Web-based Screenin Web-based Screening Questions

2025 National Household Survey on
Behavioral Health (NHSBH): Final Web
Screening Specifications for
Programming

Substance Abuse and Mental Health Services Administration
Center for Behavioral Health Statistics and Quality
Rockville, Maryland
Last Revised: July 30, 2024

2025 National Household Survey on Behavioral Health
(NHSBH): Final Web Screening Specifications for
Programming
Acknowledgments
This report was prepared for the Substance Abuse and Mental Health Services Administration
(SAMHSA), U.S. Department of Health and Human Services (HHS), under Contract No.
75S20322C00001 with RTI International. Marlon Daniel served as the government project
officer and as the contracting officer representative.
Public Domain Notice
All material appearing in this report is in the public domain and may be reproduced or copied
without permission from SAMHSA. Citation of the source is appreciated. However, this
publication may not be reproduced or distributed for a fee without the specific, written
authorization of the Office of Communications, SAMHSA, HHS.
Electronic Access
This publication may be downloaded at https://www.samhsa.gov/data/.
Recommended Citation
Center for Behavioral Health Statistics and Quality. (2024). 2025 National Household Survey on
Behavioral Health (NHSBH): Final web screening specifications for programming. Substance
Abuse and Mental Health Services Administration.
Originating Office
Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health
Services Administration, 5600 Fishers Lane, Room 15-E09D, Rockville, MD 20857. For
questions about this report, please email [email protected].
Nondiscrimination Notice/Aviso de no discriminación
SAMHSA complies with applicable federal civil rights laws and does not discriminate on the
basis of race, color, national origin, age, disability, or sex. SAMHSA cumple con las leyes
federales de derechos civiles aplicables y no discrimina por motivos de raza, color, nacionalidad,
edad, discapacidad o sexo.
U.S. Department of Health and Human Services
Substance Abuse and Mental Health Services Administration
Center for Behavioral Health Statistics and Quality
Populations Survey Branch
Last Revised: July 30, 2024

ii

2025 NHSBH HU Web Screening Application Specifications
Document Format:
Each question is represented by a table (see template below).
Table Template:
VARIABLE NAME
Universe Receiving Question

ASK

Question Text
1
0

Yes
No

SPANISH
NEXT

Spanish translation of English question text.
Logic to next items.

TABLET

Comments about how tablet mode may need to differ from web/phone call-in.

POP UP

Explanation and text of any pop ups that respondents might receive on this screen.

1

LANG
ASK

ALL

Would you like to complete this screening in English or Spanish?
English
Spanish
Please click next to continue
SPANISH

¿Le gustaría completar esta encuesta de selección de participantes en inglés o español?
Inglés
Español
Haga clic en Siguiente para continuar

NEXT

IF LANG = SPANISH, SHOW SCREENER IN SPANISH AND PROCEED WITH
ROUTING LOGIC
IF LANG = ENGLISH, SHOW SCREENER IN ENGLISH AND PROCEED WITH
ROUTING LOGIC
IF LANG NE BLANK, GO TO INSTRUCTIONS

TABLET

Tablet version has a Spanish toggle that can be used by the interviewer if necessary.

POP UP

NA

INSTRUCTIONS
ASK

ALL

Welcome to the National Household Survey on Behavioral Health .
Please answer the following questions to determine if anyone in your household will be selected for an
interview. These questions should only take 5 minutes to answer, so please complete them in one
sitting.
To continue, if you are 18 years old or older and a resident of this household, please enter the
participant code from the letter you received:

If you need help, call the 1-800 number listed above.
OMB No: 0930-0110 Expires: XX/XX/XXXX
NOTICE: Public reporting burden (or time) for 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. Send
comments regarding this burden estimate or any other aspect of this collection of information, including
suggestions for reducing this burden to: SAMHSA Reports Clearance Officer Paperwork Reduction Project
(0930-0110) Center for Behavioral Health Statistics and Quality 5600 Fishers Lane, Room 15E57B,
Rockville, MD 20857. 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. The OMB control number
for this project is 0930-0110.

2

SPANISH

Bienvenido(a) a la Encuesta Nacional sobre la Salud y el Consumo de Drogas.
Por favor, responda las siguientes preguntas para determinar si alguien en su hogar será
seleccionado para una entrevista. Estas preguntas solo deben tomar 5 minutos en
responder, por lo que le pedimos que las complete en una sola sesión.
Para continuar, si tiene 18 años de edad o más y vive en este hogar, ingrese el código de
participante que se encuentra en la carta que recibió:

Si necesita ayuda, llame al número 1-800 que se indica arriba.
Número de OMB: 0930-0110 Fecha de vencimiento: XX/XX/XXXX
NOTA: Se calcula que el tiempo aproximado que le tomará a cada participante en dar esta
información será 5 minutos por la entrevista, incluyendo el tiempo para repasar las
instrucciones, buscar las fuentes de información existentes, juntar y mantener los datos
requeridos, así como completar y revisar la recopilación de datos. Envíe sus comentarios
acerca de este cálculo de tiempo o acerca de cualquier otro aspecto relacionado con esta
recolección de datos, incluyendo sugerencias respecto a la reducción del tiempo, a SAMHSA
Reports Clearance Officer, Paperwork Reduction Project (0930-0110); Center for Behavioral
Health Statistics and Quality; 5600 Fishers Lane; Room 15E57B; Rockville, MD 20857.
Ninguna agencia está autorizada a realizar o a patrocinar ninguna recopilación de datos o
información sin presentar un número de control OMB válido, ni está obligada ninguna persona
a participar en una recopilación de datos si no existe dicho número. El número de control OMB
para este proyecto es 0930-0110.

NEXT

IF INSTRUCTIONS = SPANISH, SHOW INSTRUCTIONS IN SPANISH AND PROCEED
WITH ROUTING LOGIC
IF RETURNING AFTER COMPLETED SCREENER: IF INSTRUCTIONS = NEXT, THEN
CAI START
IF RETURNING AFTER INCOMPLETE SCREENER AFTER MORE THAN ONE HOUR:
IF INSTRUCTIONS = NEXT, THEN IDENTIFY SR1

TABLET

Tablet version has a different text introducing the interviewer, RTI, DHHS, and the lead
letter. The web/phone call-in version has an abbreviated introduction to omit unnecessary
information based on the respondent having read the UTC or CA letter to get to the web
screening.

POP UP

NA

IDENTIFY SR1
ASK

ALL
[LINK] FAQ [/LINK] [PHONE ICON] [LINK] 800-848-4079

First, to verify, do you live at:
[FILL ADDRESS]?
1 Yes
2 No

3

[/LINK]

SPANISH

Primero, para verificar, ¿vive usted en:
[FILL ADDRESS]?
1 Sí
2 No

NEXT

IF IDENTIFY SR1 = YES, THEN IDENTIFY SR2
IF IDENTIFY SR1 = NO, THEN THANK YOU

TABLET

Tablet version has IDENTIFY SR1 and 2 as one item. They have been divided into two
items but will remain on the same screen because IDENTIFY SR2 is not optional in the
web/phone call-in screener. Tablet version is phrased to be read by the FI. Web/phone
call-in version text has been edited for self-administration.

POP UP

NA

IDENTIFY SR2
ASK

IF IDENTIFY SR1 = YES
[LINK] FAQ [/LINK] [PHONE ICON] [LINK] 800-848-4079

[/LINK]

Are you 18 or older?
1 Yes
2 No
SPANISH

NEXT

¿Tiene 18 años de edad o más?
1 Sí
2 No
IF IDENTIFY SR2 = YES, THEN SR AGREEMENT
IF IDENTIFY SR2 = NO, THEN NO, THEN THANK YOU

TABLET

Tablet version has IDENTIFY SR1 and SR2 as one item. They have been divided into two
items but will remain on the same screen because IDENTIFY SR2 is not optional in the
web/phone call-in screener.

POP UP

NA

4

SR AGREEMENT
ASK

IF IDENTIFY SR2 = YES
[LINK] FAQ [/LINK] [ [PHONE ICON] [LINK] 800-848-4079

[/LINK]

The following questions will ask for some general information about each person aged 12 or older in
your household. This is to determine if anyone will be selected for the interview. It should only take a
few minutes.
Each person selected for an interview will receive a $30 gift card when that interview is completed.
Also, please understand that federal law keeps your answers confidential, your participation is
voluntary, and you can refuse to answer any question.
If you have questions about the study, call the Project Representative at 1-800-848-4079. If you have
questions about your rights as a study participant, call RTI International’s Office of Research Protection
at 1-866-214-2043 (a toll-free number).
SPANISH

Las siguientes preguntas le pedirán información general sobre cada persona que tenga
12 años de edad o más en su hogar. Esto es para determinar si alguien será
seleccionado para la entrevista. Solo debe tomar unos cuantos minutos.
Cada persona seleccionada para una entrevista recibirá una tarjeta de regalo de $30
dólares cuando se complete esa entrevista.
Además, comprenda que la ley federal mantiene sus respuestas en forma confidencial,
que su participación es voluntaria y que puede negarse a responder cualquier pregunta.
Si tiene preguntas sobre el estudio, puede llamar al representante del proyecto al 1-800848-4079. Si tiene preguntas sobre sus derechos como participante del estudio, sírvase
llamar a la Oficina de RTI International para la Protección de Participantes en Estudios al
1-866-214-2043.

NEXT

IF SR AGREEMENT = NEXT, THEN SR OCCUPANCY

TABLET

Tablet version uses a longer consent script.

POP UP

NA

SR OCCUPANCY
ASK

IF SR AGREEMENT = NEXT
[LINK] FAQ [/LINK] [PHONE ICON] [LINK] 800-848-4079

[/LINK]

(Did/Will) you live at [ADDRESS FILL] for most of the time during the months of (DATA COLLECTION
PERIOD)?
1 Yes
2 No

5

SPANISH

¿(Vivió/Vivirá) usted en [ADDRESS FILL] la mayor parte del tiempo durante los meses
de ((DATA COLLECTION PERIOD)?
1 Sí
2 No

NEXT

IF SR OCCUPANCY = YES, THEN TOTAL SDU MEMBERS
IF SR OCCUPANCY = NO, THEN POP UP

TABLET

Tablet version includes an FI note confirming that OCCUPANCY = NO before closing the
case. Added a pop up to the web/phone call-in mode to be sure respondents aren’t
closing cases incorrectly.

POP UP

ENGLISH:
IF NO: Just to confirm, you answered in the previous question that you (will NOT live/have
NOT lived) at [ADDRESS FILL] for most of the time during the months of (DATA
COLLECTION PERIOD)? Is this correct?
SPANISH:
IF NO: Solo para confirmar, usted respondió en la pregunta anterior que (NO vivirá/NO ha
vivido) en [ADDRESS FILL] la mayor parte del tiempo durante los meses de ((DATA
COLLECTION PERIOD)? ¿Es esto correcto?
1 Yes Sí
2 No No
(IF YES, GO TO OCCUPANCY. IF NO, SR OCCUPANCY.)

OCCUPANCY
ASK

IF SR OCCUPANCY POP UP = YES
[LINK] FAQ [/LINK] [PHONE ICON] [LINK] 800-848-4079

[/LINK]

Is there anyone else in your household who (lived/will live) at [ADDRESS FILL] for most of the time
during (DATA COLLECTION PERIOD)?
Do not include anyone who (lived/will live) at school or somewhere else for most of the time during
(DATA COLLECTION PERIOD).
1 Yes
2 No

6

SPANISH

¿Hay alguna otra persona en su hogar que (vivió/vivirá) en [ADDRESS FILL] la mayor
parte del tiempo (DATA COLLECTION PERIOD)?
No incluya a nadie que (vivió/vivirá) en la escuela o en otro lugar la mayor parte del
tiempo durante (DATA COLLECTION PERIOD).
1 Sí
2 No

NEXT

IF OCCUPANCY = YES, THEN TOTAL SDU MEMBERS
IF OCCUPANCY = NO, THEN POP UP

TABLET

Tablet version includes an FI note confirming that OCCUPANCY = NO before closing the
case. Added a pop up to the web/phone call-in mode to be sure respondents aren’t
closing cases incorrectly.

POP UP

ENGLISH:
IF OCCUPANCY = NO AND TOTAL SDU MEMBERS = 0: Just to confirm, you answered
in the previous question that, including yourself, no one in your household lived at
[ADDRESS FILL] for most of the time during (DATA COLLECTION PERIOD). Is this
correct?
SPANISH:
IF OCCUPANCY = NO AND TOTAL SDU MEMBERS = 0: Sírvase confirmar,
incluyéndose usted, nadie en su hogar (vivió/vivirá) en [ADDRESS FILL] la mayor parte
del tiempo durante (DATA COLLECTION PERIOD)?
1 Yes Sí
2 No No
(IF YES, GO TO THANK YOU. IF NO, TOTAL SDU MEMBERS)

TOTAL SDU MEMBERS
ASK

IF SR OCCUPANCY = YES OR SR OCCUPANCY POP UP = YES OR OCCUPANCY =
YES
[LINK] FAQ [/LINK] [PHONE ICON] [LINK] 800-848-4079

[/LINK]

[IF SR OCCUPANCY = YES] Including yourself, how many people (lived/will live) at [ADDRESS
FILL] for most of the time during (DATA COLLECTION PERIOD)?
[IF OCCUPANCY = YES] How many people in your household (lived/will live) at [ADDRESS FILL] for
most of the time during (DATA COLLECTION PERIOD)?
Do not include anyone who (lived/will live) at school or somewhere else for most of the time during
(DATA COLLECTION PERIOD).
_______ # of people (including/other than) yourself (RANGE 0-20)

7

SPANISH

[IF SR OCCUPANCY = YES] Incluyéndose usted, ¿cuántas personas (vivieron/vivirán)
en [ADDRESS FILL] la mayor parte del tiempo durante (DATA COLLECTION
PERIOD)?
[IF OCCUPANCY = YES] ¿Cuántas personas en su hogar (vivieron/vivirán) en
[ADDRESS FILL] la mayor parte del tiempo durante (DATA COLLECTION PERIOD)?
No incluya a nadie que (vivió/vivirá) en la escuela o en otro lugar la mayor parte del
tiempo durante (DATA COLLECTION PERIOD).
_______ número de personas (incluyéndose / además de) usted (RANGE 0-20)

NEXT

IF TOTAL SDU MEMBERS = 0, THEN POP UP
IF TOTAL SDU MEMBERS = 1, THEN MEMBERS 12 OR OLDER
IF TOTAL SDU MEMBERS > 1, THEN MEMBERS 12 OR OLDER

TABLET

Tablet version has some optional text on this screen. Web/phone call-in version will have
all text included.

POP UP

ENGLISH:
[IF SR OCCUPANCY = YES AND TOTAL SDU MEMBERS = 0] Please confirm, including
yourself, No one in your household (lived/will live) at [ADDRESS FILL] for most of the time
during (DATA COLLECTION PERIOD)?
SPANISH:
[IF SR OCCUPANCY = YES AND TOTAL SDU MEMBERS = 0] Sírvase confirmar,
incluyéndose usted, nadie en su hogar (vivió/vivirá) en [ADDRESS FILL] la mayor parte
del tiempo durante (DATA COLLECTION PERIOD)?
1 Yes Sí
2 No No
(IF YES, GO TO THANK YOU. IF NO, TOTAL SDU MEMBERS)

MEMBERS 12 OR OLDER
ASK

IF TOTAL SDU MEMBERS NE BLANK
[LINK] FAQ [/LINK] [PHONE ICON] [LINK] 800-848-4079

[/LINK]

[IF TOTAL SDU MEMBERS > 1] Of these (TOTAL SDU MEMBERS) people, how many are now age
12 or older [IF SR OCCUPANCY = YES] (including you)?
_______ (RANGE 1-TOTAL SDU MEMBERS)
[IF TOTAL SDU MEMBERS = 1 AND SR OCCUPANCY = YES] Are you the only person who (will
live/lived) at this household for most of the time during (DATA COLLECTION PERIOD)?
[IF TOTAL SDU MEMBER = 1 AND OCCUPANCY = YES] Is this person age 12 or older?
1 Yes
2 No

8

SPANISH

[IF TOTAL SDU MEMBERS > 1] De estas (TOTAL SDU MEMBERS) personas, ¿cuántas
tienen 12 años o más actualmente [IF SR OCCUPANCY = YES] (incluyéndose usted)?
_______ (RANGE 1-TOTAL SDU MEMBERS)
[IF TOTAL SDU MEMBERS = 1 AND SR OCCUPANCY = YES] ¿Es usted la única
persona que (vivirá/vivió) en este hogar la mayor parte del tiempo durante (DATA
COLLECTION PERIOD)?
[IF TOTAL SDU MEMBER = 1 AND OCCUPANCY = YES] ¿Tiene esta persona 12 años
o más?
1 Sí
2 No

NEXT

IF MEMBERS 12 OR OLDER = 0 OR > TOTAL SDU MEMBERS, THEN MEMBERS 12
OR OLDER = 0 POP UP
IF MEMBERS 12 OR OLDER = NO, THEN THANK YOU
IF SR OCCUPANCY = YES AND MEMBERS 12 OR OLDER = 1 OR YES, THEN SR
AGE
IF OCCUPANCY = YES AND MEMBERS 12 OR OLDER = 1 OR YES, THEN OTHER
MEMBERS
IF MEMBERS 12 OR OLDER > 1 AND OCCUPANCY = YES, THEN OTHER MEMBERS
IF MEMBERS 12 OR OLDER > 1 AND SR OCCUPANCY = YES, THEN SR AGE

TABLET

Tablet version includes FI administered pop ups. These have been modified for
web/phone call-in administration.

POP UP

ENGLISH:
IF MEMBERS 12 OR OLDER = 0: Please answer this question again. Of these (TOTAL
SDU MEMBERS) people, how many are now age 12 or older?
If the answer is still 0, please click on Next. If you need to change your answer, please
enter the correct answer in the box above.
_______ (RANGE 0-TOTAL SDU MEMBERS)
SPANISH:
IF MEMBERS 12 OR OLDER = 0: Responda esta pregunta nuevamente. De estas
(TOTAL SDU MEMBERS) personas, ¿cuántas tienen 12 años o más actualmente?
Si la respuesta sigue siendo 0, haga clic en Siguiente. Si necesita cambiar su respuesta,
ingrese la respuesta correcta en el cuadro de arriba.
_______ (RANGE 0-TOTAL SDU MEMBERS)
IF 0, GO TO THANK YOU.
IF 1 OR >1 AND SR OCCUPANCY = YES, GO TO SR AGE.
IF 1 AND OCCUPANCY = YES, GO TO OTHER MEMBERS

9

SR AGE
ASK

IF SR OCCUPANCY = YES OR ROSTER NE BLANK OR CONFIRM ROSTER FOR SR =
NO
[LINK] FAQ [/LINK] [PHONE ICON] [LINK] 800-848-4079

[/LINK]

[IF SR OCCUPANCY = YES] How old are you?
______ ENTER AGE
[IF SR OCCUPANCY = NO] Next are a few questions about the people who live at [ADDRESS FILL].
Let’s start with the oldest and work down to the youngest.
How old is the oldest person? Do not include yourself.
______ ENTER AGE
SPANISH

[IF SR OCCUPANCY = YES] ¿Cuántos años tiene usted?
______ INGRESE LA EDAD
[IF SR OCCUPANCY = NO] A continuación hay algunas preguntas sobre las personas
que viven en [ADDRESS FILL]. Empecemos con la persona de mayor edad hasta llegar a
la persona menor.
¿Cuántos años tiene la persona de mayor edad? No se incluya usted.
______ INGRESE LA EDAD

NEXT

IF SR AGE NE BLANK AND SR OCCUPANCY = YES, THEN SR SEX
IF SR AGE NE BLANK AND SR OCCUPANCY = NO, THEN SR RELATION

TABLET

Tablet version includes FI administered pop ups. These have been modified for
web/phone call-in administration.

POP UP

ENGLISH:
IF SR AGE > 99: Please confirm, are you (AGE) years old?
- (IF YES, GO TO SR SEX. IF NO, GO TO SR AGE).
IF SR AGE <18: Please confirm, are you (AGE) years old?
- IF SR AGE < 18 = YES, THEN “An adult resident at this address must complete
these questions. Thank you for your time.”
- IF SR AGE < 18 = NO, THEN GO TO SR AGE.
SPANISH:
IF SR AGE > 99: Sírvase confirmar, ¿tiene usted (AGE) años de edad?
- (IF YES, GO TO SR SEX. IF NO, GO TO SR AGE).
IF SR AGE <18: Sírvase confirmar, ¿tiene usted (AGE) años de edad?
- IF SR AGE < 18 = YES, THEN “Una persona adulta que vive en esta dirección
debe completar estas preguntas. Gracias por tu tiempo.”
- IF SR AGE < 18 = NO, THEN GO TO SR AGE

10

SR SEX
IF SR AGE NE BLANK

ASK

[LINK] FAQ [/LINK] [PHONE ICON] [LINK] 800-848-4079 [/LINK]
What sex were you assigned at birth, on your original birth certificate?
1
2

Male
Female

SPANISH

¿Qué sexo le fue asignado al nacer, en su certificado de nacimiento original?
1 Hombre
2 Mujer
IF SR SEX NE BLANK, THEN SR GENDER

NEXT
TABLET

NA

POP UP

ENGLISH:
IF SEX =BLANK, “Answer required” is displayed offering “Don’t know” and
“Rather not say” as additional options.
SPANISH:
IF SEX =BLANK, “Se necesita una respuesta” is displayed offering “No sé” and “Prefiero
no contestar” as additional options.

SR GENDER
ASK

IF SR SEX NE BLANK
[LINK] FAQ [/LINK] [PHONE ICON] [LINK] 800-848-4079

[/LINK]

Do you describe yourself as male, female, transgender, or do you use a different term? (Check all that
apply.)
1
2
3
4

Male
Female
Transgender
I use a different term

11

SPANISH

¿Se describe usted como hombre, mujer, transgénero o utiliza un término diferente?
(Marque todas las opciones que correspondan)
1
2
3
4

NEXT

Hombre
Mujer
Transgénero
Utilizo un término diferente

IF SR GENDER NE BLANK AND SR AGE = 18-65, THEN SR MILITARY
IF SR GENDER NE BLANK AND SR AGE NE 18-65, THEN SR HISPANIC
IF SR GENDER = I USE A DIFFERENT TERM, THEN SR DIFTERM

TABLET

Tablet version does not include the instruction to check all that apply.

POP UP

ENGLISH:
IF SR GENDER =BLANK, “Answer required” is displayed offering “Don’t know” and
“Rather not say” as additional options.
SPANISH:
IF SR GENDER =BLANK, “Se necesita una respuesta” is displayed offering “No sé” and
“Prefiero no contestar” as additional options.

SR DIFTERM
ASK

IF SR GENDER = I USE A DIFFERENT TERM
[LINK] FAQ [/LINK] [PHONE ICON] [LINK] 800-848-4079

[/LINK]

What term do you use?
_______ (ALLOW 50 CHARACTERS)
SPANISH
NEXT

¿Qué término usa?
SR MILITARY

TABLET

NA

POP UP

ENGLISH:
IF SR DIFTERM =BLANK, “Answer required” is displayed offering “Don’t know” and
“Rather not say” as additional options.
SPANISH:
IF SR DIFTERM =BLANK, “Se necesita una respuesta” is displayed offering “No sé” and
“Prefiero no contestar” as additional options.

12

SR MILITARY
ASK

IF SR GENDER NE BLANK AND SR AGE = 18-65
[LINK] FAQ [/LINK] [PHONE ICON] [LINK] 800-848-4079

[/LINK]

Are you currently on active duty in the United States military?
1 Yes
2 No
SPANISH

¿Está usted actualmente en servicio activo en las fuerzas armadas de los Estados
Unidos?
1 Sí
2 No

NEXT

IF SR MILITARY NE BLANK, THEN SR HISPANIC

TABLET

NA

POP UP

ENGLISH:
IF SR MILITARY = BLANK, “Answer required” is displayed offering
“Rather not say” as an additional option.
SPANISH:
IF SR MILITARY = BLANK, “Se necesita una respuesta” is displayed offering “Prefiero no
contestar” as an additional option.

SR HISPANIC
ASK

IF SR MILITARY NE BLANK OR (SR GENDER NE BLANK AND SR AGE NE 18-65)
[LINK] FAQ [/LINK] [PHONE ICON] [LINK] 800-848-4079

[/LINK]

Are you of Hispanic, Latino or Spanish origin?
That is, do any of these groups describe your national origin or ancestry – Puerto Rican, Cuban,
Cuban-American, Mexican, Mexican-American, Chicano, Central or South American, or origin in some
other Spanish-speaking country?
1 Yes
2 No

13

SPANISH

¿Es usted de origen hispano, latino o español?
¿Es decir que su origen nacional o ascendencia se puede describir como puertorriqueño,
cubano, cubanoamericano, mexicano, mexicanoamericano, chicano, centro o
sudamericano, o es nativo(a) de otro país donde se habla español?
1 Sí
2 No

NEXT

IF SR HISPANIC NE BLANK, THEN SR RACE

TABLET

Tablet version has some optional text on this screen. Web/phone call-in version will have
all text included.

POP UP

ENGLISH:
IF SR HISPANIC =BLANK, “Answer required” is displayed offering “Don’t know” and
“Rather not say” as additional options.
SPANISH:
IF SR HISPANIC =BLANK, “Se necesita una respuesta” is displayed offering “No sé” and
“Prefiero no contestar” as additional options.

SR RACE
ASK

IF SR HISPANIC NE BLANK
[LINK] FAQ [/LINK] [PHONE ICON] [LINK] 800-848-4079

[/LINK]

[IF HISPANIC = YES] We recorded that you are of Hispanic/Latino origin. This question is about race.
What is your race? (Check all that apply.)
1 American Indian or Alaska Native
2 Asian
3 Black or African American
4 Native Hawaiian or other Pacific Islander
5 White

14

SPANISH

IF HISPANIC = YES] Hemos registrado que usted de origen hispano o latino. Esta
pregunta se trata sobra la raza. Seleccione una opción.
¿Cuál es su raza? (Marque todas las opciones que correspondan)
1 Indígena americana o nativa de Alaska
2 Asiática
3 Negra o afroamericana
4 Nativa de Hawái o de otra isla del Pacifico
5 Blanca

NEXT

IF SR RACE NE BLANK, THEN SR CONFIRM ROSTER

TABLET

Tablet version does not include the instruction to check all that apply.

POP UP

ENGLISH:
IF SR RACE =BLANK, “Answer required” is displayed offering “Don’t know” and
“Rather not say” as additional options.
SPANISH:
IF SR RACE =BLANK, “Se necesita una respuesta” is displayed offering “No sé” and
“Prefiero no contestar” as additional options.

SR CONFIRM ROSTER
ASK

IF SR RACE NE BLANK
[LINK] FAQ [/LINK] [ [PHONE ICON] [LINK] 800-848-4079

Please review your information:
Age AGE FILL
Sex SEX FILL
Gender GENDER FILL
Active Military Duty MILITARY FILL
Hispanic HISPANIC FILL
Race RACE FILL
Is this correct?
1 Yes
2 No (Edit)

15

[/LINK]

SPANISH

Por favor, revise su información:
Edad AGE FILL
Sexo SEX FILL
Género GENDER FILL
Servicio militar activo MILITARY FILL
Hispano(a) HISPANIC FILL
Raza RACE FILL
¿Es eso correcto?
1 Sí
2 No (Cambiar)

NEXT

IF SR CONFIRM ROSTER = YES AND MEMBERS 12 OR OLDER ≥ 2, THEN OTHER
MEMBERS
IF SR CONFIRM ROSTER = YES AND MEMBERS 12 OR OLDER = 1, THEN VERIFY
ROSTER DATA
IF SR CONFIRM ROSTER = NO, THEN EDIT ROSTER OPTION

TABLET

Tablet version is phrased to be read by the FI. Web/phone call-in version text has been
edited for self-administration.

POP UP

NA

EDIT ROSTER OPTION
ASK

IF SR CONFIRM ROSTER = NO
[LINK] FAQ [/LINK] [PHONE ICON] [LINK] 800-848-4079

Edit your selections below
Age
Sex
Gender

AGE FILL
MALE FEMALE
To select more than one gender,
press the Control Key and select other gender(s)
MALE FEMALE TRANSGENDER [DIFTERM FILL]
Active Military Duty YES NO
Hispanic
YES NO
Race
To select more than one race,
press the Control key and select other race(s)
[LIST WITH RACE OPTIONS]
[IF NOT SR] Relation [LIST WITH RELATIONSHIP OPTIONS]
Is this correct?

16

[/LINK]

SPANISH

Cambie sus respuestas a continuación
Edad
Sexo
Género

AGE FILL
HOMBRE MUJER
Para seleccionar más de un género,
presione la tecla “Control” y seleccione otro(s) género(s)
HOMBRE MUJER TRANSGÉNERO [DIFTERM FILL]
Servicio activo militar SÍ NO
Hispano(a)
SÍ NO
Raza
Para seleccionar más de una raza,
presione la tecla que dice “Ctrl” (Control) y seleccione otra(s)
raza(s)
[LIST WITH RACE OPTIONS]
¿Es esto correcto?

NEXT

IF SR CONFIRM ROSTER = YES AND MEMBERS 12 OR OLDER ≥ 2, THEN OTHER
MEMBERS
IF SR CONFIRM ROSTER = YES AND MEMBERS 12 OR OLDER = 1, THEN VERIFY
ROSTER DATA

TABLET

Tablet version is phrased to be read by the FI. Web/phone call-in version text has been
edited for self-administration.

POP UP

NA

OTHER MEMBERS
ASK

IF SR CONFIRM ROSTER = YES AND MEMBERS 12 OR OLDER ≥ 2
[LINK] FAQ [/LINK] [PHONE ICON] [LINK] 800-848-4079

[/LINK]

[IF SR OCCUPANCY = YES AND MEMBERS 12 OR OLDER = 2] Now we need some general
information about the other person in this household who is 12 years old or older.
How old is this person?
______ ENTER AGE
[IF MEMBERS 12 OR OLDER > 2] Now we need some general information about all of the other
people in this household who are 12 years old or older. Let's start with the oldest and work down to
the youngest.
How old is the oldest person? Do not include yourself.
______ ENTER AGE
[IF OCCUPANCY = YES AND MEMBERS 12 OR OLDER = 2]
How old is this person?
______ ENTER AGE

17

SPANISH

[IF SR OCCUPANCY = YES AND MEMBERS 12 OR OLDER = 2] Ahora necesitamos
información general sobre la otra persona en este hogar que tenga 12 años de edad o
más.
¿Cuántos años tiene esta persona?
______ INGRESE LA EDAD
Ahora necesitamos alguna información general acerca de todas las otras personas en
este hogar que tengan 12 años o más. Empecemos con la persona mayor hasta llegar a
la persona menor.
¿Cuántos años tiene la persona mayor? No se incluya usted.
______ INGRESE LA EDAD
[IF OCCUPANCY = YES AND MEMBERS 12 OR OLDER = 2]
¿Cuántos años tiene esta persona?
______ INGRESE LA EDAD

NEXT

IF OTHER MEMBERS = NEXT, THEN RELATION

TABLET

Tablet version is phrased to be read by the FI. Web/phone call-in version has been edited
for self-administration.

POP UP

ENGLISH:
IF OTHER MEMBERS AGE = BLANK OR <12, “Please enter the age of your household
member who is at least 12 years old. If there are no other household members that are at
least 12 years old, please click "Done"”
IF OTHER MEMBERS AGE > 99: Please confirm, is this person (AGE) years old?
SPANISH:
IF OTHER MEMBERS AGE = BLANK OR <12, “Ingrese la edad del miembro de su hogar
que tenga por lo menos 12 años de edad. Si no hay otros miembros que tengan al menos
12 años de edad, haga clic en “Listo”
IF OTHER MEMBERS AGE > 99: Sírvase confirmar, ¿tiene esta persona (AGE) años de
edad?

18

PERSON # RELATION
ASK

IF OTHER MEMBERS NE BLANK
[LINK] FAQ [/LINK] [PHONE ICON] [LINK] 800-848-4079

How is this person related to you?
Spouse
Child (includes half, step, foster, or adoptive)
Child-in-law
Sibling (includes half, step, foster, or adoptive)
Sibling-in-law
Parent/Guardian (includes step, foster, or adoptive)
Parent-in-law
Uncle or Aunt
Nephew or Niece
Grandparent
Grandchild
Cousin
Ex-Spouse
Unmarried Partner
Housemate or Roommate
Tenant, Boarder, or Exchange Students
Other relative
Other Non-relative
Relationship Unspecified
SPANISH

¿Cómo está relacionada esta persona con usted?
Esposo(a)
Hijo(a) (incluye hijastro(a), hijo(a) “foster” o hijo(a) adoptivo(a))
Nieto(a)
Yerno/nuera
Hermano(a) (incluye medio(a) hermano(a), hermanastro(a),
hermano(a) “foster” o hermano(a) adoptivo(a))
Cuñado(a)
Padre/madre o tutor(a) legal (incluye padrastro/
madrastra, padre/madre “foster” o padre/madre
adoptivo(a)
Suegro(a)
Tío(a)
Sobrino(a)
Abuelo(a)
Nieto(a)
Primo(a)
Ex-esposo(a)
Pareja (sin estar casados)
Compañero(a) de casa o de cuarto
Inquilino(a)/Pensionista/Intercambio estudiantil
Otro pariente
Otra persona que no es pariente

NEXT

SEX

19

[/LINK]

TABLET

Tablet version has an additional “Relationship Unspecified” category. Web/phone call-in
version does not have that response option.

POP UP

ENGLISH:
IF MORE THAN ONE SPOUSE: You have indicated some other household member as
your spouse and you have chosen spouse again. Do you have more than one spouse?
(IF YES, THEN MILITARY OR HISPANIC. IF NO, RELATION.)
IF RELATION = BLANK, THEN “Answer required” and “Please select a relation” are
displayed.
SPANISH:
IF MORE THAN ONE SPOUSE: Usted ha indicado a otro miembro del hogar como su
(esposo/esposa) y ha seleccionado (esposo/esposa) nuevamente. ¿Tiene usted más de
un(a) esposo(a)?
(IF YES, THEN MILITARY OR HISPANIC. IF NO, RELATION.)
IF RELATION = BLANK, THEN “Se necesita una respuesta” and “Seleccione una opción”
are displayed.

PERSON # SEX
IF RELATION NE BLANK

ASK

[LINK] FAQ [/LINK] [PHONE ICON] [LINK] 800-848-4079 [/LINK]
What sex was this person assigned at birth, on their original birth certificate?
1
2

Male
Female

SPANISH

¿Qué sexo le fue asignado a esta persona al nacer, en su certificado original de
nacimiento?
1 Hombre
2 Mujer

NEXT

IF SEX NE BLANK, THEN GENDER

TABLET

NA

POP UP

ENGLISH:
IF SEX =BLANK, “Answer required” is displayed offering “Don’t know” and
“Rather not say” as additional options.
SPANISH:
IF SEX =BLANK, “Se necesita una respuesta” is displayed offering “No sé” and “Prefiero
no contestar” as additional options.

20

PERSON # GENDER
IF SEX NE BLANK

ASK

[LINK] FAQ [/LINK] [PHONE ICON] [LINK] 800-848-4079 [/LINK]
Does this person describe themself as male, female, transgender, or do they use a different term?
(Check all that apply.)
1
2
3
4

Male
Female
Transgender
They use a different term

SPANISH

¿Se describe esta persona como hombre, mujer, transgénero o utiliza un término
diferente? (Marque todas las opciones que correspondan)
1 Hombre
2 Mujer
3 Transgénero
4 Utiliza un término diferente

NEXT

IF GENDER NE BLANK AND AGE = 17-65, THEN MILITARY
IF GENDER NE BLANK AND AGE NE 17-65, THEN HISPANIC

TABLET

NA

POP UP

ENGLISH:
IF GENDER =BLANK, “Answer required” is displayed offering “Don’t know” and
“Rather not say” as additional options.
SPANISH:
IF GENDER =BLANK, “Se necesita una respuesta” is displayed offering “No sé” and
“Prefiero no contestar” as additional options.

21

PERSON # DIFTERM
ASK

IF GENDER = I USE A DIFFERENT TERM
[LINK] FAQ [/LINK] [PHONE ICON] [LINK] 800-848-4079

[/LINK]

What term do they use?
_______ (ALLOW 50 CHARACTERS)
SPANISH
NEXT

¿Qué término usa?
MILITARY

TABLET

NA

POP UP

ENGLISH:
IF DIFTERM =BLANK, “Answer required” is displayed offering “Don’t know” and
“Rather not say” as additional options.
SPANISH:
IF DIFTERM =BLANK, “Se necesita una respuesta” is displayed offering “No sé” and
“Prefiero no contestar” as additional options.

PERSON # MILITARY
ASK

IF GENDER NE BLANK AND AGE = 17-65
[LINK] FAQ [/LINK] [PHONE ICON] [LINK] 800-848-4079

[/LINK]

Is this person currently on active duty in the United States military?
1 Yes
2 No
SPANISH

¿Está esta persona actualmente en servicio activo en las fuerzas armadas de los Estados
Unidos?
1 Sí
2 No

NEXT

IF MILITARY NE BLANK, THEN HISPANIC

TABLET

NA

POP UP

ENGLISH:
IF PERSON # MILITARY =BLANK, “Answer required” is displayed offering “Don’t know”
and “Rather not say” as additional options
SPANISH:
IF PERSON # MILITARY =BLANK, “Se necesita una respuesta” is displayed offering “No
sé” and “Prefiero no contestar” as additional options

22

PERSON # HISPANIC
ASK

IF MILITARY NE BLANK OR (GENDER NE BLANK AND AGE NE 17-65)
[LINK] FAQ [/LINK] [PHONE ICON] [LINK] 800-848-4079

[/LINK]

Is this person of Hispanic, Latino or Spanish origin?
That is, do any of these groups describe (his/her/this person’s) national origin or ancestry – Puerto
Rican, Cuban, Cuban-American, Mexican, Mexican-American, Chicano, Central or South American, or
origin in some other Spanish-speaking country?
1 Yes
2 No
SPANISH

¿Es esta persona de origen hispano, latino o español?
¿Es decir que su origen nacional o ascendencia se puede describir como puertorriqueño,
cubano, cubanoamericano, mexicano, mexicanoamericano, chicano, centro o
sudamericano, o es nativo(a) de otro país donde se habla español?
1 Sí
2 No

NEXT

IF HISPANIC NE BLANK, THEN RACE

TABLET

Tablet version has some optional text on this screen. Web/phone call-in version will have
all text included.

POP UP

ENGLISH:
IF PERSON # HISPANIC =BLANK, “Answer required” is displayed offering “Don’t know”
and “Rather not say” as additional options
SPANISH:
IF PERSON # HISPANIC =BLANK, “Se necesita una respuesta” is displayed offering “No
sé” and “Prefiero no contestar” as additional options

PERSON # RACE
ASK

IF HISPANIC NE BLANK
[LINK] FAQ [/LINK] [PHONE ICON] [LINK] 800-848-4079

[/LINK]

[IF PERSON # HISPANIC = YES] We recorded that you have chosen Hispanic/Latino origin for this
person. This question is about race.
What is (his/her/this person’s) race (Check all that apply)
1 American Indian or Alaska Native
2 Asian
3 Black or African American
4 Native Hawaiian or other Pacific Islander
5 White

23

SPANISH

[IF PERSON # HISPANIC = YES] Hemos registrado que usted ha seleccionado origen
hispano o latino para esta persona. Esta pregunta se refiere a la raza. Seleccione una
opción para la raza.
¿Cuál es la raza de (él/ella/esta persona)? Marque todas las opciones que correspondan.
1 Indígena americana o nativa de Alaska
2 Asiática
3 Negra o afroamericana
4 Nativa de Hawái o de otra isla del Pacifico
5 Blanca

NEXT

IF RACE NE BLANK, THEN CONFIRM ROSTER

TABLET

Tablet version does not have the instruction to check all that apply.

POP UP

ENGLISH:
IF PERSON # RACE =BLANK, “Answer required” is displayed offering “Don’t know” and
“Rather not say” as additional options
SPANISH:
IF PERSON # RACE =BLANK, “Se necesita una respuesta” is displayed offering “No sé”
and “Prefiero no contestar” as additional options

PERSON # CONFIRM ROSTER
ASK

IF RACE NE BLANK
[LINK] FAQ [/LINK] [PHONE ICON] [LINK] 800-848-4079

Please review (your information/the information for your [PERSON # RELATION FILL]:
Age AGE FILL
Sex SEX FILL
Gender GENDER FILL
Active Military Duty MILITARY FILL
Hispanic HISPANIC FILL
Race RACE FILL
Is this correct?
1 Yes
2 No (Edit)

24

[/LINK]

SPANISH

Por favor, revise (su información/la información de su [PERSON # RELATION FILL]:
Edad
Sexo
Género
Servicio militar activo
Hispano(a)
Raza

AGE FILL
SEX FILL
GENDER FILL
MILITARY FILL
HISPANIC FILL
RACE FILL

¿Es esto correcto?
1 Sí
2 No (Cambiar)
NEXT

IF CONFIRM ROSTER = YES AND MORE MEMBERS TO BE ROSTERED, THEN AGE
FOR NEXT HH MEMBER
IF SR CONFIRM ROSTER = YES AND NO MORE MEMBERS TO BE ROSTERED,
THEN VERIFY ROSTER DATA
IF SR CONFIRM ROSTER = NO, THEN EDIT ROSTER SELECTIONS

TABLET

Tablet version is phrased to be read by the FI. Web/phone call-in version text has been
edited for self-administration.

POP UP

NA

EDIT PERSON # ROSTER OPTION
ASK

IF CONFIRM ROSTER = NO
[LINK] FAQ [/LINK] [PHONE ICON] [LINK] 800-848-4079

Edit your selections below
Age
Sex
Gender

AGE FILL
MALE FEMALE
To select more than one gender,
press the Control Key and select other gender(s)
MALE FEMALE TRANSGENDER [DIFTERM FILL]
Active Military Duty YES NO
Hispanic
YES NO
Race
To select more than one race,
press the Control key and select other race(s)
[LIST WITH RACE OPTIONS]
[IF NOT SR] Relation [LIST WITH RELATIONSHIP OPTIONS]
Is this correct?

25

[/LINK]

SPANISH

Cambie sus respuestas a continuación
Edad
Sexo
Género

AGE FILL
HOMBRE MUJER
Para seleccionar más de un género,
presione la tecla “Control” y seleccione otro(s) género(s)
HOMBRE MUJER TRANSGÉNERO [DIFTERM FILL]
Servicio activo militar SÍ NO
Hispano(a)
SÍ NO
Raza
Para seleccionar más de una raza,
presione la tecla que dice “Ctrl” (Control) y seleccione otra(s)
raza(s)
[LIST WITH RACE OPTIONS]
¿Es esto correcto?

NEXT

IF CONFIRM ROSTER = YES AND MORE HH MEMBERS TO ROSTER, THEN OTHER
MEMBERS
IF CONFIRM ROSTER = YES AND NO MORE HH MEMBERS TO ROSTER, THEN
VERIFY ROSTER DATA

TABLET

Tablet version is phrased to be read by the FI. Web/phone call-in version text has been
edited for self-administration.

POP UP

NA

VERIFY ROSTER DATA
ASK

(IF CONFIRM ROSTER = YES AND MEMBERS 12 OR OLDER = 1) OR (IF CONFIRM
ROSTER = YES AND NO MORE MEMBERS TO BE ROSTERED)
[LINK] FAQ [/LINK] [PHONE ICON] [LINK] 800-848-4079

[/LINK]

These are the people listed as 12 years old or older and living in this household for most of the time
during the months of (DATA COLLECTION PERIOD).
LIST MEMBER NUMBER, AGE, AND RELATIONSHIP FOR EACH ROSTER MEMBER
EACH ROSTER MEMBER HAS AN EDIT FUNCTION BUTTON AND ALL MEMBERS WHO ARE NOT
SR HAVE A DELETE BUTTON.
Add Member button.
(If any household member who is 12 or older is missing, please click the Add button.)
If this information is correct and there are no other household members over 12 years old, please click
the Submit button.
[SUBMIT]

26

SPANISH

Estas son las personas que figuran como mayores de 12 años de edad y que viven en
este hogar la mayor parte del tiempo durante los meses de (DATA COLLECTION
PERIOD).
Agregar miembro del hogar
(Si falta algún miembro del hogar que tenga 12 años o más, haga clic en el botón de
Agregar).
Si esta información es correcta y no hay otros miembros del hogar que tengan más de 12
años, haga clic en el botón Enviar.
[ENVIAR]

NEXT

ENGLISH:
IF EDIT FUNCTION SELECTED, THEN EDIT ROSTER OPTION
IF DELETE FUNCTION SELECTED, THEN “Are you sure you want to delete this
household member?”
IF VERIFY ROSTER DATA = SUBMIT, THEN RESPONDENT SELECTION
IF VERIFY ROSTER DATA = Add Member+, THEN PERSON # AGE
SPANISH:
IF DELETE FUNCTION SELECTED, THEN ¿Está seguro(a) que desea borrar a este
miembro del hogar de la lista?

TABLET

Tablet version is phrased to be read by the FI. Web/phone call-in version text has been
edited for self-administration. Pop ups were created to allow editing of the roster
information similar to what an FI would do in the field.

POP UP

NA

RESPONDENT SELECTION
ASK

IF VERIFY ROSTER DATA = YES
[LINK] FAQ [/LINK] [PHONE ICON] [LINK] 800-848-4079

[/LINK]

[IF ONE OR TWO SELECTED] Congratulations! The following people from this household have been
selected to participate in the National Household Survey on Behavioral Health interview.
RELATION
SELECTIONS

AGE

[IF NO ONE SELECTED] Thank you for completing this screening. No one in your household was
selected to complete an interview. You will not be contacted again about this survey.

27

SPANISH

[IF ONE OR TWO SELECTED] ¡Felicitaciones! Las siguientes personas de este hogar
han sido seleccionadas para participar en la entrevista de la Encuesta Nacional sobre la
Salud y el Consumo de Drogas.
RELATION
SELECTIONS

AGE

[IF NO ONE SELECTED] Gracias por completar las preguntas de selección de
participantes. No se seleccionó a nadie en su hogar para completar una entrevista. No
volveremos a comunicarnos con usted sobre esta encuesta.
NEXT

IF RESPONDENT SELECTION = NEXT, THEN CAI START

TABLET

Tablet version does not have this screen.

POP UP

NA

YOUTHR1
ASK

IF RESPONDENT SELECTION = YOUTH R
[LINK] FAQ [/LINK] [PHONE ICON] [LINK] 800-848-4079 [/LINK]

[IF ONE OR TWO YOUTH R SELECTED] Because a youth respondent has been selected to
participate in the National Household Survey on Behavioral Health interview, we must first speak with a
parent via telephone before that interview can begin:
INTERVIEW A: [AGE] [RELATIONSHIP]
Are you the parent or guardian for [IF ONE YOUTH SELECTED: this youth? OR IF TWO YOUTH
SELECTED: these youth]
PARENT
GUARDIAN
NOT THE PARENT OR GUARDIAN
[IF TWO YOUTH SELECTED] INTERVIEW B: [AGE] [RELATIONSHIP]
PARENT
GUARDIAN
I AM NOT THE PARENT OR GUARDIAN OF THIS YOUTH

28

SPANISH

[IF ONE OR TWO YOUTH R SELECTED] Debido a que un(a) joven ha sido
seleccionado(a) para participar en la entrevista de la Encuesta Nacional sobre la Salud y
el Consumo de Drogas, primero debemos hablar con uno de los padres por teléfono
antes de poder comenzar esa entrevista:
INTERVIEW A: [AGE] [RELATIONSHIP]
¿Es usted el padre/la madre o tutor(a) de [IF ONE YOUTH SELECTED: este(a) joven?
OR IF TWO YOUTH SELECTED: estos(as) jóvenes]
PADRE/MADRE
TUTOR(A)
NO SOY EL PADRE/LA MADRE O TUTOR(A)
[IF TWO YOUTH SELECTED] INTERVIEW B: [AGE] [RELATIONSHIP]
PADRE/MADRE
TUTOR(A)
NO SOY EL PADRE/LA MADRE O TUTOR(A)

NEXT

IF ONE YOUTH R SELECTED AND YOUTHR1a = YES, THEN YOUTHR3 – SR IS
PARENT
IF ONE YOUTH R SELECTED AND YOUTHR1a = NO, THEN YOUTHR2 SR – NOT
PARENT
IF TWO YOUTH R SELECTED AND YOUTHR1a = YES AND YOUTHR1b = YES, THEN
YOUTHR3 – SR IS PARENT
IF TWO YOUTH R SELECTED AND YOUTHR1a = YES AND YOUTHR1b = NO, THEN
YOUTHR4 – SR PARENT/NOT PARENT
IF TWO YOUTH R SELECTED AND YOUTHR1a = NO AND YOUTHR1b = YES, THEN
YOUTHR4 – SR PARENT/NOT PARENT
IF TWO YOUTH R SELECTED AND YOUTHR1a = NO AND YOUTHR1b = NO, THEN
YOUTHR2 – SR NOT PARENT

TABLET

Tablet version does not have this screen.

POP UP

NA

29

YOUTHR2 – SR NOT PARENT
ASK

IF (ONE YOUTH R SELECTED AND YOUTHR1a = NO) OR (TWO YOUTH R
SELECTED AND YOUTHR1a = NO AND YOUTHR1b = NO)
[LINK] FAQ [/LINK] [PHONE ICON] [LINK] 800-848-4079 [/LINK]

[IF (ONE YOUTH R SELECTED AND YOUTHR1a = NO) OR (TWO YOUTH R SELECTED AND
YOUTHR1a = NO AND YOUTHR1b = NO) Before your [AGE] [RELATIONSHIP] can begin the
interview, we must first speak with a parent (or guardian) via telephone and get their permission.
Please inform the parent(s) of this youth that they have been selected for an interview and ask that a
parent call 1-800-848-4079 to speak with an authorized project representative if the youth is interested
in participating in this study, which asks about tobacco, alcohol, and drug use or non-use and other
health related issues.
[IF TWO YOUTH R SELECTED AND YOUTHR1a = NO AND YOUTHR1b = NO] Before your [AGE]
[RELATIONSHIP] and [AGE] [RELATIONSHIP] can begin the interview, we must first speak with a
parent (or guardian) via telephone for each youth and get their permission.
Please inform the parent(s) of these youth that they have been selected for an interview and ask that a
parent call 1-800-848-4079 to speak with an authorized project representative if the youths are
interested in participating in this study, which asks about tobacco, alcohol, and drug use or non-use
and other health related issues.
[ALL] We ask that the parent and youth be at home when they call so the youth can begin the interview
from a private location soon after the call is completed.
Also, please ask the parent to have the letter sent to your household with the Participant Code
available during this call, which should only take a few minutes.
Please take a moment now to write down this number and give it to the parent.

30

SPANISH

[IF (ONE YOUTH R SELECTED AND YOUTHR1a = NO) OR (TWO YOUTH R
SELECTED AND YOUTHR1a = NO AND YOUTHR1b = NO) Antes de que su
[RELATIONSHIP] de [AGE] años pueda comenzar la entrevista, primero debemos hablar
por teléfono con uno de los padres (o tutor(a)) y obtener su permiso.
Por favor, informe a uno de los padres de este(a) joven que él/ella ha sido
seleccionado(a) para una entrevista y pídale a uno de los padres que llame al 1-800-8484079 para hablar con un representante autorizado del proyecto si el/la joven está
interesado(a) en participar en este estudio, el cual hace preguntas sobre el uso o no uso
de tabaco, alcohol y drogas, y otros asuntos relacionados con la salud.
Antes de que su [RELATIONSHIP] de [AGE] años y su [RELATIONSHIP] de [AGE] años
puedan comenzar la entrevista, primero debemos hablar por teléfono con uno de los
padres (o tutor(a)) de cada joven y obtener su permiso.
Por favor, informe a uno de los padres de estos(as) jóvenes que ellos(as) han sido
seleccionados(as) para una entrevista y pídale a uno de los padres que llame al 1-800848-4079 para hablar con un representante autorizado del proyecto si los/las jóvenes está
interesados(as) en participar en este estudio, el cual hace preguntas sobre el uso o no
uso de tabaco, alcohol y drogas, y otros asuntos relacionados con la salud.
[ALL] [IF ONE YOUTH] Es necesario que uno de los padres y el/la joven estén en casa
cuando llamen para que el/la joven pueda comenzar la entrevista desde un lugar privado
poco después de que finalice la llamada.
[ALL] [IF TWO YOUTH] Es necesario que uno de los padres y los(as) jóvenes estén en
casa cuando llamen para que los(as) jóvenes puedan comenzar la entrevista desde un
lugar privado poco después de que finalice la llamada.
También pídale a uno de los padres que, durante esta llamada, tenga a la mano la carta
que se le envió a su hogar con el código de participante. La llamada tomará solo unos
minutos.
Por favor, anote este número ahora y entrégueselo a uno de los padres.

NEXT

YOUTHR2 – SR NOT PARENT = NEXT, THEN YOUTHR2A – SR NOT PARENT,
REQUEST CONTACT INFO

TABLET

Tablet version does not have this screen.

POP UP

NA

31

YOUTHR2A – SR NOT PARENT, REQUEST CONTACT INFO
ASK

IF YOUTHR2 – SR NOT PARENT = NEXT
[LINK] FAQ [/LINK] [PHONE ICON] [LINK] 800-848-4079 [/LINK]

To help us speak with a parent about [this interview/these interviews], we would like your first name
and phone number so a project representative can call you to then speak with a parent of [this
youth/these youths]. Or a parent may call 1-800-848-4079 to speak with an authorized project
representative to provide permission.
We will NOT share your name or phone number or contact you for any other reason.
When the project representative calls your phone number and someone answers, they will ask for you
by first name, reference your completion of this screening and mention the age and gender of anyone
selected for an interview.
Are you willing to provide your first name and phone number so our project representative can call
you?
YES
NO
SPANISH

Para poder hablar con uno de los padres sobre [esta entrevista/estas entrevistas], nos
gustaría que nos diera su nombre (sin el apellido) y su número de teléfono para que un
representante del proyecto pueda llamarle para luego hablar con uno de los padres de
[este(a) joven/estos(as) jóvenes]. O uno de los padres puede llamar al 1-800-848-4079
para hablar con un representante autorizado del proyecto para proporcionar el permiso.
NO compartiremos su nombre o número de teléfono, ni nos comunicaremos con usted
por ninguna otra razón.
Cuando el representante del proyecto llame a su número de teléfono y alguien conteste,
preguntará por usted por su nombre (sin el apellido) y hará referencia a estas preguntas
de selección de participantes que usted completó, y mencionará la edad y el sexo de
cualquier persona seleccionada para una entrevista.
¿Estaría dispuesto(a) a proporcionarnos su nombre (sin el apellido) para que un
representante del proyecto le pueda llamar?
YES
NO

NEXT

IF YOUTHR2A – SR NOT PARENT, REQUEST CONTACT INFO = YES, THEN SR
PHONE
IF YOUTHR2A – SR NOT PARENT, REQUEST CONTACT INFO = NO AND AN ADULT
RESPONDENT SELECTED, THEN START CAI ADULT
IF YOUTHR2A – SR NOT PARENT, REQUEST CONTACT INFO = NO AND NO OTHER
RESPONDENT SELECTED, THEN THANK YOU

TABLET

Tablet version does not have this screen.

POP UP

NA

32

SR PHONE
ASK

IF YOUTHR2A – SR NOT PARENT, REQUEST CONTACT INFO = YES
[LINK] FAQ [/LINK] [PHONE ICON] [LINK] 800-848-4079 [/LINK]

Please enter your first name and phone number so that our project representative can contact you
about [this/these] upcoming [interview/interviews].
First Name:
OPEN ENDED RESPONSE OPTION
Phone Number:
OPEN ENDED RESPOSE OPTION WITH FAINT PLACEHOLDER TEXT XXX XXXXXXX TO
PROMPT USERS TO ENTER FULL PHONE NUMBER INCLUDING AREA CODE
SPANISH

Ingrese su nombre (sin el apellido) y número de teléfono para que nuestro representante
del proyecto pueda llamarle sobre [esta próxima entrevista] [estas próximas entrevistas].
Nombre (sin el apellido):
OPEN ENDED RESPONSE OPTION
Número de teléfono:
OPEN ENDED RESPOSE OPTION WITH FAINT PLACEHOLDER TEXT XXX XXXXXXX
TO PROMPT USERS TO ENTER FULL PHONE NUMBER INCLUDING AREA CODE

NEXT

IF SR PHONE = NEXT AND AN ADULT RESPONDENT SELECTED, THEN START CAI
ADULT
IF SR PHONE = NEXT AND NO OTHER RESPONDENT SELECTED, THEN THANK
YOU

TABLET

Tablet version does not have this screen.

POP UP

NA

YOUTHR3 – SR IS PARENT
ASK

IF (ONE YOUTH R SELECTED AND YOUTHR1a = YES) OR (TWO YOUTH R
SELECTED AND YOUTHR1a = YES AND YOUTHR1b = YES)
[LINK] FAQ [/LINK] [PHONE ICON] [LINK] 800-848-4079 [/LINK]

Before your [AGE] [RELATIONSHIP] [IF TWO SELECTED: and [AGE] [RELATIONSHIP]] can
participate in this study, which asks about tobacco, alcohol, and drug use or non-use and other health
related issues, we need to speak with you via telephone to get your permission.
If your child would like to participate in this interview and it is OK with you for your [child/children] to
participate, please call 1-800-848-4079 to speak with an authorized project representative. The call
should only take a few minutes so we can discuss your [child’s/children’s] participation in this interview,
provide you with additional information, and document your verbal permission.
We ask that you please be at home with your [child/children] when you call so your [AGE]
[RELATIONSHIP] [IF TWO SELECTED: and [AGE] [RELATIONSHIP]] can begin the interview from a
private location soon after the call is completed. Your [child/children] will [IF TWO SELECTED: each]
receive a $30 gift card after completing the interview.
Also, please have the letter sent to your household with the Participant Code available during this call.

33

SPANISH

IF ONE SELECTED: Antes de que su [RELATIONSHIP] de [AGE] años pueda participar
en este estudio, el cual hace preguntas sobre el uso o no uso de tabaco, alcohol y
drogas, y otros asuntos relacionados con la salud, primero debemos hablar por teléfono
con usted para obtener su permiso.
IF TWO SELECTED: Antes de que su [RELATIONSHIP] de [AGE] años y su
[RELATIONSHIP] de [AGE] años puedan participar en este estudio, el cual hace
preguntas sobre el uso o no uso de tabaco, alcohol y drogas, y otros asuntos
relacionados con la salud, primero debemos hablar por teléfono con usted para obtener
su permiso.
Si a su hijo(a) le gustaría participar en esta entrevista y usted está de acuerdo con que
[su hijo(a) participe/sus (hijos(as) participen], llame al 1-800-848-4079 para hablar con un
representante autorizado del proyecto. La llamada solo tomará unos minutos para que
podamos hablar sobre la participación de [su hijo(a)/sus hijos(as)] en esta entrevista, para
proporcionarle información adicional y documentar su permiso verbal.
IF ONE SELECTED: Le pedimos que esté en su casa con su hijo(a) cuando llame para
que su [RELATIONSHIP] de [AGE] años pueda comenzar la entrevista desde un lugar
privado poco después de que finalice la llamada. Su hijo(a) recibirá una tarjeta de regalo
de $30 dólares después de completar la entrevista.
IF TWO SELECTED: Le pedimos que esté en su casa con sus hijos(as) cuando llame
para que su [RELATIONSHIP] de [AGE] años y su [RELATIONSHIP] de [AGE] años
puedan comenzar la entrevista desde un lugar privado poco después de que finalice la
llamada. Cada uno(a) de sus hijos(as) recibirá una tarjeta de regalo de $30 dólares
después de completar la entrevista.
También le pedimos que, durante la llamada, tenga a la mano la carta que se le envió a
su hogar con el código de participante. La llamada tomará solo unos minutos.

NEXT

YOUTHR3 – SR IS PARENT = NEXT, THEN YOUTHR3A – SR IS PARENT, CONTACT
INFO

TABLET

Tablet version does not have this screen.

POP UP

NA

YOUTHR3A – SR IS PARENT, CONTACT INFO
ASK

IF YOUTHR3 – SR IS PARENT = NEXT
[LINK] FAQ [/LINK] [PHONE ICON] [LINK] 800-848-4079 [/LINK]

If you prefer, we can call you to speak about your [child’s/children’s] participation in this interview if you
provide your first name and phone number.
We will NOT share your name or phone number or contact you for any other reason.
When the project representative calls your phone number and someone answers, they will ask for you
by first name, reference your completion of this screening and mention the age and gender of anyone
selected for an interview to that person. If you and your child are available at that time, the call should
only take a few minutes.
Are you willing to provide your first name and phone number so our project representative can call
you?

34

SPANISH

Si lo prefiere, podemos llamarle para hablar acerca de la participación de su
[hijo(a)/hijos(as)] en esta entrevista si proporciona su nombre (sin el apellido) y su número
de teléfono.
NO compartiremos su nombre o número de teléfono, ni nos comunicaremos con usted
por ninguna otra razón.
Cuando el representante del proyecto llame a su número de teléfono y alguien conteste,
preguntará por usted por su nombre (sin el apellido) y hará referencia a estas preguntas
de selección de participantes que usted completó, y le mencionará a esa persona la edad
y el sexo de cualquier persona seleccionada para una entrevista. Si usted y su hijo(a)
están disponibles en ese momento, la llamada solo debe tomar unos minutos.
¿Estaría dispuesto(a) a proporcionarnos su nombre (sin el apellido) y su número de
teléfono para que un representante del proyecto le pueda llamar?

NEXT

IF YOUTHR3A – SR IS PARENT, CONTACT INFO = YES, THEN YOUTHR3 – SR IS
PARENT, PARENT PHONE
IF YOUTHR3A – SR IS PARENT, CONTACT INFO = NO AND AN ADULT
RESPONDENT SELECTED, THEN START CAI ADULT
IF YOUTHR3A – SR IS PARENT, CONTACT INFO = NO AND NO OTHER
RESPONDENT SELECTED, THEN THANK YOU

TABLET

Tablet version does not have this screen.

POP UP

NA

YOUTHR3 – SR IS PARENT, PARENT PHONE
ASK

IF YOUTHR3A – SR IS PARENT, CONTACT INFO = YES
[LINK] FAQ [/LINK] [PHONE ICON] [LINK] 800-848-4079 [/LINK]

Please enter your first name and phone number so that our project representative can contact you
about [this/these] upcoming [interview/interviews].
First Name:
OPEN ENDED RESPONSE OPTION
Phone Number:
OPEN ENDED RESPOSE OPTION WITH FAINT PLACEHOLDER TEXT XXX XXXXXXX TO
PROMPT USERS TO ENTER FULL PHONE NUMBER INCLUDING AREA CODE

35

SPANISH

Ingrese su nombre y número de teléfono para que nuestro representante del proyecto
pueda llamarle sobre [esta próxima entrevista] [estas próximas entrevistas].
Nombre (sin el apellido):
OPEN ENDED RESPONSE OPTION
Número de teléfono:
OPEN ENDED RESPOSE OPTION WITH FAINT PLACEHOLDER TEXT XXX XXXXXXX
TO PROMPT USERS TO ENTER FULL PHONE NUMBER INCLUDING AREA CODE

NEXT

IF YOUTHR3A – SR IS PARENT, PARENT PHONE = NEXT AND AN ADULT
RESPONDENT SELECTED, THEN START CAI ADULT
IF YOUTHR3A – SR IS PARENT, PARENT PHONE = NEXT AND NO OTHER
RESPONDENT SELECTED, THEN THANK YOU

TABLET

Tablet version does not have this screen.

POP UP

NA

YOUTHR4 – SR PARENT/NOT PARENT
ASK

IF (TWO YOUTH R SELECTED AND YOUTHR1a = YES AND YOUTHR1b = NO) OR
(TWO YOUTH R SELECTED AND YOUTHR1a = NO AND YOUTHR1b = YES)
[LINK] FAQ [/LINK] [PHONE ICON] [LINK] 800-848-4079 [/LINK]

[IF (TWO YOUTH R SELECTED AND YOUTHR1a = YES AND YOUTHR1b = NO) OR (TWO YOUTH
R SELECTED AND YOUTHR1a = NO AND YOUTHR1b = YES)] Before your [AGE] [RELATIONSHIP]
and [AGE] [RELATIONSHIP] can begin the interview, we must first speak with a parent (or guardian)
via telephone and get their permission.
If your child would like to participate in this interview and it is OK with you for your child to participate,
please call 1-800-848-4079 to speak with an authorized project representative. The call should only
take a few minutes so we can discuss your child’s participation in this interview, provide you with
additional information, and document your verbal permission.
Please inform the parent(s) of your [AGE] [RELATIONSHIP] that they have been selected for an
interview and ask that a parent call 1-800-848-4079 to speak with an authorized project representative
if the youth is interested in participating in this study, which asks about tobacco, alcohol, and drug use
or non-use and other health related issues.
We ask that the parent and youth be at home when they call so the youth can begin the interview from
a private location soon after the call is completed.
Also, please have the letter sent to your household with the Participant Code available during this call,
which should only take a few minutes.
Please take a moment now to write down this number and give it to the parent of your [AGE]
[RELATIONSHIP].

36

SPANISH

[IF (TWO YOUTH R SELECTED AND YOUTHR1a = YES AND YOUTHR1b = NO) OR
(TWO YOUTH R SELECTED AND YOUTHR1a = NO AND YOUTHR1b = YES)] Antes de
que su [RELATIONSHIP] de [AGE] años y su [RELATIONSHIP] de [AGE] años puedan
comenzar la entrevista, primero debemos hablar por teléfono con uno de los padres (o
tutor(a)) y obtener su permiso.
Si a su hijo(a) le gustaría participar en esta entrevista y usted está de acuerdo en que su
hijo(a) participe, llame al 1-800-848-4079 para hablar con un representante autorizado del
proyecto. La llamada tomará solo unos minutos para poder hablar sobre la participación
de su hijo(a) en esta entrevista, para proporcionarle información adicional y documentar
su permiso verbal.
Por favor, informe a uno de los padres de su [RELATIONSHIP] de [AGE] años, que él/ella
ha sido seleccionado(a) para una entrevista y pídale a uno de los padres que llame al
1-800-848-4079 para hablar con un representante autorizado si el/la joven está
interesado(a) en participar en este estudio, el cual hace preguntas sobre el uso o no uso
de tabaco, alcohol y drogas, y otros asuntos relacionados con la salud.
Es necesario que uno de los padres y el/la joven estén en casa cuando llamen para que
el/la joven pueda comenzar la entrevista desde un lugar privado poco después de que
finalice la llamada.
También le pedimos que, durante esta llamada, tenga a la mano la carta que se le envió a
su hogar con el código de participante. La llamada tomará solo unos minutos.
Por favor, anote este número ahora y entrégueselo a uno de los padres de su
[RELATIONSHIP] de [AGE] años.

NEXT

YOUTHR4 – SR PARENT/NOT PARENT = NEXT, THEN YOUTHR4A – SR
PARENT/NOT PARENT, REQUEST CONTACT INFO

TABLET

Tablet version does not have this screen.

POP UP

NA

YOUTHR4A – SR PARENT/NOT PARENT, CONTACT INFO
ASK

IF YOUTHR4 – SR PARENT/NOT PARENT = NEXT
[LINK] FAQ [/LINK] [PHONE ICON] [LINK] 800-848-4079 [/LINK]

If you prefer, we can call you to speak about your child’s participation in this interview or to help us
speak to a parent of your [AGE] [RELATIONSHIP] if you provide your first name and phone number.
We will NOT share your name or phone number or contact you for any other reason.
When the project representative calls your phone number and someone answers, they will ask for you
by first name, reference your completion of this screening and mention the age and gender of anyone
selected for an interview to that person. If you and your child are available at that time, the call should
only take a few minutes.
Are you willing to provide your first name and phone number so our project representative can call
you?

37

SPANISH

Si lo prefiere, podemos llamarle para hablar acerca de la participación de su hijo(a) en
esta entrevista o para ayudarnos a hablar con uno de los padres de su [RELATIONSHIP]
de [AGE] años si proporciona su nombre (sin el apellido) y su número de teléfono.
NO compartiremos su nombre o número de teléfono, ni nos comunicaremos con usted
por ninguna otra razón.
Cuando el representante del proyecto llame a su número de teléfono y alguien conteste,
preguntará por usted por su nombre (sin el apellido) y hará referencia a estas preguntas
de selección de participantes que usted completó, y le mencionará a esa persona la edad
y el sexo de cualquier persona seleccionada para una entrevista. Si usted y su hijo(a)
están disponibles en ese momento, la llamada solo debe tomar unos minutos.
¿Estaría dispuesto(a) a proporcionarnos su nombre (sin el apellido) y su número de
teléfono para que un representante del proyecto le pueda llamar?

NEXT

IF YOUTHR4A – SR PARENT/NOT PARENT, CONTACT INFO = YES, THEN YOUTHR4
– SR PARENT/NOT PARENT, PHONE
IF YOUTHR4A – SR IS PARENT, CONTACT INFO = NO, THEN THANK YOU

TABLET

Tablet version does not have this screen.

POP UP

NA

YOUTHR4 – SR PARENT/NOT PARENT, PHONE
ASK

IF YOUTHR4A – SR PARENT/NOT PARENT, CONTACT INFO = YES
[LINK] FAQ [/LINK] [PHONE ICON] [LINK] 800-848-4079 [/LINK]

Please enter your first name and phone number so that our project representative can contact you
about [this/these] upcoming [interview/interviews].
First Name:
OPEN ENDED RESPONSE OPTION
Phone Number:
OPEN ENDED RESPOSE OPTION WITH FAINT PLACEHOLDER TEXT XXX XXXXXXX TO
PROMPT USERS TO ENTER FULL PHONE NUMBER INCLUDING AREA CODE

38

SPANISH

Ingrese su nombre (sin el apellido) y número de teléfono para que nuestro representante
del Proyecto pueda llamarle sobre [esta próxima entrevista] [estas próximas entrevistas].
Nombre (sin el apellido):
OPEN ENDED RESPONSE OPTION
Número de teléfono:
OPEN ENDED RESPOSE OPTION WITH FAINT PLACEHOLDER TEXT XXX XXXXXXX
TO PROMPT USERS TO ENTER FULL PHONE NUMBER INCLUDING AREA CODE

NEXT

IF YOUTHR4 – SR PARENT/NOT PARENT, PHONE = NEXT, THEN THANK YOU

TABLET

Tablet version does not have this screen.

POP UP

NA

CAI START, ADULT ONLY
ASK

IF RESPONDENT SELECTION NE BLANK AND ONE OR TWO ADULT RESPONDENTS
SELECTED
[LINK] FAQ [/LINK] [PHONE ICON] [LINK] 800-848-4079 [/LINK]

[IF ONLY ADULT SELECTED IS SR] If you are interested in participating, you can begin the interview
right now. The survey will take about an hour and should be completed in one sitting at home. It is also
recommended you complete the interview on a computer rather than a phone or tablet, but that is not
required. You will receive a $30 gift card after you complete the interview.
[IF ONE ADULT SELECTED BUT NOT SR OR (TWO ADULTS SELECTED AND ONE INTERVIEW
COMPLETED)] Is this person, your [AGE] [RELATIONSHIP], available? The interview can be started
right now. It will take about an hour and should be completed in one sitting at home. It is also
recommended the interview be completed on a computer rather than a phone or tablet, but that is not
required. Anyone who completes the full interview will receive a $30 gift card at the end of the
interview.
[IF TWO ADULTS SELECTED] Are either of these people available now? The interview can be started
right now. It will take about an hour and should be completed in one sitting at home. It is also
recommended the interview be completed on a computer rather than a phone or tablet, but that is not
required. Anyone who completes the full interview will receive a $30 gift card at the end of the
interview.
[START INTERVIEW BUTTON AND NO BUTTON FOR EACH SELECTED RESPONDENT]

39

SPANISH

[IF ONLY ADULT SELECTED IS SR] Si está interesado(a) en participar, puede comenzar
la entrevista ahora mismo. La entrevista tomará como una hora y media y se debe
completar en una sola sesión desde casa. También se recomienda completar la
entrevista en una computadora en lugar de un teléfono o una tableta, pero eso no es
absolutamente necesario. Usted recibirá una tarjeta de regalo de $30 dólares después de
completar la entrevista.
[IF ONE ADULT SELECTED BUT NOT SR OR (TWO ADULTS SELECTED AND ONE
INTERVIEW COMPLETED)] ¿Está disponible esta persona, su [RELATIONSHIP] de
[AGE] años? La entrevista puede comenzar ahora mismo. Tomará como una hora y
media y se debe completar en una sola sesión desde casa. También se recomienda
completar la entrevista en una computadora en lugar de un teléfono o tableta, pero eso no
es absolutamente necesario. Cualquier persona que complete la entrevista en su totalidad
recibirá una tarjeta de regalo de $30 dólares al final de la entrevista.
[IF TWO ADULTS SELECTED] ¿Está alguna de estas personas disponible ahora? La
entrevista puede comenzar ahora mismo. Tomará como una hora y media y se debe
completar en una sola sesión desde casa. También se recomienda completar la
entrevista en una computadora en lugar de un teléfono o tableta, pero eso no es
absolutamente necesario. Cualquier persona que complete la entrevista en su totalidad
recibirá una tarjeta de regalo de $30 dólares al final de la entrevista.
[START INTERVIEW BUTTON AND NO BUTTON FOR EACH SELECTED
RESPONDENT]

NEXT

IF CAI START, ADULT ONLY = YES, THEN GO TO WEB CAI
IF CAI START, ADULT ONLY = NO, THEN THANK YOU

TABLET

Tablet version does not have this screen.

POP UP

ENGLISH:
To confirm, you are the [AGE] [RELATIONSHIP (IF SR: person)] selected to complete this
interview?
Yes [START INTERVIEW]
No [BACK TO SELECTIONS]
SPANISH:
Solo para confirmar, ¿es usted el/la [RELATIONSHIP (IF SR: persona)] de [AGE] años
seleccionada para completar esta entrevista?
Sí [COMENZAR LA ENTREVISTA]
No [REGRESAR A LA PANTALLA DE SELECCIÓN]

40

CAI START, YOUTH ONLY
ASK

IF RESPONDENT SELECTION NE BLANK AND ONLY YOUTH RESPONDENTS
SELECTED
[LINK] FAQ [/LINK] [PHONE ICON] [LINK] 800-848-4079 [/LINK]

This interview will take about an hour and should be completed in one sitting at home. It is also
recommended you complete the interview on a computer rather than a phone or tablet, but that is not
required. You will receive a $30 gift card after you complete the interview.
[IF YOUTH PERMISSION NOT GIVEN] Please have the parent(s) of your [AGE] [RELATIONSHIP] ([IF
TWO SELECTED: and your [AGE] [RELATIONSHIP]) call 1-800-848-4079 to speak with an authorized
project representative if [the youth is/these youth are] interested in participating in this study, which
asks about tobacco, alcohol, and drug use or non-use and other health related issues.
We ask that the parent and youth be at home when they call so the youth can begin the interview from
a private location soon after the call is completed.
Also, please have the letter sent to your household with the Participant Code available during this call,
which should only take a few minutes.
[IF ONE YOUTH SELECTED AND PERMISSION GIVEN] Is this person, your [AGE]
[RELATIONSHIP], available? The interview can be started right now.
[IF TWO YOUTH SELECTED AND PERMISSION GIVEN] Are either of these two people, your [AGE]
[RELATIONSHIP] and your [AGE] [RELATIONSHIP], available? The interview can be started right
now.
[START INTERVIEW BUTTON AND NO BUTTON FOR EACH SELECTED RESPONDENT]

41

SPANISH

Esta entrevista tomará aproximadamente una hora y debe completarse en una sola
sesión desde casa. También se recomienda completar la entrevista en una computadora
en lugar de un teléfono o tableta, pero eso no es absolutamente necesario. Usted recibirá
una tarjeta de regalo de $30 dólares después de completar la entrevista.
[IF YOUTH PERMISSION NOT GIVEN] Pídale a uno de los padres de su
[RELATIONSHIP] de [AGE] años ([IF TWO SELECTED: y su [RELATIONSHIP] de [AGE]
años que llame al 1-800-848-4079 para hablar con un representante autorizado si [el/la
joven está interesado(a)/estos(as) jóvenes están interesados(as)] en participar en este
estudio, el cual hace preguntas sobre el uso o no uso de tabaco, alcohol y drogas, y otros
asuntos relacionados con la salud.
Es necesario que uno de los padres y el/la joven estén en casa cuando llamen para que
el/la joven pueda comenzar la entrevista desde un lugar privado poco después de que
finalice la llamada.
También le pedimos que, durante esta llamada, tenga a la mano la carta que se le envió a
su hogar con el código de participante. La llamada tomará solo unos minutos.
[IF ONE YOUTH SELECTED AND PERMISSION GIVEN] ¿Está disponible esta persona,
su [RELATIONSHIP] de [AGE] años? La entrevista puede comenzar ahora mismo.
[IF TWO YOUTH SELECTED AND PERMISSION GIVEN] ¿Está disponible cualquiera de
estas personas, su [RELATIONSHIP] de [AGE] años y su [RELATIONSHIP] de [AGE]
años? La entrevista puede comenzar ahora mismo.
[START INTERVIEW BUTTON AND NO BUTTON FOR EACH SELECTED
RESPONDENT]

NEXT

IF CAI START, YOUTH ONLY = YES, THEN GO TO WEB CAI
IF CAI START, YOUTH ONLY = NO, THEN THANK YOU

TABLET

Tablet version does not have this screen.

POP UP

ENGLISH:
To confirm, you are the [AGE] [RELATIONSHIP (IF SR: person)] selected to complete this
interview?
Yes [START INTERVIEW]
No [BACK TO SELECTIONS]
SPANISH:
Solo para confirmar, ¿eres tú el/la [RELATIONSHIP (IF SR: persona)] de [AGE] años
seleccionada para completar esta entrevista?
Sí [COMENZAR LA ENTREVISTA]
No [REGRESAR A LA PANTALLA DE SELECCIÓN]

42

CAI START, ADULT AND YOUTH
ASK

IF RESPONDENT SELECTION NE BLANK AND ONE ADULT AND ONE YOUTH
RESPONDENT SELECTED
[LINK] FAQ [/LINK] [PHONE ICON] [LINK] 800-848-4079 [/LINK]

[ALL] This interview will take about an hour and should be completed in one sitting at home. It is also
recommended you complete the interview on a computer rather than a phone or tablet, but that is not
required. You will receive a $30 gift card after you complete the interview.
[IF YOUTH PERMISSION NOT GIVEN] Please have the parent(s) of your [AGE] [RELATIONSHIP] ([IF
TWO SELECTED: and your [AGE] [RELATIONSHIP]) call 1-800-848-4079 to speak with an authorized
project representative if [the youth is/these youth are] interested in participating in this study, which
asks about tobacco, alcohol, and drug use or non-use and other health related issues.
We ask that the parent and youth be at home when they call so the youth can begin the interview from
a private location soon after the call is completed.
Also, please have the letter sent to your household with the Participant Code available during this call,
which should only take a few minutes.
[IF ADULT SELECTED IS SR AND YOUTH PERMISSION NOT GIVEN] Adults who are selected can
begin the interview right now. If you are interested in participating, you can click the START
INTERVIEW button below.
[IF ADULT SELECTED NOT SR AND YOUTH PERMISSION NOT GIVEN] Adults who are selected
can begin the interview right now. Is this person, your [AGE] [RELATIONSHIP], available?
[IF YOUTH PERMISSION GIVEN] Are either of these people available now? The interview can be
started right now.
[START INTERVIEW BUTTON AND NO BUTTON FOR EACH SELECTED RESPONDENT]
SPANISH

[ALL] Esta entrevista tomará como una hora y media y se debe completar en una sola
sesión desde casa. También se recomienda completar la entrevista en una computadora
en lugar de un teléfono o una tableta, pero eso no es absolutamente necesario. Usted
recibirá una tarjeta de regalo de $30 dólares después de completar la entrevista.
[IF YOUTH PERMISSION NOT GIVEN] Pídale a uno de los padres de su
[RELATIONSHIP] de [AGE] años ([IF TWO SELECTED: y su [RELATIONSHIP] de [AGE]
años que llame al 1-800-848-4079 para hablar con un representante autorizado si [el/la
joven está interesado(a)/estos(as) jóvenes están interesados(as)] en participar en este
estudio, el cual hace preguntas sobre el uso o no uso de tabaco, alcohol y drogas, y otros
asuntos relacionados con la salud.
Es necesario que uno de los padres y el/la joven estén en casa cuando llamen para que
el/la joven pueda comenzar la entrevista desde un lugar privado poco después de que
finalice la llamada.
También le pedimos que, durante esta llamada, tenga a la mano la carta que se le envió a
su hogar con el código de participante. La llamada tomará solo unos minutos.
[IF ADULT SELECTED IS SR AND YOUTH PERMISSION NOT GIVEN] Los adultos que
son seleccionados puede comenzar la entrevista ahora mismo. Si está interesado(a) en
participar, puede hacer clic en el botón COMENZAR LA ENTREVISTA a continuación.
[IF ADULT SELECTED NOT SR AND YOUTH PERMISSION NOT GIVEN] Los adultos
que son seleccionados puede comenzar la entrevista ahora mismo. ¿Está disponible esta
persona, su [RELATIONSHIP] de [AGE] años?
[IF YOUTH PERMISSION GIVEN] ¿Está cualquiera de estas personas disponible en este
momento? La entrevista puede comenzar ahora mismo.
[START INTERVIEW BUTTON AND NO BUTTON FOR EACH SELECTED
RESPONDENT]

43

NEXT

IF CAI START, ADULT AND YOUTH = YES, THEN GO TO WEB CAI
IF CAI START, ADULT AND YOUTH = NO, THEN THANK YOU

TABLET

Tablet version does not have this screen.

POP UP

ENGLISH:
To confirm, you are the [AGE] [RELATIONSHIP (IF SR: person)] selected to complete this
interview?
Yes [START INTERVIEW]
No [BACK TO SELECTIONS]
SPANISH:
IF ADULT: Solo para confirmar, ¿es usted el/la [RELATIONSHIP (IF SR: persona)] de
[AGE] años seleccionada para completar esta entrevista?
Sí [COMENZAR LA ENTREVISTA]
No [REGRESAR A LA PANTALLA DE SELECCIÓN]
IF YOUTH: Solo para confirmar, ¿eres tú el/la [RELATIONSHIP (IF SR: persona)] de
[AGE] años seleccionada para completar esta entrevista?
Sí [COMENZAR LA ENTREVISTA]
No [REGRESAR A LA PANTALLA DE SELECCIÓN]

44

THANK YOU
ASK

IF (IDENTIFY SR1 = NO) OR (IDENTIFY SR2 = NO) OR (OCCUPANCY = NO) OR
(TOTAL SDU MEMBERS = 0 POP UP = 0) OR (MEMBERS 12 OR OLDER = 0 POP UP
= 0) OR (RESPONDENT SELECTION = BLANK) OR (SR PHONE1 = NO) OR (SR
PHONE2 = NEXT) OR (YOUTHR2A – SR NOT PARENT, REQUEST CONTACT INFO =
NO AND NO OTHER RESPONDENT SELECTED) OR (SR PHONE = NEXT AND NO
OTHER RESPONDENT SELECTED) OR (YOUTHR3A – SR IS PARENT, CONTACT
INFO = NO AND NO OTHER RESPONDENT SELECTED) OR (YOUTHR3A – SR IS
PARENT, PARENT PHONE = NEXT AND NO OTHER RESPONDENT SELECTED) OR
(CAI START, ADULT = NO)
[LINK] FAQ [/LINK] [PHONE ICON] [LINK] 800-848-4079

[/LINK]

[IF IDENTIFY SR1 = NO OR IDENTIFY SR2 = NO] An adult resident at this address must complete
these questions. Thank you for your time.
[TOTAL SDU MEMBERS = 0 POP UP = 0 OR MEMBERS 12 OR OLDER = 0 POP UP = 0] Thank you
for your time.
[OCCUPANCY = NO] Thank you for your time. This household is not eligible to participate in this
study.
[RESPONDENT SELECTION = BLANK] No one in your household has been selected for an interview.
Thank you for your time.
[IF SR SELECTED AND START CAI NOT SELECTED] Please come back to this page to begin the
survey. The interview can be started at any time. It will take about an hour and should be completed in
one sitting at home. It is also recommended the interview be completed on a computer rather than a
phone or tablet, but that is not required. Anyone who completes the full interview will receive a $30 gift
card at the end of the interview. Thank you for your time. Please click the Exit button.
[IF SR NOT SELECTED AND START CAI NOT SELECTED] Please inform those in your household of
their selection for the interview and please provide the letter you received with the website address and
participant code. The interview can be started at any time. It will take about an hour and should be
completed in one sitting at home. It is also recommended the interview be completed on a computer
rather than a phone or tablet, but that is not required. Anyone who completes the full interview will
receive a $30 gift card at the end of the interview. Thank you for your time. Please click the Exit button.
[IF (SR PHONE = NEXT AND NO OTHER RESPONDENT SELECTED) OR (IF YOUTHR3A – SR IS
PARENT, PARENT PHONE = NEXT AND NO OTHER RESPONDENT SELECTED, THEN THANK
YOU)] A project representative will call you soon at the telephone number you provided to get parental
permission to conduct the interviews. Or a parent may call 1-800-848-4079 to speak with an authorized
project representative to provide permission. Please note, to protect your privacy, interviewers are not
permitted to communicate via text message. Thank you for your time. Please click the Exit button. [IF
(YOUTHR3A – SR IS PARENT, CONTACT INFO = NO AND NO OTHER RESPONDENT
SELECTED) OR (YOUTHR4A – SR IS PARENT, CONTACT INFO = NO) OR (YOUTHR2A – SR NOT
PARENT, REQUEST CONTACT INFO = NO AND NO OTHER RESPONDENT SELECTED)] Thank
you for your time. Please inform the parent(s) of [IF ONE YOUTH SELECTED: this youth] [IF TWO
YOUTH SELECTED: these youth] that they have been selected for an interview and ask that a parent
call 1-800-848-4079 to speak with an authorized project representative if the youths are interested in
participating in this study, which asks about tobacco, alcohol, and drug use or non-use and other
health related issues.
We ask that the parent and youth be at home when they call so the youth can begin the interview from
a private location soon after the call is completed.
Also, please ask the parent to have the letter sent to your household with the Participant Code
available during this call, which should only take a few minutes.
Please take a moment now to write down this number and give it to the parent.

45

SPANISH

NEXT

[IF IDENTIFY SR1 = NO OR IDENTIFY SR2 = NO] Una persona adulta que viva en esta
dirección debe completar estas preguntas. Gracias por su tiempo.
[TOTAL SDU MEMBERS = 0 POP UP = 0 OR MEMBERS 12 OR OLDER = 0 POP UP =
0] Gracias por su tiempo.
[OCCUPANCY = NO] Gracias por su tiempo. Este hogar no reúne los requisitos para
participar en este estudio.
[RESPONDENT SELECTION = BLANK] Nadie en su hogar ha sido seleccionado para
una entrevista. Gracias por su tiempo.
[IF SR SELECTED AND START CAI NOT SELECTED] Regrese a esta página para
comenzar la encuesta. La entrevista se puede iniciar en cualquier momento. Tomará
como una hora y media y se debe completar en una sola sesión desde casa. También se
recomienda completar la entrevista en una computadora en lugar de un teléfono o tableta,
pero eso no es absolutamente necesario. Cualquier persona que complete la entrevista
en su totalidad recibirá una tarjeta de regalo de $30 dólares al final de la entrevista.
Gracias por su tiempo. Haga clic en el botón Salir.
[IF SR NOT SELECTED AND START CAI NOT SELECTED] Por favor, informe a los
miembros de su hogar que han sido seleccionados para la entrevista y proporcione la
carta que recibió donde se indica el sitio web y el código de participante. La entrevista se
puede iniciar en cualquier momento. Tomará como una hora y media y se debe completar
en una sola sesión desde casa. También se recomienda completar la entrevista en una
computadora en lugar de un teléfono o tableta, pero eso no es absolutamente necesario.
Cualquier persona que complete la entrevista en su totalidad recibirá una tarjeta de regalo
de $30 dólares al final de la entrevista. Gracias por su tiempo. Haga clic en el botón Salir.
[IF (SR PHONE = NEXT AND NO OTHER RESPONDENT SELECTED) OR (IF
YOUTHR3A – SR IS PARENT, PARENT PHONE = NEXT AND NO OTHER
RESPONDENT SELECTED, THEN THANK YOU)] Un representante del proyecto lo(a)
llamará pronto al número de teléfono que proporcionó para obtener permiso de uno de los
padres para realizar las entrevistas. O uno de los padres puede llamar al 1-800-848-4079
para hablar con un representante autorizado del proyecto para proporcionar el permiso.
Tenga en cuenta que, para proteger su privacidad, los entrevistadores no pueden
comunicarse por mensaje de texto. Gracias por su tiempo. Haga clic en el botón Salir. [IF
(YOUTHR3A – SR IS PARENT, CONTACT INFO = NO AND NO OTHER RESPONDENT
SELECTED) OR (YOUTHR4A – SR IS PARENT, CONTACT INFO = NO) OR
(YOUTHR2A – SR NOT PARENT, REQUEST CONTACT INFO = NO AND NO OTHER
RESPONDENT SELECTED)] Gracias por su tiempo. Por favor, informe a uno de los
padres de [IF ONE YOUTH SELECTED: este(a) joven, que ha sido seleccionado(a)] [IF
TWO YOUTH SELECTED: estos(as) jóvenes, que han sido seleccionados(as)] para una
entrevista y pídale a uno de los padres que llame al 1-800-848-4079 para hablar con un
representante autorizado del proyecto si los jóvenes están interesados en participar en
este estudio, el cual hace preguntas sobre el uso o no uso de tabaco, alcohol y drogas, y
otros asuntos relacionados con la salud.
Es necesario que uno de los padres y el/la joven estén en casa cuando llamen para que
el/la joven pueda comenzar la entrevista desde un lugar privado poco después de que
finalice la llamada.
También pídale a uno de los padres que, durante esta llamada, tenga a la mano la carta
que se le envió a su hogar con el código de participante. La llamada tomará solo unos
minutos.
Por favor, anote este número ahora y entrégueselo a uno de los padres.
NA

TABLET

Tablet version does not have this screen.

POP UP

NA

46