Attachment E Attachment E: COVID-19 Monthly Outcome Survey – Ipsos Om

Attachment E: COVID-19 Monthly Outcome Survey – Ipsos Omnibus COVID Questions

Item #: CV1

Question Type: Single punch

CV1: Currently, would you say your physical health is… Select one answer only

Variable Label: CV1: Physical health

Value	Value Label
1	Excellent
2	Very good
3	Good
4	Fair
5	Poor
-99	Refused

Question Type: Grid

CV2. Have you experienced any of the following symptoms in the past 2 weeks? Select one answer from each row in the grid

// Randomize subitem order //

Variable Name	Variable Text	Variable Label
CV2_1_Fever	Fever	CV2_1: IPSOS Fever
CV2_2_Cough	Dry Cough	CV2_2: IPSOS Dry cough
CV2_3_Breath	Shortness of Breath	CV2_3: IPSOS Shortness of breath
CV2_4_Senses	Decreased Sense of Smell/Taste	CV2_4: IPSOS Decreased sense of smell and taste
CV2_5_Flu	Other Flu like Symptoms	CV2_5: IPSOS Flu symptoms

Value	Value Label
1	Yes
2	No
3	Don’t know
-99	Refusal

Question Type: Grid

CV3. Has anyone else in your household besides yourself experienced any of the following symptoms in the past two weeks? Select one answer from each row in the grid

// Randomize subitem order //

Variable Name	Variable Text	Variable Label
CV3_1_Fever	Fever	CV3_1: IPSOS Fever
CV3_2_Cough	Dry Cough	CV3_2: IPSOS Dry cough
CV3_3_Breath	Shortness of Breath	CV3_3: IPSOS Shortness of breath
CV3_4_Senses	Decreased Sense of Smell/Taste	CV3_4: IPSOS Decreased sense of smell and taste
CV3_5_Flu	Other Flu like Symptoms	CV3_5: IPSOS Flu symptoms

Value	Value Label
1	Yes
2	No
3	Don’t know
-99	Refusal

Question Type: Multi punch

CV4: Have you, or someone in your immediate family, been diagnosed with the coronavirus/COVID-19? Select all answers that apply

Variable Name	Variable Text	Variable Label
CV4_1_Self	Yes, I have	CV4_1: IPSOS Self COVID diagnosis
CV4_2_Family	Yes, someone in my family has	CV4_2: IPSOS Family COVID diagnosis
CV4_3_No	No	CV4_3: IPSOS No COVID diagnosis

Value	Value Label
1	Marked
0	Not Marked

Question Type: Multi punch

CV5: Have you sought any medical help related to your COVID-19 like symptoms or COVID-19 diagnosis? Select all answers that apply

// Ask if CV2 = 1 (any symptoms) OR CV4 = 1 (Yes, I have) //

Variable Name	Variable Text	Variable Label
CV5_1_Hospital	Gone to a hospital or emergency room	CV5_1: IPSOS Hospital or emergency room
CV5_2_Urgent care	Gone to an urgent care facility	CV5_2: IPSOS Urgent care facility
CV5_3_Doctor	Visited a doctor’s office	CV5_3: IPSOS Visited doctor’s office
CV5_4_Phone	Consulted with a healthcare provider over the phone	CV5_4: IPSOS Consulted with healthcare provider over the phone
CV5_5_Video	Consulted with a healthcare provider using a video chat system	CV5_5: IPSOS Consulted with healthcare provider using video chat
CV5_6_Chat	Consulted with a healthcare provider using chat, text, or email	CV5_6: IPSOS Consulted with healthcare provider using chat, text, or email
CV5_7_None	None of the above	CV5_7: IPSOS None of the above

Value	Value Label
1	Marked
0	Not Marked
-100	Valid skip

Item #: CV6a

Question Type: Single punch

CV6a: What was your employment status prior to the coronavirus/COVID-19 pandemic? Select one answer only

Variable Label: CV6a: IPSOS Employment status prior to COVID pandemic

Value	Value Label
1	Employed full time (35 hours or more per week) for pay with an organization or company
2	Employed part time (less than 35 hours per week) for pay with an organization or company
3	Self-employed
4	Unemployed, looking for work
5	Unable to work due to a disability
6	On temporary layoff from a job
7	Retired
8	A student
9	Other
-99	Refused

Item #: CV6b

Question Type: Single punch

CV6b: Has your employment status changed since the coronavirus/COVID-19 pandemic? Select one answer only

// Ask if CV6a = 1|2|3|4|6|8|9 //

Variable Label: CV6b: IPSOS Employment status changed since COVID pandemic

Value	Value Label
1	Yes
2	No
-99	Refused
-100	Valid skip

Item #: CV6c

Question Type: Single punch

CV6c: What is your current employment status? Select one answer only

// Ask if CV6b = 1 (Yes). All others derived from CV6a. //

Variable Label: CV6c: IPSOS Current employment status

Value	Value Label
1	Employed full time (35 hours or more per week) for pay with an organization or company
2	Employed part time (less than 35 hours per week) for pay with an organization or company
3	Self-employed
4	Unemployed, looking for work
5	Unable to work due to a disability
6	On temporary layoff from a job
7	Retired
8	A student
9	Other
-99	Refused
-100	Valid skip

Item #: CV7a

Question Type: Single punch

CV7a: Are you classified as an essential worker? Select one answer only

// Ask if EMPLOYMENT = 1|2|3 //

Variable Label: CV7a: IPSOS Essential worker

Value	Value Label
1	Yes
2	No
3	Don’t know
-99	Refused
-100	Valid skip

Item #: CV7b

Question Type: Single punch

CV7b: Are you a healthcare worker? Select one answer only

// Ask if EMPLOYMENT = 1|2|3 //

Variable Label: CV7b: IPSOS Healthcare worker

Value	Value Label
1	Yes
2	No
3	Don’t know
-99	Refused
-100	Valid skip

Item #: CV8a

Question Type: Single punch

CV8a: Below is a list of different kinds of health insurance. Which of the following was your primary source of insurance coverage prior to the coronavirus/COVID-19 pandemic? Select one answer only

Variable Label: CV8a: IPSOS Insurance coverage prior to COVID pandemic

Value	Value Label
1	Health insurance through your or someone else’s employer or union
2	Medicare, a government plan that pays healthcare bills for people aged 65 or older and for some disabled people
3	Medicaid, or any state government medical assistance plan for those with lower incomes
4	Health insurance that you bought from the federal Health Insurance Marketplace, also known as Healthcare.gov, or a state-run Health Insurance Marketplace
5	Veteran’s Affairs (VA), Department of Defense, or other military programs
6	Health insurance from some other source
7	I do not have any healthcare insurance/coverage
-99	Refused

Item #: CV8b

Question Type: Single punch

CV8b: Has your health insurance status changed since the coronavirus/COVID-19 pandemic? Select one answer only

Variable Label: CV8b: IPSOS Insurance changed since COVID pandemic

Value	Value Label
1	Yes
2	No
-99	Refused

Item #: CV8c

Question Type: Single punch

CV8c: What is your current primary source of insurance coverage? Select one answer only

// Ask if CV8b = 1. All others derived from CV8a //

Variable Label: CV8c: IPSOS Current insurance coverage

Value	Value Label
1	Health insurance through your or someone else’s employer or union
2	Medicare, a government plan that pays healthcare bills for people aged 65 or older and for some disabled people
3	Medicaid, or any state government medical assistance plan for those with lower incomes
4	Health insurance that you bought from the federal Health Insurance Marketplace, also known as Healthcare.gov, or a state-run Health Insurance Marketplace
5	Veteran’s Affairs (VA), Department of Defense, or other military programs
6	Health insurance from some other source
7	I do not have any healthcare insurance/coverage
-99	Refused
-100	Valid skip

Question Type: Multi punch

CV9: Since the coronavirus/COVID-19 pandemic, have you received any of the following financial assistance from the government? Select all answers that apply

Variable Name	Variable Text	Variable Label
CV9_1_Unemployment benefits	Unemployment benefits	CV9_1: IPSOS Unemployment benefits
CV9_2_COVID enhanced	COVID-19 related enhanced unemployment benefits	CV9_2: IPSOS COVID related enhanced unemployment benefits
CV9_3_CARES	CARES Act check (direct stimulus payments)	CV9_3: IPSOS CARES Act check
CV9_4_None	None of the above	CV9_4: IPSOS None

Value	Value Label
1	Marked
0	Not Marked

Question Type: Multi punch

CV10: Have you changed your daily routine in any way specifically because of the coronavirus/COVID-19 pandemic? Select all answers that apply

// Ask CV10_1 & CV10_2 if XPARENT = 1 //

Variable Name	Variable Text	Variable Label
CV10_1_Children home	I have kept my children home from school	CV10_1: IPSOS kept children home from school
CV10_2_Home schooled	I home schooled my children	CV10_2: IPSOS home schooled children
CV10_3_Work from home	I have worked from home more than before the pandemic	CV10_3: IPSOS worked from home more than before the pandemic
CV10_4_Return to work	I have recently returned to work after a temporary closure of my company	CV10_4: IPSOS returned to work after temporary closure
CV10_5_None	None of the above	CV10_5: IPSOS None

Value	Value Label
1	Marked
0	Not Marked
-100	Valid skip

Question Type: Grid

CV11. Has anyone else in your household besides yourself experienced any of the following symptoms in the past two weeks? Select one answer from each row in the grid

// Randomize subitem order //

Variable Name	Variable Text	Variable Label
CV11_1_Nervous	Feeling nervous, anxious, or on edge	CV11_1: IPSOS Household nervous, anxious, on edge
CV11_2_Worrying	Not being able to stop or control worrying	CV11_2: IPSOS Household not able to stop worrying
CV11_3_Depressed	Feeling down, depressed or hopeless	CV11_3: IPSOS Household feeling down, depressed, or hopeless
CV11_4_Little interest	Little interest or pleasure in doing things	CV11_4: IPSOS Household little interest or pleasure

Value	Value Label
1	Not at all
2	Several days
3	More than half the days
4	Nearly every day
-99	Refusal

Question Type: Grid

CV12. How difficult have these problems made it for you to do your work, take care of things at home, or get along with other people? Select one answer only

// Ask if matching CV11 = 2|3|4. Randomize subitem order //

Variable Name	Variable Text	Variable Label
CV12_1_Nervous	Feeling nervous, anxious, or on edge	CV12_1: IPSOS Self nervous, anxious, on edge
CV12_2_Worrying	Not being able to stop or control worrying	CV12_2: IPSOS Self not able to stop worrying
CV12_3_Depressed	Feeling down, depressed or hopeless	CV12_3: IPSOS Self feeling down, depressed, or hopeless
CV12_4_Little interest	Little interest or pleasure in doing things	CV12_4: IPSOS Self little interest or pleasure

Value	Value Label
1	Not at all
2	Several days
3	More than half the days
4	Nearly every day
-99	Refusal
-100	Valid skip

Item #: CV13

Question Type: Single punch

CV13: During the past week, how much of your day have you been spending at home during your normal working or waking hours, including your front or back yard? Select one answer only

Variable Label: CV13: IPSOS Time spent at home

Value	Value Label
1	The entire day. I never go outside my home
2	Most of the day, with an occasional trip outside my home
3	Some of the day. I am in and out of my home all day
4	Very little of the day. I am rarely at home
-99	Refused

Item #: CV14

Question Type: Multi punch

CV14: During the past week, when you were outside your home, did you practice any of the following?

// Ask if CV13 = 2|3|4. Randomize response option order //

Variable Label: CV14: IPSOS COVID 14

Value	Value Label
1	Kept social distance from others
2	Wore a mask
3	Avoided enclosed spaces
4	Washed or sanitized hands frequently
5	None of the above
-99	Refused
-100	Valid skip

Value	Value Label
1	Marked
0	Not Marked
-100	Valid skip

We would now like to ask you some questions about coronavirus (COVID-19) prevention and social distancing.

Item #: CV15

Question Type: Single punch

CV15: Approximately how many times yesterday did you wash your hands with soap and water or use hand sanitizer? Select one answer only

Variable Label: CV15: IPSOS Wash hands yesterday

Value	Value Label
1	0 times
2	1-6 times
3	More than 6 times
-99	Refused

Item #: CV16

Question Type: Single punch

CV16: For how long do you usually wash your hands each time? Select one answer only

// Ask if CV15 = 2|3. //

Variable Label: CV16: IPSOS Wash hands time

Value	Value Label
1	Less than 10 seconds
2	10-19 seconds
3	20 seconds or more
-99	Refused
-100	Valid skip