Form Approved
OMB No: 0920-1262
OMB Exp. Date: XX/XX/XXXX
National HIV Behavioral Surveillance System among Transgender Women (NHBS-Trans)
Attachment #6a (Spanish)
Eligibility Screener (Spanish)
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
Variables from prior section(s) used in this section of the questionnaire |
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Section |
Question # |
Variable name |
Variable label |
Preloaded variables |
-- |
IDATE |
Interview date |
Interviewer Entered Information |
IE2 |
CITY |
City |
Universe_ES. |
All Rs. |
INTRO_ES. |
DISPLAY: "DIGA: Quisiera agradecerle nuevamente su interés en esta encuesta de salud. Recuerde que toda la información que usted me proporcione se mantendrá confidencial y que no le preguntaré cuál es su nombre. Primero, le haré algunas preguntas sobre usted y luego la computadora determinará si se le seleccionó para participar en la encuesta de salud. |
CALC_BEGSCR. |
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|
BEGSCR |
Time at beginning of screener |
BEGSCR = Current time |
ES1. |
¿Cuál es su fecha de nacimiento? |
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DOB |
Date of birth |
|
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|
|
__ __ /__ __ / __ __ __ __ (MM/DD/YYYY) |
|
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|
Range (Año) |
1900-2100 |
|
|
|
No Sabe (Año) |
9999 |
|
|
|
Rehusó Contestar (Año) |
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: "ENTREVISTANTE: La fecha de nacimiento no puede ser HOY o después de hoy." 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. |
Entonces, usted tiene [fill with calculated age (AGE)] años. ¿Correcto? |
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C_AGE |
Confirm AGE |
|
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|
|
No |
0 |
|
|
|
Sí |
1 |
|
HardEdit_ES1a. |
If calculated AGE NOT correct (ES1a EQ 0), DISPLAY: "ENTREVISTANTE: Por favor oprima 'ok', para ingresar de nuevo la fecha de nacimiento." 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. |
En los últimos 12 meses, es decir, desde [fill with interview month, formatted as text] del año pasado, ¿completó por lo menos parte de la encuesta de salud que (Nombre del Proyecto) está llevando a cabo? Pudo haber sido aquí o en otro lugar. |
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E_PART |
Eligibility, previous participant |
|
||
|
|
No |
0 |
|
|
|
Sí |
1 |
|
|
|
No Sabe |
9 |
|
|
|
Rehusó Contestar |
7 |
|
ES2a. |
¿Se considera de origen hispano, latino o español?
[ENTREVISTANTE: Si es necesario, diga “Solo responda Sí o No”.] |
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HISPANIC |
Latino ethnicity |
|
||
|
|
No |
0 |
|
|
|
Sí |
1 |
|
|
|
No Sabe |
9 |
|
|
|
Rehusó Contestar |
7 |
|
Check_ES2a. |
If R is Latino (ES2a EQ 1), go to ES2b. Else, go to ES2c. |
ES2b. |
¿Cuáles de las siguientes categorías describen su origen hispano, latino o español? Puede elegir más de una opción.
[LEA las opciones. MARQUE TODAS las que correspondan]. |
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HSPTYP |
Hispanic Ancestry (number reported) |
|
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|
HSPTYPA |
Mexicano |
|
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HSPTYPB |
Puertorriqueño |
|
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HSPTYSC |
Cubano |
|
|
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HSPTYPD |
Dominicano |
|
|
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HSPTYPE |
Otro origen hispano, latino o español |
|
|
|
|
No Sabe |
9 |
|
|
|
Rehusó Contestar |
7 |
|
Check_ES2b. |
If R reports 'Another' Hispanic origin (HSPTYPE EQ 1), go to ES2b.spec. Else, go to ES2c. |
ES2b.spec. |
¿Cuál es su origen hispano, latino o español? |
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SPECHSP |
Other specified Latino origin |
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|
|
__ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ |
||
|
|
{text response; max length = 100 characters} |
||
|
|
No Sabe |
9 |
|
|
|
Rehusó Contestar |
7 |
|
ES2c. |
[Entregue la Tarjeta de Respuestas A a su Participante.]
¿A cuál grupo o grupos raciales considera usted que pertenece? Puede elegir más de una opción.
[LEA las opciones. MARQUE TODAS las que correspondan]. |
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RACE |
Racial group (number reported) |
|
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RACEA |
Indoamericano o nativo de Alaska |
|
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RACEB |
Asiático |
|
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RACEC |
Negro o afroamericano |
|
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RACED |
Nativo de Hawái o de otra isla del Pacífico |
|
|
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RACEE |
Blanco |
|
|
|
|
No Sabe |
9 |
|
|
|
Rehusó Contestar |
7 |
|
|
|
No Aplica |
8 |
|
INTRO_ES3. |
DISPLAY: "DIGA: Las siguientes preguntas tratan sobre su identidad de género, que es la manera en que usted describe su género, y su sexo registrado al nacer, que es el sexo registrado en su certificado original de nacimiento.” |
ES3. |
[Entregue la Tarjeta de Respuestas B a su Participante.]
¿Cómo describe su identidad de género actual? Puede seleccionar más de una respuesta.
[LEA las opciones. MARQUE TODAS las que correspondan]. |
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|
GENDR2 |
Gender identity |
|
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GENDA |
Mujer |
|
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GENDB |
Mujer transgénero |
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GENDC |
Persona transfemenina |
|
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GENDD |
Hombre |
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GENDE |
Hombre transgénero |
|
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GENDF |
Persona transmasculina |
|
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GENDG |
Persona no binaria |
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|
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GENDH |
Género no listado anteriormente |
|
|
|
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No Sabe |
9 |
|
|
|
Rehusó Contestar |
7 |
|
Check_ES3spec. |
If R is other gender (GENDH EQ 1), go to ES3spec. Else, go to ES4. |
ES3spec. |
ENTREVISTANTE: Especifique sus otras identidades de género.
[Separe con comas en caso de múltiples identidades indicadas.]
|
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SPECGEND |
Specified other gender identity |
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|
|
__ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ |
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|
|
{text response; max length = 100 characters} |
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|
|
No Sabe |
9 |
|
|
|
|
Rehusó Contestar |
7 |
|
ES4. |
¿Con qué sexo se le registró al nacer?
[NO lea las opciones.] |
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SXBRTHR2 |
Sex assigned at birth |
|
||
|
|
Masculino |
1 |
|
|
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Femenino |
2 |
|
|
|
Intersexo/ambiguo |
3 |
|
|
|
No Sabe |
9 |
|
|
|
Rehusó Contestar |
7 |
|
INTRO_ES5. |
DISPLAY: "DIGA: Las siguientes preguntas tratan sobre los idiomas que usted habla.” |
ES5. |
¿Qué tan bien habla inglés?
[LEA las opciones.] |
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ENGPFCY |
English proficiency |
|
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|
|
Muy bien |
1 |
|
|
|
Bien |
2 |
|
|
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No muy bien |
3 |
|
|
|
Para nada |
4 |
|
|
|
No Sabe |
9 |
|
|
|
Rehusó Contestar |
7 |
|
ES6. |
¿Qué tan bien habla español?
[LEA las opciones.] |
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SPNPFCY |
Spanish proficiency |
|
||
|
|
Muy bien |
1 |
|
|
|
Bien |
2 |
|
|
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No muy bien |
3 |
|
|
|
Para nada |
4 |
|
|
|
No Sabe |
9 |
|
|
|
Rehusó Contestar |
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. |
ES7_ATL. |
¿En qué condado vive actualmente?
[NO lea las opciones.] |
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ATLCTYR6 |
Eligibility, Atlanta county of residence |
|
|
|
Barrow County |
1 |
|
|
Bartow County |
2 |
|
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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 |
|
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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 |
|
|
Otra opción |
88 |
|
|
No Sabe |
999 |
|
|
Rehusó Contestar |
777 |
|
Check_ES7_BLT. |
Go to CALC_E_CITY. |
ES7_BLT. |
¿En qué condado vive actualmente?
[NO lea las opciones.] |
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BLTCTYR5 |
Eligibility, Baltimore county of residence |
|
|
|
Baltimore City |
1 |
|
|
Anne Arundel |
2 |
|
|
Baltimore |
3 |
|
|
Carroll |
4 |
|
|
Harford |
5 |
|
|
Howard |
6 |
|
|
Queen Anne's |
7 |
|
|
Otra opción |
88 |
|
|
No Sabe |
999 |
|
|
Rehusó Contestar |
777 |
|
CALC_BLTELR5. |
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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. |
¿En qué condado/ciudad/pueblo vive actualmente?
[NO lea las opciones.] |
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BOSCTYR5 |
Eligibility, Boston city or town of residence |
|
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|
|
Allston |
1 |
|
|
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Back Bay |
2 |
|
|
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Brookline |
7 |
|
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Cambridge |
8 |
|
|
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Chelsea |
10 |
|
|
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Dorchester |
12 |
|
|
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East Boston |
14 |
|
|
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Fenway / Kenmore |
15 |
|
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Jamaica Plain |
17 |
|
|
|
Lynn |
18 |
|
|
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Malden |
20 |
|
|
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Medford |
21 |
|
|
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Revere |
26 |
|
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|
Roxbury |
28 |
|
|
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Somerville |
29 |
|
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South Boston |
30 |
|
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South End |
31 |
|
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Boston (other) |
37 |
|
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Essex County (other) |
38 |
|
|
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Middlesex County (other) |
39 |
|
|
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Norfolk County (other) |
40 |
|
|
|
Plymouth County (other) |
41 |
|
|
|
Suffolk County (other) |
42 |
|
|
|
Otra opción |
88 |
|
|
|
No Sabe |
999 |
|
|
|
Rehusó Contestar |
777 |
|
CALC_BSTELR5. |
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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. |
¿En qué condado vive actualmente?
[NO lea las opciones.] |
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CHICTYR5 |
Eligibility, Chicago county of residence |
|
|
|
Cook County |
1 |
|
|
DuPage County |
3 |
|
|
Grundy County |
4 |
|
|
Kendall County |
6 |
|
|
McHenry County |
7 |
|
|
Will County |
8 |
|
|
Otra opción |
88 |
|
|
No Sabe |
999 |
|
|
Rehusó Contestar |
777 |
|
CALC_CHIELR5. |
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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. |
¿En qué condado vive actualmente?
[NO lea las opciones.] |
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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 |
|
|
Otra opción |
88 |
|
|
No Sabe |
999 |
|
|
Rehusó Contestar |
777 |
|
CALC_DALELR5. |
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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. |
¿En qué condado vive actualmente?
[NO lea las opciones.] |
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DENCTYR5 |
Eligibility, Denver county of residence |
|
|
|
Adams County |
1 |
|
|
Arapahoe County |
2 |
|
|
Broomfield County |
3 |
|
|
Clear Creek County |
4 |
|
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Denver County |
5 |
|
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Douglas County |
6 |
|
|
Elbert County |
7 |
|
|
Gilpin County |
8 |
|
|
Jefferson County |
9 |
|
|
Park County |
10 |
|
|
Otra opción |
88 |
|
|
No Sabe |
999 |
|
|
Rehusó Contestar |
777 |
|
CALC_DENELR5. |
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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. |
¿En qué condado vive actualmente?
[NO lea las opciones.] |
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DETCTYR5 |
Eligibility, Detroit county of residence |
|
|
|
Macomb County |
0 |
|
|
Oakland County |
1 |
|
|
Wayne County |
2 |
|
|
Otra opción |
88 |
|
|
No Sabe |
999 |
|
|
Rehusó Contestar |
777 |
|
CALC_DETELR5. |
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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. |
¿En qué condado vive actualmente?
[NO lea las opciones.] |
||
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 |
|
|
Otra opción |
88 |
|
|
No Sabe |
999 |
|
|
Rehusó Contestar |
777 |
|
CALC_HOUELR5. |
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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. |
¿En qué condado vive actualmente?
[NO lea las opciones.] |
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LAXCTYR5 |
Eligibility, Los Angeles county of residence |
|
||
|
|
Los Angeles County |
1 |
|
|
|
Otra opción |
88 |
|
|
|
No Sabe |
999 |
|
|
|
Rehusó Contestar |
777 |
|
CALC_LAXELR5. |
|
|
LAXELR5 |
Eligible county resident: LAX |
LAXELR5 = if ((LAXCTYR5=1), 1,0) |
Check_ES7_MIA. |
Go to CALC_E_CITY. |
ES7_MIA. |
¿En qué condado vive actualmente?
[NO lea las opciones.] |
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MIACTYR5 |
Eligibility, Miami county of residence |
|
||
|
|
Miami-Dade County |
1 |
|
|
|
Otra opción |
88 |
|
|
|
No Sabe |
999 |
|
|
|
Rehusó Contestar |
777 |
|
CALC_MIAELR5. |
|
|
MIAELR5 |
Eligible county resident: MIA |
MIAELR5 = if ((MIACTYR5=1), 1,0) |
Check_ES7_MEM. |
Go to CALC_E_CITY. |
ES7_MEM. |
¿En qué condado vive actualmente?
[NO lea las opciones.] |
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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 |
|
|
|
Otra opción |
88 |
|
|
|
No Sabe |
999 |
|
|
|
Rehusó Contestar |
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. |
¿En qué condado vive actualmente?
[NO lea las opciones.] |
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NAUCTYR5 |
Eligibility, Nassau county of residence |
|
|
|
Nassau County |
1 |
|
|
Suffolk County |
2 |
|
|
Otra opción |
88 |
|
|
No Sabe |
999 |
|
|
Rehusó Contestar |
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. |
¿En qué condado vive actualmente?
[NO lea las opciones.] |
|||
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 |
|
|
|
Otra opción |
88 |
|
|
|
No Sabe |
999 |
|
|
|
Rehusó Contestar |
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. |
¿En qué "parish" vive actualmente?
[NO lea las opciones.] |
||
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 |
|
|
Otra opción |
88 |
|
|
No Sabe |
999 |
|
|
Rehusó Contestar |
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. |
¿En qué condado vive actualmente?
[NO lea las opciones.] |
||
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 |
|
|
Otra opción |
88 |
|
|
No Sabe |
999 |
|
|
Rehusó Contestar |
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. |
¿En qué condado vive actualmente?
[NO lea las opciones.] |
||
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 |
|
|
Otra opción |
88 |
|
|
No Sabe |
999 |
|
|
Rehusó Contestar |
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. |
¿En qué condado vive actualmente?
[NO lea las opciones.] |
||
PHLCTYR5 |
Eligibility, Philadelphia county of residence |
||
|
Delaware County |
3 |
|
|
Philadelphia County |
5 |
|
|
Otra opción |
88 |
|
|
No Sabe |
999 |
|
|
Rehusó Contestar |
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. |
¿En qué condado vive actualmente?
[NO lea las opciones.] |
||
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 |
|
|
Otra opción |
88 |
|
|
No Sabe |
999 |
|
|
Rehusó Contestar |
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. |
¿En qué condado vive actualmente?
[NO lea las opciones.] |
||
SDGCTYR5 |
Eligibility, San Diego county of residence |
|
|
|
San Diego County |
1 |
|
|
Otra opción |
88 |
|
|
No Sabe |
999 |
|
|
Rehusó Contestar |
777 |
|
CALC_SDGELR5. |
|
|
SDGEL |
Eligible county resident: SDG |
SDGELR5 = if ((SDGCTYR5=1), 1,0) |
Check_ES7_SFO. |
Go to CALC_E_CITY. |
ES7_SFO. |
¿En qué condado vive actualmente?
[NO lea las opciones.] |
||
SFOCTYR5 |
Eligibility, San Francisco county of residence |
||
|
San Francisco County |
2 |
|
|
San Mateo County |
3 |
|
|
Otra opción |
88 |
|
|
No Sabe |
999 |
|
|
Rehusó Contestar |
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. |
¿En qué municipio (condado) vive actualmente?
[NO lea las opciones.] |
||
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 |
|
|
Otra opción |
88 |
|
|
No Sabe |
999 |
|
|
Rehusó Contestar |
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. |
¿En qué condado vive actualmente?
[NO lea las opciones.] |
|||
SEACTYR5 |
Eligibility, Seattle county of residence |
|||
|
|
King County |
1 |
|
|
|
Snohomish County |
2 |
|
|
|
Otra opción |
88 |
|
|
|
No Sabe |
999 |
|
|
|
Rehusó Contestar |
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. |
¿En qué condado vive actualmente?
[NO lea las opciones.] |
|||
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 |
|
|
|
Otra opción |
88 |
|
|
|
No Sabe |
999 |
|
|
|
Rehusó Contestar |
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. |
ENTREVISTANTE: Especifique otro condado (Si Boston, especifique otra ciudad o pueblo): |
||
SPECCNTY |
Specify other county |
||
|
__ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ |
||
|
|
{text response; max length = 100 characters} |
ES8a. |
ENTREVISTANTE: ¿Está esta persona alerta y puede completar la encuesta en inglés o español? |
|||
E_CAP |
Eligibility: able to complete |
|
||
|
|
No |
0 |
|
|
|
Sí |
1 |
|
Check_ES8b. |
If R is not able to complete the survey (ES8a EQ 0), go to ES8b. Else, go to ES8c. |
ES8b. |
ENTREVISTANTE: Especifique la razón por la que la persona no puede completar la entrevista: [MARQUE TODAS las que correspondan.] |
|||
E_CAPA |
Eligibility: Reason not able to complete |
|
||
|
E_CAPAA |
No puede entender ni dar su consentimiento |
|
|
|
E_CAPAB |
No puede hablar ni entender inglés o español |
|
|
ES8c. |
ENTREVISTANTE: ¿Le dijo su supervisor de campo que esta persona no puede completar la encuesta por alguna otra razón? |
|||
E_FS |
Eligibility: field supervisor reason |
|
||
|
|
No |
0 |
|
|
|
Sí |
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. |
ENTREVISTANTE: Especifique otra razón por la que la persona no puede completar la entrevista: [MARQUE TODAS las que correspondan.] |
|||
E_FSA |
Eligibility: cannot complete |
|
||
|
E_FSAA |
Se sabe que es una participante anterior |
|
|
|
E_FSAB |
La edad reportada no es posible ( <18 años ) |
|
|
INTRO_CALC_EL_TRANS. |
DISPLAY: “DIGA: Hemos terminado la primera serie de preguntas. Ahora la computadora determinará si se le seleccionó para participar en la encuesta.” |
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) |
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
Author | Doyle, Katherine (CDC/OID/NCHHSTP) |
File Modified | 0000-00-00 |
File Created | 2023-08-27 |