Changes to Screener Survey

Attachment C-1. Changes to Waves A-I Screener Survey (004).docx

Extended Evaluation of the National Tobacco Prevention and Control Public Education Campaign

Changes to Screener Survey

OMB: 0920-1083

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Attachment C-1. Changes to Waves A-I Screener Survey

Item

Currently Approved Question Text

Currently Approved Responses

Revision Type

Revised Question Text

Revised Responses

ABS_S3b.

Are you…?

1.Male

2.Female

Revision based on HHS Best Practices for Demographic Questions: Race/Ethnicity (R/E) and Sexual Orientation/Gender Identity (SO/GI), 5/20/21

ABS_GEND: What sex were you assigned at birth, on your original birth certificate?

1. Male

2. Female

3. Refused

4. Don’t know

ABS_NQRACE1.

This is about Hispanic ethnicity. Are you of Spanish, Hispanic, or Latino descent?

1. No, I am not

2. Yes, Mexican, Mexican American, Chicano

3. Yes, Puerto Rican

4. Yes, Cuban

5. Yes, Central American

6. Yes, South American

7. Yes, Caribbean

8. Yes, Other Spanish/Hispanic/Latino

Revision based on HHS Best Practices for Demographic Questions: Race/Ethnicity (R/E) and Sexual Orientation/Gender Identity (SO/GI), 5/20/21

ABS_NQRACE2_FRESH [M]

What is your race?

American Indian or Alaska Native – Type in name of enrolled or principal tribe


Asian

Indian

Chinese

Filipino

Japanese

Korean

Vietnamese

Other Asian – Type in race


Black or African American


Native Hawaiian or Other Pacific Islander

Guamanian or Chamorro

Samoan

Other Pacific Islander – Type in race


White


ALL_G1619

Would you say that you can…? [GRID]


Carry on a conversation in Spanish, both understanding and speaking


Read a newspaper or book in Spanish


Carry on a conversation in English, both understanding and speaking


Read a newspaper or book in English


Very well

Pretty well

Just a little

Not at all

Deletion: replaced with language questions that are more clear and relevant (listed in next 3 rows)



QACSLAN1



Addition to note other languages spoken by participants

Do you speak a language other than English at home?

1. Yes

2. No

QACSLAN2



Addition to note other languages spoken by participants

What language do you speak at home other than English?

1. Spanish

2. Chinese (any dialect)

3. Tagalog

4. Vietnamese

5. French

6. German

7. Another language

QACSLAN3



Addition to assess English language comprehension

How well do you speak English?

1. Very well

2. Well

3. Not well

4. Not at all



File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorBreithaupt, Laura (CDC/DDNID/NCCDPHP/OSH)
File Modified0000-00-00
File Created2022-10-03

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