INJCT. |
ES14. |
Step-by-step, tell me how you prepare your drugs.
[INTERVIEWER: Description could include: --Mix drugs with water or lemon juice/vinegar--Use cooker /Heat drugs--Use filter] |
||
E_INJPRP |
Eligibility, prepare drugs |
|
|
|
Description OK |
1 |
|
|
Description Not OK |
2 |
|
ES15. |
Step-by-step, tell me how you inject your drugs.
[INTERVIEWER: Description could include: --Tie off and find vein (IVDU)--Clean injection site--Register (IVDU)] |
||
E_HWINJ |
Eligibility, how is injection done |
|
|
|
Description OK |
1 |
|
|
Description Not OK |
2 |
|
ES16. |
What type of syringe do you usually inject with?
[INTERVIEWER: Description could include: --Syringe size (in cc's or units)--Needle size (gauge, length)--Cap (color, number)(Can also ask where they usually get syringes, what they do with them after injecting, and how they know if they are new or used.)] |
||
E_STYP |
Eligibility, type of syringe used |
|
|
|
Description OK |
1 |
|
|
Description Not OK |
2 |
|
CALC_E_INJKNW. |
|
|
E_INJKNW |
Eligible: Injection knowledge |
E_INJKNW = if ((E_INJPRP=1 AND E_HWINJ=1 AND E_STYP=1),1,0) |
CALC_E_INJCT. |
|
|
E_INJCT |
Eligible: Injection signs or knowledge |
E_INJCT = if (E_INJSIG=1 OR (E_INJSIG=2 AND E_INJKNW=1),1,0) |
Check_HET_Behavioral_Eligibility. |
Go to INTRO_ES18. |
Check_INTRO_ES17. |
If R male or female (ES9 EQ 1 or 2), go to INTRO_ES17. If R NOT male or female (ES9 EQ 3, DK, or REF), go to CALC_E_VAS12. |
INTRO_ES17.
|
DISPLAY: "READ: The next questions are about having sex. Please remember your answers will be kept private." |
ES17. |
Have you had sex with a [if R is male, fill with "woman"; if R is female, fill with "man"] in the past 12 months? |
||
E_OPPSEX |
Eligibility: opposite sex partner, past 12 mos. |
|
|
|
No |
0 |
|
|
Yes |
1 |
|
|
Don't Know |
9 |
|
|
Refuse to Answer |
7 |
|
Check_ES17a.
|
If R had sex with opposite-sex partner (ES17 EQ 1), go to ES17a. Else, go to CALC_E_VAS12. |
ES17a. |
Did you have vaginal sex? By vaginal sex, I mean [if R is male, fill with "you put your penis in her vagina"; if R is female, fill with "he put his penis in your vagina"]. |
||
E_VS12 |
Eligibility: Vaginal sex past 12mos |
|
|
|
No |
0 |
|
|
Yes |
1 |
|
|
Don't Know |
9 |
|
|
Refuse to Answer |
7 |
|
Check_ES17b.
|
If R had vaginal sex (ES17a EQ 1), go to CALC_E_VAS12. Else, go to ES17b. |
ES17b. |
Did you have anal sex? By anal sex, I mean [if R is male, fill with "you put your penis in her anus or butt"; if R is female, fill with "he put his penis in your anus or butt"]. |
||
E_AS12 |
Eligibility: Anal sex past 12mos |
|
|
|
No |
0 |
|
|
Yes |
1 |
|
|
Don't Know |
9 |
|
|
Refuse to Answer |
7 |
|
Check_ES17conf.
|
If R reported sex but neither vaginal nor anal sex with opposite sex partner (ES17 EQ 1 & ES17a EQ 0 & ES17b EQ 0), go to ES17conf. Else, go to CALC_E_VAS12. |
ES17conf. |
So, in the last 12 months, you only had oral sex with a [if R is male, fill with "woman"; if R is female, fill with "man"]? Is that correct? |
||
C_OS12 |
Eligibility: Oral sex confirmation only |
|
|
|
No |
0 |
|
|
Yes |
1 |
. |
Check_CALC_E_VAS12.
|
If oral sex only NOT correct (ES17conf EQ 0), go back to ES17a. Else, go to CALC_E_VAS12. |
CALC_E_VAS12. |
|
|
E_VAS12 |
Eligibility: Opposite Sex Partner, p 12mos |
If (E_VS12 =DK or REF) & (E_AS12 =DK or REF), E_VAS12=9. Else if (E_VS12 = 1 or E_AS12 = 1), E_VAS12 =1. Else, E_VAS12 = 0. |
INTRO_ES18. |
DISPLAY: "READ: The next questions are about languages you speak." |
ES18. |
How well do you speak English?
[READ choices.] |
||
ENGPFCY |
English proficiency |
|
|
|
Very well |
1 |
|
|
Well |
2 |
|
|
Not well |
3 |
|
|
Not at all |
4 |
|
|
Don't Know |
9 |
|
|
Refuse to Answer |
7 |
|
ES19. |
How well do you speak Spanish?
[READ choices.] |
||
SPNPFCY |
Spanish proficiency |
|
|
|
Very well |
1 |
|
|
Well |
2 |
|
|
Not well |
3 |
|
|
Not at all |
4 |
|
|
Don't Know |
9 |
|
|
Refuse to Answer |
7 |
|
INTRO_Check_CALC_EL. |
DISPLAY: "READ: We've finished the first series of questions. Now the computer will determine whether you've been selected to participate in the survey." |
May
31, 2019
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
Author | CDC User |
File Modified | 0000-00-00 |
File Created | 2021-01-15 |