Redesign Field Tes Redesign Field Test

2020 NSDUH Redesign Field Test
Attachment FT-10 – Screening Questions

NSDUH Screening Application Specifications
HU Screening
Document Format:
• Screen names are in bold, upper-case letters.
• English text to be read by FIs is shown in black font.
• FI instructions are provided in black, upper-case text that is not in brackets. In the screening
program, FI instructions appear in red, upper-case letters.
• Text of any pop-up screens are provided in bracketed logic using upper-case text in quotations.
• Programming logic is designated by black, upper-case text in brackets.
• Fills are designated by parenthesis and italics.
• Response categories are underlined.

The line number and address are located at the top of each screen. During the roster questions asking
about age through military, touch the address line to see DU LINE box, an enlarged display of the
CaseID and address. If a case is an Added DU, the DU LINE box displays the link line number.

STUDY INTRODUCTION
Hello, my name is (FI NAME) with RTI International in North Carolina. We are conducting a
nationwide study sponsored by the U.S. Department of Health and Human Services.
[IF NOT ADDED DU] You should have received a letter explaining the study.
[IF NOT ADDED DU] HAND R COPY OF LETTER IF NEEDED
[IF ADDED DU] HAND R LEAD LETTER, ALLOW TIME TO READ
Next [IDENTIFY SR]

IDENTIFY SR [IF STUDY INTRODUCTION = NEXT]
First, just let me verify: Do you live here?
IF NOT OBVIOUS:
And are you 18 or older?
IF NO TO EITHER, ASK FOR AN ADULT RESIDENT, TOUCH “PREVIOUS”, AND BEGIN
AGAIN.
SR Available [ADDRESS VERIFICATION]
SR Not Available [EXIT SCREENING: “ARE YOU SURE YOU WANT TO EXIT
SCREENING?” IF Yes, RECORD OF CALLS. IF No, IDENTIFY SR.]

ADDRESS VERIFICATION [IF IDENTIFY SR = SR AVAILABLE]
1

I just need to verify -- is this
STREET: (NUMBER AND STREET)
CITY: (CITY)
STATE: (STATE)
ZIP: (ZIP)
Address Is Correct [INFORMED CONSENT]
Need to Edit Address [EDIT ADDRESS]
FI At Wrong Address [SELECT CASE]

EDIT ADDRESS [IF ADDRESS VERIFICATION = NEED TO EDIT ADDRESS]
TOUCH THE ITEM YOU NEED TO EDIT
STREET # (NUMBER)
STREET: (STREET)
APT.#: (APARTMENT NUMBER)
CITY: (CITY)
STATE: (STATE)
ZIP: (ZIP)
Update [SAVE UPDATED ADDRESS, THEN ADDRESS VERIFICATION]

INFORMED CONSENT [IF ADDRESS VERIFICATION = ADDRESS IS CORRECT]
GIVE PERSON STUDY DESCRIPTION AND SAY
Please read this statement. It describes the survey and the laws that ensure the confidentiality of
any information you provide. It also explains that your answers are used for statistical purposes
only and that your participation is voluntary. If anyone is selected for the full interview, each
person who completes the interview will receive ($30/$50) in cash.
[IF INCENTIVE SEGMENT] HAND RESPONDENT $5 CASH.
Next [IF APT/CONDO=NO, MISSED DUs; IF APT/CONDO=YES, OCCUPANCY]

MISSED DUs [IF INFORMED CONSENT = NEXT AND APT/CONDO=NO]
Are there any other living quarters within this structure or on this property, such as a separate
apartment with a separate entrance?
Yes [MISSED DU ADDRESS]
[IF ADDED DU: CANNOT ADD UNIT
“YOU CANNOT ADD A MISSED DU
FROM A DU THAT HAS BEEN ADDED”
MISSED DUs]

No [OCCUPANCY]

2

MISSED DU ADDRESS [IF MISSED DUs = YES]
RECORD STREET ADDRESS OR DESCRIPTION OF UNIT
STREET #:
STREET:
APT.#: (APARTMENT NUMBER)
Update [Add Another DU: “DURING
THIS SESSION, YOU HAVE ADDED
1 UNIT. YOU STILL HAVE 4 UNUSED
ADDED LINES LEFT IN THIS SEGMENT.
DO YOU WANT TO ADD ANOTHER
MISSED DU?” IF Yes, MISSED DU
ADDRESS. IF No, OCCUPANCY.]

Cancel [CANCEL DU: “ARE YOU SURE
YOU WANT TO CANCEL ADDITION
OF THIS DU? IF Yes, OCCUPANCY.
IF No, MISSED DU ADDRESS.]

OCCUPANCY [IF MISSED DUs = NO OR APT/CONDO=YES OR MISSED DU ADDRESS =
UPDATE OR CANCEL MISSED DU = YES]
(Did/Will) you or anyone else in this household live here for most of the time during the months
of (DATA COLLECTION PERIOD)?

Yes [TOTAL SDU MEMBERS]

No [OCCUPANCY – CONFIRMATION: YOUR
‘NO’ RESPONSE WILL CONCLUDE THIS
SCREENING AND FINALIZE THIS CASE. DO YOU
WANT TO CHANGE YOUR ANSWER? (‘YES’
WILL CONTINUE SCREENING. ‘NO’ WILL
FINALIZE THE CASE.) IF Yes, OCCUPANCY. IF
No, OCCUPANCY-CLOSE CASE: ARE YOU SURE
YOU WANT TO CLOSE OUT THIS CASE? IF Yes,
VERIFICATION. IF No, OCCUPANCY]

TOTAL SDU MEMBERS [IF OCCUPANCY= YES]
(Including yourself), how many people in this household (lived/will live) here for most of the time
during (DATA COLLECTION PERIOD)? (Do not include anyone who (lived/will live) at school
or somewhere else for most of the time during DATA COLLECTION PERIOD).)

ENTER NUMBER 1-20 [MEMBERS 12 OR OLDER]
[IF 1 TOTAL SDU MEMBERS = 1, ONLY HOUSEHOLD MEMBER: “CONFIRM
RESPONSE: IS THERE ONLY 1 PERSON IN THIS HOUSEHOLD?” IF No, TOTAL
SDU MEMBERS. IF Yes, ONLY ELIGIBLE HH MEMBER: “Is that you?” IS
THIS SCREENING RESPONDENT THE ONE ELIGIBLE RESIDENT OF THE DU?
IF No, AGE. IF Yes, SR AGE.]

3

MEMBERS 12 OR OLDER [IF TOTAL SDU MEMBERS NE BLANK AND >1]
Of these (TOTAL SDU MEMBERS) people, how many are now age 12 or older?
ENTER SUBSET OF TOTAL SDU MEMBERS [ROSTER INTRO]
[IF MEMBERS 12 OR OLDER = 1, ONLY ELIGIBLE MEMBER: “CONFIRM
RESPONSE: IS THERE ONLY 1 PERSON AGE 12 OR OLDER IN THIS
HOUSEHOLD?” IF No, MEMBERS 12 OR OLDER. IF Yes, ONLY ELIGIBLE
HH MEMBER: “(Is that you?) IS THIS SCREENING RESPONDENT THE ONE
ELIGIBLE RESIDENT OF THE DU?” IF No, AGE. IF Yes, SR AGE

ROSTER INTRO [IF MEMBERS 12 OR OLDER NE 1 OR BLANK]
Next I'll ask a few questions about the people who live here. Let's start with you. (Have you
lived/Will you live) here for most of (DATA COLLECTION PERIOD)?
Yes [SR AGE]
No [SR NOT HH MEMBER]

SR AGE [IF ROSTER INTRO = YES OR ROSTER NE BLANK OR CONFIRM ROSTER FOR SR =
NO]
How old are you?
ENTER AGE [SR GENDER]
[IF SR AGE ≥ 99, ROSTER: PLEASE VERIFY: Let me confirm, are you (AGE) years old?
IF Yes, SR GENDER. IF No, SR AGE.]

SR GENDER [IF SR AGE NE BLANK]
ASK ONLY IF NOT OBVIOUS
Are you male or female?
Male
Female
[IF AGE 17-65, MILITARY, OTHERWISE SR HISPANIC]

SR MILITARY [IF SR GENDER NE BLANK AND SR AGE = 17-65]
Are you currently on active duty in the United States military?

Yes
No

4

Refused
[HISPANIC]

SR HISPANIC [IF SR MILITARY NE BLANK OR (SR GENDER NE BLANK AND SR AGE NE
17-65) ]
Are you of Hispanic, Latino or Spanish origin?
(That is, do any of these groups describe your national origin or ancestry – Puerto Rican, Cuban,
Cuban-American, Mexican, Mexican-American, Chicano, Central or South American, or origin
in some other Spanish-speaking country?)
Yes
No
[SR RACE]

SR RACE [IF SR HISPANIC NE BLANK]
Are you White, Black or African American, American Indian or Alaska Native, Native Hawaiian
or other Pacific Islander, or Asian?
White
Black or African American
American Indian or Alaska Native
Native Hawaiian/other Pacific Islander
Asian
Other
(CHECK ALL THAT APPLY)

SR CONFIRM ROSTER [IF SR RACE NE BLANK]
[IF RACE, HISPANIC, AND/OR MILITARY IS ‘BLANK’ OR ‘OTHER’ OMIT RESPECTIVE
FILLS FROM CONFIRM ROSTER SCREEN.]
CONFIRM:
I have listed you as a/an (AGE) year old (GENDER). You are (RACE), (HISPANIC), and are/are
not on active duty in the United States military.
Is this correct?
Yes [OTHER MEMBERS] [IF ROSTER NE BLANK , THEN VERIFY ROSTER DATA]
No [SR AGE]

SR NOT HH MEMBER

[IF ROSTER INTRO = NO AND MEMBERS 12 OR OLDER ≥ 2]
5

Even though you (have not lived/will not) live here for most of (DATA COLLECTION
PERIOD), I need some general information about all of the other people in this
household who are 12 years old or older and (have lived/will live) here for most of those
months. Let’s start with the oldest and work down to the youngest.
Next [AGE]
OTHER MEMBERS [IF SR CONFIRM ROSTER = YES AND MEMBERS 12 OR OLDER ≥ 2]
Now I need some general information about (the other person/all of the other people) in
this household who (is/are) 12 years old or older. [IF MEMBERS 12 OR OLDER >2]
Let's start with the oldest and work down to the youngest.
Next [AGE]

ROSTER SCREEN 1
AGE [IF (OTHER MEMBERS NE BLANK) OR (CONFIRM ROSTER = NO) OR SR NOT HH
MEMBER NE BLANK OR (TOTAL SDU MEMBERS = 1 AND ONLY ELIGIBLE HH MEMBER =
No) OR (MEMBERS 12 OR OLDER = 1 AND ONLY ELIGIBLE HH MEMBER = No)]
[IF MEMBERS 12 OR OLDER = 1 OR 2] How old is this person?
[IF MEMBERS 12 OR OLDER > 2 HH MEMBERS] How old is the (oldest/next oldest) person?
ENTER AGE [RELATION]
[IF AGE ≥ 99, ROSTER: PLEASE VERIFY: IS (AGE) THE CORRECT AGE FOR THIS
PERSON? IF Yes, RELATION. IF No, AGE.]

RELATION [IF AGE NE BLANK]
How is this person related to you?
Husband
Wife
Son (includes step, foster, or adoptive)
Daughter (includes step, foster, or
adoptive)
Son-in-law/Daughter-in-law
Brother (includes half, step, foster, or
adoptive)
Sister (includes half, step, foster, or
adoptive)
Brother-in-law/Sister-in-law
Parent/Guardian (incl. step, foster, or
adoptive)

6

Parent-in-law
Aunt/Uncle
Nephew/Niece
Grandparent
Grandchild
Cousin
Ex-Spouse
Unmarried Partner
Housemate or Roommate
Tenant/Boarder/Exch Student
Other relative
Other Non-relative
Relationship Unspecified

[IF (SR=FEMALE AND RELATION=WIFE) OR IF (SR=MALE AND
RELATION=HUSBAND), RELATION VERIFICATION: YOU HAVE INDICATED THAT
THIS PERSON IS YOUR [WIFE/HUSBAND]. IS THAT CORRECT? If Yes, HISPANIC OR
GENDER. If No, SR GENDER: IS THE SR’S GENDER CORRECT (FEMALE/MALE)?
(ANSWERING ‘NO’ WILL CHANGE THE SR’S GENDER). If Yes, ROSTER: PLEASE
MAKE THE NECESSARY CORRECTIONS TO THE RELATIONSHIP AND/OR GENDER
OF THE PERSON YOU ARE CURRENTLY ROSTERING. If No, ROSTER: THE SR’S
GENDER HAS BEEN CHANGED TO [FEMALE/MALE.]
[IF MORE THAN ONE HUSBAND or MORE THAN ONE WIFE, Multiple Spouses: YOU
HAVE ALREADY ENTERED A RECORD FOR SPOUSE. DOES THIS SR HAVE
MULTIPLE [WIVES/HUSBANDS]? IF Yes, HISPANIC. If No, RELATION.]
[IF RELATION = HUSBAND, WIFE, SON, DAUGHTER, BROTHER OR SISTER
HISPANIC, OTHERWISE GENDER]

GENDER [IF RELATION NE HUSBAND, WIFE, SON, DAUGHTER, BROTHER OR SISTER]
ASK ONLY IF NOT OBVIOUS
Is this person male or female?
Male
Female
Refused
[IF AGE 17-65, MILITARY, OTHERWISE HISPANIC]

MILITARY [IF GENDER NE BLANK AND AGE 17-65]
(Is he/Is she/Is this person) currently on active duty in the United States military?
Yes
No

7

Refused
Unknown
[HISPANIC]

ROSTER SCREEN 2
HISPANIC [IF MILITARY NE BLANK OR (GENDER NE BLANK AND AGE NE 17-65)]
(Is he/Is she/Is this person) of Hispanic, Latino or Spanish origin?
(That is, do any of these groups describe (his/her/their) national origin or ancestry – Puerto
Rican, Cuban, Cuban-American, Mexican, Mexican-American, Chicano, Central or South
American, or origin in some other Spanish-speaking country?)
Yes
No
Refused
Unknown
[RACE]

RACE [IF HISPANIC NE BLANK]
(Is he/Is she/Is this person) White, Black or African American, American Indian or Alaska
Native, Native Hawaiian or other Pacific Islander, or Asian?
White
Black or African American
American Indian or Alaska Native
Native Hawaiian/other Pacific Islander
Asian
Other
(CHECK ALL THAT APPLY)
Refused
Unknown
[CONFIRM ROSTER]

CONFIRM ROSTER [IF RACE NE BLANK]
[IF RACE, HISPANIC, AND/OR MILITARY IS ‘BLANK,’ ‘OTHER’, ‘DK’, OR ‘REF’ OMIT
RESPECTIVE FILLS FROM CONFIRM ROSTER SCREEN.]
CONFIRM:

8

I have listed your (AGE) year old (RELATIONSHIP). (He/She) is (RACE), (HISPANIC) [IF AGE
17-65] and (is/is not) on active duty the United States military.
Is this correct?
Yes
No

[AGE FOR NEXT HH MEMBER, OTHERWISE VERIFY ROSTER DATA]
[AGE]

VERIFY ROSTER DATA [IF CONFIRM ROSTER = YES ]
[IF CONFIRM ROSTER = YES AND MEMBERS 12 OR OLDER=1]
DO NOT READ TO RESPONDENT. WHEN READY, TOUCH NEXT TO MAKE
SELECTION.
TO MAKE CORRECTIONS: TOUCH AND HOLD THE ROSTER LINE THAT YOU
WANT TO EDIT, THEN TOUCH 'EDIT' FROM THE POP-UP MENU.
[IF CONFIRM ROSTER = YES AND MEMBERS 12 OR OLDER>=2]
I need to make sure this list is accurate. I have listed...
[READ AGES AND RELATIONSHIPS ROSTERED].
TO MAKE CORRECTIONS: TOUCH AND HOLD THE ROSTER LINE THAT YOU
WANT TO EDIT, THEN TOUCH 'EDIT’ FROM THE POP-UP MENU.
Relation (Relationship)
AGE (Age)
SR (Y for Screening Respondent)
PROGRAMMER NOTE: INCLUDE SR DESIGNATION BUT DO NOT ALLOW
EDITING
[TOUCH AND HOLD ANY ROSTER LINE, Choose an Action: IF Show Details]
Relation: Relationship
Age: Age
Gender: M, F, R
Hispanic: Y, N, U, R
Race: W, B, I, P, A, O
Military: Y, N, U, R
Eligible: E, I)
[TOUCH AND HOLD ANY ROSTER LINE, Choose an Action: IF Edit. EDIT ROSTER
RECORD: DO YOU WANT TO EDIT THE ROSTER INFORMATION FOR THE (AGE)
9

YEAR OLD (RELATION)? IF Yes, EDIT ROSTER MEMBER. IF No, VERIFY ROSTER
DATA.]
[+MEMBER OR FUNCTIONS TO ADD ROSTER MEMBERS]
Next [SINCENT01 OR START SELECTION]
SINCENT01 [IF INCENTIVE SEGMENT] IF NOT DONE EARLIER HAND RESPONDENT
$5 CASH.
[CHECK BOX] CASH ACCEPTED
[CHECK BOX] CASH REFUSED
I have checked a box to indicate that (you accepted/you refused) the $5 in cash for
completing this screening.
The tablet will now begin the selection process to see if anyone is selected to
participate in the full interview.
Next [START SELECTION]
START SELECTION
THE PROGRAM WILL START THE SELECTION PROCESS. ARE YOU SURE YOU ARE
READY TO MAKE THE SELECTIONS?
Yes [RESPONDENT SELECTION]
No [VERIFY ROSTER DATA]
[IF INTERVIEW A = BLANK, NO SELECTION: NO ONE WAS SELECTED FOR AN
INTERVIEW AT THIS HOUSEHOLD. PLEASE COLLECT VERIFICATION
INFORMATION.]

RESPONDENT SELECTION [START SELECTION = YES AND INTERVIEW A NE BLANK]
Interview A
[QC FORM]
Roster #: (Roster # of selected member, None)
QuestID: (7-digit Questionnaire ID, BLANK)
Relation: (Relationship to SR, BLANK)
Age: (AGE, BLANK)
Race: (W, B, I, P, A, O, BLANK)

Sex: (M, F, BLANK)
Hispanic: (Y, N, BLANK)

Interview B
[QC FORM]
Roster #: (Roster # of selected member, None)
QuestID: (7-digit Questionnaire ID, BLANK)
Relation: (Relationship to SR, BLANK)
Age: (AGE, BLANK)

Sex: (M, F, BLANK)

10

Race: (W, B, I, P, A, O, BLANK)

Hispanic: (Y, N, BLANK)

ALL INELIGIBLE [START SELECTION = YES AND ALL ROSTER MEMBERS MILITARY OR
INELIGIBLE]
ALL MEMBER(S) WERE INDICATED AS MILITARY OR INELIGIBLE. NO ONE IS
ELIGIBLE FOR SELECTION.
OK [VERIFICATION]

11

NSDUH Screening Application Specifications
GQU Screening
Document Format:
• Screen names are in bold, upper-case letters.
• English text to be read by FIs is shown in black font.
• FI instructions are provided in black, upper-case text that is not in brackets. In the screening
program, FI instructions appear in red, upper-case letters.
• Text of any pop-up screens are provided in bracketed logic using upper-case text in quotations.
• Programming logic is designated by black, upper-case text in brackets.
• Fills are designated by parenthesis and italics.
• Response categories are underlined.

STUDY INTRODUCTION
Hello, my name is (FI NAME) with RTI International in North Carolina. We are conducting a
nationwide study sponsored by the U.S. Department of Health and Human Services.
You should have received a letter explaining the study.
HAND R COPY OF LETTER IF NEEDED
Next [IDENTIFY SR]

IDENTIFY SR [IF STUDY INTRODUCTION = NEXT]
First, just let me verify: do you live here?
IF NOT OBVIOUS:
And are you 18 or older?

IF NO TO EITHER, ASK FOR AN ADULT RESIDENT, TOUCH “PREVIOUS”, AND BEGIN
AGAIN.
SR Available [ADDRESS VERIFICATION]
SR Not Available [EXIT SCREENING: “ARE YOU SURE YOU WANT TO EXIT
SCREENING?” IF Yes, RECORD OF CALLS. IF No,
IDENTIFY SR.]

ADDRESS VERIFICATION [IF IDENTIFY SR = SR AVAILABLE]
I just need to verify -- is this
STREET: (NUMBER AND STREET)
CITY: (CITY)
STATE: (STATE)

12

ZIP: (ZIP)
Address Is Correct [INFORMED CONSENT]
Need to Edit Address [EDIT ADDRESS]
FI At Wrong Address [SELECT CASE]

EDIT ADDRESS [IF ADDRESS VERIFICATION = NEED TO EDIT ADDRESS]
TOUCH THE ITEM YOU NEED TO EDIT
STREET #: (NUMBER)
STREET: (STREET)
APT.#: (APARTMENT NUMBER)
CITY: (CITY)
STATE: (STATE)
ZIP: (ZIP)
Update [SAVE UPDATED ADDRESS, THEN ADDRESS VERIFICATION]

INFORMED CONSENT [IF ADDRESS VERIFICATION = ADDRESS IS CORRECT]
GIVE PERSON STUDY DESCRIPTION AND SAY
Please read this statement. It describes the survey and the legislation that assures the
confidentiality of any information you provide. It also explains that your answers are used for
statistical purposes only and that your participation is voluntary. If anyone is selected for the full
interview, that person will receive ($30/$50) in cash after the interview is completed.
[IF INCENTIVE SEGMENT] GIVE PERSON $5 FOR PARTICIPATION
Next [TRANSIENT]

TRANSIENT [IF INFORMED CONSENT = NEXT]
INTERVIEWER: IS THIS GQU A TRANSIENT SHELTER?
Yes [UNIT TYPE]
No [OCCUPANCY]

UNIT TYPE [IF TRANSIENT = YES]
ARE THE LISTED UNITS…
ROOMS [TOTAL GQU MEMBERS]
BEDS, OR [ROSTER #1 AGE]

13

PERSONS [ROSTER #1 AGE]

OCCUPANCY [IF TRANSIENT = NO]
(Did/Will) you or anyone else in this room live here for most of the time during the
months of (DATA COLLECTION PERIOD)?
Yes [TOTAL GQU MEMBERS]

No [OCCUPANCY – CONFIRMATION:
YOUR ‘NO’ RESPONSE WILL
CONCLUDE THIS SCREENING
AND FINALIZE THIS CASE. DO
YOU WANT TO CHANGE YOUR
ANSWER? (‘YES’ WILL CONTINUE
SCREENING. ‘NO’ WILL FINALIZE THE
CASE.) IF Yes, OCCUPANCY. IF No,
OCCUPANCY-CLOSE CASE: ARE YOU SURE
YOU WANT TO CLOSE OUT THIS CASE? IF
Yes, VERIFICATION. IF No, OCCUPANCY]

TOTAL GQU MEMBERS [IF OCCUPANCY = YES OR IF UNIT TYPE = ROOMS]
[IF TRANSIENT = YES AND UNIT TYPE = ROOMS] (Including yourself) How many people
are staying in this room?
[IF TRANSIENT = NO] (Including yourself) How many people (lived/will live) in this room for
most of the time during (DATA COLLECTION PERIOD)?
ENTER NUMBER 1-20 [MEMBERS 12 OR OLDER]
[IF TOTAL GQU MEMBERS = 1, ONLY MEMBER: CONFIRM RESPONSE: IS
THERE ONLY 1 PERSON LIVING HERE? IF No, TOTAL GQU MEMBERS. IF
Yes AND UNIT TYPE = ROOMS, ROSTER #1 AGE. IF Yes AND TRANSIENT =
NO, ROSTER: IS THIS SCREENING RESPONDENT THE ONE ELIGIBLE
RESIDENT OF THE DU? IF Yes, ROSTER #1 AGE USING ‘YOUR’ FILL. IF No,
ROSTER #1 AGE USING ‘THIS PERSON’ FILL].

MEMBERS 12 OR OLDER [IF TOTAL GQU MEMBERS NE BLANK AND >1]
[IF TRANSIENT = YES] How many of these [TOTAL GQU MEMBERS] people are now age 12
or older.
[IF TRANSIENT = NO] Of these [TOTAL GQU MEMBERS] people, how many are now age 12
or older?
ENTER SUBSET OF TOTAL GQU MEMBERS [ROSTER # AGE]
[IF MEMBERS 12 OR OLDER = 1, ONLY ELIGIBLE MEMBER: “CONFIRM
RESPONSE: IS THERE ONLY 1 PERSON AGE 12 OR OLDER IN THIS UNIT?” IF
No, MEMBERS 12 OR OLDER. IF Yes AND UNIT TYPE = ROOMS ROSTER # 1

14

AGE. IF Yes AND TRANSIENT = NO, Only Eligible HH Member: “(Is that you?)”
IS THIS SCREENING RESPONDENT THE ONE ELIGIBLE RESIDENT OF THE
DU? IF Yes, ROSTER #1 AGE USING ‘YOUR’ FILL. IF No, ROSTER #1 AGE
USING ‘THIS PERSON’ FILL].

ROSTER #1 AGE [IF MEMBERS 12 OR OLDER NE BLANK OR TOTAL GQU MEMBERS = 1
OR IF UNIT TYPE = BEDS OR PERSONS]
How old (are/is) (you/this person)?
ENTER AGE [ROSTER #1 NAME]

ROSTER #1 NAME [IF ROSTER #1 AGE NE BLANK]
What is (your/this person’s) first name?
ENTER FIRST NAME [ROSTER #1 GENDER]

ROSTER #1 GENDER [IF ROSTER #1 NAME NE BLANK]
ASK ONLY IF NOT OBVIOUS
(Are you/Is this person) male or female?
Male
Female
[IF AGE 17-65, ROSTER #1 MILITARY, OTHERWISE ROSTER #1 HISPANIC]

ROSTER #1 MILITARY [IF ROSTER #1 RACE NE BLANK AND ROSTER #1 AGE = 17-65]
(Are you/Is he/Is she) currently on active duty in the United States military?
Yes
No
Refused
[ROSTER #1 HISPANIC]

ROSTER #1 HISPANIC [IF ROSTER #1 MILITARY NE BLANK OR (ROSTER #1 GENDER NE
BLANK AND AGE NE 17-65)]
(Are you/Is he/Is she) of Hispanic, Latino or Spanish origin?
(That is, do any of these groups describe (your/his/her) national origin or ancestry – Puerto Rican,
Cuban, Cuban-American, Mexican, Mexican-American, Chicano, Central or South American, or
origin in some other Spanish-speaking country?)
Yes

15

No
[ROSTER #1 RACE]

ROSTER #1 RACE [IF ROSTER #1 HISPANIC NE BLANK]
(Are you/Is he/Is she) White, Black or African American, American Indian or Alaska Native,
Native Hawaiian or other Pacific Islander, or Asian?
White
Black or African American
American Indian or Alaska Native
Native Hawaiian/other Pacific Islander
Asian
Other
(CHECK ALL THAT APPLY)
[CONFIRM ROSTER]

CONFIRM ROSTER [IF ROSTER #1 RACE NE BLANK]
[IF RACE, HISPANIC, AND/OR MILITARY IS ‘OTHER’, ‘DK’, OR ‘REF’ OMIT
RESPECTIVE FILLS FROM CONFIRM ROSTER SCREEN.]
CONFIRM:
I have listed (you as) a/an (AGE) year old (GENDER) resident. (You are/He is/She is) (RACE),
(HISPANIC) [IF AGE =17-65] and (are/are not) on active duty in the United States military.
Is this correct
Yes [IF MEMBERS 12 OR OLDER ≥ 2 OTHER MEMBERS. IF UNIT TYPE = BEDS OR
PERSONS OR UNIT TYPE = ROOMS AND TOTAL GQU MEMBERS OR MEMBERS
12 OR OLDER =1 VERIFY ROSTER DATA]
No [ROSTER #1 AGE]
[IF MEMBERS 12 OR OLDER=1 AND SR=NO, NO SR: “INTERVIEWER: YOU HAVE NOT
IDENTIFIED A SCREENING RESPONDENT. IF THE SCREENING RESPONDENT IS A
MEMBER OF THE HOUSEHOLD, EDIT HIS/HER ROSTER RECORD AND MARK THE
APPROPRIATE ITEM.”]

OTHER MEMBERS [IF CONFIRM ROSTER = YES AND MEMBERS 12 OR OLDER ≥ 2]
READ TO RESPONDENT:

16

Now I need some general information about (the other person/all of the other people) who
(is/are) 12 years old or older. [IF MEMBERS 12 OR OLDER >2] Let's start with the oldest and
work down to the youngest.
Next [AGE]

ROSTER SCREEN 1
AGE [IF OTHER MEMBERS NE BLANK OR CONFIRM ROSTER = NO]
[IF MEMBERS 12 OR OLDER = 2] How old is this person?
[IF MEMBERS 12 OR OLDER > 2 HH MEMBERS] How old is the (oldest/next oldest) person?
ENTER AGE [NAME]
[IF AGE ≥ 99, ROSTER: PLEASE VERIFY: IS (AGE) THE CORRECT AGE FOR THIS
PERSON? IF Yes, NAME. IF No, AGE.]

NAME [IF AGE NE BLANK]
What is this person’s first name?
ENTER FIRST NAME [GENDER]

GENDER [IF NAME NE BLANK]
ASK ONLY IF NOT OBVIOUS
Is this person male or female?
Male
Female
Refused
[IF AGE 17-65, MILITARY, OTHERWISE HISPANIC]

MILITARY [IF GENDER NE BLANK AND AGE 17-65]
(Is he/Is she/Is this person) currently on active duty in the United States military?
Yes
No
Refused
Unknown

17

[HISPANIC]

ROSTER SCREEN 2
HISPANIC [IF MILITARY NE BLANK OR (GENDER NE BLANK AND AGE NE 17-65)]
(Is he/Is she/Is this person) of Hispanic, Latino or Spanish origin?
(That is, do any of these groups describe (his/her/their) national origin or ancestry – Puerto
Rican, Cuban, Cuban-American, Mexican, Mexican-American, Chicano, Central or South
American, or origin in some other Spanish-speaking country?)
Yes
No
Refused
Unknown
[RACE]

RACE [IF HISPANIC NE BLANK]
(Is he/Is she/Is this person) White, Black or African American, American Indian or Alaska
Native, Native Hawaiian or other Pacific Islander, or Asian?
White
Black or African American
American Indian or Alaska Native
Native Hawaiian/other Pacific Islander
Asian
Other
(CHECK ALL THAT APPLY)
Refused
Unknown
[CONFIRM ROSTER]

CONFIRM ROSTER [IF
RACE NE BLANK]
[IF RACE, HISPANIC, AND/OR MILITARY IS ‘OTHER’, ‘DK’, OR ‘REF’ OMIT
RESPECTIVE FILLS FROM CONFIRM ROSTER SCREEN.]
CONFIRM:
I have listed a/an (AGE) year old (GENDER) resident. (He/She) is (RACE), (HISPANIC) [IF
AGE 17-65] and (is/is not) on active duty in the United States military.

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Is this correct?
Yes [AGE FOR NEXT GQU MEMBER, OTHERWISE VERIFY ROSTER DATA]
No [AGE]
[IF ALL MEMBERS ROSTERED AND NO SCREENING RESPONDENT, NO SR:
“INTERVIEWER: YOU HAVE NOT IDENTIFIED A SCREENING RESPONDENT. IF THE
SCREENING RESPONDENT IS A MEMBER OF THE HOUSEHOLD, EDIT HIS/HER
ROSTER RECORD AND MARK THE APPROPRIATE ITEM.”]

VERIFY ROSTER DATA [IF CONFIRM ROSTER = YES]
[IF CONFIRM ROSTER = YES AND MEMBERS 12 OR OLDER=1]
DO NOT READ TO RESPONDENT. WHEN READY, TOUCH NEXT TO MAKE
SELECTION.
TO MAKE CORRECTIONS: TOUCH AND HOLD THE ROSTER LINE THAT YOU WANT
TO EDIT, THEN TOUCH 'EDIT' FROM THE POP-UP MENU.
[IF CONFIRM ROSTER = YES AND MEMBERS 12 OR OLDER>=2]
I need to make sure this list is accurate. I have listed...
[READ LIST OF OCCUPANTS NAMES AND AGES].
TO MAKE CORRECTIONS: TOUCH AND HOLD THE ROSTER LINE THAT YOU WANT
TO EDIT, THEN TOUCH 'EDIT' FROM THE POP-UP MENU.
Name (First Name)
AGE (Age)
SR (Y for Screening Respondent)
[UPON TOUCHING ON ANY ROSTER LINE, Choose an Action: IF Show Details SELECT SHOW
DETAILS]
Name: First Name
Age: Age
Gender: M, F, R
Hispanic: Y, N, U, R
Race: W, B, I, P, A, O
Military: Y, N, U, R
Eligible: E, I
[TOUCH AND HOLD ANY ROSTER LINE, Choose an Action: IF Edit. EDIT ROSTER RECORD:
DO YOU WANT TO EDIT THE ROSTER INFORMATION FOR THE (AGE) YEAR OLD (NAME)?
IF Yes, EDIT ROSTER MEMBER. IF No, VERIFY ROSTER DATA.]
[+MEMBER OR FUNCTIONS TO ADD ROSTER MEMBERS]

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Next [START SELECTION]

SINCENT01 [IF INCENTIVE SEGMENT] HAND RESPONDENT $5 CASH.
[CHECK BOX] CASH ACCEPTED
[CHECK BOX] CASH REFUSED
I have checked a box to indicate that (you accepted/you refused) the $5 in cash for
completing this screening.
The tablet will now begin the selection process to see if anyone is selected to
participate in the full interview.
Next [START SELECTION]

START SELECTION
THE PROGRAM WILL START THE SELECTION PROCESS. ARE YOU SURE YOU ARE
READY TO MAKE THE SELECTIONS?
Yes [RESPONDENT SELECTION]
No [VERIFY ROSTER DATA]
[IF INTERVIEW A = BLANK, NO SELECTION: NO ONE WAS SELECTED FOR AN
INTERVIEW AT THIS GQU. PLEASE COLLECT VERIFICATION INFORMATION.]

RESPONDENT SELECTION [START SELECTION = YES AND INTERVIEW A NE BLANK]
Interview A
[QC FORM]
Roster #: (Roster # of selected member, None)
QuestID: (7-digit Questionnaire ID, BLANK)
Name: (First Name, BLANK)
Age: (AGE, BLANK)
Race: (W, B, I, P, A, O, BLANK)

Sex: (M, F, BLANK)
Hispanic: (Y, N, BLANK)

Interview B
[QC FORM]
Roster #: (Roster # of selected member, None)
QuestID: (7-digit Questionnaire ID, BLANK)
Name: (First Name, BLANK)
Age: (AGE, BLANK)
Race: (W, B, I, P, A, O, BLANK)

Sex: (M, F, BLANK)
Hispanic: (Y, N, BLANK)

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NEXT [IF INTEVIEW A = BLANK, THEN VERIFICATION]
[IF INTERVIEW A NE BLANK, THEN SELECTIONS]

21

NSDUH Screening Application Specifications
Verification
Document Format:
• Screen/menu names are in bold, upper-case letters.
• FI instructions are provided in black, upper-case text that is not in brackets. In the screening
program, FI instructions appear in red, upper-case letters.
• Text of any pop-up screens are provided in bracketed logic using upper-case text in quotations.
• Programming logic is designated by black, upper-case text in brackets.
• Fills are designated by parenthesis and italics.
• Response categories are underlined.
• Explanatory text in italics

VERIFICATION [IF SCREENING RESULT CODE = 10, 13, 18, 22, 26 OR IF RESPONDENT
SELECTION = ‘NONE’ FOR BOTH A AND B INTERVIEW OR IF OCCUPANCY =
‘NO’ OR IF ALL ROSTER MEMBERS = INELIGIBLE]
So that my supervisor may check the quality of my work, may I please have your first name
and telephone number?
FIRST NAME: (Screening Respondent’s first name)
Not Avail.
Ref.
PHONE: (Area code and phone number)
Home
Cell
Work
Not Avail.
Ref.
CONFIRM NUMBER WITH R.
NOTES TO VERIFICATION CALLER: (Text field for notes about best
times to call screening respondent or clarification about work number if caller has
to go through an operator.)

Done [CHECKS FOR COMPLETE DATA ENTRY, RECORD OF CALLS]
Clear [VERIFICATION WITH ENTRY CLEARED]

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