Screener and questionnaire

Attachment B: Proposed Web Questionnaire Introduction Screen, Telephone Interview Introduction, and RANDS during COVID-19 Questionnaire

 

Form Approved  

OMB No. 0920-XXXX 

Exp. Date: XX/XX/XXXX  

Notice – CDC estimates the average public reporting burden for this collection of information as 20 minutes per response, including the time for reviewing instructions, searching existing data/information sources, gathering and maintaining the data/information 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/ATSDR Information Collection Review Office, 1600 Clifton Road, MS D-74, Atlanta, GA 30333; ATTN: PRA (0920-0278).

Assurance of Confidentiality – We take your privacy very seriously.  All information that relates to or describes identifiable characteristics of individuals, a practice, or an establishment will be used only for statistical purposes.  NCHS staff, contractors, and agents will not disclose or release responses in identifiable form without the consent of the individual or establishment in accordance with section 308(d) of the Public Health Service Act (42USC 242m) and the Confidential Information Protection and Statistical Efficiency Act (Title III of the Foundations for Evidence-Based Policymaking Act of 2018 (Pub. L. No. 115-435, 132 Stat. 5529)).  In accordance with CIPSEA, every NCHS employee, contractor, and agent has taken an oath and is subject to a jail term of up to five years, a fine of up to $250,000, or both if he or she willfully discloses ANY identifiable information about you.

 

Proposed Web Questionnaire Introduction Screen 

 

  The National Center for Health Statistics, part of the Centers for Disease Control and Prevention, is conducting a study and we need your help.  We are interested in your health and wellness, and will be asking you a series of questions about your health history, behaviors, and opinions.  This should take about 20 minutes or less to complete.  Participation in this survey is completely voluntary, and you may skip any question(s) you do not want to answer and may quit the survey at any time.  You will not receive any monetary reward or incentive for participating in this survey.  The information being collected is for research purposes only, and will assist NCHS and CDC in their ongoing efforts to track the health of the American public.  Your data will be held confidential, will be used for statistical purposes only, and will not be disclosed or released to other persons without your consent in accordance with Section 308(d) of the Public Health Service Act [42 U.S.C. 242m(d)] and the Confidential Information and Statistical Efficiency Act (Title III of the Foundations for Evidence-Based Policymaking Act of 2018, Pub. L. No. 115-435, 132 Stat. 5529, § 302)..   

 

If you have any questions about this study, please call the office of the Ethics Review Board at the National Center for Health Statistics, toll-free at 1-800-223-8118.  Please leave a brief message with your name and phone number.  Say that you are calling about Protocol #2016-16-XX [Note:  The amendment number will be inserted into the form once NCHS ERB approval has been received]. Your call will be returned as soon as possible. 

 

Click the “Next” button below to begin. 

Proposed Phone Interview Introduction

Introduction and verification of respondent’s name. 

 

Explain why calling 

• We are asking for your help as we construct a health survey on behalf of the National Center for Health Statistics, part of the Centers for Disease Control and Prevention.  

• Phone call takes on average 20 minutes to complete. 

 

Share confidentiality, informed consent, and voluntary participation information 

• All information which would permit identification of an individual, a practice, or an establishment will be held confidential, and will be used for statistical purposes only by NCHS staff and agents and will not be disclosed or released to other persons without your consent.  If you have any questions about your rights as a participant in this research study, call NCHS’ Confidentiality Officer at (888) 642-1459.   

• Participation is voluntary, but will assist greatly in helping further our nation’s understanding of health and how we ask the public about public health issues. 

RANDS during COVID-19 Questionnaire 

General health

PHSTAT		Would you say your health in general is excellent, very good, good, fair, or poor?
	1.	Excellent
	2.	Very Good
	3.	Good
	4.	Fair
	5.	Poor
	77.	[Don’t Know]
	99.	[Refused]

SRHPSYCH		Would you say your mental health is excellent, very good, good, fair, or poor?
	1.	Excellent
	2.	Very Good
	3.	Good
	4.	Fair
	5.	Poor
	77.	[Don’t Know]
	99.	[Refused]

PROBE_SRH		When you said your health in general was [FILL: PHSTAT], which of the following, if any, were you thinking about?
	1.	Your diet and nutrition
	2.	Your exercise habits
	3.	Your smoking or drinking habits
	4.	Your health problems or conditions
	5.	Your lack of health problems or conditions
	6.	The amount of pain that you have
	7.	Your ability to do daily activities without assistance
	8.	The amount of sleep you get
	9.	Your mental or emotional health
	10.	The Coronavirus or COVID-19 pandemic
	11.	Something else, please specify
	77.	[Don’t Know]
	99.	[Refused]

WG Anxiety and Depression

ANXFREQ		How often do you feel worried, nervous or anxious? Would you say daily, weekly, monthly, a few times a year, or never?
	1.	Daily
	2.	Weekly
	3.	Monthly
	4.	A few times a year
	5.	Never
	77.	[Don’t Know]
	99.	[Refused]

ANXMED		Do you take prescription medication for these feelings?
	1.	Yes
	2.	No
	77.	[Don’t Know]
	99.	[Refused]

[SKIP: If ANXMED = c(1,RF,DK), goto ANXLEVEL; ELSE if ANXMED = 2 AND if ANXFREQ = 5, goto DEPFREQ; ELSE if ANXMED =2 AND if ANXFREQ = c(1-4, RF, DK), goto ANXLEVEL]

ANXLEVEL		Thinking about the last time you felt worried, nervous or anxious, how would you describe the level of these feelings? [IF MODE=PHONE, READ: Would you say a little, a lot, or somewhere in between?]
	1.	A little
	2.	A lot
	3.	Somewhere in between a little and a lot
	77.	[Don’t Know]
	99.	[Refused]

[DOV_ANX]		If ANXFREQ == 4 or ANXFREQ==5, DOV_ANX=1; If ANXFREQ==1, 2, or 3 AND ANXLEVEL==1, DOV_ANX=2; If ANXFREQ==2, or 3 AND ANXLEVEL==3, DOV_ANX=2; If ANXFREQ==3 AND ANXLEVEL==2, DOV_ANX=2 If ANXFREQ==1 AND ANXLEVEL==3, DOV_ANX=3 If ANXFREQ==2 AND ANXLEVEL==2, DOV_ANX=3; If ANXFREQ==1 AND ANXLEVEL==2, DOV_ANX=4; If ANXFREQ==99 OR ANXLEVEL==99, DOV_ANX=99
	1.
	2.
	3.
	4.
	99.	[Refused]

DEPFREQ		How often do you feel depressed? Would you say daily, weekly, monthly, a few times a year, or never?
	1.	Daily
	2.	Weekly
	3.	Monthly
	4.	A few times a year
	5.	Never
	77.	[Don’t Know]
	99.	[Refused]

DEPMED		Do you take prescription medication for depression?
	1.	Yes
	2.	No
	77.	[Don’t Know]
	99.	[Refused]

[SKIP: If DEPMED = c(1,RF,DK), goto DEPLEVEL; ELSE if DEPMED = 2 AND if DEPFREQ = 5, goto PHQ1; ELSE if DEPMED =2 AND if DEPFREQ = c(1-4, RF, DK), goto DEPLEVEL]

DEPLEVEL		Thinking about the last time you felt depressed, how depressed did you feel? [IF MODE=PHONE, READ: Would you say a little, a lot, or somewhere in between?]
	1.	A little
	2.	A lot
	3.	Somewhere in between a little and a lot
	77.	[Don’t Know]
	99.	[Refused]

[DOV_DEP]		If DEPFREQ == 4 or DEPFREQ ==5, DOV_ DEP=1; If DEPFREQ==1, 2, or 3 AND DEPLEVEL==1, DOV_ DEP=2; If DEPFREQ==2, or 3 AND DEPLEVEL==3, DOV_ DEP=2; If DEPFREQ==3 AND DEPLEVEL==2, DOV_ DEP=2 If DEPFREQ==1 AND DEPLEVEL==3, DOV_ DEP=3 If DEPFREQ==2 AND DEPLEVEL==2, DOV_ DEP=3; If DEPFREQ==1 AND DEPLEVEL==2, DOV_ DEP=4; If DEPFREQ==99 OR DEPLEVEL==99, DOV_ DEP=99
	1.
	2.
	3.
	4.
	99.	[Refused]

Chronic Conditions

CHRON_INTRO	[If Mode=Phone, read: Now I’m going to ask you about certain medical conditions] [If Mode=Web, display: The next few questions are about medical conditions you may have been told you had. Have you ever been told by a doctor or other health professional that you had…]

HYPEV		[If Mode=Phone, read: Have you ever been told by a doctor or other health professional that you had] Hypertension, also called high blood pressure?
	1.	Yes
	2.	No
	77.	[Don’t Know]
	99.	[Refused]

CHLEV		[If Mode=Phone, read: Have you ever been told by a doctor or other health professional that you had] High cholesterol?
	1.	Yes
	2.	No
	77.	[Don’t Know]
	99.	[Refused]

CHDEV		[If Mode=Phone, read: Have you ever been told by a doctor or other health professional that you had] Coronary heart disease?
	1.	Yes
	2.	No
	77.	[Don’t Know]
	99.	[Refused]

ASEV		[If Mode=Phone, read if necessary: Have you ever been told by a doctor or other health professional that you had] Asthma?
	1.	Yes
	2.	No
	77.	[Don’t Know]
	99.	[Refused]

[SKIP: IF ASEV==1, CONTINUE; Else if ASEV==c(2,DK, R), SKIP TO COPDEV]

ASTILL		Do you still have asthma?
	1.	Yes
	2.	No
	77.	[Don’t Know]
	99.	[Refused]

COPDEV		[If Mode=Phone, read if necessary: Have you ever been told by a doctor or other health professional that you had] Chronic Obstructive Pulmonary Disease, C.O.P.D., emphysema, or chronic bronchitis?
	1.	Yes
	2.	No
	77.	[Don’t Know]
	99.	[Refused]

PREDIB		[If Mode=Phone, read if necessary: Have you ever been told by a doctor or other health professional that you had] Prediabetes or borderline diabetes?
	1.	Yes
	2.	No
	77.	[Don’t Know]
	99.	[Refused]

[SKIP: If GENDER=Female, continue to GESDIB; if GENDER!=Female, skip to DIBEV]

DIBEV		[IF PREDIB=1 or GESDIB=1, fill: Not including prediabetes or gestational diabetes] [If Mode=Phone, read: Have you ever been told by a doctor or other health professional that you had] Diabetes?
	1.	Yes
	2.	No
	77.	[Don’t Know]
	99.	[Refused]

CANEV		[If Mode=Phone, read: Have you ever been told by a doctor or other health professional that you had] Cancer or a malignancy of any kind?
	1.	Yes
	2.	No
	77.	[Don’t Know]
	99.	[Refused]

AUTOIM		Do you currently have a health condition that a doctor or other health professional told you weakens the immune system, making it easier for you to get sick?
	1.	Yes
	2.	No
	77.	[Don’t Know]
	99.	[Refused]

PROBE_AUTOEV		What is this condition?
	1.	[Open]
	77.	[Don’t Know]
	99.	[Refused]

CIGINTRO	These next questions are about cigarette smoking

SMKEV		Have you smoked at least 100 cigarettes in your entire life?
	1.	Yes
	2.	No
	77.	[Don’t Know]
	99.	[Refused]

SMNOW		Do you now smoke cigarettes every day, some days or not at all?
	1.	Every day
	2.	Some days
	3.	Not at all
	77.	[Don’t Know]
	99.	[Refused]

ECIGNOW		Do you now vape or use e-cigarettes every day, some days or not at all?
	1.	Every day
	2.	Some days
	3.	Not at all
	77.	[Don’t Know]
	99.	[Refused]

Employment and Benefits

EMPLASTWK		Last week, did you work for pay at a job or business?
	1.	Yes
	2.	No
	77.	[Don’t Know]
	99.	[Refused]

[SKIP: If EMPLASTWK==1, R, DK, CONTINUE to SICKLEAVE; Else, SKIP to EMPRSNOWK]

[SKIP: If EMPLASTWK==2, CONTINUE TO EMPRSNOWK; Else SKIP to COVID_WRKPREV]

[IF EMPRSNOWK==1, 4, 5, or 8, CONTINUE TO COVID_NOWK; Else, SKIP to COVID_WRKPREV]

COVID_NOWK		Were you unable to work because you or a family member was sick with the Coronavirus?
	1.	Yes
	2.	No
	77.	[Don’t Know]
	99.	[Refused]

Insurance

HICOV		Are you covered by any kind of health insurance or some other kind of health care plan?
	1.	Yes
	2.	No
	77.	[Don’t Know]
	99.	[Refused]

COVID_INS		Did you lose health insurance coverage at any point in the last two months?
	1.	Yes
	2.	No
	77.	[Don’t Know]
	99.	[Refused]

Access to care and regular health provider (e.g. telemedicine)

COVID_CARE		At any time in the last 4 weeks, did you need medical care for something other than Coronavirus, but not get it because of the Coronavirus pandemic?
	1.	Yes
	2.	No
	77.	[Don’t Know]
	99.	[Refused]

USUALPL		Is there a place that you usually go to if you are sick and need health care?
	1.	Yes
	2.	No, there is no place
	3.	There is more than one place
	77.	[Don’t Know]
	99.	[Refused]

[SKIP: If USUALPL==1, 3, R, DK, CONTINUE to USPKIND; Else if USUALPL==2, SKIP to NOCARTYP]

USPLKIND		What kind of place [FILL: USUALPL==1 “is it?”; USUALP== 3, R, DK “do you go most often?”] [If Mode=Phone, READ: “A doctor's office or health center; an urgent care center, a clinic in a drug store or grocery store; a hospital emergency room; a VA Medical Center or VA outpatient clinic; or some other place?”
	1.	Doctor's office or health center
	2.	Urgent care center
	3.	Clinic in a drug store or grocery store
	4.	Hospital emergency room
	5.	VA Medical Center or VA outpatient clinic
	6.	Some other place, please specify
	77.	[Don’t Know]
	99.	[Refused]

TELMED		In the last two months, has this provider offered you an appointment with a doctor, nurse, or other health professional by video or by phone?
	1.	Yes
	2.	No
	77.	Don’t Know
	99.	[Refused]

[SKIP: If TELEMED==1, CONTINUE; Else, SKIP to NOCARTYP]

TELEMEDUSE		In the last two months, have you had an appointment with a doctor, nurse, or other health professional by video or by phone?
	1.	Yes
	2.	No
	77.	Don’t Know
	99.	[Refused]

TELMEDNEW		Did this provider offer you an appointment with a doctor, nurse, or other health professional by video or by phone before the Coronavirus pandemic?
	1.	Yes
	2.	No
	77.	Don’t Know
	99.	[Refused]

NOCARTYP		In the last two months, were you unable to get any of the following types of care for any reason?
	1.	Urgent Care for an Accident or Illness
	2.	A Surgical Procedure
	3.	Diagnostic or Medical Screening Test
	4.	Treatment for Ongoing Condition
	5.	A Regular Check-up
	6.	Prescription drugs or medications
	7.	Dental Care
	77.	[Don’t Know]
	99.	[Refused]

[SKIP: For each type selected in NOCARTYP, DISPLAY/READ COVIDNOCAR; If no types selected in NOCARTYP, SKIP to SYMPTOMS]

COVIDNOCAR		[FILL: “Regarding your NOCARTYP”] Were you unable able to get this because of the Coronavirus pandemic?
	1.	Yes, because of the pandemic
	2.	No, not because of the pandemic
	77.	[Don’t Know]
	99.	[Refused]

NOCARDIR		[FILL: “Regarding your NOCARTYP”] Did your medical provider make this decision or did you?
	1.	You decided
	2.	The provider decided
	3.	Both have occurred
	77.	[Don’t Know]
	99.	[Refused]

[SKIP: IF NOCARDIR== 1, 3, DK, R CONTINUE to NOCARWHYMD; Else SKIP]

NOCARWHYMD		What reasons were you given for this decision? Select all that apply
	1.	Medical office was closed
	2.	Priority was given to other types of appointments
	3.	Medical office reduced available appointments
	4.	No reason was given
	5.	Something else, please specify
	77.	[Don’t Know]
	99.	[Refused]

[SKIP: IF NOCARDIR==2, 3, DK, R, CONTINUE TO NOCARWHYR; Else SKIP to CV19DIAG]

NOCARWHYR		What reasons did you have for your decision? Select all that apply
	1.	The cost of the care
	2.	No access to transportation
	3.	Childcare or eldercare responsibilities
	4.	Did not want to leave your house
	5.	Did not want to risk being at a medical facility
	6.	Something else, please specify
	77.	[Don’t Know]
	99.	[Refused]

Covid-19 Health

COVIDEV		Has a doctor or other health professional ever told you that you had or likely had Coronavirus or COVID-19?Coronavirus
	1.	Yes
	2.	No
	77.	[Don’t Know]
	99.	[Refused]

[IF PRE_NHISTEST==1, Continue to NHIS_TEST; Else, if PRE_NHISTEST==2, Skip to ALT_NHISTEST1]

NHIS_TEST		Have you ever been tested for Coronavirus or COVID-19?
	1.	Yes
	2.	No
	77.	[Don’t Know]
	99.	[Refused]

[SKIP: IF NHIS_TEST==1, CONTINUE TO PROBE_TESTTYPE; Else SKIP to SUSPECT]

PROBE_TESTTYP		What kind of Coronavirus test did you receive? Please select all that apply
	1.	A test to determine if you were infected with the Coronavirus at the time of the test
	2.	An antibody test to determine if you had the Coronavirus in the past
	3.	Something else, please specify
	77.	[Don’t Know]
	99.	[Refused]

ALT_NHISTEST1		Have you ever had a test to determine if you were infected with Coronavirus or COVID-19 at the time of the test ?
	1.	Yes
	2.	No
	77.	[Don’t Know]
	99.	[Refused]

ALT_NHISTEST2		Have you ever had an antibody test to determine if you had Coronavirus or COVID-19 in the past?
	1.	Yes
	2.	No
	77.	[Don’t Know]
	99.	[Refused]

NHIS_RSLT		Did the test find that you had Coronavirus or COVID-19?
	1.	Yes
	2.	No
	3.	Did not receive results
	77.	Don’t Know
	99.	[Refused]

[SKIP: IF NHIS_RSLT == c(3,77), CONTINUE to PROBE_RSLT; Else if NHIS_RSLT ==c(2, DK, R), SKIP to SUSPECT; Else if NHIS_RSLT==1, SKIP to COVIDSEEK]

PROBE_RSLT		Were you not told the results, are you still waiting on the results, or do you not remember the results of the test?
	1.	Not told results
	2.	Still waiting on results
	3.	Do not remember results
	77.	[Don’t Know]
	99.	[Refused]

[SKIP: If NHIS_RSLT==1, SKIP to COVIDCAR]

SUSPECT		Do you suspect that you have ever had the Coronavirus or Covid-19?
	1.	Yes
	2.	No
	77.	Don’t Know
	99.	[Refused]

PROBE_SUSPECT		Why do believe this?
	1.	[OPEN TEXT]
	77.	[Don’t Know]
	99.	[Refused]

[SKIP: IF CV19DIAG==1 OR RESULTS==1 OR SUSPECT==1, READ/DISPLAY COVIDSEEK; Else Skip to QUARANTINE]

COVIDSEEK		Did you seek medical care for Coronavirus or Covid-19?
	1.	Yes
	2.	No
	77.	[Don’t Know]
	99.	[Refused]

[If COVIDCAR==2, CONTINUE to COVIDCARNO; Else SKIP to SYMPTOMS]

COVIDCARNO		Why did you not seek this medical care?
	1.	Too expensive
	2.	Not available
	3.	Symptoms were not severe enough
	4.	Something else, please specify
	77.	[Don’t Know]
	99.	[Refused]

QUARANTINE		Have you isolated or quarantined yourself because of the Coronavirus?
	1.	Yes
	2.	No
	77.	[Don’t Know]
	99.	[Refused]

[If PRE_QUAR==1, Continue to PROBE_QUAR1; Else if PRE_QUAR==2, Skip to PROBE_QUAR2]

PROBE_QUAR1		When answering the previous question about isolating or quarantining because of the Coronavirus, which of the following if any were you thinking about?
	1.	Staying inside your house and not leaving at all
	2.	Staying in one room in your house as much as possible
	3.	Limiting interactions with members of your household as much as possible
	4.	Limiting interactions with people outside your household as much as possible
	5.	Leaving your house for essential purposes only, such as grocery shopping, healthcare appointments, and exercise
	6.	Staying six feet away from other people as much as possible
	7.	Something else, please specify
	77.	[Don’t Know]
	99.	[Refused]

PROBE_QUAR2		When answering the previous question about isolating or quarantining because of the Coronavirus, what were you thinking about?
	1.	[Open]
	77.	[Don’t Know]
	99.	[Refused]

Preventative Covid Health Behaviors

PREVFREQ		In the last two months, have you done the following more, about the same, or less than before?
	1.	Washed your hands for 20 seconds with soap and water
	2.	Used hand sanitizer
	3.	Coughed or sneezed into a tissue or sleeve
	4.	Cleaned or sterilized commonly-touched surfaces, such as door knobs
	5.	Avoided contact with sick people
	6.	Kept a six-foot distance between yourself and people outside your household
	7.	Avoided gathering with groups of 10 or more people
	8.	Stayed at home except for essential purposes, such medical appointments, grocery shopping, or exercise
	77.	[Don’t Know]
	99.	[Refused]

Disruption and Access to Non-Covid Health Care

DISR_MED		At any point since the Coronavirus pandemic began, have you been able, unable, or have not needed… To get medications?
	1.	Able
	2.	Unable
	3.	Have not needed
	77.	[Don’t Know]
	99.	[Refused]

DISR_DOC		At any point since the Coronavirus pandemic began, have you been able, unable, or have not needed… To get a doctor’s appointment or some other kind of healthcare?
	1.	Able
	2.	Unable
	3.	Have not needed
	77.	[Don’t Know]
	99.	[Refused]

FEEL_ANX		Since the Coronavirus pandemic began, have you felt more stressed or anxious, less stressed or anxious, or about the same?
	1.	More stressed or anxious
	2.	Less stressed or anxious
	3.	About the same
	77.	[Don’t Know]
	99.	[Refused]

FEEL_DEP		Since the Coronavirus pandemic began, have you felt more lonely or sad, less lonely or sad, or about the same?
	1.	More lonely or sad
	2.	Less lonely or sad
	3.	About the same
	77.	[Don’t Know]
	99.	[Refused]

FEEL_SOC		Since the Coronavirus pandemic began, have you felt more socially connected to family or friends, less socially connected to family or friends, or about the same?
	1.	More socially connected
	2.	Less socially connected
	3.	About the same
	77.	[Don’t Know]
	99.	[Refused]

Affect Redux

GADPHQ_INTRO	[If Mode=PHONE, read: Finally, I’m going to ask you about how often you may have felt some things over the last 2 week.] [If Mode=Web, display: The next questions are about how often you may have felt some things over the last 2 weeks. Over the last 2 weeks, how often have you:]

GAD71		[If Mode=Phone, read: Over the last 2 weeks, how often have you been bothered by any of the following problems?] Feeling nervous, anxious, or on edge. [If Mode=Phone, read if necessary: Would you say not at all, several days, more than half the days, or nearly every day?]
	1.	Not at all
	2.	Several days
	3.	More than half the days
	4.	Nearly every day
	77.	[Don’t Know]
	99.	[Refused]

GAD72		[If Mode=Phone, read: Over the last 2 weeks, how often have you been bothered by any of the following problems?] Not being able to stop or control worrying. [If Mode=Phone, read if necessary: Would you say not at all, several days, more than half the days, or nearly every day?]
	1.	Not at all
	2.	Several days
	3.	More than half the days
	4.	Nearly every day
	77.	[Don’t Know]
	99.	[Refused]

DOV_GAD		[Create DOV] For GAD71 and GAD72, “Not at all”=0, “Several…”=1, “More than half…”=2, “Nearly every…”=3. If sum(GAD71 and GAD72)>=3, DOV_GAD=1, else DOV_PHQ=0
	0.
	1.

PHQ81		[If Mode=Phone, read: Over the last 2 weeks, how often have you been bothered by any of the following problems?] Little interest or pleasure in doing things [If Mode=Phone, read: Would you say not at all, several days, more than half the days, or nearly every day?]
	1.	Not at all
	2.	Several days
	3.	More than half the days
	4.	Nearly every day
	77.	[Don’t Know]
	99.	[Refused]

PHQ82		[If Mode=Phone, read: Over the last 2 weeks, how often have you been bothered by any of the following problems?] Feeling down, depressed, or hopeless. [If Mode=Phone, read if necessary: Would you say not at all, several days, more than half the days, or nearly every day?]
	1.	Not at all
	2.	Several days
	3.	More than half the days
	4.	Nearly every day
	77.	[Don’t Know]
	99.	[Refused]

DOV_PHQ		[Create DOV] For PHQ81 and PHQ82, “Not at all”=0, “Several…”=1, “More than half…”=2, “Nearly every…”=3. If sum(PHQ81 and PHQ82)>=3, DOV_PHQ=1, else DOV_PHQ=0
	0.
	1.

[SKIP: If DOV_ANX==2, 3, or 4 OR DOV_GAD==1, Display PROBE_ANX; Else SKIP]

PROBE_ANX		Which of the following statements, if any, describe any of your feelings of being nervous or anxious?
	1.	Sometimes the feelings can be so intense that my chest hurts and I have trouble breathing
	2.	These are positive feelings that help me to accomplish goals and be productive.
	3.	The feelings sometimes interfere with my life, and I wish that I did not have them.
	4.	Feeling that way is normal, and everyone feels that way sometimes
	5.	I have been told by a medical professional that I have anxiety.
	6.	I have these feelings because of the Coronavirus pandemic
	77.	[Don’t Know]
	99.	[Refused]

[SKIP: If DOV_DEP==2, 3, or 4 OR DOV_PHQ==1, Display PROBE_DEP; Else SKIP]

PROBE_DEP		Which of the following statements, if any, describe any of your feelings of being sad or depressed?
	1.	Sometimes the feelings can be so intense that I cannot get out of bed.
	2.	The feelings sometimes interfere with my life, and I wish that I did not have them.
	3.	I get over the feelings quickly.
	4.	Feeling that way is normal, and everyone feels that way sometimes.
	5.	I have been told by a medical professional that I have depression.
	6.	I have these feelings because of the Coronavirus pandemic
	77.	[Don’t Know]
	99.	[Refused]

PROBE_RPEPI		When do you think the Coronavirus pandemic began? Your best guess is fine.
	1.	[Open]
	77.	Don’t Know
	99.	[Refused]

PROBE_RPAFFECT		When did the Coronavirus pandemic first affect your daily life? Your best guess is fine.
	1.	[Open]
	77.	Don’t Know
	99.	[Refused]

PROBE_PANDEMIC		Why do you say that?
	1.	[Open]
	77.	Don’t Know
	99.	[Refused]

PROBE_WAYS		List the ways that the Coronavirus pandemic has affected your life.
	1.	[Open]
	77.	Don’t Know
	99.	[Refused]