Attachment II: Cognitive Interview Protocol
National Health Interview Survey for Teens
(NHIS-TEEN)
Cognitive Interviews
OMB# 0607-0725
November 2023
Cognitive Testing of NHIS TEEN
PARTICIPANT ID #: _________________________ DATE: ____ / ____ / ___
INTERVIEWER’S NAME:_________________________________________________
START TIME: ______: ______ AM / PM
Hello, my name is ______ and I work for the Census Bureau. It’s nice to meet you and thank you very much for helping us out today.
IF NECESSARY, CREATE SMALL TALK TO BUILD RAPPORT WITH THE TEEN BY ASKING A QUESTION, SUCH AS:
What is your favorite subject in school? RESPOND ACCORDINGLY (e.g., if the teen responds with “science,” ask them what they are studying in their science class).
Let me start by telling you a little bit about what we're doing here. The Census Bureau administers many surveys in addition to counting people in the US every 10 years. Since so many agencies rely on data from the Census Bureau, it is extremely important that this information be as accurate as possible.
In order to help us improve our surveys, we turn to teens like you to find out if our questions make sense and are easy to understand and answer. The survey we'll talk about today is conducted by the National Center for Health Statistics, which is part of the Centers for Disease Control and Prevention, or CDC. It’s important that the data from the survey itself is as accurate as possible because it is being used to help us learn about the health and well-being of America's teens. The research we’re doing today will help us figure out if changes we have made to the questionnaire are working for teens like you, and it will help us improve the accuracy of data.
I'm going to go through the questionnaire like a real interview, but I'm mainly interested in your reactions to the questions. So after we go through the survey questions, I’m going to ask you some follow up questions about the survey questions you answered. For example, I might reread a question from the survey, and ask you what certain words or phrases in the question mean to you, or what you were thinking about when you were answering. Whenever I reread a question from the survey, I will show the question wording on the screen for you to reference. There are no right or wrong answers, we just want to know your thoughts and reactions to the questions to help us make them better so that other teens like you can easily understand them. The things we will talk about in the interview today will only be used in our research to help us improve the survey. Your name will not be attached to anything you say. Direct quotes may be used in research papers and professional presentations, but your name and any names you might mention today will never be used in our reports and presentations.
Your parent signed a form giving you permission to participate today. I am going to tell you about what was in that document. The document that your parent signed explains the purpose of the study and how we will protect your information. In addition to what I have just mentioned about never sharing your name or any names you say during the interview, I would like to draw your attention to the fact that:
Your participation is voluntary and you may stop the interview at any time
You can refuse to answer any of the questions asked or take a break at any time
By law, your answers cannot and will NOT be shared with anyone, including your parents or guardians without your permission.
As stated in the form, we would like to record this interview to assist in our ability to write a report summarizing the interview.
ASK PARTICIPANT IF (S)HE HAD ANY QUESTIONS ABOUT THE CONSENT FORM.
While you are responding to the survey, I’d like you to tell me what’s going through your mind. What I would like you to do is tell me what you are thinking and feeling as you come up with your answers. This could include any thought that comes to mind when reading a question or answering a question, or any reactions you’re having. You do not have to read aloud if you would not do that at home. I might remind you to think aloud if you start getting quiet.
No practice think aloud. Encourage respondents to think aloud as needed throughout interview.
I'd like to ask for your permission to record the session today. The main reason we record these interviews is so that we don't have to rely on notes or our memories later. This allows me to concentrate on what you're saying during the interview.
Do you have any questions about the recording?
AFTER ANSWERING QUESTIONS AND GIVING FURTHER EXPLANATION, CONTINUE. IF THE PARTICIPANT IS NO LONGER INTERESTED IN PARTICIPATING, THANK THE PARTICIPANT FOR THEIR TIME AND END THE INTERVIEW.
Screen Sharing
I am going to need you to go ahead and share your screen with us. Make sure you have closed any windows you do not want us to record as the recording is turned on.
Now - do you see the share icon? It might look like a square with an arrow pointing up. Go ahead and click on that.
[IF ABLE TO SEE SCREEN] Okay great I can see your screen. Now we can get started with the task.
[IF UNABLE TO SEE SCREEN, WILL NEED TO TROUBLESHOOT]
We’re going to start the survey now. I’m going to paste a link in the chat, could you please click that link to start the survey?
[All teens]:
Are you comfortable with me recording this interview?
IF PARTICIPANT PROVIDES CONSENT TO HAVE THE SESSION RECORDED:
I’m going to turn on the recording now, and once it is on, I’m going to ask for your permission to record today, and then we will get started.
TURN ON RECORDING, ASK FOR PERMISSION TO RECORD ON THE TAPE, AND BEGIN THE INTERVIEW.
OK, let’s begin.
INTERVIEWER INSTRUCTIONS:
Note any confusion or difficulties respondents have with the questions.
[LINK TO SURVEY HERE]
RETROSPECTIVE PROBING (R=respondent):
IF YOU NOTICED R HAVING COGNITIVE DIFFICULTY ANSWERING ANY OF THE SURVEY QUESTIONS THAT HAVE PROBES, MAKE SURE TO MAKE A NOTE OF R’S DIFFICULTY FOR LATER FOLLOW UP. WHEN ASKING THE SCRIPTED RETROSPECTIVE PROBES, BE SURE TO PROBE ON ANY OF THE RESPONDENT’S APPARENT DIFFICULTY OR HESITATION THAT YOU NOTICED.
2024 National Health Interview Survey for Teens (NHIS TEEN)
(See Attachment II for the full text of the 2024 National Health Interview Survey for Teens (NHIS-Teen) to be tested. The respondents will answer the survey while thinking aloud. There will be no probing during the survey. If a respondent asks for clarification during the survey, interviewers will encourage the respondent to answer the question as they would if the interviewer was not able to provide clarification. After the full survey has been administered, the interviewer will administer the probing questions in Section 5.)
Now we’re going to switch gears and I’m going to ask you questions about some of the survey questions you just answered. As a reminder, there are no right or wrong answers. We’re just interested in understanding how the questions are working and seeing if there’s anything we need to do to make them more clear.
[Note: Interviewers will be trained to use the scripted probes as necessary to elicit the desired information. If a teens responses to scripted probes are not sufficient to answer the research questions, interviewers will ask additional unscripted probes in an attempt to gather more information. Similarly, if teens provide ample information in response to an earlier probe, interviewers may skip subsequent probes that are asking for redundant information. When necessary, interviewers may ask a redundant probe to confirm that they correctly understood what the teen previously explained.]
Probes (PADAYS):
[INSTRUCT R TO PROCEED TO NEXT SCREEN WHICH WILL DISPLAY A COPY OF PADAYS]
[PADAYS 17. In a typical week during the school year, how often do you exercise, play a sport, or participate in physical activity for at least 60 minutes a day?]
This is one question I asked. Earlier, when you responded to this question, you answered____.
How did you come up with your answer to this question? [If needed] Can you tell me more about that?
What time frame were you thinking of when answering this question?
[If needed] Did any other physical activity come to mind when answering this question? Which one?
Probes (STRENGTH):
[INSTRUCT R TO PROCEED TO NEXT SCREEN WHICH WILL DISPLAY A COPY OF STRENGTH]
[STRENGTH 18. In a typical week during the school year, how often do you do exercises to strengthen or tone your muscles, such as sit-ups, push-ups, or lifting weights?]
This is another question I asked. Earlier, when you saw this question, you answered____.
How did you come up with your answer to this question?
"Did any other exercises to strengthen or tone your muscles come to mind when answering this question? [If needed] Which one?
Probes (PHONESLEEP):
[INSTRUCT R TO PROCEED TO NEXT SCREEN WHICH WILL DISPLAY A COPY OF PHONESLEEP][NEW PHONESLEEP 22 . How long before going to sleep do you last use a smartphone, tablet, or other device with a screen in the room where you sleep?
This is another question I asked. Earlier, when you saw this question, you answered____.
Can you tell me what this question is asking in your own words?
What devices with a screen do you use in the room where you sleep?
Probes (SLEEPPILL):
[INSTRUCT R TO PROCEED TO NEXT SCREEN WHICH WILL DISPLAY A COPY OF SLEEPPILL]
[NEW SLEEPPILL 23. How often do you take medication to help you fall asleep or stay asleep?
Include both prescribed and over-the-counter medication.]
This is another question I asked. Earlier, when you saw this question, you answered____.
How did you come up with your answer to this question?
What are some examples of this type of medication?
Have you taken anything to help you sleep but you didn’t think they would count for this question? [If yes] Can you tell me more about why you didn’t think they would count?
Probes (SOCIALMEDIA):
[INSTRUCT R TO PROCEED TO NEXT SCREEN WHICH WILL DISPLAY A COPY OF SOCIALMEDIA]
[NEW SOCIALMEDIA 24. The next question asks about social media, such as Instagram, TikTok, Snapchat, and Twitter/X. How often do you use social media?]
This is another question I asked. Earlier, when you saw this question, you answered____.
How did you come up with your answer to this question?
What comes to mind when you hear the term “social media”?
Which social media platforms do you use the most?
Are there other social media platforms that you think should be included on this list?
Probes (WEIGHTPILL):
[INSTRUCT R TO PROCEED TO NEXT SCREEN WHICH WILL DISPLAY A COPY OF WEIGHTPILL][NEW WEIGHTPILL 27. Have you ever vomited or taken laxatives to lose weight or to keep from gaining weight?]
This is another question I asked. Earlier, when you saw this question, you answered____.
How did you come up with your answer to this question?
What does the term “laxatives” mean in your own words?
Probes (TBILOSTCON):
[INSTRUCT R TO PROCEED TO NEXT SCREEN WHICH WILL DISPLAY A COPY OF TBILOSTCON]
[TBILOSTCON 28.During the past 12 months, as a result of a blow or jolt to the head, have you ever been knocked out or lost consciousness?]
This is another question I asked. Earlier, when you saw this question, you answered____.
Can you tell me what this question is asking in your own words?
What does the phrase “a blow or jolt to the head” mean to you? [If specific examples not mentioned] Can you give some examples of a blow or jolt to the head?
Was there anything you were unsure about whether it counted for this question?
Probes (TBIDAZED):
[INSTRUCT R TO PROCEED TO NEXT SCREEN WHICH WILL DISPLAY A COPY OF TBIDAZED]
[TBIDAZED 29. During the past 12 months, as a result of a blow or jolt to the head, have you ever been dazed or had a gap in your memory?]
This is another question I asked. Earlier, when you saw this question, you answered____.
What does the term “dazed” mean to you?
Probes (TBIHEADSYM):
[INSTRUCT R TO PROCEED TO NEXT SCREEN WHICH WILL DISPLAY A COPY OF TBIHEADSYN]
[TBIHEADSYM 30. During the past 12 months, as a result of a blow or jolt to the head, have you had headaches, vomiting, blurred vision, or changes in mood or behavior?]
This is another question I asked. Earlier, when you saw this question, you answered____.
What does the phrase “changes in mood or behavior” mean to you in this question?
Probes (NEWCHANGES):
[INSTRUCT R TO PROCEED TO NEXT SCREEN WHICH WILL DISPLAY A COPY OF NEWCHANGES]
[NEWCHANGES 34. During the past 12 months, has a doctor or other health care professional talked to you about understanding the changes in health care that happen at age 18?
This can include understanding changes in privacy, consent, access to information, or decision-making.]
This is another question I asked. Earlier, when you saw this question, you answered____.
What types of changes in health care did you think about when answering this question?
Probes (GAINSKILLS):
[INSTRUCT R TO PROCEED TO NEXT SCREEN WHICH WILL DISPLAY A COPY OF GAINSKILLS]
[GAINSKILLS 36. During the past 12 months, has a doctor or other health care professional talked to you about gaining skills to manage your health and health care?]
This is another question I asked. Earlier, when you saw this question, you answered____.
What type of skills did you think about when answering this question?
Probes (EATPLAY): [Probe asked if they answered yes to the survey question]
[INSTRUCT R TO PROCEED TO NEXT SCREEN WHICH WILL DISPLAY A COPY OF SOCIALMEDIA]
[NEW EATPLAY 37. During the past 12 months, has a doctor or other health care professional talked to you about eating healthy or getting regular exercise?]
This is another question I asked. Earlier, when you saw this question, you answered yes.
Did your doctor talk to you about one or both of these things? [If yes] What types of things did your doctor talk to you about?
Probes (SCRNSI):
[INSTRUCT R TO PROCEED TO NEXT SCREEN WHICH WILL DISPLAY A COPY OF SCRNSI]
[NEW SCRNSI 40. During the past 12 months, has a doctor or other health care professional asked you if you had feelings of wanting to end your life?
This could include you filling out a questionnaire about how you have been feeling recently.]
This is another question I asked. Earlier, when you saw this question, you answered____.
Can you tell me in your own words what this question is asking?
Probes (SHEALTH):
[INSTRUCT R TO PROCEED TO NEXT SCREEN WHICH WILL DISPLAY A COPY OF SOCIALMEDIA]
[SHEALTH 41. During the past 12 months, has a doctor or other health care professional talked with you about changes to your developing body or safe sex practices?
This is another question I asked. Earlier, when you saw this question, you answered____.
How did you come up with your answer to this question?
[If yes to the survey question] Did your doctor talk to you about one or both of these things?
Are these topics you feel comfortable talking to your doctor about?
Probes (MHTHRPYSCH):
[INSTRUCT R TO PROCEED TO NEXT SCREEN WHICH WILL DISPLAY A COPY OF MHTHRPSYCH]
[NEW MHTHRPYSCH 44. During the past 12 months, did you receive counseling or therapy through the school system, such as seeing a school social worker, a school psychologist, or a school counselor?]
This is another question I asked. Earlier, when you saw this question, you answered____.
Can you tell me in your own words what this question is asking?
[If they answered yes to the survey question] Who were you thinking of when you answered yes to this question? [If not specified] Do you know what their role is at your school?
Are there other people at your school that provide these services?
Probes (MHTHNDSGMA):
[INSTRUCT R TO PROCEED TO NEXT SCREEN WHICH WILL DISPLAY A COPY OF MHTHNDSGMA]
[MHTHNDSGMA 46. During the past 12 months, was there any time when you needed counseling or therapy from a mental health professional, but did not get it because you were afraid of what others would think of you?]
This is another question I asked. Earlier, when you saw this question, you answered____.
Can you tell me in your own words what this question is asking?
Who are the type of individuals that teens wouldn’t want to know if they needed counseling or therapy?
What are some examples of a mental health professional?
Probes (MHTHNDDKH):
[INSTRUCT R TO PROCEED TO NEXT SCREEN WHICH WILL DISPLAY A COPY OF MHTHNDDKH]
[MHTHNDDKH 47. During the past 12 months, was there any time when you needed counseling or therapy from a mental health professional, but did not get it because you didn’t know where to go or how to get help?]
This is another question I asked. Earlier, when you saw this question, you answered____.
How did you come up with your answer to this question?
Do you know of ways teens could get help if they needed counseling or therapy?
Probes (MHONLINE):
[INSTRUCT R TO PROCEED TO NEXT SCREEN WHICH WILL DISPLAY A COPY OF MHONLINE]
[NEW MHONLINE 48. During the past 12 months, have you tried to get help from an on-line tool, including mobile apps or texting services, to help with your emotions, concentration, behavior, or mental health?]
This is another question I asked. Earlier, when you saw this question, you answered____.
What mobile apps or texting services were you thinking about when you answered this question?
Were there any online tools you’ve used that you didn’t think would count for this question? [If yes and needed] What made you decide they didn’t count here?
Probes (UNFAIRRE):
[INSTRUCT R TO PROCEED TO NEXT SCREEN WHICH WILL DISPLAY A COPY OF SOCIALMEDIA]
[UNFAIRRE 60. Has anyone ever treated or judged you unfairly because of your race, ethnic background, or national origin?]
This is another question I asked. Earlier, when you saw this question, you answered____.
What does the phrase “ethnic background” mean to you in this question?
What does “national origin” mean to you in this question?
Probes (UNFAIRAP):
[INSTRUCT R TO PROCEED TO NEXT SCREEN WHICH WILL DISPLAY A COPY OF UNFAIRAP]
[NEW UNFAIRAP 62. Has anyone ever treated or judged you unfairly because of a health condition or disability you may have?]
This is another question I asked. Earlier, when you saw this question, you answered____.
How easy or difficult was it to answer this question? [If needed] Can you tell me more about that?
Probes (SIMPACT):
[INSTRUCT R TO PROCEED TO NEXT SCREEN WHICH WILL DISPLAY A COPY OF SIMPACT]
[NEW SIMPACT 63. During the past 12 months, has anyone close to you planned, attempted, or died by suicide?]
This is another question I asked. Earlier, when you saw this question, you answered____.
What does the phrase “close to you” mean to you in this question?
Probes (SELFHARM):
[INSTRUCT R TO PROCEED TO NEXT SCREEN WHICH WILL DISPLAY A COPY OF SELFHARM]
[NEW SELFHARM 64. Have you ever hurt yourself on purpose without wanting to die, such as cutting, burning, or bruising yourself?]
This is another question I asked. Earlier, when you saw this question, you answered____.
Can you tell me in your own words what this question is asking?
Probes (CYBERVIC): [ABLE TO BE SKIPPED IF RUNNING LOW ON TIME]
[INSTRUCT R TO PROCEED TO NEXT SCREEN WHICH WILL DISPLAY A COPY OF CYBERVIC]
[CYBERVIC 66. During the past 12 months, have you ever been electronically bullied?
Count being bullied through texting, Instagram, Facebook, Snapchat, or other social media.]
This is another question I asked. Earlier, when you saw this question, you answered____.
In your own words, what does it mean to be “electronically bullied?”
Probes (RESPECT): [ABLE TO BE SKIPPED IF RUNNING LOW ON TIME]
[INSTRUCT R TO PROCEED TO NEXT SCREEN WHICH WILL DISPLAY A COPY OF RESPECT]
[RESPECT 69. You are treated with less courtesy or respect than other people your age.]
This is another question I asked. Earlier, when you saw this question, you answered____.
Can you tell me in your own words what this question is asking?
What are some examples of being treated with less courtesy or respect?
Probes (POORSERVICE): [ABLE TO BE SKIPPED IF RUNNING LOW ON TIME]
[INSTRUCT R TO PROCEED TO NEXT SCREEN WHICH WILL DISPLAY A COPY OF POORSERVICE]
[POORSERVICE 70. You receive poorer service than other people your age at restaurants or stores.]
This is another question I asked. Earlier, when you saw this question, you answered____.
What comes to mind when you hear the phrase “poorer service” in this question?
Probes (NOTSMART): [ABLE TO BE SKIPPED IF RUNNING LOW ON TIME]
[INSTRUCT R TO PROCEED TO NEXT SCREEN WHICH WILL DISPLAY A COPY OF NOTSMART]
[NOTSMART 71. People act as if they think you are not smart.]
This is another question I asked. Earlier, when you saw this question, you answered____.
How did you come up with your answer to this question?
Probes (LSATIS11):
[INSTRUCT R TO PROCEED TO NEXT SCREEN WHICH WILL DISPLAY A COPY OF LSATIS11]
[LSATIS11 2. Using a scale of 0 to 10, where 0 means "very dissatisfied" and 10 means "very satisfied", how do you feel about your life as a whole these days?]
This is another question I asked. Earlier, when you saw this question, you answered____.
How did you come up with your answer? [If needed] Can you tell me a little bit more about that?
What does the phrase “these days” mean to you in this question?
Probes (WELL):
[INSTRUCT R TO PROCEED TO NEXT SCREEN WHICH WILL DISPLAY A COPY OF INTRO1 AND WELL]
[NEW Intro1. We would like to know what thoughts about your life you've had during the past several weeks. Think about how you spend each day and night, and then think about how your life has been during most of this time. For each statement, indicate if you strongly disagree, disagree, agree, or strongly agree.
NEW WELL 3. My life is going well.]
Earlier, your response to this question was ____.
All respondents:
How easy or difficult was it to answer this question? [If needed] Can you tell me more about that?
What does “going well” mean to you in this question?
What time frame were you thinking of when you answered this question?
How many days is “several” days to you?
Probes (WLDCHNG):
[INSTRUCT R TO PROCEED TO NEXT SCREEN WHICH WILL DISPLAY A COPY OF WLDCHNG]
[NEW WLDCHNG 5. I would like to change many things in my life.]
This is another question I asked. Earlier, when you saw this question, you answered____.
How easy or difficult was it to answer this question? [If needed] Can you tell me more about that?
What kinds of things were you thinking about when you answered this question?
Probes (GOODLIFE):
[INSTRUCT R TO PROCEED TO NEXT SCREEN WHICH WILL DISPLAY A COPY OF GOODLIFE]
[NEW GOODLIFE 7. I have a good life.]
This is another question I asked. Earlier, when you saw this question, you answered____.
What does the word “a good life” mean to you in this question? [If needed] Can you tell me more about that?
Probes (MANAGE): [ABLE TO BE SKIPPED IF RUNNING LOW ON TIME]
[INSTRUCT R TO PROCEED TO NEXT SCREEN WHICH WILL DISPLAY A COPY OF MANAGE]
[MANAGE. When something upsetting happens to you, how often can you manage your emotions?]
This is another question I asked. Earlier, when you saw this question, you answered____.
How did you come up with your answer to this question? [If needed] Can you tell me more about that?
What does the term “manage” mean to you in this question?
Probes (STRESSFUL): [ABLE TO BE SKIPPED IF RUNNING LOW ON TIME]
[INSTRUCT R TO PROCEED TO NEXT SCREEN WHICH WILL DISPLAY A COPY OF STRESSFUL]
[STRESSFUL 12. When something stressful happens to you, how often can you deal with it in positive ways?]
This is another question I asked. Earlier, when you saw this question, you answered____.
How did you come up with your answer to this question?
Can you give some examples of positive ways someone might deal with stressful events?
Probes (SUPPORT): [ABLE TO BE SKIPPED IF RUNNING LOW ON TIME]
[INSTRUCT R TO PROCEED TO NEXT SCREEN WHICH WILL DISPLAY A COPY OF MHONLINE]
[SUPPORT 51. How often do you get the social and emotional support you need?]
This is another question I asked. Earlier, when you saw this question, you answered____.
Can you tell me in your own words what this question is asking?
What does the phrase “emotional support” mean to you in this question?
What does the phrase “social support” mean to you in this question?
Probes (LACKCOM):
[INSTRUCT R TO PROCEED TO NEXT SCREEN WHICH WILL DISPLAY A COPY OF LACKCOM]
[NEW LACKCOM 57. How often do you feel that you lack companionship?]
This is another question I asked. Earlier, when you saw this question, you answered____.
What does companionship mean to you in this question?
Probes (SAFE): [ABLE TO BE SKIPPED IF RUNNING LOW ON TIME]
[INSTRUCT R TO PROCEED TO NEXT SCREEN WHICH WILL DISPLAY A COPY OF SAFE]
[NEW SAFE 72. I feel safe in my neighborhood.]
This is another question I asked. Earlier, when you saw this question, you answered____.
What do you think of as your neighborhood?
[If needed] What does “feel safe” mean to you in this question?
Debriefing Questions:
Overall, what did you think of this survey? Was it easy or difficult?
Is there anything you wanted to say about the survey questions that you haven’t had a chance to talk about yet?
Those are all of the questions that I had for you today. Thank you very much for your participation. We will be mailing out your $50 incentive for participating in this study in the next few days. Since some of the questions we discussed today deal with sensitive topics, we are also including a handout with both general health resources as well as a few resources for teen help lines that some teens might find useful. If you’d like, we can also email you those links right now. Would you like us to email them? Or send them in the chat? [If yes to email] What email address should we send them to?
TURN OFF THE RECORDING
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | Betsari Otero Class (CENSUS/CBSM FED) |
| File Modified | 0000-00-00 |
| File Created | 2025-08-12 |