Eligibility Screener (English)

Barriers and Facilitators to Expanding the NHBS to Conduct HIV Behavioral Surveillance Among Transgender Women (NHBS-Trans)

Att 4a_Eligibility Screener (English)

OMB: 0920-1262

Document [docx]
Download: docx | pdf

Form Approved

OMB No: 0920-1262

OMB Exp. Date: XX/XX/XXXX











National HIV Behavioral Surveillance System among Transgender Women (NHBS-Trans)

Attachment #5a (English)

Eligibility Screener (English)

















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/ATSDR Reports Clearance Officer; 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30329; Attn: OMB-PRA (0920-1262)

NHBS TRANS QUESTIONNAIRE

ELIGIBILITY SCREENER (ES)

Variables from prior section(s) used in this section of the questionnaire

Section

Question #

Variable name

Variable label

Preloaded variables

--

IDATE

Interview date

Interviewer Entered Information

IE2

CITY

City



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.



BEGSCR

Time at beginning of screener

BEGSCR = Current time





ES1.

What is your date of birth?

DOB

Date of birth




__ __ /__ __ / __ __ __ __ (MM/DD/YYYY)





Range (Year)

1900-2100




Don't Know (Year)

9999




Refuse to Answer (Year)

7777




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.



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?

C_AGE

Confirm AGE




No

0




Yes

1




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 INTRO_CALC_EL_TRANS.

Else, go to ES2.



ES2.

In the past 12 months, that is, since [fill with interview month, formatted as text] of last year, 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.

E_PART

Eligibility, previous participant




No

0




Yes

1




Don't Know

9




Refuse to Answer

7




Race and ethnicity



ES2a.

Do you consider yourself to be of Hispanic, Latino/a, or Spanish origin?



[INTERVIEWER: If necessary, say "Just tell me Yes or No."]

HISPANIC

Latino ethnicity




No

0




Yes

1




Don't Know

9




Refuse to Answer

7




Check_ES2a.

If R is Latino (ES2a EQ 1), go to ES2b. Else, go to ES2c.



ES2b.

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.]

HSPTYP

Hispanic Ancestry (number reported)



HSPTYPA

Mexican




HSPTYPB

Puerto Rican




HSPTYSC

Cuban




HSPTYPD

Dominican




HSPTYPE

Another Hispanic, Latino/a, or Spanish origin





Don't Know

9




Refuse to Answer

7




Check_ES2b.

If R reports 'Another' Hispanic origin (HSPTYPE EQ 1), go to ES2b.spec.

Else, go to ES2c.



ES2b.spec.

What is your Hispanic, Latino/a, or Spanish origin?

SPECHSP

Other specified Latino origin



__ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __



{text response; max length = 100 characters}



Don't Know

9




Refuse to Answer

7




ES2c.

[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.]

RACE

Racial group (number reported)



RACEA

American Indian or Alaska Native




RACEB

Asian




RACEC

Black or African American




RACED

Native Hawaiian or Other Pacific Islander




RACEE

White





Don't Know

9




Refuse to Answer

7




Not Applicable

8




INTRO_ES3.

DISPLAY: "READ: The following questions are about your gender identity, which is the way you describe your gender, and sex assigned at birth, which is the sex listed on your original birth certificate.”



ES3.

[Give Respondent Flashcard B.]



How do you describe your current gender identity? You can choose more than one answer.



[READ choices, CHECK ALL that apply.]


GENDR2

Gender identity




GENDA

Woman




GENDB

Transgender woman




GENDC

Transfeminine




GENDD

Man




GENDE

Transgender man




GENDF

Transmasculine




GENDG

Nonbinary




GENDH

A gender not listed here





Don’t Know

9




Refuse to Answer

7




Check_ES3spec.

If R is other gender (GENDH EQ 1), go to ES3spec.

Else, go to ES4.



ES3spec.

INTERVIEWER: Specify other gender identity/ies.



[Separate multiple reported identities with commas.]


SPECGEND

Specified other gender identity



__ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __



{text response; max length = 100 characters}



Don’t Know

9




Refuse to Answer

7




ES4.

What was your sex assigned at birth?



[DO NOT read choices.]

SXBRTHR2

Sex assigned at birth




Male

1




Female

2




Intersex/ambiguous

3




Don’t Know

9




Refuse to Answer

7






INTRO_ES5.

DISPLAY: "READ: The next questions are about languages you speak.”



ES5.

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




ES6.

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






Check_CountyofResidence.

If IE2 EQ 1, go to ES7_ATL.

If IE2 EQ 2, go to ES7_BLT.

If IE2 EQ 3, go to ES7_BOS.

If IE2 EQ 4, go to ES7_CHI.

If IE2 EQ 5, go to ES7_DAL.

If IE2 EQ 6, go to ES7_DEN.

If IE2 EQ 7, go to ES7_DET.

If IE2 EQ 9, go to ES7_HOU.

If IE2 EQ 10, go to ES7_LAX.

If IE2 EQ 11, go to ES7_MIA.

If IE2 EQ 12, go to ES7_MEM.

If IE2 EQ 13, go to ES7_NAU.

If IE2 EQ 14 go to ES7_NEW.

If IE2 EQ 15, go to ES7_NOL.

If IE2 EQ 16, go to ES7_NYC.

If IE2 EQ 17, go to ES7_NOR.

If IE2 EQ 18, go to ES7_PHL.

If IE2 EQ 19, go to ES7_PTL.

If IE2 EQ 21, go to ES7_SDG.

If IE2 EQ 22, go to ES7_SFO.

If IE2 EQ 23, go to ES7_SJN.

If IE2 EQ 24, go to ES7_SEA.

If IE2 EQ 25, go to ES7_WDC.



County of Residence

ES7_ATL.

What county do you currently live in?



[DO NOT read choices.]

ATLCTYR6

Eligibility, Atlanta county of residence



Barrow County

1



Bartow County

2



Butts County

3



Carroll County

4



Cherokee County

5



Clayton County

6



Cobb County

7



Coweta County

8



Dawson County

9



DeKalb County

10



Douglas County

11



Fayette County

12



Forsyth County

13



Fulton County

14



Gwinnett County

15



Haralson County

16



Heard County

17



Henry County

18



Jasper County

19



Lamar County

20



Meriwether County

21



Morgan County

22



Newton County

23



Paulding County

24



Pickens County

25



Pike County

26



Rockdale County

27



Spalding County

28



Walton County

29



Other

88



Don't Know

999



Refuse to Answer

777




CALC_ATLELR6.



ATLELR6

Eligible county resident: ATL

ATLELR6 = if ((ATLCTYR6=1 OR ATLCTYR6=2 OR ATLCTYR6=3 OR ATLCTYR6=4 OR ATLCTYR6=5 OR ATLCTYR6=6 OR ATLCTYR6=7 OR ATLCTYR6=8 OR ATLCTYR6=9 OR ATLCTYR6=10 OR ATLCTYR6=11 OR ATLCTYR6=12 OR ATLCTYR6=13 OR ATLCTYR6=14 OR ATLCTYR6=15 OR ATLCTYR6=16 OR ATLCTYR6=17 OR ATLCTYR6=18 OR ATLCTYR6=19 OR ATLCTYR6=20 OR ATLCTYR6=21 OR ATLCTYR6=22 OR ATLCTYR6=23 OR ATLCTYR6=24 OR ATLCTYR6=25 OR ATLCTYR6=26 OR ATLCTYR6=27 OR ATLCTYR6=28 OR ATLCTYR6=29), 1,0)





Check_ES7_BLT.

Go to CALC_E_CITY.



ES7_BLT.

What county do you currently live in?



[DO NOT read choices.]

BLTCTYR5

Eligibility, Baltimore county of residence



Baltimore City

1



Anne Arundel

2



Baltimore

3



Carroll

4



Harford

5



Howard

6



Queen Anne's

7



Other

88



Don't Know

999



Refuse to Answer

777




CALC_BLTELR5.



BLTELR5

Eligible county resident: BLT

BLTELR5 = if ((BLTCTYR5=1 OR BLTCTYR5=2 OR BLTCTYR5=3 OR BLTCTYR5=4 OR BLTCTYR5=5 OR BLTCTYR5=6 OR BLTCTYR5=7), 1,0)



Check_ES7_BOS.

Go to CALC_E_CITY.



ES7_BOS.

What county/city/town do you currently live in?



[DO NOT read choices.]

BOSCTYR5

Eligibility, Boston city or town of residence




Allston

1




Back Bay

2




Brookline

7




Cambridge

8




Chelsea

10




Dorchester

12




East Boston

14




Fenway / Kenmore

15




Jamaica Plain

17




Lynn

18




Malden

20




Medford

21




Revere

26




Roxbury

28




Somerville

29




South Boston

30




South End

31




Boston (other)

37




Essex County (other)

38




Middlesex County (other)

39




Norfolk County (other)

40




Plymouth County (other)

41




Suffolk County (other)

42




Other

88




Don't Know

999




Refuse to Answer

777




CALC_BSTELR5.



BSTELR5

Eligible county resident: BOS

BSTELR5 = if ((BOSCTYR5=1 OR BOSCTYR5=2 OR BOSCTYR5=7 OR BOSCTYR5=8 OR BOSCTYR5=10 OR BOSCTYR5=12 OR BOSCTYR5=14 OR BOSCTYR5=15 OR BOSCTYR5=17 OR BOSCTYR5=18 OR BOSCTYR5=20 OR BOSCTYR5=21 OR BOSCTYR5=26 OR BOSCTYR5=28 OR BOSCTYR5=29 OR BOSCTYR5=30 OR BOSCTYR5=31 OR BOSCTYR5=37 OR BOSCTYR5=38 OR BOSCTYR5=39 OR BOSCTYR5=40 OR BOSCTYR5=41 OR BOSCTYR5=42), 1,0)



Check_ES7_CHI.

Go to CALC_E_CITY.



ES7_CHI.

What county do you currently live in?



[DO NOT read choices.]

CHICTYR5

Eligibility, Chicago county of residence



Cook County

1



DuPage County

3



Grundy County

4



Kendall County

6



McHenry County

7



Will County

8



Other

88



Don't Know

999



Refuse to Answer

777




CALC_CHIELR5.



CHIELR5

Eligible county resident: CHI

CHIELR5 = if ((CHICTYR5=1 OR CHICTYR5=3 OR CHICTYR5=4 OR CHICTYR5=6 OR CHICTYR5=7 OR CHICTYR5=8), 1,0)



Check_ES7_DAL.

Go to CALC_E_CITY.



ES7_DAL.

What county do you currently live in?



[DO NOT read choices.]

DALCTYR5

Eligibility, Dallas county of residence



Collin County

1



Dallas County

2



Denton County

4



Ellis County

5



Hunt County

6



Kaufman County

7



Rockwall County

8



Other

88



Don't Know

999



Refuse to Answer

777




CALC_DALELR5.



DALELR5

Eligible county resident: DAL

DALELR5 = if ((DALCTYR5=1 OR DALCTYR5=2 OR DALCTYR5=4 OR DALCTYR5=5 OR DALCTYR5=6 OR DALCTYR5=7 OR DALCTYR5=8), 1,0)



Check_ES7_DEN.

Go to CALC_E_CITY.



ES7_DEN.

What county do you currently live in?



[DO NOT read choices.]

DENCTYR5

Eligibility, Denver county of residence



Adams County

1



Arapahoe County

2



Broomfield County

3



Clear Creek County

4



Denver County

5



Douglas County

6



Elbert County

7



Gilpin County

8



Jefferson County

9



Park County

10



Other

88



Don't Know

999



Refuse to Answer

777




CALC_DENELR5.



DENELR5

Eligible county resident: DEN

DENELR5 = if ((DENCTYR5=1 OR DENCTYR5=2 OR DENCTYR5=3 OR DENCTYR5=4 OR DENCTYR5=5 OR DENCTYR5=6 OR DENCTYR5 =7 OR DENCTYR5=8 OR DENCTYR5=9 OR DENCTYR5=10), 1,0)



Check_ES7_DET.

Go to CALC_E_CITY.



ES7_DET.

What county do you currently live in?



[DO NOT read choices.]

DETCTYR5

Eligibility, Detroit county of residence



Macomb County

0



Oakland County

1



Wayne County

2



Other

88



Don't Know

999



Refuse to Answer

777




CALC_DETELR5.



DETELR5

Eligible county resident: DET

DETELR5 = if ((DETCTYR5=0 OR DETCTYR5=1 OR DETCTYR5=2), 1,0)



Check_ES7_HOU.

Go to CALC_E_CITY.



ES7_HOU.

What county do you currently live in?



[DO NOT read choices.]

HOUCTYR5

Eligibility, Houston county of residence



Austin County

1



Brazoria County

2



Chambers County

3



Fort Bend County

4



Galveston County

5



Harris County

6



Liberty County

7



Montgomery County

8



Waller County

10



Other

88



Don't Know

999



Refuse to Answer

777






CALC_HOUELR5.



HOUELR5

Eligible county resident: HOU

HOUELR5= if ((HOUCTYR5=1 OR HOUCTYR5=2 OR HOUCTYR5=3 OR HOUCTYR5=4 OR HOUCTYR5=5 OR HOUCTYR5=6 OR HOUCTYR5=7 OR HOUCTYR5=8 OR HOUCTYR5=10), 1,0)



Check_ES7_LAX.

Go to CALC_E_CITY.





ES7_LAX.

What county do you currently live in?



[DO NOT read choices.]

LAXCTYR5

Eligibility, Los Angeles county of residence




Los Angeles County

1




Other

88




Don't Know

999




Refuse to Answer

777




CALC_LAXELR5.



LAXELR5

Eligible county resident: LAX

LAXELR5 = if ((LAXCTYR5=1), 1,0)



Check_ES7_MIA.

Go to CALC_E_CITY.



ES7_MIA.

What county do you currently live in?



[DO NOT read choices.]

MIACTYR5

Eligibility, Miami county of residence




Miami-Dade County

1




Other

88




Don't Know

999




Refuse to Answer

777




CALC_MIAELR5.



MIAELR5

Eligible county resident: MIA

MIAELR5 = if ((MIACTYR5=1), 1,0)



Check_ES7_MEM.

Go to CALC_E_CITY.



ES7_MEM.

What county do you currently live in?



[DO NOT read choices.]

MEMCTYR5

Eligibility, Memphis county of residence




Fayette County, TN

1




Shelby County, TN

2




Tipton County, TN

3




Benton County, MS

4




DeSoto County, MS

5




Marshall County, MS

6




Tate County, MS

7




Tunica County, MS

8




Crittendon County, AR

9




Other

88




Don't Know

999




Refuse to Answer

777




CALC_MEMELR5.



MEMELR5

Eligible county resident: MEM

MEMELR5 = if ((MEMCTYR5=1 OR MEMCTYR5=2 OR MEMCTYR5=3 OR MEMCTYR5=4 OR MEMCTYR5=5 OR MEMCTYR5=6 OR MEMCTYR5=7 OR MEMCTYR5=8 OR MEMCTYR5=9 ), 1,0)





Check_ES7_NAU.

Go to CALC_E_CITY.



ES7_NAU.

What county do you currently live in?



[DO NOT read choices.]

NAUCTYR5

Eligibility, Nassau county of residence



Nassau County

1



Suffolk County

2



Other

88



Don't Know

999



Refuse to Answer

777




CALC_NAUELR5.



NAUELR5

Eligible county resident: NAU

NAUELR5 = if ((NAUCTYR5=1 OR NAUCTYR5=2), 1,0)



Check_ES7_NEW.

Go to CALC_E_CITY.



ES7_NEW.

What county do you currently live in?



[DO NOT read choices.]

NEWCTYR5

Eligibility, Newark county of residence




Essex County, NJ

1




Hunterdon County, NJ

2




Hudson County, NJ

3




Morris County, NJ

4




Somerset County, NJ

5




Sussex County, NJ

6




Union County, NJ

7




Pike County, PA

8




Other

88




Don't Know

999




Refuse to Answer

777






CALC_NEWELR5.



NEWELR5

Eligible county resident: NEW

NEWELR5 = if ((NEWCTYR5=1 OR NEWCTYR5=2 OR NEWCTYR5=3 OR NEWCTYR5=4 OR NEWCTYR5=5 OR NEWCTYR5=6 OR NEWCTYR5=7 OR NEWCTYR5=8), 1,0)



Check_ES7_NOL.

Go to CALC_E_CITY.



ES7_NOL.

What parish do you currently live in?



[DO NOT read choices.]

NOLCTYR5

Eligibility, New Orleans parish of residence


Jefferson Parish

1



Orleans Parish

2



Plaquemines Parish

3



St. Bernard Parish

4



St. Charles Parish

5



St. James Parish

6



St. John the Baptist Parish

7



St. Tammany Parish

8



Other

88



Don't Know

999



Refuse to Answer

777




CALC_NOLEL.



NOLELR5

Eligible parish resident: NOL

NOLELR5 = if ((NOLCTYR5=1 OR NOLCTYR5=2 OR NOLCTYR5=3 OR NOLCTYR5=4 OR NOLCTYR5=5 OR NOLCTYR5=6 OR NOLCTYR5=7 OR NOLCTYR5=8), 1,0)





Check_ES7_NYC.

Go to CALC_E_CITY.





ES7_NYC.

What county do you currently live in?



[DO NOT read choices.]

NYCCTYR5

Eligibility, New York City county of residence


Bronx County, NY

1



Kings County, NY

2



New York County, NY

3



Orange County, NY

4



Queens County, NY

5



Richmond County, NY

6



Rockland County, NY

7



Westchester County, NY

8



Bergen County, NJ

9



Middlesex County, NJ

11



Monmouth County, NJ

12



Ocean County, NJ

13



Passaic County, NJ

14



Other

88



Don't Know

999



Refuse to Answer

777




CALC_NYCELR5.



NYCELR5

Eligible county resident: NYC

NYCELR5 = if ((NYCCTYR5=1 OR NYCCTYR5=2 OR NYCCTYR5=3 OR NYCCTYR5=4 OR NYCCTYR5=5 OR NYCCTYR5=6 OR NYCCTYR5=7 OR NYCCTYR5=8 OR NYCCTYR5=9 OR NYCCTYR5=11 OR NYCCTYR5=12 OR NYCCTYR5=13 OR NYCCTYR5=14), 1,0)





Check_ES7_NOR.

Go to CALC_E_CITY.





ES7_NOR.

What county do you currently live in?



[DO NOT read choices.]

NORCTYR5

Eligibility, Norfolk county of residence



Chesapeake City, VA

1



Gloucester County, VA

2



Hampton City, VA

3



Isle of Wight County, VA

4



James City County, VA

5



Mathews County, VA

6



Newport News City, VA

7



Norfolk City, VA

8



Poquoson City, VA

9



Portsmouth City, VA

10



Suffolk City, VA

11



Virginia Beach City, VA

13



Williamsburg City, VA

14



York County, VA

15



Currituck County, NC

16



Gates County, NC

20



Other

88



Don't Know

999



Refuse to Answer

777




CALC_NORELR5.



NORELR5

Eligible county resident: NOR

NORELR5 = if ((NORCTYR5=1 OR NORCTYR5=2 OR NORCTYR5=3 OR NORCTYR5=4 OR NORCTYR5=5 OR NORCTYR5=6 OR NORCTYR5=7 OR NORCTYR5=8 OR NORCTYR5=9 OR NORCTYR5=10 OR NORCTYR5=11 OR NORCTYR5=13 OR NORCTYR5=14 OR NORCTYR5=15 OR NORCTYR5=16 OR NORCTYR5=20), 1,0)





Check_ES7_PHL.

Go to CALC_E_CITY.



ES7_PHL.

What county do you currently live in?



[DO NOT read choices.]

PHLCTYR5

Eligibility, Philadelphia county of residence


Delaware County

3



Philadelphia County

5



Other

88



Don't Know

999



Refuse to Answer

777




CALC_PHLELR5.



PHLELR5

Eligible county resident: PHL

PHLELR5 = if ((PHLCTYR5=3 OR PHLCTYR5=5), 1,0)





Check_ES7_PTL.

Go to CALC_E_CITY.





ES7_PTL.

What county do you currently live in?



[DO NOT read choices.]

PTLCTYR5

Eligibility, Portland county of residence



Clackamas County, OR

1



Columbia County, OR

2



Multnomah County, OR

3



Washington County, OR

4



Yamhill County, OR

5



Clark County, WA

6



Skamania County, WA

7



Other

88



Don't Know

999



Refuse to Answer

777




CALC_PTLELR5.



PTLELR5

Eligible county resident: PTL

PTLELR5 = if ((PTLCTYR5=1 OR PTLCTYR5=2 OR PTLCTYR5=3 OR PTLCTYR5=4 OR PTLCTYR5=5 OR PTLCTYR5=6 OR PTLCTYR5=7), 1,0)





Check_ES7_SDG.

Go to CALC_E_CITY.



ES7_SDG.

What county do you currently live in?



[DO NOT read choices.]

SDGCTYR5

Eligibility, San Diego county of residence



San Diego County

1



Other

88



Don't Know

999



Refuse to Answer

777






CALC_SDGELR5.



SDGEL

Eligible county resident: SDG

SDGELR5 = if ((SDGCTYR5=1), 1,0)



Check_ES7_SFO.

Go to CALC_E_CITY.



ES7_SFO.

What county do you currently live in?



[DO NOT read choices.]

SFOCTYR5

Eligibility, San Francisco county of residence


San Francisco County

2



San Mateo County

3



Other

88



Don't Know

999



Refuse to Answer

777




CALC_SFOELR5.



SFOELR5

Eligible county resident: SFO

SFOELR5 = if ((SFOCTYR5=2 OR SFOCTYR5=3), 1,0)



Check_ES7_SJN.

Go to CALC_E_CITY.



ES7_SJN.

What municipality (county) do you currently live in?



[DO NOT read choices.]

SJNCTYR6

Eligibility, San Juan county (municipio) of residence


Aguas Buenas

1



Aibonito

2



Barceloneta

3



Barranquitas

4



Bayamón

5



Caguas

6



Canóvanas

7



Carolina

8



Cataño

9



Cayey

10



Ceiba

11



Ciales

12



Cidra

13



Comerío

14



Corozal

15



Dorado

16



Fajardo

17



Florida

18



Guaynabo

19



Gurabo

20



Humacao

21



Juncoa

22



Las Piedras

23



Loíza

24



Luquillo

25



Manatí

26



Manuabo

27



Morovis

28



Naguabo

29



Naranjito

30



Orocovis

31



Río Grande

32



San Juan

33



San Lorenzo

34



Toa Alta

35



Toa Baja

36



Trujillo Alto

37



Vega Alta

38



Vega Baja

39



Yabucoa

40



Other

88



Don't Know

999



Refuse to Answer

777






CALC_SJNELR6.



SJNELR6

Eligible municipality resident: SJN

SJNELR6 = if ((SJNCTYR6=1 OR SJNCTYR6=2 OR SJNCTYR6=3 OR SJNCTYR6=4 OR SJNCTYR6=5 OR SJNCTYR6=6 OR SJNCTYR6=7 OR SJNCTYR6=8 OR SJNCTYR6=9 OR SJNCTYR6=10 OR SJNCTYR6=11 OR SJNCTYR6=12 OR SJNCTYR6=13 OR SJNCTYR6=14 OR SJNCTYR6=15 OR SJNCTYR6=16 OR SJNCTYR6=17 OR SJNCTYR6=18 OR SJNCTYR6=19 OR SJNCTYR6=20 OR SJNCTYR6=21 OR SJNCTYR6=22 OR SJNCTYR6=23 OR SJNCTYR6=24 OR SJNCTYR6=25 OR SJNCTYR6=26 OR SJNCTYR6=27 OR SJNCTYR6=28 OR SJNCTYR6=29 OR SJNCTYR6=30 OR SJNCTYR6=31 OR SJNCTYR6=32 OR SJNCTYR6=33 OR SJNCTYR6=34 OR SJNCTYR6=35 OR SJNCTYR6=36 OR SJNCTYR6=37 OR SJNCTYR6=38 OR SJNCTYR6=39 OR SJNCTYR6=40), 1,0)



Check_ES7_SEA.

Go to CALC_E_CITY.



ES7_SEA.

What county do you currently live in?



[DO NOT read choices.]

SEACTYR5

Eligibility, Seattle county of residence



King County

1




Snohomish County

2




Other

88




Don't Know

999




Refuse to Answer

777




CALC_SEAELR5.



SEAELR5

Eligible county resident: SEA

SEAELR5 = if ((SEACTYR5=1 OR SEACTYR5=2), 1, 0)



Check_ES7_WDC.

Go to CALC_E_CITY.



ES7_WDC.

What county do you currently live in?



[DO NOT read choices.]

WDCCTYR5

Eligibility, Washington DC county of residence




District of Columbia

1




Calvert County, MD

2




Charles County, MD

3




Prince George's County, MD

4




Alexandria City, VA

5




Fairfax City, VA

6




Falls Church City, VA

7




Fredericksburg City, VA

8




Manassas City, VA

9




Manassas Park City, VA

10




Arlington County, VA

11




Clarke County, VA

12




Culpeper County, VA

13




Fairfax County, VA

14




Fauquier County, VA

15




Loudoun County, VA

16




Prince William County, VA

17




Rappahannock County, VA

18




Spotsylvania County, VA

19




Stafford County, VA

20




Warren County, VA

21




Jefferson County, WV

22




Other

88




Don't Know

999




Refuse to Answer

777




CALC_WDCELR5.



WDCELR5

Eligible county resident: WDC

WDCELR5 = if ((WDCCTYR5=1 OR WDCCTYR5=2 OR WDCCTYR5=3 OR WDCCTYR5=4 OR WDCCTYR5=5 OR WDCCTYR5=6 OR WDCCTYR5=7 OR WDCCTYR5=8 OR WDCCTYR5=9 OR WDCCTYR5=10 OR WDCCTYR5=11 OR WDCCTYR5=12 OR WDCCTYR5=13 OR WDCCTYR5=14 OR WDCCTYR5=15 OR WDCCTYR5=16 OR WDCCTYR5=17 OR WDCCTYR5=18 OR WDCCTYR5=19 OR WDCCTYR5=20 OR WDCCTYR5=21 OR WDCCTYR5=22), 1,0)



CALC_E_CITY.



E_CITY

Eligible city resident

E_CITY = if ((ATLELR6=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 SJNELR6=1 or SEAELR5=1 or WDCELR5=1),1,0)



Check_ES7spec.

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 ES7spec.

Else, go to INTRO_ES8.





ES7spec.

INTERVIEWER: Specify other county (If Boston, Specify other city or town):

SPECCNTY

Specify other county


__ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __



{text response; max length = 100 characters}

Interviewer assessment

ES8a.

INTERVIEWER: Is this person alert and capable of completing the survey in English or Spanish?

E_CAP

Eligibility: able to complete




No

0




Yes

1






Check_ES8b.

If R is not able to complete the survey (ES8a EQ 0), go to ES8b.

Else, go to ES8c.



ES8b.

INTERVIEWER: Specify reason person not able to complete the interview: [CHECK ALL THAT APPLY.]

E_CAPA

Eligibility: Reason not able to complete



E_CAPAA

Not able to understand or consent




E_CAPAB

Cannot speak and understand English or Spanish





ES8c.

INTERVIEWER: Did your field supervisor tell you that this person cannot complete the survey for some other reason?

E_FS

Eligibility: field supervisor reason




No

0




Yes

1




Check_ES8d.

If field supervisor stated that R is not able to complete the survey for some other reason (ES8c EQ 1), go to ES8d.

Else, go to INTRO_CALC_EL_TRANS.



ES8d.

INTERVIEWER: Specify other reason person not able to complete the interview: [CHECK ALL THAT APPLY.]

E_FSA

Eligibility: cannot complete



E_FSAA

Known previous participant




E_FSAB

Reported age not plausible (<18 years old)







INTRO_CALC_EL_TRANS.

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.”





Cycle Eligibility Calculation

CALC_EL_TRANS.



EL_TRANS

Eligible: TRANS cycle

EL_TRANS = IF((DOB^=.DK AND DOB^=.REF AND AGE>17 AND E_PART=0 AND E_CITY=1 AND E_CAP=1 AND E_FS=0 AND ((SXBRTH=1 AND GENDA=1) OR (SXBRTH=1 AND GENDB=1) OR (SXBRTH=1 AND GENDC=1) OR (SXBRTH=3 AND GENDB=1) OR (SXBRTH=3 AND GENDC=1) OR (SXBRTH=1 AND GENDG=1) OR (SXBRTH=1 AND GENDH=1), 1, 0)



CALC_ENDSCR.



ENDSCR

Time eligibility screener ended

ENDSCR = Current time



END_ES.

If R NOT eligible for cycle (EL_TRANS EQ 0), go to END Section (END).

If R eligible for cycle (EL_TRANS EQ 1)
DISPLAY: "READ: Congratulations! The computer has selected you to participate in the health survey. Let me tell you about it. [
INTERVIEWER: Proceed with the consent process.]" Then, go to Consent Section (CN).



File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorDoyle, Katherine (CDC/OID/NCHHSTP)
File Modified0000-00-00
File Created2023-08-18

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