P-0015A COVID-19 Facility-Level Supplement

2024 MCBS Community Questionnaire

Variable Name

MR Screen Name

Question Type

CVQ-COVID-19

Question Text/Description

Code List

Routing

(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED

(01) BOX CV1
(02) BOX CV1
(-8) BOX CV2
(-9) BOX CV2

(01) 1 VACCINATION
(02) 2 VACCINATIONS
(03) 3 VACCINATIONS
(04) 4 OR MORE VACCINATIONS
(-8) DON'T KNOW
(-9) REFUSED

PREVYRDS

(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED

(01) EVRHDCVD
(02) NOVCREAS
(-8) EVRHDCVD
(-9) EVRHDCVD

COVID-19 QUESTIONNAIRE SPECIFICATIONS
CRITERIA
INTTYPE=ALL
SPALIVE=1
SEASON=ALL WINTER
SPPROXY=SP or PROXY
Other: N/A
PLACEMENT
Administer after PVQ

VACCDOSE

BOX CVBEG

routing

IF INTYPE is C007 [sample_person.INTTYPE=7] OR SP HAS NEVER REPORTED A DOSE OF COVID-19
VACCINE [DOSENUM = 0 OR P_VACCDOSE=2/NO ] GO TO VACCDOSE,
ELSE GO TO BOX CV1.

VACCDOSE

yes/no

The next questions are about coronavirus or COVID-19 vaccination. Have you had at least one dose of a
COVID-19 vaccination?

BOX CV1

routing

IF SP DID NOT REPORT ANY DOSES OF VACCINE [VACCDOSE=2/NO] GO TO NO NOVCREAS,
ELSE IF SP HAS PREVIOUSLY REPORTED FOUR OR MORE DOSES OF COVID-19 VACCINE
[DOSENUMB=4 OR MORE VACCINATIONS] GO TO PREVYRDS,
ELSE GO TO DOSENUMB.

How many COVID-19 vaccinations have you received in total?
DOSENUMB

DOSENUMB

code one

IF NEEDED: Please include booster shots and any additional doses.
IF NEEDED: This question is asking for the total number of COVID-19 vaccine doses that [you have/(SP) has]
received since the vaccine first became available in December 2020.

PREVYRDS

PREVYRDS

yes/no

In [PREVIOUS YEAR], did you receive at least one dose of the COVID-19 vaccine?

Page 1 of 9

2024 MCBS Community Questionnaire

Variable Name

MR Screen Name

CVQ-COVID-19

Question Type

Question Text/Description

Code List

Routing

NOVCREAS

NOVCREAS

code all

(01) NOT YET ELIGIBLE TO RECIEVE COVID-19
BOOSTER DOSE
(02) PLANS TO GET A BOOSTER AND IS ELIGIBLE,
BUT HASN'T YET
(03) THINKS THEY HAVE ENOUGH IMMUNITY TO
COVID-19 FROM PRIOR DOSES OF THE VACCINE
(04) NOT WORRIED ABOUT GETTING COVID-19
(05) DOCTOR HAS NOT RECOMMENDED IT
(06) ALREADY HAD COVID-19
(07) NOT REQUIRED TO GET A COVID-19 BOOSTER
(BY WORK OR SCHOOL)
(08) EXPERIENCED SIDE EFFECTS FROM
PREVIOUS DOSE(S) OF THE COVID-19 VACCINE
(01) CONCERNED ABOUT POSSIBLE SIDE EFFECTS
OF A COVID-19 VACCINE
(02) CONCERNED ABOUT HAVING AN ALLERGIC
REACTION
(03) DOESN'T KNOW IF A COVID-19 VACCINE WILL
PROTECT THEM
(04) DOESN’T BELIEVE THEY NEED A COVID-19
Why did you not get a COVID-19 vaccine in [PREVIOUS YEAR]? For what reason didn’t [you/(SP)] get a COVIDVACCINE
19 vaccine [since (REFERENCE DATE)])?
(05) ALREADY HAD COVID-19
(06) DOES NOT SPEND TIME WITH ANY HIGH-RISK
[PROBE: Any other reason?]
(01)-(8 20); (-8), (-9) BOX CV2 BOX
PEOPLE
(07) PLANS TO USE MASKS OR OTHER
CVEND
DO NOT READ ALOUD. CODE BASED ON WHAT THE RESPONDENT SAYS.
PRECAUTIONS INSTEAD
(91) NOVACOS
(08) DOESN'T THINK VACCINES ARE BENEFICIAL
CHECK ALL THAT APPLY.
(09) THINKS IMMUNE SYSTEM IS STRONG ENOUGH
(10) DOCTOR HAS NOT RECOMMENDED IT
IF R IS NOT ELIGIBLE FOR THEIR NEXT DOSE, SELECT "NOT ELIGIBLE FOR NEXT DOSE YET."
(11) PLANS TO WAIT AND SEE IF IT IS SAFE AND
MAY GET IT LATER
(12) CONCERNED ABOUT THE COST OF A COVID19 VACCINE
(13) DOESN'T TRUST COVID-19 VACCINES
(14) DOESN’T THINK COVID-19 IS THAT BIG OF A
THREAT
(15) HARD TO GET A COVID-19 VACCINE
(16) FAMILY AND FRIENDS ARE CHOOSING NOT TO
GET A COVID-19 VACCINE
(17) AFRAID OF NEEDLES
(18) CAN’T GET THE BRAND OF VACCINE THAT
THEY PREFER
(19) APPOINTMENT SCHEDULED
(20) HAS A HEALTH OR MEDICAL CONDITION
WHICH PREVENTS GETTING THE VACCINE
(21) NOT ELIGIBLE FOR NEXT DOSE YET
(91) OTHER
(-8) DON’T KNOW
(-9) REFUSED

NOVACOS

NOVACOS

verbatim

OTHER (SPECIFY)

BOX CVA

routing

IF SP IS IN THE BASELINE SAMPLE [sample_person.INTTYPE=3], GO TO EVRSUS,
ELSE GO TO COVSUS.

EVRSUS

yes/no

[Have you/Has (SP)] ever suspected that [you have/he has/she has] had the coronavirus or COVID-19?

EVRSUS

(01) CONTINUOUS ANSWER

BOX CV2 BOX CVEND

(01) YES
(02) NO
(-8) DON'T KNOW
(-7) REFUSED

(01) SUSPECTY
(02) BOX CVB
(-8) BOX CVB
(-7) BOX CVB

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2024 MCBS Community Questionnaire

CVQ-COVID-19

Variable Name

MR Screen Name

Question Type

Question Text/Description

COVSUS

COVSUS

yes/no

(01) YES
Since [REFERENCE DATE], [have you/has (SP)] suspected that [you have/he has/she has] had the coronavirus (02) NO
or COVID-19?
(-8) DON'T KNOW
(-7) REFUSED

What symptoms did [you/(SP)] have that made [you/(SP)] suspect [you/he/she] had the coronavirus?
SUSPECTY

SUSPECTY

code all
INTERVIEWER CODE BASED ON VERBATIM RESPONSE FROM RESPONDENT.

BOX CV2
BOX CVB

routing

Code List

Routing

(01) SUSPECTY
(02) BOX CVB
(-8) BOX CVB
(-7) BOX CVB

(01) FEVER
(02) ONGOING DRY COUGH
(03) RUNNY NOSE
(04) SNEEZING
(05) SHORTNESS OF BREATH
(06) HEADACHE
(07) SORE THROAT
(08) NAUSEA
(09) VOMITING
(10) EXTREME FATIGUE
(11) CHILLS/REPEATED SHAKING WITH CHILLS
(12) MUSCLE PAIN
(13) NEW LOSS OF TASTE OR SMELL
(14) LOSS OF APPETITE
(15) DIARRHEA
(91) OTHER
(-8) DON'T KNOW
(-7) REFUSED

BOX CVB

(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED

TSTCVDYR

(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED

(01) TESTTYPE
(02) BOX CV3
(-8) BOX CV3
(-9) BOX CV3

IF INTTYPE is C007 [sample_person.INTTYPE=7]IF SP IS IN THE BASELINE SAMPLE
[sample_person.INTTYPE=3], GO TO EVRHDCVD EVRCVTLD,
ELSE GO TO TSTCVDYR COVTOLD.

[Have you/Has (SP)] ever tested positive for COVID-19 or been told by a doctor or other health care provider
that [you have/(SP) has] or had COVID-19?

EVRHDCVD

EVRHDCVD

yes/no

[IF NEEDED: Some COVID-19 tests are done by swabbing the nose or mouth to test for COVID-19 infection at
the time of the test. Other tests look for COVID-19 antibodies by looking at someone’s blood to see if they have
ever been infected with COVID-19. COVID-19 tests can be done at home by yourself or by someone else, and
some tests are done by a health professional.]
INCLUDE ANTIBODY TESTS, WHICH TEST WHETHER SOMEONE HAS EVER BEEN INFECTED WITH
COVID-19.

In [PREVIOUS YEAR], [were you/was (SP)] tested at least one time to see whether [you were/(SP) was] infected
with COVID-19?
TSTCVDYR

TSTCVDYR

yes/no

[IF NEEDED: For example, the test can be done by swabbing the nose or mouth. Some tests can be done by
yourself or by someone else at home, and some tests are done by a health professional.]
INCLUDE ANTIBODY TESTS, WHICH TEST WHETHER SOMEONE HAS EVER BEEN INFECTED WITH
COVID-19.

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2024 MCBS Community Questionnaire

Variable Name

MR Screen Name

Question Type

EVRCVTLD

EVRCVTLD

yes/no

CVQ-COVID-19

Question Text/Description

Code List

Has a doctor or other health professional ever told [you/(SP)] that [you have/he has/she has] or likely had
coronavirus or COVID-19?

(01) YES
(02) NO
(-8) DON'T KNOW
(-7) REFUSED

[IF NEEDED: A doctor or other health professional might make this diagnosis based on a test for COVID-19 or
based on symptoms [you have/(SP)] has].

COVTOLD

TESTTYPE

Routing

BOX CVC

yes/no

Since [REFERENCE DATE], has a doctor or other health professional told [you/(SP)] that [you have/he has/she (01) YES
has] or likely had coronavirus or COVID-19?
(02) NO
(-8) DON'T KNOW
[IF NEEDED: A doctor or other health professional might make this diagnosis based on a test for COVID-19 or (-7) REFUSED
based on symptoms [you have/(SP)] has].

BOX CVC

TESTTYPE

code all

(01) NASAL OR THROAT SWAB OR SALIVA TEST
THAT WAS COLLECTED OR READ BY A HEALTH
CARE PROFESSIONAL
What kind of test(s) did [you/(SP)] take? A nasal or throat swab or saliva test that was collected or read by a
(02) AT-HOME TEST THAT WAS READ BY
health care professional, an at-home test that was read by yourself or a non-health care professional, or a blood
YOURSELF OR A NON-HEALTH CARE
test to look for COVID-19 antibodies?
PROFESSIONAL
(03) BLOOD TEST TO LOOK FOR COVID-19
SELECT ALL THAT APPLY
ANTIBODIES
(-8) DON'T KNOW
(-9) REFUSED

COVRSLT

BOX CVC

routing

IF SP IS IN THE BASELINE SAMPLE [sample_person.INTTYPE=3], GO TO EVRCVTST,
ELSE GO TO COVTEST.

COVTOLD

[Have you/has(SP)] ever been tested to see whether [you were/he was/she was] infected with coronavirus or
COVID-19 at the time of the test?

EVRCVTST

EVRCVTST

yes/no

[IF NEEDED: For example, the test can be done by swabbing [your/his/her] nose or mouth. Some tests can be
done by yourself or by someone else at home, and some tests are done by a health professional.]

(01) YES
(02) NO
(-8) DON'T KNOW
(-7) REFUSED

(01) COVRSLT
(02) BOX CV1A
(-8) BOX CV1A
(-7) BOX CV1A

(01) YES
(02) NO
(-8) DON'T KNOW
(-7) REFUSED

(01) COVRSLT
(02) BOX CV1A
(-8) BOX CV1A
(-7) BOX CV1A

DO NOT INCLUDE ANTIBODY TESTS, WHICH TEST WHETHER SOMEONE HAS EVER BEEN INFECTED
WITH CORONAVIRUS.

Since [REFERENCE PERIOD], [have you/has(SP)] been tested to see whether [you were/he was/she was]
infected with coronavirus or COVID-19 at the time of the test?
COVTEST

COVTEST

yes/no

[IF NEEDED: For example, the test can be done by swabbing [your/his/her] nose or mouth. Some tests can be
done by yourself or by someone else at home, and some tests are done by a health professional.]
DO NOT INCLUDE ANTIBODY TESTS, WHICH TEST WHETHER SOMEONE HAS EVER BEEN INFECTED
WITH CORONAVIRUS.

Page 4 of 9

2024 MCBS Community Questionnaire

Variable Name

MR Screen Name

Question Type

CVQ-COVID-19

Question Text/Description

Code List

Routing

Did the test(s) find that [you/(SP)] had coronavirus or COVID-19?

COVRSLT

SWABWAIT

COVRSLT

SWABWAIT

code one

code one

(01) YES, THE TEST SHOWED R HAD COVID-19
[IF NEEDED: If [you/(SP)] had more than one test in [PREVIOUS YEAR] [since (REFERENCE PERIOD)] to see (02) NO, THE TEST SHOWED R DID NOT HAVE
whether [you were/he was/she (SP) was] infected with coronavirus or COVID-19, answer yes if any of them were COVID-19
positive.]
(03) NO RESULTS YET
(-8) DON’T KNOW
DO NOT INCLUDE ANTIBODY TESTS, WHICH TEST WHETHER SOMEONE HAS EVER BEEN INFECTED
(-9) REFUSED
WITH CORONAVIRUS COVID-19.

How long did it take to get [your/(SP)’s] test results? Did [you/he/she] get the results the same day, the next day,
(01) SAME DAY
within 2-3 days, within 4-6 days, or after 7 days or more?
(02) NEXT DAY
(03) 2-3 DAYS
[IF NEEDED: If [you have/(SP) has] had more than one test to see whether [you were/he was/she was] infected
(04) 4-6 DAYS
with coronavirus or COVID-19 at the time of the test, think about [your/his/her] most recent test.]
(05) 7 DAYS OR MORE
(-8) DON’T KNOW
DO NOT INCLUDE ANTIBODY TESTS, WHICH TEST WHETHER SOMEONE HAS EVER BEEN INFECTED
(-7) REFUSED
WITH CORONAVIRUS.

(01) CVDSVRE SWABWAIT
(02) BOX CV3 SWABWAIT
(03) CVTSTPAY
(-8) BOX CV3 CVTSTPAY
(-9) BOX CV3 CVTSTPAY

CVTSTPAY

How much did [you/(SP)] pay out of pocket for the test: none of the cost, part of the cost, or all of the cost?
[IF NEEDED: Please answer to the best of your knowledge.]
CVTSTPAY

CVDSVRE

CVDSEEK

(01) NONE OF THE COST
(02) PART OF THE COST
[IF NEEDED: If [you have/(SP) has] had more than one test to see whether [you were/he was/she was] infected (03) ALL OF THE COST
with coronavirus or COVID-19 at the time of the test, think about [your/his/her] most recent test.]
(-8) DON'T KNOW
(-7) REFUSED
DO NOT INCLUDE ANTIBODY TESTS, WHICH TEST WHETHER SOMEONE HAS EVER BEEN INFECTED
WITH CORONAVIRUS.

CVTSTPAY

code one

BOX CV1A

routing

IF EVRCVTLD=YES OR COVRSLT=01 THEN GO TO CVDSVRE.
ELSE GO TO VACROST.

code one

When [you/(SP)] had COVID-19 in [PREVIOUS YEAR], Hhow would you describe [your/(SP)’s] coronavirus
COVID-19 symptoms when they were at their worst? Would you say [you/(SP)he/she] had no symptoms, mild
symptoms, moderate symptoms, or severe symptoms?

(01) NO SYMPTOMS
(02) MILD SYMPTOMS
(03) MODERATE SYMPTOMS
(04) SEVERE SYMPTOMS
(-8) DON'T KNOW
(-9) REFUSED

CVDSEEK

In [PREVIOUS YEAR], Ddid [you/(SP)] seek medical care for coronavirus or COVID-19?

(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED

CVDHOSP
(01) CVDHOSP
(02) CVDEXPEN-CV1
(-8) CVDHOSP
(-7) CVDHOSP

CVDSVRE

CVDSEEK

yes/no

BOX CV1A

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2024 MCBS Community Questionnaire

Variable Name

MR Screen Name

Question Type

CVDEXPEN

CV1

grid

CVQ-COVID-19

Question Text/Description
Why did [you/(SP)] not seek medical care?
READ EACH ITEM AND RECORD YES/NO RESPONSE:
Was it too expensive?

Code List

Routing

(01) YES
(02) NO
(-8) DON'T KNOW
(-7) REFUSED

CVDNTAVA-CV1

CVDNTAVA

CV1

grid

Was it not available?

(01) YES
(02) NO
(-8) DON'T KNOW
(-7) REFUSED

CVDSYMNS-CV1

CVDSYMNS

CV1

grid

Were [your/(SP)'s] symptoms not severe enough?

(01) YES
(02) NO
(-8) DON'T KNOW
(-7) REFUSED

CVDOTHER-CV1

CVDOTHER

CV1

grid

Was there some other reason?

(01) YES
(02) NO
(-8) DON'T KNOW
(-7) REFUSED

CVDHOSP

CVDHOSP

CVDHOSP

yes/no

(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED

BOX CV3 LONGCVD

(01) YES
(02) NO
(03) NOT APPLICABLE, RECENTLY DIAGNOSED
WITH COVID-19 (LESS THAN THREE MONTHS)
(-8) DON'T KNOW
(-7) REFUSED

FACEMASK VACROST

(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED

(01) VACDAT-VACDATMM
(02) BOX CV2
(-8) BOX CVEND
(-9) BOX CVEND

In [PREVIOUS YEAR] [were you/was (SP)] [Have you/Has (SP)] been hospitalized overnight for coronavirus
COVID-19?
[IF NEEDED: This could include visiting the emergency room or being admitted to the hospital.]

BOX CV3

routing

If Respondent has ever had COVID-19 [EVRHDCVD=1/YES] OR tested positive for COVID in [PREVIOUS
YEAR] [COVRSLT=1/YES], GO TO LONGCVD.
ELSE, go to FACEMASK.

Did [you/(sp)] have any symptoms lasting 3 months or longer that [you/(sp)] did not have prior to having
coronavirus or COVID-19?
LONGCVD

LONGCVD

yes/no

VACROST

VACROST

roster

[IF NEEDED: Long term symptoms may include tiredness or fatigue, difficulty thinking, concentrating,
forgetfulness or memory problems, sometimes referred to as "brain fog," difficulty breathing or shortness of
breath, joint or muscle pain, fast-beating or pounding heart (also known as heart palpitations), chest pain,
dizziness on standing, depression, anxiety or mood changes.]

[You/(SP) previously reported the following COVID-19 vaccines.]
[Have you/Has (SP)] received any [additional] doses of a COVID-19 vaccine?

Page 6 of 9

2024 MCBS Community Questionnaire

Variable Name

MR Screen Name

Question Type

CVQ-COVID-19

Question Text/Description

Code List

Routing

When did [you/(SP)] receive this dose of the COVID-19 vaccine?

VACDATMM

VACDAT

date

IF NEEDED: [You/(SP)] may have been given a “COVID-19 Vaccination Record Card” with this information on it.
MONTH (VACMON)
It could be helpful to refer to that card if it is available.

VACDAT-VACDATYY

PLEASE ENTER COVID-19 VACCINE DOSES IN THE ORDER THEY WERE RECEIVED, STARTING FROM
THE EARLIEST DOSE RECEIVED TO THE MOST RECENT DOSE RECEIVED.

When did [you/(SP)] receive this dose of the COVID-19 vaccine?

VACDATYY

VACDAT

date

IF NEEDED: [You/(SP)] may have been given a “COVID-19 Vaccination Record Card” with this information on it.
YEAR (VACYR)
It could be helpful to refer to that card if it is available.

VACNME

PLEASE ENTER COVID-19 VACCINE DOSES IN THE ORDER THEY WERE RECEIVED, STARTING FROM
THE EARLIEST DOSE RECEIVED TO THE MOST RECENT DOSE RECEIVED.

Which COVID-19 vaccine did (you/(SP)) get?
(01) PFIZER-BIONTECH/COMIRNATY
(02) MODERNA/SPIKEVAX
(03) JOHNSON & JOHNSON/JANSSEN
(04) NOVAVAX
IF NEEDED: [You/(SP)] may have been given a “COVID-19 Vaccination Record Card” with this information on it. (91) OTHER
It could be helpful to refer to that card if it is available.
(-8) DON'T KNOW
(-9) REFUSED
ONLY USE THE ‘OTHER’ CATEGORY TO ADD VACCINE MANUFACTURERS APPROVED IN AN FI MEMO
IF NEEDED: Examples include Pfizer-BioNTech/Comirnaty, Moderna/Spikevax, and Johnson &
Johnson/Janssen, and Novavax.

(01)-(04), (-8), (-9) VACSITE
(91) VACNMEOS

VACNME

VACNME

code one

VACNMEOS

VACNMEOS

text

OTHER (SPECIFY)

(01)-(12), (-8), (-9) VACMOR
(91) VACSITOS

VACMOR

(01) CONTINUOUS ANSWER

VACSITE

VACSITE

code one

(01) FACILITY ONLY- FACILITY NAME (DO NOT
DISPLAY)
(02) PHARMACY/DRUG STORE
(03) DOCTORS OFFICE OR GROUP PRACTICE
(04) MASS VACCINATION SITE
(05) MANAGED CARE PLAN CENTER/HMO
Where did [you/(SP)] go for this dose of the COVID-19 vaccine?
(06) NEIGHBORHOOD/FAMILY HEALTH
CENTER/MEDICAL CLINIC
A MASS VACCINATION SITE IS A LOCATION THAT WAS SET UP ESPECIALLY TO ADMINISTER COVID-19
(07) COMPANY CLINIC/WORKPLACE
VACCINES, OFTEN ORGANIZED BY A LOCAL, STATE, OR FEDERAL AGENCY. MASS VACCINATION
(08) WALK-IN URGENT CENTER
SITES MAY BE LOCATED AT A SHOPPING CENTER, CONVENTION CENTER, SPORTING FACILITY,
(09) HOSPITAL
CHURCH, LIBRARY, HOSPITAL OR OTHER COMMUNITY LOCATION.
(10) VA FACILITY
(11) HEALTH DEPARTMENT OFFICE
(12) AT HOME
(91) OTHER, SPECIFY
(-8) DON’T KNOW
(-9) REFUSED

VACSITOS

VACSITOS

text

OTHER (SPECIFY)

(01) CONTINUOUS ANSWER

VACSITE

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2024 MCBS Community Questionnaire

Variable Name

VACMOR

PRSUMVAC

MR Screen Name

Question Type

VACMOR

yes/no

BOX CV2

routing

PRSUMVAC

code one

CVQ-COVID-19

Question Text/Description

Code List

[Have you/Has (SP)] had any other COVID-19 vaccine doses?

(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED

PLEASE ENTER COVID-19 VACCINE DOSES IN THE ORDER THEY WERE RECEIVED, STARTING FROM
THE EARLIEST DOSE RECEIVED TO THE MOST RECENT DOSE RECEIVED.

Now that a vaccine to prevent COVID-19 is available to most adults in the United States, will [you/(SP)] get it?
Definitely, probably, probably not, definitely not, or are you not sure?

[PROBE: Any other reason?]
NOVCREAS

code all

(01) VACDAT-VACDATMM
(02) BOX CVEND
(-8) BOX CVEND
(-9) BOX CVEND

IF NO VACCINE DOSES IN THE ROSTER, GO TO PRSUMVAC,
ELSE IF AT LEAST ONE DOSE IN ROSTER AND VACROST=02/NO, GO TO NOVCREAS.
ELSE GO TO BOX CVEND.

For what reason didn’t [you/(SP)] get a COVID-19 vaccine [since (REFERENCE DATE)])?

NOVCREAS

Routing

DO NOT READ ALOUD. CODE BASED ON WHAT THE RESPONDENT SAYS.
CHECK ALL THAT APPLY.
IF R IS NOT ELIGIBLE FOR THEIR NEXT DOSE, SELECT "NOT ELIGIBLE FOR NEXT DOSE YET."

(01) DEFINITELY
(02) PROBABLY
(03) PROBABLY NOT
(04) DEFINITELY NOT
(05) NOT SURE
(-9) REFUSED

NOVCREAS

(01) CONCERNED ABOUT POSSIBLE SIDE EFFECTS
OF A COVID-19 VACCINE
(02) CONCERNED ABOUT HAVING AN ALLERGIC
REACTION
(03) DOESN'T KNOW IF A COVID-19 VACCINE WILL
PROTECT THEM
(04) DOESN’T BELIEVE THEY NEED A COVID-19
VACCINE
(05) ALREADY HAD COVID-19
(06) DOES NOT SPEND TIME WITH ANY HIGH-RISK
PEOPLE
(07) PLANS TO USE MASKS OR OTHER
PRECAUTIONS INSTEAD
(08) DOESN'T THINK VACCINES ARE BENEFICIAL
(09) THINKS IMMUNE SYSTEM IS STRONG ENOUGH
(10) DOCTOR HAS NOT RECOMMENDED IT
(11) PLANS TO WAIT AND SEE IF IT IS SAFE AND
MAY GET IT LATER
(01)-(20); (-8), (-9) BOX CVEND
(12) CONCERNED ABOUT THE COST OF A COVID- (91) NOVACOS
19 VACCINE
(13) DOESN'T TRUST COVID-19 VACCINES
(14) DOESN’T THINK COVID-19 IS THAT BIG OF A
THREAT
(15) HARD TO GET A COVID-19 VACCINE
(16) FAMILY AND FRIENDS ARE CHOOSING NOT TO
GET A COVID-19 VACCINE
(17) AFRAID OF NEEDLES
(18) CAN’T GET THE BRAND OF VACCINE THAT
THEY PREFER
(19) APPOINTMENT SCHEDULED
(20) HAS A HEALTH OR MEDICAL CONDITION
WHICH PREVENTS GETTING THE VACCINE
(21) NOT ELIGIBLE FOR NEXT DOSE YET
(91) OTHER
(-8) DON’T KNOW
(-9) REFUSED

Page 8 of 9

2024 MCBS Community Questionnaire

CVQ-COVID-19

Variable Name

MR Screen Name

Question Type

Question Text/Description

Code List

Routing

NOVACOS

NOVACOS

verbatim

OTHER (SPECIFY)

(01) CONTINUOUS ANSWER

BOX CVEND

code one

(01) NONE OF THE TIME
(02) SOME OF THE TIME
(03) MOST OF THE TIME
In [PREVIOUS YEAR], how often did [you/(SP)] wear a facemask when out in public? Would you say none of the
(04) ALL OF THE TIME
time, some of the time, most of the time, or all of the time?
(05) NOT APPLICABLE- R DOES NOT GET OUT
(-8) DON'T KNOW
(-9) REFUSED

FACEMASK

FACEMASK

Since April 1, 2021, [have you/has (SP)] worn a facemask when out in public in response to the coronavirus or
COVID-19?
PREVMASK

PREVMASK

yes/no

(01) YES
(02) NO
(03) NOT APPLICABLE
IF THE RESPONDENT HAS WORN A FACEMASK IN SOME SETTINGS BUT NOT OTHERS (FOR EXAMPLE, (-8) DON'T KNOW
INSIDE BUT NOT OUTSIDE), SELECT "YES."
(-7) REFUSED

BOX CVEND

routing

IF SEASON=FALL, GO TO HFQ.
ELSE IF SEASON=WINTER, GO TO KNQ.
ELSE IF SEASON=SUMMER AND RESPONDENT=SP, GO TO CPQ.
ELSE IF SEASON=SUMMER AND RESPONDENT=PROXY, GO TO IAQ.

BOX CVEND

BOX CVEND

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