NSC_HH Pulse Survey - Attachment B, Vaccine Questions and Current Questions for Deletion

Household Pulse Survey Non-Substantive Change Memorandum – December 22, 2020

Attachment B: Proposed Intent to Vaccinate Questions / Current Survey Questions Proposed for Deletion

1. Proposed New COVID-19 Intent to Vaccinate Questions

RECVDVACC

1. Have you received a COVID-19 vaccine?

-Yes – go to ALLDOSES

-No – skip to GETVACC

ALLDOSES

2. Did you receive (or do you plan to receive) all required doses?

Yes – skip to HADCOVID

No – go to WHYNOT

GETVACC

3. Once a vaccine to prevent COVID-19 is available to you, would you… 

1. Definitely get a vaccine – skip to DIFFICULTGETVACC

2. Probably get a vaccine  - ask WHYNOT

3. Probably NOT get a vaccine – ask WHYNOT

4. Definitely NOT get a vaccine – ask WHYNOT

WHYNOT:

4. Which of the following, if any, are reasons that you [are only probably likely to/probably won’t/definitely won’t] [get a COVID-19 vaccine/won’t receive all required doses of the COVID-19 vaccine]? (Select all that apply.)

Scripter: randomize

1. I am concerned about possible side effects of a COVID-19 vaccine

2. I don’t know if a COVID-19 vaccine will work

3. I don’t believe I need a COVID-19 vaccine – go to WHYNOT2

4. I don’t like needles

5. I don’t like vaccines

6. My doctor has not recommended I get a COVID-19 vaccine

7. I plan to wait and see if it is safe and may get it later

8. I don’t know how to get it

9. I am concerned about the cost of a COVID-19 vaccine

10. Other (please specify: _____) [ANCHOR]

WHYNOT2 (If don’t believe I need a COVID-19 vaccine)

5. Why not? (mark all that apply)

Scripter: randomize

1. I already had COVID-19

2. I am not a member of a high-risk group

3. I plan to use masks or other precautions instead

4. I don’t believe COVID-19 is a serious illness

5. Other (please specify: _____) [ANCHOR]

HADCOVID:

6. Has a doctor or other health care provider ever told you that you have COVID-19?

Yes / No / Not sure

2. Items from Current Phase 3 Questionnaire Proposed for Deletion

Q14 Are you receiving pay for the time you are not working? Select only one answer.[TAF(F1]  

• Yes, I use paid leave  

• Yes, I receive full pay but do not have to take leave  

• Yes, I receive partial pay  

• No, I receive no pay 

 

Q14c Including yourself, how many people in your household received Unemployment Insurance (UI) benefits since March 13, 2020? Please enter a number. [TAF(F1]  

______________________________________

 

 

Q21d Were any of these trips canceled because of the coronavirus pandemic? Include trips you had not made travel reservations or arrangements for in your answer. Select only one answer. [TAF(F1]  

• Yes  

• No 

Q23 Getting enough food can also be a problem for some people. [JMF(F1] Which of these statements best describes the food eaten in your household before March 13, 2020? Select only one answer.  

• Enough of the kinds of food (I/we) wanted to eat   

• Enough, but not always the kinds of food (I/we) wanted to eat  

• Sometimes not enough to eat  

• Often not enough to eat [JMF(F2]  

Q27b In which month(s) were SNAP or food stamp benefits received? Select all that apply. 

• January 2020  

• February 2020  

• March 2020  

• April 2020  

• May 2020  

• June 2020  

• July 2020  

• August 2020  

• September 2020  

• October 2020  

• November 2020  

• December 2020 [JMF(F1] 

Q30 How confident are you that your household will be able to afford the kinds of food you need for the next four weeks? Select only one answer. 

• Not at all confident  

• Somewhat confident  

• Moderately confident  

• Very confident  [JMF(F1] 

Q31 Would you say your health in general is excellent, very good, good, fair, or poor? Select only one answer.[TAF(F1]  

• Excellent  

• Very good  

• Good  

• Fair  

• Poor