Attachment A: Rapid Surveys System Round 8 Questionnaire
Substance Abuse and Mental Health Services Administration (SAMHSA), Center for Behavioral Health Statistics and Quality (CBHSQ) – National Survey on Drug Use and Health (NSDUH)
Substance use prevalence
Risk perceptions of substance use
Suicidal thoughts, plans, and attempts
Generalized Anxiety Disorder Scale (GAD-7)
Arrested and booked for breaking the law
Mental Health Treatment
Alcohol and Drug Treatment
Overdoes reversal
Recovery from drug and alcohol use
Recovery from mental health problems
National Center for Injury Prevention (NCIPC), Division of Injury Prevention (DIP) – Artificial Intelligence, suicide, and help seeking behaviors
Use of AI chatbot or companion
Use of AI chatbot or companion for emotional support
Time spent using AI chatbot or companion for emotional supports
Use of AI chatbot or companion while having suicidal thoughts
Feeling understood by AI chatbot or companion
Sense of connection with AI chatbot or companion
Sense of pandering from AI chatbot or companion
Trust advice from AI chatbot and companion
AI chatbot and companions can think the same way as a human
Ever received advice from AI chatbot or companion that felt harmful
Preference for AI chatbot or human for emotional support
NCHS
Rapid Survey System - Round 8
MODE = WEB, CATI (NORC ONLY)
REFUSALS/DON’T KNOW:
CAWI REFUSALS/DK:
DO NOT INCLUDE DON’T KNOW/REFUSED OPTIONS ON SCREEN FOR CAWI UNLESS SPECIFIED IN ITEM RESPONSE OPTIONS. CODE REFUSALS/SKIPS AS FOLLOWS:
IMPLICIT REFUSAL/WEB SKIP = -6
DON’T KNOW (WHEN SPECIFIED ON SCREEN) = -9
CATI REFUSALS/DK:
INCLUDE THE FOLLOWING DON’T KNOW/REFUSED OPTIONS FOR INTERVIEWERS ON SCREEN FOR ALL QUESTIONS IN CATI. INTERVIEWERS SHOULD NOT READ REF/DK OPTIONS UNLESS OTHERWISE SPECIFIED IN RESPONSE OPTIONS. CODE AS FOLLOWS:
REFUSAL = -7
DON’T KNOW = -9
LEGITIMATE SKIPS
CODE ALL LEGITIMATE SKIPS FOR CATI AND CAWI AS FOLLOWS:
ANSWER REQUIREMENT/ PROMPTS AND VALIDATION
RESPONDENTS SHOULD BE ABLE TO SKIP ALL ITEMS, AND NO ITEMS SHOULD BE REQUIRED. DO NOT USE SOFT PROMPTS FOR ITEMS THAT ARE SKIPPED. ERROR/VALIDATION MESSAGES (E.G., OUT OF BOUNDS RESPONSES) SHOULD BE PROGRAMMED AS SPECIFIED.
QUESTION INFORMATION FORMATTING:
ALL QUESTIONS WILL BE FORMATTED AS FOLLOWS:
[UNIVERSE/SKIP LOGIC]
[QUESTION TYPE]
DISP = TEXT DISPLAY
S = SINGLE RESPONSE
M = MULTI-CHECK
NUMBOX = NUMERIC INPUT
TEXTBOX = TEXT INPUT
GRID = MATRIX GRID
VARIABLE NAME
QUESTION STEM
IF CAWI/CATI QUESTION TEXT IS DIFFERENT, “[CAWI]” AND “[CATI]” WILL PRECEDE MODE SPECIFIC TEXT
CAWI RESPONSE OPTIONS
CATI RESPONSE OPTIONS IF DIFFERENT FROM CAWI; ELSE ONLY ONE COMMON SET OF RESPONSE OPTIONS WILL BE SPECIFIED.
CATI INSTRUCTIONS AND RESPONSE OPTIONS THAT SHOULD NOT BE READ WILL BE IN ALL CAPS. CATI RESPONSE OPTIONS WILL ALSO INCLUDE “DO NOT READ” INSTRUCTIONS; ELSE CATI TEXT/RESPONSE OPTIONS SHOULD BE READ BY INTERVIEWER. NORC/IPSOS MAY FORMAT RESPONSE OPTIONS THAT SHOULD NOT BE READ AS ALL CAPS AND/OR IN LOWER CASE WITH EXPLICIT “DO NOT READ” INSTRUCTIONS.
ON WEB DISPLAY ONE ITEM PER PAGE UNLESS OTHERWISE SPECIFIED. SCREEN BREAKS ARE DENOTED BY LINES BETWEEN ITEMS.
CREATE VARIABLES:
QUEX_LANG
BASED
ON LANGUAGE SELECTED IN INSTRUMENT:
ENGLISH = 1
SPANISH = 2
PRELOAD PROFILE DEMOGRAPHICS AND RENAME/CREATE VARIABLES AS FOLLOWS:
HHSIZE
NUMERIC HH SIZE, CAPPED AT 6+
AGE
NORC = DOB (RECODE DOB TO AGE IN YEARS)
IPSOS = AGECONS
NUMERIC AGE IN YEARS
SEX
NORC
= SEX
IPSOS = SEX
1 MALE
NORC/IPSOS: AS NECESSARY, INCLUDE YOUR STANDARD PANEL CAWI INTRO SCREENS AND CATI INBOUND/OUTBOUND/CALLBACK/VOICEMAIL SCRIPTS BEFORE “INTRODUCTION.”
INTRODUCTION
[DISPLAY IF CAWI]
The National Center for Health Statistics (NCHS), part of the Centers for Disease Control and Prevention (CDC), is conducting a study and we need your help. We are interested in your health and wellness and will be asking you a series of questions about your health history, behaviors, and opinions. This should take about 20 minutes or less to complete. Participation in this survey is completely voluntary, and you may skip any question(s) you do not want to answer and may quit the survey at any time. The information being collected will assist NCHS and CDC in their ongoing efforts to track the health of the American public. Your data will be kept confidential, will be used for statistical purposes only, and will not be disclosed or released to other persons without your consent in accordance with Section 308(d) of the Public Health Service Act [42 U.S.C. 242m(d)] and Confidential Information Protection and Statistical Efficiency Act (44 U.S.C. 3561-3583).
If you have any questions about your rights as a participant in this research study, call NCHS’ Ethics Review Board toll-free at 1-800-223-8118 and mention you are calling about Protocol #2023-04. Your call will be returned as soon as possible.
[PROGRAMMER: REDUCE TEXT SIZE SLIGHTLY; TEXT BELOW BOARDED BY THIN BLACK BOX/OUTLINE]
CDC estimates the average public reporting burden for this collection of information as [IF CAWI: 20 minutes; IF CATI: 30 minutes] per response, including the time for reviewing instructions, searching existing data/information sources, gathering and maintaining the data/information needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Information Collection Review Office, 1600 Clifton Road, MS H21-8, Atlanta, GA 30333; ATTN: PRA (0920-1408).
We take your privacy very seriously. All information that relates to or describes identifiable characteristics of individuals, a practice, or an establishment will be used only for statistical purposes. NCHS staff, contractors, and agents will not disclose or release responses in identifiable form without the consent of the individual or establishment in accordance with section 308(d) of the Public Health Service Act (42 U.S.C. 242m(d)), and the Confidential Information Protection and Statistical Efficiency Act or CIPSEA (44 U.S.C. 3561-3583). In accordance with CIPSEA, every NCHS employee, contractor, and agent has taken an oath and is subject to a jail term of up to five years, a fine of up to $250,000, or both if he or she willfully discloses ANY identifiable information about you. In addition to the above cited laws, NCHS complies with the Federal Cybersecurity Enhancement Act of 2018 (6 U.S.C. § 663) which protects Federal information systems from cybersecurity risks by screening their networks. |
[DISPLAY IF CATI]
We are asking for your help on behalf of the National Center for Health Statistics (NCHS), part of the Centers for Disease Control and Prevention (CDC).
This survey will take on average [IF CAWI: 20 minutes; IF CATI: 30 minutes] to complete.
Participation in this survey is completely voluntary, and you may skip any question(s) you do not want to answer and may quit the survey at any time.
The information being collected will assist NCHS and CDC in their ongoing efforts to track the health of the American public.
Your data will be kept confidential and will be used for statistical purposes only by NCHS staff and agents and will not be disclosed or released to other persons without your consent.
If you have any questions about your rights as a participant in this research study, call NCHS’ Ethics Review Board toll-free at 1-800-223-8118 and mention you are calling about Protocol #2023-04. Your call will be returned as soon as possible.
[PROGRAMMER: REDUCE TEXT SIZE SLIGHTLY; TEXT BELOW BOARDED BY THIN BLACK BOX/OUTLINE]
[CATI] READ THE FOLLOWING IF THE RESPONDENT HAS ADDITIONAL QUESTIONS ABOUT BURDEN, PRIVACY, OR CONFIDENTIALITY
CDC estimates the average public reporting burden for this collection of information as 30 minutes per response, including the time for reviewing instructions, searching existing data/information sources, gathering and maintaining the data/information needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Information Collection Review Office, 1600 Clifton Road, MS H21-8, Atlanta, GA 30333; ATTN: PRA (0920-1408).
We take your privacy very seriously. All information that relates to or describes identifiable characteristics of individuals, a practice, or an establishment will be used only for statistical purposes. NCHS staff, contractors, and agents will not disclose or release responses in identifiable form without the consent of the individual or establishment in accordance with section 308(d) of the Public Health Service Act (42 U.S.C. 242m(d)), and Confidential Information Protection and Statistical Efficiency Act or CIPSEA (44 U.S.C. 3561-3583). In accordance with CIPSEA, every NCHS employee, contractor, and agent has taken an oath and is subject to a jail term of up to five years, a fine of up to $250,000, or both if he or she willfully discloses ANY identifiable information about you. In addition to the above cited laws, NCHS complies with the Federal Cybersecurity Enhancement Act of 2018 (6 U.S.C. § ) which protects Federal information systems from cybersecurity risks by screening their networks. |
[PROGRAMMER: SECTION HEADERS ARE FOR INTERNAL USE ONLY. DO NOT PROGRAM TO APPEAR ON SCREEN.]
[CREATE “START_TIME” AND “START_DATE”; RECORD START_TIME IN HH:MM:SS; RECORD START_DATE IN MM:DD:YYYY]
[CREATE “START_HIS_TIME” AND “START_HIS_DATE”; RECORD TIME IN HH:MM:SS; RECORD DATE IN MM:DD:YYYY]
[SHOW ALL]
[S]
HIS_GENERAL
[CAWI] Would you say your health in general is…
[CATI] Would you say your health in general is excellent, very good, good, fair, or poor?
[CAWI RESPONSE OPTIONS:]
1 Excellent
2 Very good
3 Good
4 Fair
5 Poor
[CATI RESPONSE OPTIONS - DO NOT READ:]
1 EXCELLENT
2 VERY GOOD
3 GOOD
4 FAIR
5 POOR
[CREATE “END_HIS_TIME” AND “END_HIS_DATE”; RECORD TIME IN HH:MM:SS; RECORD DATE IN MM:DD:YYYY]
[CREATE “START_CHR_TIME” AND “START_CHR_DATE”; RECORD TIME IN HH:MM:SS; RECORD DATE IN MM:DD:YYYY]
[SHOW ALL]
[S]
CHR_HYPEV
Have you ever been told by a doctor or other health professional that you had hypertension, also called high blood pressure?
[CAWI] If you take medication to control your high blood pressure, please answer yes.
[CATI] ENTER '1' (YES) IF RESPONDENT IS TAKING MEDICATION TO CONTROL HIS/HER HIGH BLOOD PRESSURE.
[CAWI RESPONSE OPTIONS:]
1 Yes
0 No
[CATI RESPONSE OPTIONS - DO NOT READ:]
1 YES
NO
[SHOW ALL]
[S]
CHR_CHLEV
Have you ever been told by a doctor or other health professional that you had high cholesterol?
[CAWI] If you take medication to control your high cholesterol, please answer yes.
[CATI] ENTER '1' IF RESPONDENT IS TAKING MEDICATION TO CONTROL HIS/HER HIGH CHOLESTEROL.
[CAWI RESPONSE OPTIONS:]
1 Yes
No
[CATI RESPONSE OPTIONS - DO NOT READ:]
1 YES
NO
[SHOW ALL]
[S]
CHR_CANEV
Have you ever been told by a doctor or other health professional that you had cancer or a malignancy of any kind?
[CAWI RESPONSE OPTIONS:]
1 Yes
0 No
[CATI RESPONSE OPTIONS - DO NOT READ:]
1 YES
NO
[SHOW ALL]
[S]
CHR_ASEV
Have you ever been told by a doctor or other health professional that you had asthma?
[CAWI RESPONSE OPTIONS:]
1 Yes
0 No
[CATI RESPONSE OPTIONS - DO NOT READ:]
1 YES
0 NO
[CREATE “END_CHR_TIME” AND “END_CHR_DATE”; RECORD TIME IN HH:MM:SS; RECORD DATE IN MM:DD:YYYY]
[CREATE “START_BMI_TIME” AND “START_BMI_DATE”; RECORD TIME IN HH:MM:SS; RECORD DATE IN MM:DD:YYYY]
[SHOW IF SEX = 2 AND AGE <=49]
[S]
BMI_PREGNOW
Are you currently pregnant?
[CAWI RESPONSE OPTIONS:]
1 Yes
0 No
[CATI RESPONSE OPTIONS - DO NOT READ:]
1 YES
0 NO
[CREATE “END_BMI_TIME” AND “END_BMI_DATE”; RECORD TIME IN HH:MM:SS; RECORD DATE IN MM:DD:YYYY]
[CREATE
“START_DIS_TIME” AND “END_DIS_DATE”; RECORD
TIME IN HH:MM:SS; RECORD DATE IN MM:DD:YYYY]
[SHOW ALL]
[S]
DIS_GLASS
Do you wear glasses or contact lenses?
[CAWI RESPONSE OPTIONS:]
1 Yes
0 No
[CATI RESPONSE OPTIONS - DO NOT READ:]
YES
NO
[SHOW ALL]
[S]
DIS_DIFSEE
Do you have difficulty [IF DIS_GLASS=1, FILL: seeing, even when wearing glasses or contact lenses; ELSE, FILL: seeing]? [CATI] Would you say no difficulty, some difficulty, a lot of difficulty, or you cannot do this at all?
[CAWI RESPONSE OPTIONS:]
1 No difficulty
2 Some difficulty
3 A lot of difficulty
4 Cannot do this at all
[CATI RESPONSE OPTIONS - DO NOT READ:]
1 NO DIFFICULTY
2 SOME DIFFICULTY
3 A LOT OF DIFFICULTY
4 CANNOT DO THIS AT ALL
[SHOW ALL]
[S]
DIS_AID
Do you use a hearing aid?
[CAWI RESPONSE OPTIONS:]
1 Yes
0 No
[CATI RESPONSE OPTIONS - DO NOT READ:]
1 YES
0 NO
[SHOW ALL]
[S]
DIS_DIFHEAR
Do you have difficulty [IF DIS_AID =1, FILL: hearing, even when using your hearing aids; ELSE, FILL: hearing]? [CATI] Would you say no difficulty, some difficulty, a lot of difficulty, or you cannot do this at all?
[CAWI RESPONSE OPTIONS:]
1 No difficulty
2 Some difficulty
3 A lot of difficulty
4 Cannot do this at all
[CATI RESPONSE OPTIONS - DO NOT READ:]
1 NO DIFFICULTY
2 SOME DIFFICULTY
3 A LOT OF DIFFICULTY
4 CANNOT DO THIS AT ALL
[SHOW ALL]
[S]
DIS_DIFWLK
Do you have difficulty walking or climbing steps? [CATI] Would you say no difficulty, some difficulty, a lot of difficulty, or you cannot do this at all?
[CAWI RESPONSE OPTIONS:]
1 No difficulty
2 Some difficulty
3 A lot of difficulty
4 Cannot do this at all
[CATI RESPONSE OPTIONS - DO NOT READ:]
1 NO DIFFICULTY
2 SOME DIFFICULTY
3 A LOT OF DIFFICULTY
4 CANNOT DO THIS AT ALL
[SHOW ALL]
[S]
DIS_DIFCOM
Using your usual language, do you have difficulty communicating, for example, understanding or being understood? [CATI] Would you say no difficulty, some difficulty, a lot of difficulty, or you cannot do this at all?
[CAWI RESPONSE OPTIONS:]
1 No difficulty
2 Some difficulty
3 A lot of difficulty
4 Cannot do this at all
[CATI RESPONSE OPTIONS - DO NOT READ:]
1 NO DIFFICULTY
2 SOME DIFFICULTY
3 A LOT OF DIFFICULTY
4 CANNOT DO THIS AT ALL
[SHOW ALL]
[S]
DIS_DIFREM
Do you have difficulty remembering or concentrating? [CATI] Would you say no difficulty, some difficulty, a lot of difficulty, or you cannot do this at all?
[CAWI RESPONSE OPTIONS:]
1 No difficulty
2 Some difficulty
3 A lot of difficulty
4 Cannot do this at all
[CATI RESPONSE OPTIONS - DO NOT READ:]
1 NO DIFFICULTY
2 SOME DIFFICULTY
3 A LOT OF DIFFICULTY
4 CANNOT DO THIS AT ALL
[SHOW ALL]
[S]
DIS_DIFCARE
Do you have difficulty with self-care, such as washing all over or dressing? [CATI] Would you say no difficulty, some difficulty, a lot of difficulty, or you cannot do this at all?
[CAWI RESPONSE OPTIONS:]
1 No difficulty
2 Some difficulty
3 A lot of difficulty
4 Cannot do this at all
[CATI RESPONSE OPTIONS - DO NOT READ:]
1 NO DIFFICULTY
2 SOME DIFFICULTY
3 A LOT OF DIFFICULTY
4 CANNOT DO THIS AT ALL
[CREATE “END_DIS_TIME” AND “END_DIS_DATE”; RECORD TIME IN HH:MM:SS; RECORD DATE IN MM:DD:YYYY]
[CREATE “START_PAI_TIME” AND “START_PAI_DATE”; RECORD TIME IN HH:MM:SS; RECORD DATE IN MM:DD:YYYY]
[SHOW ALL]
[S]
PAI_FREQ3M
The next questions are about pain you may have had in the past three months.
In the past three months, how often did you have pain? [CATI] Would you say never, some days, most days, or every day?
Please answer based on your usual use of medication.
[CAWI RESPONSE OPTIONS:]
0 Never
1 Some days
2 Most days
3 Every day
[CATI RESPONSE OPTIONS - DO NOT READ:]
0 NEVER
1 SOME DAYS
2 MOST DAYS
3 EVERY DAY
[SHOW IF PAI_FREQ3M= 1, 2, OR 3]
[S]
PAI_AMNT
Thinking about the last time you had pain, how much pain did you have? [CATI] Would you say a little, a lot, or somewhere in between?
[CAWI RESPONSE OPTIONS:]
1 A little
2 A lot
3 Somewhere in between a little and a lot
[CATI RESPONSE OPTIONS - DO NOT READ:]
1 A LITTLE
2 A LOT
3 SOMEWHERE IN BETWEEN A LITTLE AND A LOT
[SHOW IF PAI_FREQ3M = 1, 2, OR 3]
[S]
PAI_WKLM3M
Over the past three months, how often did your pain limit your life or work activities? [CATI] Would you say never, some days, most days, or every day?
[CAWI RESPONSE OPTIONS:]
0 Never
1 Some days
2 Most days
3 Every day
[CATI RESPONSE OPTIONS - DO NOT READ:]
0 Never
1 SOME DAYS
2 MOST DAYS
3 EVERY DAY
[CREATE “END_PAI_TIME” AND “END_PAI_DATE”; RECORD TIME IN HH:MM:SS; RECORD DATE IN MM:DD:YYYY]
[CREATE “START_NIC_TIME” AND “START_NIC_DATE”; RECORD TIME IN HH:MM:SS; RECORD DATE IN MM:DD:YYYY]
[SHOW ALL]
[S]
NIC_CIG01
These next questions are about cigarette smoking.
Have you ever smoked part or all of a cigarette?
[CAWI RESPONSE OPTIONS:]
1 Yes
0 No
[CATI RESPONSE OPTIONS - DO NOT READ:]
1 YES
[SHOW IF NIC_CIG01 = -6, -7]
[S]
NIC_CIGREF1
The answer that people give us about their cigarette smoking are important to this study’s success. We know that this information is personal, but remember your answer will be kept confidential.
Please think again about answering this question: Have you ever smoked part or all of a cigarette?
[CAWI RESPONSE OPTIONS:]
1 Yes
0 No
[CATI RESPONSE OPTIONS - DO NOT READ:]
1 YES
[SHOW IF NIC_CIG01 = 1 OR NIC_CIGREF = 1]
[S]
NIC_CIG05
Now think about the past 30 days, that is, from [DATEFILL] up to and including today. During the past 30 days, have you smoked part or all of a cigarette?
[CAWI RESPONSE OPTIONS:]
1 Yes
0 No
[CATI RESPONSE OPTIONS - DO NOT READ:]
1 YES
NO
[PROGRAMMER NOTE: POPULATE DATEFILL WITH DATE 30 DAYS PRIOR TO TIME OF ANSWERING THIS QUESTION (INCLUDING DAY OF ANSWERING THIS QUESTION). DISPLAY ONLY MONTH AND DAY. FOR EXAMPLE, “September 30th.”
DISPLAY A CALENDAR ICON BENEATH THE QUESTION TEXT THAT RESPONDENTS CAN CLICK ON TO OPEN A CALENDAR THAT HIGHLIGHTS THE PAST 30 DAY REFERENCE PERIOD.]
[SHOW ALL]
[S]
NIC_VPLIF
The next questions are about vaping nicotine with e-cigarettes or other vaping devices. These devices might also be called vapes, vape pens, or mods. When answering, please include any device that heats a liquid containing nicotine into a vapor.
Have you ever, even once, vaped nicotine with an e-cigarette or other vaping device?
[CAWI RESPONSE OPTIONS:]
1 Yes
0 No
[CATI RESPONSE OPTIONS - DO NOT READ:]
1 YES
NO
[SHOW IF NIC_VPLIF = -6, -7]
[S]
NIC_VPLIFREF
The answer that people give us about vaping nicotine with e-cigarettes or other vaping devices are important to this study’s success. We know that this information is personal, but remember your answers will be kept confidential.
Please think again about answering this question: Have you ever, even once vaped nicotine with an e-cigarette or other vaping device?
[CAWI RESPONSE OPTIONS:]
1 Yes
0 No
[CATI RESPONSE OPTIONS - DO NOT READ:]
1 YES
[SHOW IF NIC_VPLIF = 1 OR NIC_VPLIFREF = 1]
[S]
NIC_VPPM
Now think about the past 30 days, that is, from [DATEFILL] up to and including today. During the past 30 days, have you vaped nicotine with an e-cigarette or other vaping device?
[CAWI RESPONSE OPTIONS:]
1 Yes
0 No
[CATI RESPONSE OPTIONS - DO NOT READ:]
1 YES
NO
[PROGRAMMER NOTE: POPULATE DATEFILL WITH DATE 30 DAYS PRIOR TO TIME OF ANSWERING THIS QUESTION (INCLUDING DAY OF ANSWERING THIS QUESTION). DISPLAY ONLY MONTH AND DAY. FOR EXAMPLE, “September 30th.”
DISPLAY A CALENDAR ICON BENEATH THE QUESTION TEXT THAT RESPONDENTS CAN CLICK ON TO OPEN A CALENDAR THAT HIGHLIGHTS THE PAST 30 DAY REFERENCE PERIOD.]
[CREATE “END_NIC_TIME” AND “END_NIC_DATE”; RECORD TIME IN HH:MM:SS; RECORD DATE IN MM:DD:YYYY]
[CREATE “START_ALC_TIME” AND “START_ALC_DATE”; RECORD TIME IN HH:MM:SS; RECORD DATE IN MM:DD:YYYY]
[SHOW ALL]
[S]
ALC_AL01
For these questions, a “drink” means a can or bottle of beer or hard seltzer, a glass of wine or a wine
cooler, a shot of liquor, or a drink with liquor in it.
Have you ever, even once, had a drink of any type of alcoholic beverage? Please do not include times
when you only had a sip or two from a drink.
[CAWI] Click HELP to see examples of alcoholic beverages.
[CATI – READ IF NECESSARY]
Examples include regular or light beer, hard cider, hard seltzer, red or white wine, champagne, fortified wines, bourbon, vodka, gin, tequila, rum, brandy, schnapps, and cocktails like margaritas or martinis.
[CAWI RESPONSE OPTIONS:]
1 Yes
0 No
[CATI RESPONSE OPTIONS - DO NOT READ:]
1 YES
[PROGRAMMER NOTE: DISPLAY IN HELP SCREEN FOR ALC_AL01]
Beer and Seltzers
Regular beer, lite or light beer, hard cider, hard seltzer, or malt liquor.
Wine
Red or white wine, rosé, Champagne, fortified wines, or wine coolers.
Liquor
Bourbon, Scotch, Gin, Tequila, Rum, or Vodka.
Liqueurs, Cordials, and Brandy
Brandy, Schnapps, Kahlua, or Triple sec.
Mixed Drinks and Cocktails
Bloody Mary, Irish coffee, Margarita Daiquiri, Martini or canned cocktail.
[SHOW IF ALC_AL01 = -6, -7]
[S]
ALC_ALREF
The answers that people give us about their use of alcohol are important to this study’s success. We
know that this information is personal, but remember your answers will be kept confidential.
Please think again about answering this question: Have you ever, even once, had a drink of any type of alcoholic beverage? Please do not include times when you only had a sip or two from a drink
[CAWI RESPONSE OPTIONS:]
1 Yes
0 No
[CATI RESPONSE OPTIONS - DO NOT READ:]
1 YES
NO
[SHOW IF ALC_AL01 = 1 OR ALC_ALREF = 1]
[S]
How long has it been since you last drank an alcoholic beverage? [CATI] Would you say within
the past 30 days – that is since [DATEFILL], more than 30 days ago but within the past 12 months, or
more than 12 months ago?
[CAWI RESPONSE OPTIONS:]
Within the past 30 days – that is since [DATEFILL]
More than 30 days ago but within the past 12 months
More than 12 months ago
-9 Don’t know
[CATI RESPONSE OPTIONS – DO NOT READ:]
WITHIN THE PAST 30 DAYS – THAT IS SINCE [DATEFILL]
MORE THAN 30 DAYS AGO BUT WITHIN THE PAST 12 MONTHS
MORE THAN 12 MONTHS AGO
-9 DON’T KNOW
[PROGRAMMER NOTE: POPULATE DATEFILL WITH DATE 30 DAYS PRIOR TO TIME OF ANSWERING THIS QUESTION (INCLUDING DAY OF ANSWERING THIS QUESTION). DISPLAY ONLY MONTH AND DAY. FOR EXAMPLE, “September 30th.”
DISPLAY A CALENDAR ICON BENEATH THE QUESTION TEXT THAT RESPONDENTS CAN CLICK ON TO OPEN A 12-MONTH CALENDAR THAT HIGHLIGHTS THE PAST 30 DAY REFERENCE PERIOD AND THE PAST 12 MONTH REFERENCE PERIOD.]
[SHOW IF ALC_ALLAST3 = -9]
[S]
ALC_ALRECDK
What is your best guess of how long it has been since you last drank an alcoholic beverage?
[CATI] Would you say within the past 30 days – that is since [DATEFILL], more than 30 days ago but
within the past 12 months, or more than 12 months ago?
[CAWI RESPONSE OPTIONS:]
Within the past 30 days – that is since [DATEFILL]
More than 30 days ago but within the past 12 months
More than 12 months ago
[CATI RESPONSE OPTIONS – DO NOT READ:]
1 WITHIN THE PAST 30 DAYS – THAT IS SINCE [DATEFILL]
MORE THAN 30 DAYS AGO BUT WITHIN THE PAST 12 MONTHS
MORE THAN 12 MONTHS AGO
[PROGRAMMER NOTE: POPULATE DATEFILL WITH DATE 30 DAYS PRIOR TO TIME OF ANSWERING THIS QUESTION (INCLUDING DAY OF ANSWERING THIS QUESTION). DISPLAY ONLY MONTH AND DAY. FOR EXAMPLE, “September 30th.”
DISPLAY A CALENDAR ICON BENEATH THE QUESTION TEXT THAT RESPONDENTS CAN CLICK ON TO OPEN A 12-MONTH CALENDAR THAT HIGHLIGHTS THE PAST 30 DAY REFERENCE PERIOD AND THE PAST 12 MONTH REFERENCE PERIOD.]
[SHOW IF ALC_ALLAST3 = -6, -7]
[S]
ALC_ALRECRE
The answers that people give us about their use of alcohol are important to this study’s success. We
know that this information is personal, but remember your answers will be kept confidential.
Please think again about answering this question: How long has it been since you last drank an alcoholic beverage? [CATI] Would you say within the past 30 days – that is since [DATEFILL], more than 30 days ago but within the past 12 months, or more than 12 months ago?
[CAWI RESPONSE OPTIONS:]
Within the past 30 days – that is since [DATEFILL]
More than 30 days ago but within the past 12 months
More than 12 months ago
[CATI RESPONSE OPTIONS – DO NOT READ:]
WITHIN THE PAST 30 DAYS – THAT IS SINCE [DATEFILL]
MORE THAN 30 DAYS AGO BUT WITHIN THE PAST 12 MONTHS
MORE THAN 12 MONTHS AGO
[PROGRAMMER NOTE: POPULATE DATEFILL WITH DATE 30 DAYS PRIOR TO TIME OF ANSWERING THIS QUESTION (INCLUDING DAY OF ANSWERING THIS QUESTION). DISPLAY ONLY MONTH AND DAY. FOR EXAMPLE, “September 30th.”
DISPLAY A CALENDAR ICON BENEATH THE QUESTION TEXT THAT RESPONDENTS CAN CLICK ON TO OPEN A 12-MONTH CALENDAR THAT HIGHLIGHTS THE PAST 30 DAY REFERENCE PERIOD AND THE PAST 12 MONTH REFERENCE PERIOD.]
[SHOW IF ALC_ALLAST3 = 1 OR ALC_ALRECDK OR ALC_ALRECRE = 1]
[NUMBOX]
Think specifically about the past 30 days, from [DATEFILL], up to and including today. During the past 30 days, on how many days did you drink one or more drinks of an alcoholic beverage?
[NUMBOX] days in the past 30 days [RANGE: 1 - 30]
-9 Don’t know
[PROGRAMMER NOTE: DO NOT ALLOW “DON’T KNOW” TO BE SELECTED IN COMBINATION WITH ENTERING A NUMBER IN THE NUMBOX. IF NUMBOX ENTRY OUTSIDE OF RANGE, DISPLAY ERROR MESSAGE: “Please enter a number between 1 and 30.”]
[PROGRAMMER NOTE: POPULATE DATEFILL WITH DATE 30 DAYS PRIOR TO TIME OF ANSWERING THIS QUESTION (INCLUDING DAY OF ANSWERING THIS QUESTION). DISPLAY ONLY MONTH AND DAY. FOR EXAMPLE, “September 30th.”
DISPLAY A CALENDAR ICON BENEATH THE QUESTION TEXT THAT RESPONDENTS CAN CLICK ON TO OPEN A CALENDAR THAT HIGHLIGHTS THE PAST 30 DAY REFERENCE PERIOD.]
[SHOW IF ALC_AL06 = -6, -7, -9]
[S]
ALC_AL06DKRE
What is your best estimate of the number of days you drank alcohol during the past 30 days?
[CAWI RESPONSE OPTIONS:]
1 or 2 days
3 to 5 days
6 to 9 days
10 to 19 days
20 to 29 days
All 30 days
[CAWI RESPONSE OPTIONS – DO NOT READ:]
1 OR 2 DAYS
3 TO 5 DAYS
6 TO 9 DAYS
10 TO 19 DAYS
20 TO 29 DAYS
ALL 30 DAYS
[PROGRAMMER NOTE: DISPLAY A CALENDAR ICON BENEATH THE QUESTION TEXT THAT RESPONDENTS CAN CLICK ON TO OPEN A CALENDAR THAT HIGHLIGHTS THE PAST 30 DAY REFERENCE PERIOD.]
[CREATE “END_ALC_TIME” AND “END_ALC_DATE”; RECORD TIME IN HH:MM:SS; RECORD DATE IN MM:DD:YYYY]
[CREATE “START_MJ_TIME” AND “START_MJ_DATE”; RECORD TIME IN HH:MM:SS; RECORD DATE IN MM:DD:YYYY]
[SHOW ALL]
[S]
The next questions are about CBD or hemp products made from hemp plants. CBD and hemp products have no or small amounts of THC and are not intended to cause a “high.” They come in many forms including oils, lotions, edibles, and isolate. People sometimes use them to relieve pain, to reduce anxiety, or to help them sleep.
Have you ever, even once, used any CBD or hemp products?
[CAWI RESPONSE OPTIONS:]
1 Yes
No
-9 Don’t know
[CATI RESPONSE OPTIONS - DO NOT READ:]
1 YES
NO
-9 DON’T KNOW
[SHOW IF MJ_CBDLIF=1]
[S]
MJ_CBDLAST
How long has it been since you last used any form of CBD or hemp product? [CATI:
Would you say within the past 30 days – that is since [DATEFILL], more than 30 days ago
but within the past 12 months, more than 12 months ago but within that past 3 years,
more than 3 years ago?]
[CAWI RESPONSE OPTIONS:]
Within the past 30 days – that is since [DATEFILL]
More than 30 days ago but within the past 12 months
More than 12 months ago but within the past 3 years
More than 3 years ago
[CATI RESPONSE OPTIONS – DO NOT READ:]
WITHIN THE PAST 30 DAYS – THAT IS SINCE [DATEFILL]
MORE THAN 30 DAYS AGO BUT WITHIN THE PAST 12 MONTHS
MORE THAN 12 MONTHS AGO BUT WITHIN THE PAST 3 YEARS
MORE THAN 3 YEARS AGO
[PROGRAMMER NOTE: POPULATE DATEFILL WITH DATE 30 DAYS PRIOR TO TIME OF ANSWERING THIS QUESTION (INCLUDING DAY OF ANSWERING THIS QUESTION). DISPLAY ONLY MONTH AND DAY. FOR EXAMPLE, “September 30th.”
DISPLAY A CALENDAR ICON BENEATH THE QUESTION TEXT THAT RESPONDENTS CAN CLICK ON TO OPEN A 12-MONTH CALENDAR THAT HIGHLIGHTS THE PAST 30 DAY REFERENCE PERIOD AND THE PAST 12 MONTH REFERENCE PERIOD.]
[SHOW ALL]
[S]
The next questions are about marijuana and cannabis products, sometimes called pot, weed, hashish, or
concentrates. Some of the ways these products can be used are smoking such as in joints, pipes, bongs,
blunts, or hookahs, vaping using vape pens, dab pens, tabletop vaporizers, or portable vaporizers,
dabbing, eating or drinking, or applying as a lotion.
[IF MJ_CBDLIF=1, -6, -7, -9] Please exclude your use of CBD or hemp products when answering these questions.
Have you ever, even once, used marijuana or any cannabis product?
[CAWI RESPONSE OPTIONS:]
1 Yes
0 No
[CATI RESPONSE OPTIONS - DO NOT READ:]
YES
[SHOW IF MJ_MJ01 = -6, -7]
[S]
The answers that people give us about their use of marijuana or any cannabis product are important to this study’s success. We know that this information is personal, but remember your answers will be kept confidential.
Please think again about answering this question: Have you ever, even once, used marijuana or any cannabis product?
[CAWI RESPONSE OPTIONS:]
1 Yes
0 No
[CATI RESPONSE OPTIONS - DO NOT READ:]
YES
NO
[SHOW IF MJ_MJ01 = 1 OR MJ_MJREF = 1]
[S]
MJ_MJLAST3
How long has it been since you last used marijuana or any cannabis product? [CATI] Would you say
within the past 30 days – that is since [DATEFILL], more than 30 days ago but within the past 12 months,
[CAWI RESPONSE OPTIONS:]
Within the past 30 days – that is since [DATEFILL]
More than 30 days ago but within the past 12 months
More than 12 months ago
-9 Don’t know
[CATI RESPONSE OPTIONS – DO NOT READ:]
WITHIN THE PAST 30 DAYS – THAT IS SINCE [DATEFILL]
MORE THAN 30 DAYS AGO BUT WITHIN THE PAST 12 MONTHS
MORE THAN 12 MONTHS AGO
-9 DON’T KNOW
[PROGRAMMER NOTE: POPULATE DATEFILL WITH DATE 30 DAYS PRIOR TO TIME OF ANSWERING THIS QUESTION (INCLUDING DAY OF ANSWERING THIS QUESTION). DISPLAY ONLY MONTH AND DAY. FOR EXAMPLE, “September 30th.”
DISPLAY A CALENDAR ICON BENEATH THE QUESTION TEXT THAT RESPONDENTS CAN CLICK ON TO OPEN A 12-MONTH CALENDAR THAT HIGHLIGHTS THE PAST 30 DAY REFERENCE PERIOD AND THE PAST 12 MONTH REFERENCE PERIOD.]
[SHOW IF MJ_MJLAST3 = -9]
[S]
What is your best guess of how long it has been since you last used marijuana or any cannabis product?
[CATI] Would you say within the past 30 days – that is since [DATEFILL], more than 30 days ago but
within the past 12 months, or more than 12 months ago?
[CAWI RESPONSE OPTIONS:]
Within the past 30 days – that is since [DATEFILL]
More than 30 days ago but within the past 12 months
More than 12 months ago
[CATI RESPONSE OPTIONS – DO NOT READ:]
WITHIN THE PAST 30 DAYS – THAT IS SINCE [DATEFILL]
MORE THAN 30 DAYS AGO BUT WITHIN THE PAST 12 MONTHS
MORE THAN 12 MONTHS AGO
[PROGRAMMER NOTE: POPULATE DATEFILL WITH DATE 30 DAYS PRIOR TO TIME OF ANSWERING THIS QUESTION (INCLUDING DAY OF ANSWERING THIS QUESTION). DISPLAY ONLY MONTH AND DAY. FOR EXAMPLE, “September 30th.”
DISPLAY A CALENDAR ICON BENEATH THE QUESTION TEXT THAT RESPONDENTS CAN CLICK ON TO OPEN A 12-MONTH CALENDAR THAT HIGHLIGHTS THE PAST 30 DAY REFERENCE PERIOD AND THE PAST 12 MONTH REFERENCE PERIOD]
[SHOW IF MJ_MJLAST3 = -6, -7]
[S]
MJ_MJRECRE
The answers that people give us about their use of marijuana or any cannabis product are important to this study’s success. We know that this information is personal, but remember your answers will be kept confidential.
Please think again about answering this question: How long has it been since you last used marijuana or
any cannabis product? [CATI] Would you say within the past 30 days – that is since [DATEFILL], more
than 30 days ago but within the past 12 months, or more than 12 months ago?
[CAWI RESPONSE OPTIONS:]
Within the past 30 days – that is since [DATEFILL]
More than 30 days ago but within the past 12 months
More than 12 months ago
[CATI RESPONSE OPTIONS – DO NOT READ:]
1 WITHIN THE PAST 30 DAYS – THAT IS SINCE [DATEFILL]
2 MORE THAN 30 DAYS AGO BUT WITHIN THE PAST 12 MONTHS
3 MORE THAN 12 MONTHS AGO
[PROGRAMMER NOTE: POPULATE DATEFILL WITH DATE 30 DAYS PRIOR TO TIME OF ANSWERING THIS QUESTION (INCLUDING DAY OF ANSWERING THIS QUESTION). DISPLAY ONLY MONTH AND DAY. FOR EXAMPLE, “September 30th.”
DISPLAY A CALENDAR ICON BENEATH THE QUESTION TEXT THAT RESPONDENTS CAN CLICK ON TO OPEN A 12-MONTH CALENDAR THAT HIGHLIGHTS THE PAST 30 DAY REFERENCE PERIOD AND THE PAST 12 MONTH REFERENCE PERIOD.]
[SHOW IF MJ_MJLAST3 = 1 OR MJ_MJRECDK =1 OR MJ_MJRECRE = 1]
[NUMBOX]
MJ_MJ06
Think specifically about the past 30 days, from [DATEFILL] up to and including today. During the past 30
days, on how many days did you use marijuana or any cannabis product?
[NUMBOX] days in the past 30 days [RANGE: 1 - 30]
-9 Don’t know
[PROGRAMMER NOTE: DO NOT ALLOW DON’T KNOW TO BE SELECTED IN COMBINATION WITH ENTERING A NUMBER IN THE NUMBOX. IF NUMBOX ENTRY OUTSIDE OF RANGE, DISPLAY ERROR MESSAGE: “Please enter a number between 1 and 30.”]
[PROGRAMMER NOTE: POPULATE DATEFILL WITH DATE 30 DAYS PRIOR TO TIME OF ANSWERING THIS QUESTION (INCLUDING DAY OF ANSWERING THIS QUESTION). DISPLAY ONLY MONTH AND DAY. FOR EXAMPLE, “September 30th.”
DISPLAY A CALENDAR ICON BENEATH THE QUESTION TEXT THAT RESPONDENTS CAN CLICK ON TO OPEN A CALENDAR THAT HIGHLIGHTS THE PAST 30 DAY REFERENCE PERIOD.]
[SHOW IF MJ_MJ06 =-6, -7, -9]
[S]
MJ_MJ06DKRE
What is your best estimate of the number of days you used marijuana or any cannabis product during
the past 30 days?
[CAWI RESPONSE OPTIONS:]
1 or 2 days
3 to 5 days
6 to 9 days
10 to 19 days
20 to 29 days
All 30 days
[CAWI RESPONSE OPTIONS – DO NOT READ:]
1 OR 2 DAYS
3 TO 5 DAYS
6 TO 9 DAYS
10 TO 19 DAYS
20 TO 29 DAYS
ALL 30 DAYS
[PROGRAMMER NOTE: DISPLAY A CALENDAR ICON BENEATH THE QUESTION TEXT THAT RESPONDENTS CAN CLICK ON TO OPEN A CALENDAR THAT HIGHLIGHTS THE PAST 30 DAY REFERENCE PERIOD.]
[SHOW IF MJ_MJLAST3 = 1 OR MJ_MJRECDK = 1 OR MJ_MJRECRE = 1]
[M]
MJ_MJMODEPM
During the past 30 days, that is, since [DATEFILL], in which of the following ways did you use marijuana or any cannabis product? Please [CAWI: select; CATI: tell me] all that apply
1 Smoking
2 Vaping
3 Dabbing waxes, shatter, or concentrates
4 Eating or drinking
5 Putting drops, strips, lozenges, or sprays in your mouth or under your tongue
6 Applying lotion or cream, or patches to your skin
7 Taking pills
8 Some other way
[PROGRAMMER NOTE: POPULATE DATEFILL WITH DATE 30 DAYS PRIOR TO TIME OF ANSWERING THIS QUESTION (INCLUDING DAY OF ANSWERING THIS QUESTION). DISPLAY ONLY MONTH AND DAY. FOR EXAMPLE, “September 30th.”
DISPLAY A CALENDAR ICON BENEATH THE QUESTION TEXT THAT RESPONDENTS CAN CLICK ON TO OPEN A CALENDAR THAT HIGHLIGHTS THE PAST 30 DAY REFERENCE PERIOD.]
[CREATE “END_MJ_TIME” AND “END_MJ_DATE”; RECORD TIME IN HH:MM:SS; RECORD DATE IN MM:DD:YYYY]
[CREATE “START_CC_TIME” AND “START_CC_DATE”; RECORD TIME IN HH:MM:SS; RECORD DATE IN MM:DD:YYYY]
[SHOW ALL]
[S]
CC_CC01
These questions are about cocaine, including all the different forms of cocaine such as
powder, ‘crack’, free base, and coca paste.
Have you ever, even once, used any form of cocaine?
[CAWI RESPONSE OPTIONS:]
1 Yes
0 No
[CATI RESPONSE OPTIONS - DO NOT READ:]
YES
[SHOW IF CC_CC01 = -6, -7]
[S]
CC_CCREF
The answers that people give us about their use of cocaine are important to this study’s
success. We know that this information is personal, but remember your answers will be kept
confidential.
Please think again about answering this question: Have you ever, even once, used any form of
cocaine?
[CAWI RESPONSE OPTIONS:]
1 Yes
0 No
[CATI RESPONSE OPTIONS - DO NOT READ:]
YES
NO
[SHOW IF CC_CC01 = 1 OR CC_CCREF = 1]
[S]
CC_CCLAST3
How long has it been since you last used any form of cocaine? [CATI] Would you say within the past 30 days – that is since [DATEFILL], more than 30 days ago but within the past 12 months, or more than 12 months ago?
[CAWI RESPONSE OPTIONS:]
Within the past 30 days – that is since [DATEFILL]
More than 30 days ago but within the past 12 months
More than 12 months ago
[CATI RESPONSE OPTIONS – DO NOT READ:]
WITHIN THE PAST 30 DAYS – THAT IS SINCE [DATEFILL]
MORE THAN 30 DAYS AGO BUT WITHIN THE PAST 12 MONTHS
MORE THAN 12 MONTHS AGO
[PROGRAMMER NOTE: POPULATE DATEFILL WITH DATE 30 DAYS PRIOR TO TIME OF ANSWERING THIS QUESTION (INCLUDING DAY OF ANSWERING THIS QUESTION). DISPLAY ONLY MONTH AND DAY. FOR EXAMPLE, “September 30th.”
DISPLAY A CALENDAR ICON BENEATH THE QUESTION TEXT THAT RESPONDENTS CAN CLICK ON TO OPEN A 12-MONTH CALENDAR THAT HIGHLIGHTS THE PAST 30 DAY REFERENCE PERIOD AND THE PAST 12 MONTH REFERENCE PERIOD.]
[CREATE “END_CC_TIME” AND “END_CC_DATE”; RECORD TIME IN HH:MM:SS; RECORD DATE IN MM:DD:YYYY]
[CREATE “START_HER_TIME” AND “START_HER_DATE”; RECORD TIME IN HH:MM:SS; RECORD DATE IN MM:DD:YYYY]
[SHOW ALL]
[S]
These next questions are about any form of heroin, such as powder or tar. Heroin can be
smoked, snorted, or injected.
Have you ever, even once, used heroin?
[CAWI RESPONSE OPTIONS:]
1 Yes
0 No
[CATI RESPONSE OPTIONS - DO NOT READ:]
YES
NO
[SHOW IF HER_HE01 = -6, -7]
[S]
HER_HEREF
The answers that people give us about their use of heroin are important to this study’s success.
We know that this information is personal, but remember your answers will be kept
confidential.
Please think again about answering this question: Have you ever, even once, used heroin?
[CAWI RESPONSE OPTIONS:]
1 Yes
0 No
[CATI RESPONSE OPTIONS - DO NOT READ:]
YES
NO
[SHOW IF HER_HE01 = 1 OR HER_HEREF = 1]
[S]
HER_HELAST3
How long has it been since you last used heroin? [CATI] Would you say within the past 30 days – that is since [DATEFILL], more than 30 days ago but within the past 12 months, or more than 12 months ago?
[CAWI RESPONSE OPTIONS:]
Within the past 30 days – that is since [DATEFILL]
More than 30 days ago but within the past 12 months
More than 12 months ago
[CATI RESPONSE OPTIONS – DO NOT READ:]
WITHIN THE PAST 30 DAYS – THAT IS SINCE [DATEFILL]
MORE THAN 30 DAYS AGO BUT WITHIN THE PAST 12 MONTHS
MORE THAN 12 MONTHS AGO
[PROGRAMMER NOTE: POPULATE DATEFILL WITH DATE 30 DAYS PRIOR TO TIME OF ANSWERING THIS QUESTION (INCLUDING DAY OF ANSWERING THIS QUESTION). DISPLAY ONLY MONTH AND DAY. FOR EXAMPLE, “September 30th.”
DISPLAY A CALENDAR ICON BENEATH THE QUESTION TEXT THAT RESPONDENTS CAN CLICK ON TO OPEN A 12-MONTH CALENDAR THAT HIGHLIGHTS THE PAST 30 DAY REFERENCE PERIOD AND THE PAST 12 MONTH REFERENCE PERIOD.]
[CREATE “END_HER_TIME” AND “END_HER_DATE”; RECORD TIME IN HH:MM:SS; RECORD DATE IN MM:DD:YYYY]
[CREATE “START_IMF_TIME” AND “START_IMF_DATE”; RECORD TIME IN HH:MM:SS; RECORD DATE IN MM:DD:YYYY]
[SHOW ALL]
[S]
IMF_IFLIF
This next question is about illegally made fentanyl, which is fentanyl that people can't get from a doctor
or pharmacy. Illegally made fentanyl can come in forms such as powder, pills, or blotter paper. It can
also be mixed with heroin or other drugs.
Have you ever, even once, used illegally made fentanyl?
[CAWI RESPONSE OPTIONS:]
1 Yes
0 No
[CATI RESPONSE OPTIONS - DO NOT READ:]
YES
[SHOW IF IMF_IFLIF = 1]
[S]
IMF_IFREC
How long has it been since you last used illegally made fentanyl? [CATI] Would you say within the past 30 days – that is since [DATEFILL], more than 30 days ago but within the past 12 months, or more than 12 months ago?
[CAWI RESPONSE OPTIONS:]
Within the past 30 days – that is since [DATEFILL]
More than 30 days ago but within the past 12 months
More than 12 months ago
[CATI RESPONSE OPTIONS – DO NOT READ:]
WITHIN THE PAST 30 DAYS – THAT IS SINCE [DATEFILL]
MORE THAN 30 DAYS AGO BUT WITHIN THE PAST 12 MONTHS
MORE THAN 12 MONTHS AGO
[PROGRAMMER NOTE: POPULATE DATEFILL WITH DATE 30 DAYS PRIOR TO TIME OF ANSWERING THIS QUESTION (INCLUDING DAY OF ANSWERING THIS QUESTION). DISPLAY ONLY MONTH AND DAY. FOR EXAMPLE, “September 30th.”
DISPLAY A CALENDAR ICON BENEATH THE QUESTION TEXT THAT RESPONDENTS CAN CLICK ON TO OPEN A 12-MONTH CALENDAR THAT HIGHLIGHTS THE PAST 30 DAY REFERENCE PERIOD AND THE PAST 12 MONTH REFERENCE PERIOD.]
[CREATE “END_IMF_TIME” AND “END_IMF_DATE”; RECORD TIME IN HH:MM:SS; RECORD DATE IN MM:DD:YYYY]
[CREATE “START_HAL_TIME” AND “START_HAL_DATE”; RECORD TIME IN HH:MM:SS; RECORD DATE IN MM:DD:YYYY]
[SHOW ALL]
[S]
HAL_LS01a
The next questions are about substances called hallucinogens. These drugs often cause
people to have rapid, intense emotional swings or to see images, hear sounds, and feel
sensations that seem real but are not.
Have you ever, even once, used LSD, also called “acid”?
[CAWI RESPONSE OPTIONS:]
1 Yes
0 No
[CATI RESPONSE OPTIONS - DO NOT READ:]
YES
NO
[SHOW ALL]
[S]
HAL_LS01e
Have you ever, even once, used psilocybin [IF CATI: (PRONOUNCED: SY-loh-SY-bin)], found in mushrooms?
[CAWI RESPONSE OPTIONS:]
1 Yes
0 No
[CATI RESPONSE OPTIONS - DO NOT READ:]
YES
NO
[CREATE “END_HAL_TIME” AND “END_HAL_DATE”; RECORD TIME IN HH:MM:SS; RECORD DATE IN MM:DD:YYYY]
[CREATE “START_METH_TIME” AND “START_METH_DATE”; RECORD TIME IN HH:MM:SS; RECORD DATE IN MM:DD:YYYY]
[SHOW ALL]
[S]
METH_ME01
These questions are about methamphetamine [IF CATI: (PRONOUNCED: meth-am-FET-a-meen)], also known as meth, crank, ice, crystal meth, or glass. It can be smoked, snorted, swallowed or injected.
Have you ever, even once, used methamphetamine?
[CAWI RESPONSE OPTIONS:]
1 Yes
0 No
[CATI RESPONSE OPTIONS - DO NOT READ:]
YES
NO
[SHOW IF METH_ME01 =-6, -7]
[S]
The answers that people give about their use of methamphetamine are important to this study’s
success. We know that this information is personal, but remember your answers will be kept
confidential.
Please think again about answering this question: Have you ever, even once, used methamphetamine?
[CAWI RESPONSE OPTIONS:]
1 Yes
0 No
[CATI RESPONSE OPTIONS - DO NOT READ:]
YES
NO
[SHOW IF METH_ME01 = 1 OR METH_MEREF = 1]
[S]
METH_MELAST3
How long has it been since you last used methamphetamine? [CATI] Would you say within the past 30 days – that is since [DATEFILL], more than 30 days ago but within the past 12 months, or more than 12 months ago?
[CAWI RESPONSE OPTIONS:]
Within the past 30 days – that is since [DATEFILL]
More than 30 days ago but within the past 12 months
More than 12 months ago
[CATI RESPONSE OPTIONS – DO NOT READ:]
WITHIN THE PAST 30 DAYS – THAT IS SINCE [DATEFILL]
MORE THAN 30 DAYS AGO BUT WITHIN THE PAST 12 MONTHS
MORE THAN 12 MONTHS AGO
[PROGRAMMER NOTE: POPULATE DATEFILL WITH DATE 30 DAYS PRIOR TO TIME OF ANSWERING THIS QUESTION (INCLUDING DAY OF ANSWERING THIS QUESTION). DISPLAY ONLY MONTH AND DAY. FOR EXAMPLE, “September 30th.”
DISPLAY A CALENDAR ICON BENEATH THE QUESTION TEXT THAT RESPONDENTS CAN CLICK ON TO OPEN A 12-MONTH CALENDAR THAT HIGHLIGHTS THE PAST 30 DAY REFERENCE PERIOD AND THE PAST 12 MONTH REFERENCE PERIOD.]
[CREATE “END_METH_TIME” AND “END_METH_DATE”; RECORD TIME IN HH:MM:SS; RECORD DATE IN MM:DD:YYYY]
[CREATE “START_KRA_TIME” AND “START_KRA_DATE”; RECORD TIME IN HH:MM:SS; RECORD DATE IN MM:DD:YYYY]
[SHOW ALL]
[S]
KRA_KA01
This next question is about kratom [IF CATI: (PRONOUNCED: KRAY-tum)], which can come in forms such as powder, pills, or leaf.
Have you ever, even once, used kratom?
[CAWI RESPONSE OPTIONS:]
1 Yes
0 No
[CATI RESPONSE OPTIONS - DO NOT READ:]
YES
[SHOW IF KRA_KA01 = 1]
[S]
KRA_KALAST3
How long has it been since you last used kratom? [CATI] Would you say within the past 30 days – that is since [DATEFILL], more than 30 days ago but within the past 12 months, or more than 12 months ago?
[CAWI RESPONSE OPTIONS:]
1 Within the past 30 days – that is, since [DATEFILL]
2 More than 30 days ago but within the past 12 months
3 More than 12 months ago
[CATI RESPONSE OPTIONS – DO NOT READ:]
1 WITHIN THE PAST 30 DAYS – THAT IS, SINCE [DATEFILL]
2 MORE THAN 30 DAYS AGO BUT WITHIN THE PAST 12 MONTHS
3 MORE THAN 12 MONTHS AGO
[PROGRAMMER NOTE: POPULATE DATEFILL WITH DATE 30 DAYS PRIOR TO TIME OF ANSWERING THIS QUESTION (INCLUDING DAY OF ANSWERING THIS QUESTION). DISPLAY ONLY MONTH AND DAY. FOR EXAMPLE, “September 30th.”
DISPLAY A CALENDAR ICON BENEATH THE QUESTION TEXT THAT RESPONDENTS CAN CLICK ON TO OPEN A 12-MONTH CALENDAR THAT HIGHLIGHTS THE PAST 30 DAY REFERENCE PERIOD AND THE PAST 12 MONTH REFERENCE PERIOD.]
[CREATE “END_KRA_TIME” AND “END_KRA_DATE”; RECORD TIME IN HH:MM:SS; RECORD DATE IN MM:DD:YYYY]
[CREATE “START_RIS_TIME” AND “START_RIS _DATE”; RECORD TIME IN HH:MM:SS; RECORD DATE IN MM:DD:YYYY]
[SHOW ALL]
[S]
We are interested in your opinion about the effects of using certain drugs and other substances.
Please indicate how much you think people risk harming themselves physically and in other ways when they do each of the following activities.
If you’re not sure, choose an answer for the amount of risk that comes closest to what you think might be true for that activity.
How much do people risk harming themselves physically and in other ways when they smoke one or
more packs of cigarettes per day? [CATI] Would you say no risk, slight risk, moderate risk, or great risk?
[CAWI RESPONSE OPTIONS]
No risk
Slight risk
Moderate risk
Great risk
[CATI RESPONSE OPTIONS – DO NOT READ:]
[SHOW ALL]
[S]
RIS_RK01c
How much do people risk harming themselves physically and in other ways when they smoke marijuana
once or twice a week? [CATI] Would you say no risk, slight risk, moderate risk, or great risk?
[CAWI RESPONSE OPTIONS]
No risk
Slight risk
Moderate risk
Great risk
[CATI RESPONSE OPTIONS – DO NOT READ:]
NO RISK
SLIGHT RISK
MODERATE RISK
GREAT RISK
[SHOW ALL]
[S]
RIS_RK01e
How much do people risk harming themselves physically and in other ways when they use LSD once or
twice a week? [CATI] Would you say no risk, slight risk, moderate risk, or great risk?
[CAWI RESPONSE OPTIONS]
No risk
Slight risk
Moderate risk
Great risk
[CATI RESPONSE OPTIONS – DO NOT READ:]
NO RISK
SLIGHT RISK
MODERATE RISK
GREAT RISK
[SHOW ALL]
[S]
RIS_RK01g
How much do people risk harming themselves physically and in other ways when they use heroin once
or twice a week? [CATI] Would you say no risk, slight risk, moderate risk, or great risk?
[CAWI RESPONSE OPTIONS]
No risk
Slight risk
Moderate risk
Great risk
[CATI RESPONSE OPTIONS – DO NOT READ:]
NO RISK
SLIGHT RISK
MODERATE RISK
GREAT RISK
[SHOW ALL]
[S]
RIS_RK01j
How much do people risk harming themselves physically and in other ways when they have four or five
drinks of an alcoholic beverage nearly every day? [CATI] Would you say no risk, slight risk, moderate risk,
or great risk?
[CAWI RESPONSE OPTIONS]
No risk
Slight risk
Moderate risk
Great risk
[CATI RESPONSE OPTIONS – DO NOT READ:]
[SHOW ALL]
[S]
RIS_RK01k
How much do people risk harming themselves physically and in other ways when they have five or more
drinks of an alcoholic beverage once or twice a week? [CATI] Would you say no risk, slight risk, moderate
risk, or great risk?
[CAWI RESPONSE OPTIONS]
No risk
Slight risk
Moderate risk
Great risk
[CATI RESPONSE OPTIONS – DO NOT READ:]
NO RISK
SLIGHT RISK
MODERATE RISK
GREAT RISK
[CREATE “END_RIS_TIME” AND “END_RIS_DATE”; RECORD TIME IN HH:MM:SS; RECORD DATE IN MM:DD:YYYY]
[CREATE “START_SUI_TIME” AND “START_SUI _DATE”; RECORD TIME IN HH:MM:SS; RECORD DATE IN MM:DD:YYYY]
[PROGRAMMER: DISPLAY IN FOOTER/BOTTOM OF EACH SCREEN IN SUI_SUICIDE SECTIONS:] <a>Need help?</a> Click here for resources.
[IF CATI: INTERVIEWER - USE THIS LINK TO ACCESS RESOURCES IF RESPONDENT NEEDS HELP/SUPPORT DURING INTERVIEW]
[PROGRAMMER: HYPERLINKS ABOVE SHOULD OPEN IN NEW WINDOW AND DISPLAY THE FOLLOWING:] Thank you for participating in this study. We realize that some of the topics covered are quite personal and can be difficult to think and talk about. We appreciate your willingness to be a part of this study and want you to know that we recognize the important contribution you have made. Sometimes when people have participated in a study like this, they realize that they are interested in following up on some of the issues that they have been asked about in the study with someone who is professionally trained to deal with these kinds of issues.
Below are some toll-free numbers of resources that you can use now or in the future if you want to speak further with someone.
You can reach the National Suicide Prevention Lifeline 988 (call or text) or https://988lifeline.org
[SHOW ALL]
[S]
SUI_INTRO
[IF CAWI: We are; IF CATI: I am] now going to ask you some questions about sensitive topics.
[CAWI] We suggest that you be in a private setting for the next questions. Remember, you don’t have to answer any question that you don’t want to. If, at any time, you need to take a break, you can quit the survey by closing the browser. You can come back to the survey whenever you want. If at any point the questions are making you upset and you would like to speak with a trained professional, please refer to the resources given at the bottom of the screen.
[CATI] I suggest that you be in a private setting for the next questions. Remember, you don’t have to answer any question that you don’t want to. If, at any time, you need to take a break, you can let me know you’d like to stop the survey. You can call back to complete the survey whenever you want or set up a time for us to call you back. If at any point the questions are making you upset and you would like to speak with a trained professional, please let me know and I can share some resources with you.
[SHOW ALL]
[S]
The next few questions are about thoughts of suicide. At any time in the past 12 months, that is from
[DATEFILL] up to and including today, did you seriously think about trying to kill yourself?
[CAWI RESPONSE OPTIONS:]
1 Yes
0 No
[CATI RESPONSE OPTIONS – DO NOT READ:]
1 YES
0 NO
[PROGRAMMER NOTE: POPULATE DATEFILL WITH DATE 12 MONTHS PRIOR TO TIME OF ANSWERING THIS QUESTION (INCLUDING DAY OF ANSWERING THIS QUESTION). DISPLAY MONTH DAY, AND YEAR. FOR EXAMPLE, “September 30, 2024.”
DISPLAY A CALENDAR ICON BENEATH THE QUESTION TEXT THAT RESPONDENTS CAN CLICK ON TO OPEN A 12-MONTH CALENDAR THAT HIGHLIGHTS THE PAST 12 MONTH REFERENCE PERIOD.]
[SHOW ALL]
[S]
SUI_SUI02
During the past 12 months, did you make any plans to kill yourself?
1 Yes
0 No
[CATI RESPONSE OPTIONS – DO NOT READ:]
1 YES
0 NO
[PROGRAMMER NOTE: DISPLAY A CALENDAR ICON BENEATH THE QUESTION TEXT THAT RESPONDENTS CAN CLICK ON TO OPEN A 12-MONTH CALENDAR THAT HIGHLIGHTS THE PAST 12 MONTH REFERENCE PERIOD.]
[SHOW ALL]
[S]
During the past 12 months, did you try to kill yourself?
[CAWI RESPONSE OPTIONS:]
1 Yes
0 No
[CATI RESPONSE OPTIONS – DO NOT READ:]
1 YES
0 NO
[PROGRAMMER NOTE: DISPLAY A CALENDAR ICON BENEATH THE QUESTION TEXT THAT RESPONDENTS CAN CLICK ON TO OPEN A 12-MONTH CALENDAR THAT HIGHLIGHTS THE PAST 12 MONTH REFERENCE PERIOD.]
[SHOW IF SUI_SUI03 = 1]
[S]
SUI_SUI04
During the past 12 months, did you get medical attention from a doctor or other health professional as a result of an attempt to kill yourself?
[CAWI RESPONSE OPTIONS:]
1 Yes
0 No
[CATI RESPONSE OPTIONS – DO NOT READ:]
1 YES
0 NO
[PROGRAMMER NOTE: DISPLAY A CALENDAR ICON BENEATH THE QUESTION TEXT THAT RESPONDENTS CAN CLICK ON TO OPEN A 12-MONTH CALENDAR THAT HIGHLIGHTS THE PAST 12 MONTH REFERENCE PERIOD.]
[SHOW IF SUI_SUI04 = 1]
[S]
SUI_SUI05
Did you stay in a hospital overnight or longer because you tried to kill yourself?
[CAWI RESPONSE OPTIONS:]
1 Yes
0 No
[CATI RESPONSE OPTIONS – DO NOT READ:]
1 YES
0 NO
[CREATE “END_SUI_TIME” AND “END_SUI_DATE”; RECORD TIME IN HH:MM:SS; RECORD DATE IN MM:DD:YYYY]
[CREATE “START_SOC_TIME” AND “START_SOC_DATE”; RECORD TIME IN HH:MM:SS; RECORD DATE IN MM:DD:YYYY]
[SHOW ALL]
[DISP]
SOC_INTRO
These next questions are about activities that can be difficult for some people because of physical, mental, or emotional conditions.
[SHOW ALL]
[S]
SOC_ERRANDS
Because of a physical, mental, or emotional condition, do you have difficulty doing errands alone, such as visiting a doctor's office or shopping? [CATI] Would you say no difficulty, some difficulty, a lot of difficulty, or you cannot do this at all?
[CAWI RESPONSE OPTIONS:]
1 No difficulty
2 Some difficulty
3 A lot of difficulty
4 Cannot do this at all
[CATI RESPONSE OPTIONS - DO NOT READ:]
1 NO DIFFICULTY
2 SOME DIFFICULTY
3 A LOT OF DIFFICULTY
4 CANNOT DO THIS AT ALL
[SHOW ALL]
[S]
SOC_PARACTIV
Because of a physical, mental, or emotional condition, do you have difficulty participating in social activities, such as visiting friends, attending clubs and meetings, or going to parties? [CATI] Would you say no difficulty, some difficulty, a lot of difficulty, or you cannot do this at all?
[CAWI RESPONSE OPTIONS:]
1 No difficulty
2 Some difficulty
3 A lot of difficulty
4 Cannot do this at all
[CATI RESPONSE OPTIONS - DO NOT READ:]
1 NO DIFFICULTY
2 SOME DIFFICULTY
3 A LOT OF DIFFICULTY
4 CANNOT DO THIS AT ALL
[SHOW ALL]
[S]
SOC_SCWRKLIM
Are you limited in the kind or amount of work you can do because of a physical, mental, or emotional problem?
Work includes paid work, volunteer work, school work, and homework.
[CAWI RESPONSE OPTIONS:]
1 Yes
0 No
[CATI RESPONSE OPTIONS - DO NOT READ:]
1 YES
0 NO
[CREATE “END_SOC_TIME” AND “END_SOC_DATE”; RECORD TIME IN HH:MM:SS; RECORD DATE IN MM:DD:YYYY]
[CREATE “START_EMP_TIME” AND “START_EMP_DATE”; RECORD TIME IN HH:MM:SS; RECORD DATE IN MM:DD:YYYY]
[SHOW ALL]
[S]
EMP_EMPLOY
Last week, did you work for pay at a job or business?
[CATI] INTERVIEWER - IF THE RESPONDENT SAYS THEY WORK, BUT NOT FOR PAY, AT A FAMILY-OWNED JOB OR BUSINESS, ENTER '1' FOR YES.
[CAWI RESPONSE OPTIONS:]
1 Yes
0 No
[CATI RESPONSE OPTIONS - DO NOT READ:]
1 YES
0 NO
[SHOW IF EMP_EMPLOY=0, -6, -7, -9]
[S]
EMP_ABSENTWK
Did you have a job or business last week, but were temporarily absent due to illness, vacation, family or maternity leave, or some other reason?
[CAWI RESPONSE OPTIONS:]
1 Yes
0 No
[CATI RESPONSE OPTIONS - DO NOT READ:]
1 YES
0 NO
[SHOW IF EMP_EMPLOY=0 AND EMP_ABSENTWK=0]
[S]
EMP_WHYNOWRK
What is the main reason you were not working for pay at a job or business last week?
[CAWI RESPONSE OPTIONS:]
Unemployed, laid off, or looking for work
Seasonal or contract work
Retired
Unable to work for health reasons or disabled
Taking care of house or family
Going to school
Working at a family-owned job or business, but not for pay
Other
[CATI RESPONSE OPTIONS – READ IF NECESSARY:]
Unemployed, laid off, or looking for work
Seasonal or contract work
Retired
Unable to work for health reasons or disabled
Taking care of house or family
Going to school
Working at a family-owned job or business, but not for pay
Other
[SHOW ALL]
EMP _INS
[GRID]
Are you covered by any of the following types of health insurance or health coverage plans?
[PROGRAMMER: DISPLAY EMP_INSA-EMP_INSH IN GRID FORMAT WITH Y/N RESPONSE COLUMNS, WHERE YES = 1 AND NO = 0]
EMP_INSA
Insurance
through a current or former employer or union of your own or another
family member
EMP_INSB Insurance purchased directly from an insurance company by you or another family member
EMP_INSC Medicare, for people 65 and older or people with certain disabilities
EMP_INSD Medicaid, Medical Assistance, or any kind of government-assistance plan for those with low incomes or a disability
EMP_INSE TRICARE or other military health care
EMP_INSF VA [CAWI: (enrolled for VA health care); CATI: That is, enrolled for VA health care]
EMP_INSG Indian Health Service
EMP_INSH Any other type of health insurance or health coverage plan (please specify) [TEXTBOX]
[PROGRAMMER: NOTE THAT RESPONDENTS WILL HAVE TO SELECT EMP_INSH=1 BEFORE THEY ARE ALLOWED TO ENTER TEXT INTO THE TEXTBOX]
[PROGRAMMER: IF EMP_INSH =1 AND TEXTBOX LEFT BLANK, PROMPT: You mentioned you had another type of health insurance or health coverage plan. Please enter the name in the text box.]
[CREATE “END_EMP_TIME” AND “END_EMP _DATE”; RECORD TIME IN HH:MM:SS; RECORD DATE IN MM:DD:YYYY]
[CREATE “START_WPH_TIME” AND “START_WPH_DATE”; RECORD TIME IN HH:MM:SS; RECORD DATE IN MM:DD:YYYY]
[SHOW ALL]
[S]
WPH_PHQOL
The next questions will ask you to rate different areas of your health.
How would you rate your quality of life, focusing on what matters most to you?
[CATI] Would you say excellent, very good, good, fair, or poor?
[CAWI RESPONSE OPTIONS:]
1 Excellent
2 Very good
3 Good
4 Fair
5 Poor
[CATI RESPONSE OPTIONS - DO NOT READ:]
1 EXCELLENT
2 VERY GOOD
3 GOOD
4 FAIR
5 POOR
[SHOW ALL]
[S]
WPH_SOCFC
How would you rate your social and family connections?
[CATI] Would you say excellent, very good, good, fair, or poor?
[CAWI RESPONSE OPTIONS:]
1 Excellent
2 Very good
3 Good
4 Fair
5 Poor
[CATI RESPONSE OPTIONS - DO NOT READ:]
1 EXCELLENT
2 VERY GOOD
3 GOOD
4 FAIR
5 POOR
[SHOW ALL]
[S]
WPH_DIET
In general, how healthy is your overall diet?
[CATI] Would you say excellent, very good, good, fair, or poor?
[CAWI RESPONSE OPTIONS:]
1 Excellent
2 Very good
3 Good
4 Fair
5 Poor
[CATI RESPONSE OPTIONS - DO NOT READ:]
1 EXCELLENT
2 VERY GOOD
3 GOOD
4 FAIR
5 POOR
[SHOW ALL]
[S]
WPH_PHYSA
How would you rate your physical activity, compared with people in your age group?
[CATI] Would you say excellent, very good, good, fair, or poor?
[CAWI RESPONSE OPTIONS:]
1 Excellent
2 Very good
3 Good
4 Fair
5 Poor
[CATI RESPONSE OPTIONS - DO NOT READ:]
EXCELLENT
VERY GOOD
GOOD
FAIR
POOR
[SHOW ALL]
[S]
WPH_STRESS
How would you rate your ability to manage stress?
[CATI] Would you say excellent, very good, good, fair, or poor?
[CAWI RESPONSE OPTIONS:]
1 Excellent
2 Very good
3 Good
4 Fair
5 Poor
[CATI RESPONSE OPTIONS - DO NOT READ:]
EXCELLENT
VERY GOOD
GOOD
FAIR
POOR
[SHOW ALL]
[S]
WPH_SLEEP
How would you rate your sleep?
[CATI] Would you say excellent, very good, good, fair, or poor?
[CAWI RESPONSE OPTIONS:]
1 Excellent
2 Very good
3 Good
4 Fair
5 Poor
[CATI RESPONSE OPTIONS - DO NOT READ:]
1 EXCELLENT
2 VERY GOOD
3 GOOD
4 FAIR
5 POOR
[SHOW ALL]
[S]
WPH_SPRT
How would you rate your ability to find meaning and purpose in your daily life?
[CATI] Would you say excellent, very good, good, fair, or poor?
[CAWI RESPONSE OPTIONS:]
1 Excellent
2 Very good
3 Good
4 Fair
5 Poor
[CATI RESPONSE OPTIONS - DO NOT READ:]
1 EXCELLENT
2 VERY GOOD
3 GOOD
4 FAIR
5 POOR
[SHOW ALL]
[S]
WPH_MANGH
How would you rate your ability to manage your health, focusing on aspects of your health that matter most to you?
[CATI] Would you say excellent, very good, good, fair, or poor?
[CAWI RESPONSE OPTIONS:]
1 Excellent
2 Very good
3 Good
4 Fair
5 Poor
[CATI RESPONSE OPTIONS - DO NOT READ:]
1 EXCELLENT
VERY GOOD
GOOD
FAIR
POOR
[CREATE “END_WPH_TIME” AND “END_WPH_DATE”; RECORD TIME IN HH:MM:SS; RECORD DATE IN MM:DD:YYYY]
[CREATE “START_SOS_TIME” AND “START_SOS_DATE”; RECORD TIME IN HH:MM:SS; RECORD DATE IN MM:DD:YYYY]
[SHOW ALL]
[S]
SOS_SUPPORT
The next questions are about social and emotional support.
How often do you get the social and emotional support you need?
[CATI] Would you say always, usually, sometimes, rarely, never?
[CAWI RESPONSE OPTIONS:]
1 Always
2 Usually
3 Sometimes
4 Rarely
5 Never
[CATI RESPONSE OPTIONS - DO NOT READ:]
1 ALWAYS
2 USUALLY
3 SOMETIMES
4 RARELY
5 NEVER
[CREATE “END_SOS_TIME” AND “END_SOS_DATE”; RECORD TIME IN HH:MM:SS; RECORD DATE IN MM:DD:YYYY]
[CREATE “START_LON_TIME” AND “START_LON_DATE”; RECORD TIME IN HH:MM:SS; RECORD DATE IN MM:DD:YYYY]
[SHOW ALL]
[S]
LON_LONELY
How often do you feel lonely?
[CATI] Would you say always, usually, sometimes, rarely, never?
[CAWI RESPONSE OPTIONS:]
1 Always
2 Usually
3 Sometimes
4 Rarely
5 Never
[CATI RESPONSE OPTIONS - DO NOT READ:]
1 ALWAYS
2 USUALLY
3 SOMETIMES
4 RARELY
5 NEVER
[CREATE “END_LON_TIME” AND “END_LON_DATE”; RECORD TIME IN HH:MM:SS; RECORD DATE IN MM:DD:YYYY]
[CREATE “START_SCN_TIME” AND “START_SCN_DATE”; RECORD TIME IN HH:MM:SS; RECORD DATE IN MM:DD:YYYY]
[SHOW ALL]
[S]
SCN_SCONNECT1
In a typical week, and not including people you live with, how many times do you get together with people that you care about and feel close to?
[CATI] Would you say never or less than once a week, 1 to 2 times a week, 3 to 4 times a week, or 5 or more times a week?
[CAWI RESPONSE OPTIONS:]
1 Never or less than once a week
2 1 to 2 times a week
3 3 to 4 times a week
4 5 or more times a week
[CATI RESPONSE OPTIONS - DO NOT READ:]
NEVER OR LESS THAN ONCE A WEEK
1 TO 2 TIMES A WEEK
3 TO 4 TIMES A WEEK
5 OR MORE TIMES A WEEK
[SHOW ALL]
[S]
SCN_SCONNECT2
In a typical week, and not including people you live with, how many times do you talk on the telephone
or by video with people that you care about and feel close to?
[CATI] Would you say never or less than once a week, 1 to 2 times a week, 3 to 4 times a week, or 5 or more times a week?
[CAWI RESPONSE OPTIONS:]
1 Never or less than once a week
2 1 to 2 times a week
3 3 to 4 times a week
4 5 or more times a week
[CATI RESPONSE OPTIONS - DO NOT READ:]
1 NEVER OR LESS THAN ONCE A WEEK
2 1 TO 2 TIMES A WEEK
3 3 TO 4 TIMES A WEEK
4 5 OR MORE TIMES A WEEK
[SHOW ALL]
[S]
SCN_SCONNECT3
During the past 12 months, how many times did you attend religious services?
Do not include special occasions such as weddings, funerals, or other special events.
[CATI] Would you say zero times, 1 to 3 times, 4 to 11 times, 12 or more times?
[CAWI RESPONSE OPTIONS:]
0 Zero times
1 1 to 3 times
2 4 to 11 times
3 12 or more times
[CATI RESPONSE OPTIONS - DO NOT READ:]
ZERO TIMES
1 TO 3 TIMES
4 TO 11 TIMES
12 OR MORE TIMES
[SHOW ALL]
[S]
SCN_SCONNECT4
During the past 12 months, how many times did you attend meetings of clubs or organizations you
belong to?
[CATI] Would you say you do not belong to a group, zero times, 1 to 3 times, 4 to 11 times, 12 or more times?
[CAWI RESPONSE OPTIONS:]
1 I do not belong to a club or organization
2 Zero times
2 1 to 3 times
3 4 to 11 times
4 12 or more times
[CATI RESPONSE OPTIONS - DO NOT READ:]
DOES NOT BELONG TO A CLUB OR ORGANIZATION
ZERO TIMES
1 TO 3 TIMES
4 TO 11 TIMES
12 OR MORE TIMES
[CREATE “END_SCN_TIME” AND “END_SCN_DATE”; RECORD TIME IN HH:MM:SS; RECORD DATE IN MM:DD:YYYY]
[CREATE “START_MTH_TIME” AND “START_MTH_DATE”; RECORD TIME IN HH:MM:SS; RECORD DATE IN MM:DD:YYYY]
[SHOW ALL]
[S]
MTH_PHQ41
Now [CATI, FILL: I’m; CAWI, FILL: we’re] going to ask you about several problems. Please tell [CATI, FILL: me; CAWI, FILL: us] how often you have been bothered, over the last 2 weeks, by any of the following problems. [CATI] For each problem there are 4 possible answers: not at all, several days, more than half of the days, or nearly every day.
Over the last two weeks, how often have you been bothered by
…little interest or pleasure in doing things? [CATI] Would you say not at all, several days, more than half of the days, or nearly every day?
[CAWI RESPONSE OPTIONS:]
0 Not at all
1 Several days
2 More than half the days
3 Nearly every day
[CATI RESPONSE OPTIONS - DO NOT READ:]
0 NOT AT ALL
1 SEVERAL DAYS
2 MORE THAN HALF THE DAYS
3 NEARLY EVERY DAY
[SHOW ALL]
[S]
MTH_PHQ42
…feeling down, depressed, or hopeless? [CATI] Would you say not at all, several days, more than half of the days, or nearly every day?
[CAWI RESPONSE OPTIONS:]
0 Not at all
1 Several days
2 More than half the days
3 Nearly every day
[CATI RESPONSE OPTIONS - DO NOT READ:]
0 NOT AT ALL
1 SEVERAL DAYS
2 MORE THAN HALF THE DAYS
3 NEARLY EVERY DAY
[SHOW ALL]
[S]
MTH_PHQ83
…trouble falling or staying asleep, or sleeping too much? [CATI] Would you say not at all, several days, more than half of the days, or nearly every day?
[CAWI RESPONSE OPTIONS:]
0 Not at all
1 Several days
2 More than half the days
3 Nearly every day
[CATI RESPONSE OPTIONS - DO NOT READ:]
0 NOT AT ALL
1 SEVERAL DAYS
2 MORE THAN HALF THE DAYS
3 NEARLY EVERY DAY
[SHOW ALL]
[S]
MTH_PHQ84
…feeling tired or having little energy? [CATI] Would you say not at all, several days, more than half of the days, or nearly every day?
[CAWI RESPONSE OPTIONS:]
0 Not at all
1 Several days
2 More than half the days
3 Nearly every day
[CATI RESPONSE OPTIONS - DO NOT READ:]
0 NOT AT ALL
1 SEVERAL DAYS
2 MORE THAN HALF THE DAYS
3 NEARLY EVERY DAY
[PROGRAMMER NOTE: DISPLAY MTH_PHQ41 – MTH_PHQ84 ON SAME SCREEN]
[SHOW ALL]
[S]
MTH_PHQ85
Over the last two weeks, how often have you been bothered by
…poor appetite or overeating? [CATI] Would you say not at all, several days, more than half of the days, or nearly every day?
[CAWI RESPONSE OPTIONS:]
0 Not at all
1 Several days
2 More than half the days
3 Nearly every day
[CATI RESPONSE OPTIONS - DO NOT READ:]
0 NOT AT ALL
1 SEVERAL DAYS
2 MORE THAN HALF THE DAYS
3 NEARLY EVERY DAY
[SHOW ALL]
[S]
MTH_PHQ86
…feeling bad about yourself, or that you are a failure, or have let yourself or your family down? [CATI] Would you say not at all, several days, more than half of the days, or nearly every day?
[CAWI RESPONSE OPTIONS:]
0 Not at all
1 Several days
2 More than half the days
3 Nearly every day
[CATI RESPONSE OPTIONS - DO NOT READ:]
0 NOT AT ALL
1 SEVERAL DAYS
2 MORE THAN HALF THE DAYS
3 NEARLY EVERY DAY
[SHOW ALL]
[S]
MTH_PHQ87
…trouble concentrating on things, such as reading the newspaper or watching television? [CATI] Would you say not at all, several days, more than half of the days, or nearly every day?
[CAWI RESPONSE OPTIONS:]
0 Not at all
1 Several days
2 More than half the days
3 Nearly every day
[CATI RESPONSE OPTIONS - DO NOT READ:]
0 NOT AT ALL
1 SEVERAL DAYS
2 MORE THAN HALF THE DAYS
3 NEARLY EVERY DAY
[SHOW ALL]
[S]
MTH_PHQ88
…moving or speaking so slowly that other people could have noticed? Or the opposite, being so fidgety or restless that you have been moving around a lot more than usual? [CATI] Would you say not at all, several days, more than half of the days, or nearly every day?
[CAWI RESPONSE OPTIONS:]
0 Not at all
1 Several days
2 More than half the days
3 Nearly every day
[CATI RESPONSE OPTIONS - DO NOT READ:]
0 NOT AT ALL
1 SEVERAL DAYS
2 MORE THAN HALF THE DAYS
3 NEARLY EVERY DAY
[PROGRAMMER NOTE: DISPLAY MTH_PHQ85 – MTH_PHQ88 ON SAME SCREEN]
[SHOW ALL]
[S]
MTH_AGAD1
Over the last two weeks, how often have you been bothered by
…feeling nervous, anxious, or on edge? [CATI] Would you say not at all, several days, more than half of the days, or nearly every day?
[CAWI RESPONSE OPTIONS:]
0 Not at all
1 Several days
2 More than half the days
3 Nearly every day
[CATI RESPONSE OPTIONS - DO NOT READ:]
0 NOT AT ALL
1 SEVERAL DAYS
2 MORE THAN HALF THE DAYS
3 NEARLY EVERY DAY
[SHOW ALL]
[S]
MTH_AGAD2
…not being able to stop or control worrying? [CATI] Would you say not at all, several days, more than half of the days, or nearly every day?
[CAWI RESPONSE OPTIONS:]
0 Not at all
1 Several days
2 More than half the days
3 Nearly every day
[CATI RESPONSE OPTIONS - DO NOT READ:]
0 NOT AT ALL
1 SEVERAL DAYS
2 MORE THAN HALF THE DAYS
3 NEARLY EVERY DAY
[SHOW ALL]
[S]
MTH_AGAD3
…worrying too much about different things? [CATI] Would you say not at all, several days, more than half of the days, or nearly every day?
[CAWI RESPONSE OPTIONS:]
0 Not at all
1 Several days
2 More than half the days
3 Nearly every day
[CATI RESPONSE OPTIONS - DO NOT READ:]
0 NOT AT ALL
1 SEVERAL DAYS
2 MORE THAN HALF THE DAYS
3 NEARLY EVERY DAY
[SHOW ALL]
[S]
MTH_AGAD4
…having trouble relaxing? [CATI] Would you say not at all, several days, more than half of the days, or nearly every day?
[CAWI RESPONSE OPTIONS:]
0 Not at all
1 Several days
2 More than half the days
3 Nearly every day
[CATI RESPONSE OPTIONS - DO NOT READ:]
0 NOT AT ALL
1 SEVERAL DAYS
2 MORE THAN HALF THE DAYS
3 NEARLY EVERY DAY
[PROGRAMMER NOTE: DISPLAY MTH_AGAD1 – MTH_AGAD4 ON SAME SCREEN]
[SHOW ALL]
[S]
MTH_AGAD5
Over the last two weeks, how often have you been bothered by
…being so restless that it is hard to sit still? [CATI] Would you say not at all, several days, more than half of the days, or nearly every day?
[CAWI RESPONSE OPTIONS:]
0 Not at all
1 Several days
2 More than half the days
3 Nearly every day
[CATI RESPONSE OPTIONS - DO NOT READ:]
0 NOT AT ALL
1 SEVERAL DAYS
2 MORE THAN HALF THE DAYS
3 NEARLY EVERY DAY
[SHOW ALL]
[S]
MTH_AGAD6
…becoming easily annoyed or irritable? [CATI] Would you say not at all, several days, more than half of the days, or nearly every day?
[CAWI RESPONSE OPTIONS:]
0 Not at all
1 Several days
2 More than half the days
3 Nearly every day
[CATI RESPONSE OPTIONS - DO NOT READ:]
0 NOT AT ALL
1 SEVERAL DAYS
2 MORE THAN HALF THE DAYS
3 NEARLY EVERY DAY
[SHOW ALL]
[S]
MTH_AGAD7
…feeling afraid as if something awful might happen? [CATI] Would you say not at all, several days, more than half of the days, or nearly every day?
[CAWI RESPONSE OPTIONS:]
0 Not at all
1 Several days
2 More than half the days
3 Nearly every day
[CATI RESPONSE OPTIONS - DO NOT READ:]
0 NOT AT ALL
1 SEVERAL DAYS
2 MORE THAN HALF THE DAYS
3 NEARLY EVERY DAY
[PROGRAMMER NOTE: DISPLAY MTH_AGAD5 – MTH_AGAD7 ON SAME SCREEN]
[CREATE “END_MTH_TIME” AND “END_MTH_DATE”; RECORD TIME IN HH:MM:SS; RECORD DATE IN MM:DD:YYYY]
[CREATE “START_AI_TIME” AND “START_AI_DATE”; RECORD TIME IN HH:MM:SS; RECORD DATE IN MM:DD:YYYY]
[SHOW ALL]
[S]
AI_AI2
AI chatbots or virtual companions use artificial intelligence to talk to people through text or voice, without another human involved. People use them for things like getting information, asking questions, or having conversations. Examples include ChatGPT, Wysa [IF CATI: (PRONOUNCED: WISE-uh)], and Replika [IF CATI: (PRONOUNCED: REP-luh-kuh)].
Have you ever used an AI chatbot or companion? [CATI] If you are unsure or don’t know, you can say that.
[CAWI RESPONSE OPTIONS:]
Yes
0 No
-9 Not sure
[CATI RESPONSE OPTIONS - DO NOT READ:]
YES
NO
-9 NOT SURE
[SHOW IF AI_AI2 = 1]
[S]
AI_AI3
AI chatbots and companions can offer emotional support by helping people feel heard, cared for, understood, and comforted. Have you ever used an AI chatbot or companion for emotional support?
[CAWI RESPONSE OPTIONS:]
1 Yes
0 No
[CATI RESPONSE OPTIONS – DO NOT READ:]
1 YES
0 NO
[SHOW IF AI_AI3 = 1]
[NUMBOX, S]
AI_AI4
In a typical week, about how much time do you spend interacting with an AI chatbot or companion for emotional support?
Please report your time in either minutes or hours per week.
[NUMBOX] Enter a number [RANGE: 1 - 1080]
[DROPDOWN] Select unit
Minutes per week
Hours per week
[ ] I do not use AI chatbots or companions for emotional support in a typical week
[PROGRAMMER NOTE: DO NOT ALLOW “I DO NOT USE AI CHATBOTS OR COMPANIONS FOR EMOTIONAL SUPPORT IN A TYPICAL WEEK” TO BE SELECTED IN COMBINATION WITH A NUMERIC ENTRY FOR MINUTES PER DAY OR HOURS PER WEEK. IF NUMBOX ENTRY LESS THAN 1, DISPLAY ERROR MESSAGE: ENTRY OUTSIDE OF RANGE. IF YOU SPEND 0 HOURS OR MINUTES PER WEEK, SELECT “I do not use AI chatbots or companions for emotional support in a typical week.”]
[SHOW IF AI_AI4a = -6, -7, -9]
[S]
AI_AI4a
What is your best estimate for how much time you spend interacting with an AI chatbot or companion for emotional support in a typical week?
[CAWI RESPONSE OPTIONS:]
1 30 minutes or less
More than 30 minutes but less than an hour
More than 1 hour but less than 3 hours
More than 3 hours but less than 5 hours
More than 5 hours but less than 10 hours
More than 10 hours
[CATI RESPONSE OPTIONS:]
1 30 minutes or less
More than 30 minutes but less than an hour
More than 1 hour but less than 3 hours
More than 3 hours but less than 5 hours
More than 5 hours but less than 10 hours
More than 10 hours
[SHOW IF (SUI_SUI01= 1 OR SUI_SUI02 = 1 OR SUI_SUI03 = 1) AND AI_AI3 = 1]
[S]
AI_AI5
Have you ever used an AI chatbot or companion for emotional support when you were having thoughts about trying to kill yourself?
[CAWI RESPONSE OPTIONS:]
1 Yes
0 No
[CATI RESPONSE OPTIONS – DO NOT READ:]
1 YES
0 NO
[SHOW IF AI_AI2 = 1]
[S]
AI_AI6
How much do you agree or disagree with the following statements? [CATI: Would you say you strongly agree, somewhat agree, somewhat disagree, or strongly disagree?]
[SHOW IF AI_AI2 = 1]
[S]
AI_AI6a
[IF CAWI: I; IF CATI: You] feel understood when talking to AI chatbots or companions.
[CAWI RESPONSE OPTIONS:]
Strongly agree
Somewhat agree
Somewhat disagree
Strongly disagree
[CATI RESPONSE OPTIONS – DO NOT READ:]
Strongly agree
Somewhat agree
Somewhat disagree
Strongly disagree
[SHOW IF AI_AI2 = 1]
[S]
AI_AI6b
[IF CAWI: I; IF CATI: You] feel a sense of connection when talking to AI chatbots or companions.
[CAWI RESPONSE OPTIONS:]
Strongly agree
Somewhat agree
Somewhat disagree
Strongly disagree
[CATI RESPONSE OPTIONS – DO NOT READ:]
Strongly agree
Somewhat agree
Somewhat disagree
Strongly disagree
[SHOW IF AI_AI2 = 1]
[S]
AI_AI6c
[IF CAWI: I feel; IF CATI: You feel] AI chatbots or companions just tell [IF CAWI: me; IF CATI: you] what [IF CAWI: I; IF CATI: you] want to hear.
[CAWI RESPONSE OPTIONS:]
Strongly agree
Somewhat agree
Somewhat disagree
Strongly disagree
[CATI RESPONSE OPTIONS – DO NOT READ:]
Strongly agree
Somewhat agree
Somewhat disagree
Strongly disagree
[SHOW IF AI_AI2 = 1]
[S]
AI_AI6d
[IF CAWI: I; IF CATI: You] trust AI chatbots and companions to provide helpful advice about emotional issues.
[CAWI RESPONSE OPTIONS:]
Strongly agree
Somewhat agree
Somewhat disagree
Strongly disagree
[CATI RESPONSE OPTIONS – DO NOT READ:]
Strongly agree
Somewhat agree
Somewhat disagree
Strongly disagree
[SHOW IF AI_AI2 = 1]
[S]
AI_AI6e
[IF CAWI: I; IF CATI: You] feel that AI chatbots and companions can think and form opinions the same way humans do.
[CAWI RESPONSE OPTIONS:]
Strongly agree
Somewhat agree
Somewhat disagree
Strongly disagree
[CATI RESPONSE OPTIONS – DO NOT READ:]
Strongly agree
Somewhat agree
Somewhat disagree
Strongly disagree
[PROGRAMMER NOTE: DISPLAY AI_AI6a – AI_AI6e ON SAME SCREEN]
[SHOW IF AI_AI2 = 1]
[S]
AI_AI7
Have you ever received advice or feedback from an AI chatbot or companion that felt emotionally harmful?
[CAWI RESPONSE OPTIONS:]
1 Yes
0 No
[CATI RESPONSE OPTIONS – DO NOT READ:]
1 YES
0 NO
[SHOW IF AI_AI2 = 1]
[S]
AI_AI8
Given the choice, would you prefer to turn to a human or to an AI chatbot or companion for emotional support? [CATI] If it depends on what you want to talk about, or you have no preference, you can say that as well
[CAWI RESPONSE OPTIONS:]
I prefer talking to an AI chatbot or companion
I prefer talking to a human
It depends on what I want to talk about
No preference
[CATI RESPONSE OPTIONS – DO NOT READ:]
YOU PREFER TALKING TO AN AI CHATBOT OR COMPANION
YOU PREFER TALKING TO A HUMAN
IT DEPENDS ON WHAT YOU WANT TO TALK ABOUT
NO PREFERENCE
[CREATE “END_AI_TIME” AND “END_AI_DATE”; RECORD TIME IN HH:MM:SS; RECORD DATE IN MM:DD:YYYY]
[CREATE “START_SPO_TIME” AND “START_SPO _DATE”; RECORD TIME IN HH:MM:SS; RECORD DATE IN MM:DD:YYYY]
[SHOW ALL]
[DISP]
SPO_DISP
The next questions are about encounters with the police or the court system.
[SHOW ALL]
[NUMBOX]
Not counting minor traffic violations, how many times during the past 12 months have you been
arrested and booked for breaking a law?
Being ‘booked’ means that you were taken into custody and processed by the police or by someone connected with the courts, even if you were then released.
[NUMBOX] times in the past 12 months [RANGE: 0 - 99]
-9 Don’t know
[PROGRAMMER NOTE: DISPLAY A CALENDAR ICON BENEATH THE QUESTION TEXT THAT RESPONDENTS CAN CLICK ON TO OPEN A 12-MONTH CALENDAR THAT HIGHLIGHTS THE PAST 30 DAY REFERENCE PERIOD AND THE PAST 12 MONTH REFERENCE PERIOD.]
[PROGRAMMER NOTE: DO NOT ALLOW “DON’T KNOW” TO BE SELECTED IN COMBINATION WITH NUMERIC ENTRY IN NUMBOX. IF NUMERIC ENTRY OUTSIDE OF RANGE, DISPLAY ERROR MESSAGE: “Please enter a number between 0 and 99.”]
[SHOW IF SPO_SP02 = 1-99, -6, -7, -9]
[S]
SPO_SP03j
The next questions are about offenses that are against the law. As you read each question, please
answer whether you were arrested and booked for that offense during the past 12 months.
In the past 12 months, were you arrested and booked for driving under the influence of alcohol or drugs?
[CAWI RESPONSE OPTIONS:]
1 Yes
No
[CATI RESPONSE OPTIONS – DO NOT READ:]
1 YES
NO
[PROGRAMMER NOTE: DISPLAY A CALENDAR ICON BENEATH THE QUESTION TEXT THAT RESPONDENTS CAN CLICK ON TO OPEN A 12-MONTH CALENDAR THAT HIGHLIGHTS THE PAST 30 DAY REFERENCE PERIOD AND THE PAST 12 MONTH REFERENCE PERIOD.]
[SHOW IF ALC_ALLAST3 = 1 OR 2 OR ALC_ALRECDK = 1 OR 2 OR ALC_ALRECRE = 1 OR 2]
[S]
SPO_SP06a
During the past 12 months, have you driven a vehicle while you were under the influence of alcohol?
[CAWI RESPONSE OPTIONS:]
1 Yes
0 No
[CATI RESPONSE OPTIONS - DO NOT READ:]
YES
NO
[PROGRAMMER NOTE: DISPLAY A CALENDAR ICON BENEATH THE QUESTION TEXT THAT RESPONDENTS CAN CLICK ON TO OPEN A 12-MONTH CALENDAR THAT HIGHLIGHTS THE PAST 30 DAY REFERENCE PERIOD AND THE PAST 12 MONTH REFERENCE PERIOD.]
[SHOW IF MAR_MJLAST3 = 1 OR 2 OR MAR_MJRECDK = 1 OR 2 OR MAR_MJRECRE = 1 OR 2]
[S]
SPO_SP06b
During the past 12 months, have you driven a vehicle while you were under the influence of marijuana?
[CAWI RESPONSE OPTIONS:]
1 Yes
0 No
[CATI RESPONSE OPTIONS - DO NOT READ:]
YES
NO
[PROGRAMMER NOTE: DISPLAY A CALENDAR ICON BENEATH THE QUESTION TEXT THAT RESPONDENTS CAN CLICK ON TO OPEN A 12-MONTH CALENDAR THAT HIGHLIGHTS THE PAST 30 DAY REFERENCE PERIOD AND THE PAST 12 MONTH REFERENCE PERIOD.]
[SHOW ALL]
[S]
SPO_SEN12a
During the past 12 months, how many times have you sold illegal drugs?
[CAWI RESPONSE OPTIONS:]
1 0 times
2 1 or 2 times
3 3 to 5 times
4 6 to 9 times
[CAWI RESPONSE OPTIONS – DO NOT READ:]
1 0 TIMES
2 1 OR 2 TIMES
3 3 TO 5 TIMES
4 6 TO 9 TIMES
5 10 OR MORE TIMES
[PROGRAMMER NOTE: DISPLAY A CALENDAR ICON BENEATH THE QUESTION TEXT THAT RESPONDENTS CAN CLICK ON TO OPEN A 12-MONTH CALENDAR THAT HIGHLIGHTS THE PAST 30 DAY REFERENCE PERIOD AND THE PAST 12 MONTH REFERENCE PERIOD.]
[CREATE “END_SPO_TIME” AND “END_SPO_DATE”; RECORD TIME IN HH:MM:SS; RECORD DATE IN MM:DD:YYYY]
[CREATE “START_NAR_TIME” AND “START_NAR _DATE”; RECORD TIME IN HH:MM:SS; RECORD DATE IN MM:DD:YYYY]
[SHOW IF MAR_MJ01 = 1 OR MAR_MJREF = 1 OR CC_CC01 = 1 OR CC_CCREF = 1 OR HER_HE01 = 1 OR HER_HEREF = 1 OR IMF_IFLIF=1 OR HAL_LS01a = 1 OR HAL_LS01e = 1 OR METH_ME01=1 OR METH_MEREF=1]
[S]
NAR_NARCANPY
If someone appears to be overdosing on opioids, they might be treated with an overdose reversal medicine, such as Narcan or naloxone [IF CATI: (PRONOUNCED: na-LOK-sone)].
During the past 12 months, have you been treated with an overdose reversal medicine?
[CAWI RESPONSE OPTIONS:]
1 Yes
0 No
[CATI RESPONSE OPTIONS – DO NOT READ:]
1 YES
0 NO
[CREATE “END_NAR_TIME” AND “END_NAR_DATE”; RECORD TIME IN HH:MM:SS; RECORD DATE IN MM:DD:YYYY]
[CREATE “START_TXT_TIME” AND “START_TXT_DATE”; RECORD TIME IN HH:MM:SS; RECORD DATE IN MM:DD:YYYY]
[SHOW ALL]
[S]
TXT_TXMHSUPP
These next questions ask about help you may have received for your mental health, emotions, or
behavior.
During the past 12 months, have you participated in a support group to help you with your mental health, emotions, or behavior?
[CAWI RESPONSE OPTIONS:]
1 Yes
No
[CATI RESPONSE OPTIONS – DO NOT READ:]
1 YES
NO
[PROGRAMMER NOTE: DISPLAY A CALENDAR ICON BENEATH THE QUESTION TEXT THAT RESPONDENTS CAN CLICK ON TO OPEN A 12-MONTH CALENDAR THAT HIGHLIGHTS THE PAST 30 DAY REFERENCE PERIOD AND THE PAST 12 MONTH REFERENCE PERIOD.]
[SHOW ALL]
[S]
TXT_TXMHER
During the past 12 months, were you seen in an emergency room or emergency department for your
mental health, emotions, or behavior?
[CAWI RESPONSE OPTIONS:]
1 Yes
0 No
[CATI RESPONSE OPTIONS – DO NOT READ:]
1 YES
0 NO
[PROGRAMMER NOTE: DISPLAY A CALENDAR ICON BENEATH THE QUESTION TEXT THAT RESPONDENTS CAN CLICK ON TO OPEN A 12-MONTH CALENDAR THAT HIGHLIGHTS THE PAST 30 DAY REFERENCE PERIOD AND THE PAST 12 MONTH REFERENCE PERIOD.]
[SHOW ALL]
[S]
TXT_TXMHRX
During the past 12 months, did you take any medication that was prescribed to you to help with your
mental health, emotions, or behavior?
[CAWI RESPONSE OPTIONS:]
1 Yes
0 No
[CATI RESPONSE OPTIONS – DO NOT READ:]
1 YES
0 NO
[PROGRAMMER NOTE: DISPLAY A CALENDAR ICON BENEATH THE QUESTION TEXT THAT RESPONDENTS CAN CLICK ON TO OPEN A 12-MONTH CALENDAR THAT HIGHLIGHTS THE PAST 30 DAY REFERENCE PERIOD AND THE PAST 12 MONTH REFERENCE PERIOD.]
[CREATE “END_TXT_TIME” AND “END_TXT_DATE”; RECORD TIME IN HH:MM:SS; RECORD DATE IN MM:DD:YYYY]
[CREATE “START_ADT_TIME” AND “START_ADT _DATE”; RECORD TIME IN HH:MM:SS; RECORD DATE IN MM:DD:YYYY]
[SHOW IF MJ_MJ01 = 1 OR MJ_MJREF = 1 OR CC_CC01 = 1 OR CC_CCREF = 1 OR HER_HE01 = 1 OR HER_HEREF = 1 OR IMF_IFLIF=1 OR HAL_LS01a = 1 OR HAL_LS01e = 1 OR METH_ME01=1 OR METH_MEREF=1 OR ALC_AL01 = 1 OR ALC_ALREF = 1]
[S]
ADT_TXSBSUPP
The next questions ask about help you may have received for your alcohol or drug use, not including nicotine or tobacco.
During the past 12 months, have you participated in a support group for your alcohol or drug use?
[CAWI RESPONSE OPTIONS:]
1 Yes
0 No
[CATI RESPONSE OPTIONS – DO NOT READ:]
1 YES
0 NO
[SHOW IF MAR_MJ01 = 1 OR MAR_MJREF = 1 OR CC_CC01 = 1 OR CC_CCREF = 1 OR HER_HE01 = 1 OR HER_HEREF = 1 OR IMF_IFLIF=1 OR HAL_LS01a = 1 OR HAL_LS01e = 1 OR METH_ME01=1 OR METH_MEREF=1 OR ALC_AL01 = 1 OR ALC_ALREF = 1]
[S]
ADT_TXSBER
During the past 12 months, were you seen in an emergency room or emergency department for your
alcohol or drug use?
[CAWI RESPONSE OPTIONS:]
1 Yes
0 No
[CATI RESPONSE OPTIONS – DO NOT READ:]
1 YES
0 NO
[CREATE “END_ADT_TIME” AND “END_ADT_DATE”; RECORD TIME IN HH:MM:SS; RECORD DATE IN MM:DD:YYYY]
[CREATE “START_ACC_TIME” AND “START_ACC_DATE”; RECORD TIME IN HH:MM:SS; RECORD DATE IN MM:DD:YYYY]
[SHOW ALL]
[S]
ACC_HTHLAST
About how long has it been since you last saw a doctor or other health professional about your health?
Include doctors seen while a patient in a hospital. Do not include dental care.
[CAWI RESPONSE OPTIONS:]
1 Less than 12 months ago
2 More than 1 year but less than 2 years ago
3 More than 2 years but less than 3 years ago
4 More than 3 years but less than 5 years ago
5 More than 5 years but less than 10 years ago
6 10 years ago or more
0 Never
[CATI RESPONSE OPTIONS – READ IF NECESSARY:]
1 Within the past year (ANY TIME LESS THAN 12 MONTHS AGO)
2 Within the last 2 years (MORE THAN 1 YEAR BUT LESS THAN 2 YEARS AGO)
3 Within the last 3 years (MORE THAN 2 YEARS BUT LESS THAN 3 YEARS AGO)
4 Within the last 5 years (MORE THAN 3 YEARS BUT LESS THAN 5 YEARS AGO)
5 Within the last 10 years (MORE THAN 5 YEARS BUT LESS THAN 10 YEARS AGO)
6 10 years ago or more
0 Never
[SHOW ALL]
[S]
ACC_HTHUSUAL
Is there a place that you usually go to if you are sick and need health care?
[CAWI RESPONSE OPTIONS:]
Yes, there is a single place
3 Yes, there is more than one place
2 No, there is no place
[CATI RESPONSE OPTIONS – DO NOT READ:]
1 YES
2 THERE IS NO PLACE
3 THERE IS MORE THAN ONE PLACE
[SHOW IF ACC_HTHUSUAL = 1, 3, -6, -7, -9]
[S]
ACC_HTHTYPE
What kind of place [IF ACC_HTHUSUAL=1, FILL: is it; ELSE, FILL: do you go to most often]? [CATI] Is it a doctor’s office or health center; an urgent care center, a clinic in a drug store or grocery store; a hospital emergency room; a VA medical center or VA outpatient clinic; or some other place?
A doctor’s office or health center is a place where you see the same doctor or the same group of doctors every visit, where you usually need to make an appointment ahead of time, and where your medical records are on file.
Urgent care centers and clinics in a drug store or grocery store are places where you do not need to make an appointment ahead of time, and usually do not see the same health care provider at each visit.
[CAWI RESPONSE OPTIONS:]
A doctor’s office or health center
Urgent care center or clinic in a drug store or grocery store
Hospital emergency room
A VA medical center or VA outpatient clinic
Some other place
I do not go to one place most often
[CATI RESPONSE OPTIONS – DO NOT READ:]
A DOCTOR’S OFFICE OR HEALTH CENTER
URGENT CARE CENTER OR CLINIC IN A DRUG STORE OR GROCERY STORE
HOSPITAL EMERGENCY ROOM
A VA MEDICAL CENTER OR VA OUTPATIENT CLINIC
SOME OTHER PLACE
YOU DO NOT GO TO ONE PLACE MOST OFTEN
[SHOW ALL]
[S]
ACC_HOSP12M
During the past 12 months, have you been hospitalized overnight?
Do not include an overnight stay in the emergency room.
[CAWI RESPONSE OPTIONS:]
1 Yes
0 No
[CATI RESPONSE OPTIONS - DO NOT READ:]
1 YES
0 NO
[SHOW ALL]
[S]
ACC_HLTH17
During the past 12 months, have you stayed overnight or longer as an inpatient in a hospital?
[CAWI RESPONSE OPTIONS:]
1 Yes
0 No
[CATI RESPONSE OPTIONS - DO NOT READ:]
1 YES
[SHOW ALL]
[NUMBOX]
ACC_HLTH19
During the past 12 months, how many times have you visited a doctor, nurse, physician assistant, or nurse practitioner about your own health at a doctor’s office, a clinic, or some other place?
[NUMBOX] visits in the past 12 months [RANGE: 0 - 365]
[PROGRAMMER NOTE: IF NUMERIC ENTRY OUTSIDE OF RANGE, DISPLAY ERROR MESSAGE: “Please enter a number between 0 and 366.”]
[CREATE “END_ACC_TIME” AND “END_ACC_DATE”; RECORD TIME IN HH:MM:SS; RECORD DATE IN MM:DD:YYYY]
[CREATE “START_HCA_TIME” AND “START_HCA_DATE”; RECORD TIME IN HH:MM:SS; RECORD DATE IN MM:DD:YYYY]
[SHOW ALL]
[S]
HCA_MHTHDLY
During the past 12 months, have you delayed getting counseling or therapy from a mental health professional because of the cost?
[CAWI RESPONSE OPTIONS:]
1 Yes
0 No
[CATI RESPONSE OPTIONS - DO NOT READ:]
1 YES
0 NO
[SHOW ALL]
[S]
HCA_MHTND
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 of the cost?
[CAWI RESPONSE OPTIONS:]
1 Yes
0 No
[CATI RESPONSE OPTIONS - DO NOT READ:]
1 YES
0 NO
[SHOW ALL]
[S]
HCA_DLYCOST
During the past 12 months, have you delayed getting medical care because of the cost?
[CAWI RESPONSE OPTIONS:]
1 Yes
0 No
[CATI RESPONSE OPTIONS - DO NOT READ:]
1 YES
0 NO
[SHOW ALL]
[S]
HCA_DNTCOST
During the past 12 months, was there any time when you needed medical care, but did not get it because of the cost?
[CAWI RESPONSE OPTIONS:]
1 Yes
0 No
[CATI RESPONSE OPTIONS - DO NOT READ:]
1 YES
0 NO
[CREATE “END_HCA_TIME” AND “END_HCA_DATE”; RECORD TIME IN HH:MM:SS; RECORD DATE IN MM:DD:YYYY]
[CREATE “START_PAY_TIME” AND “START_PAY_DATE”; RECORD TIME IN HH:MM:SS; RECORD DATE IN MM:DD:YYYY]
[SHOW ALL]
[S]
PAY_BILL12M
In the past 12 months, did you or anyone in your family have problems paying or were unable to pay medical bills?
Include bills from doctors, dentists, hospitals, therapists, medication, equipment, nursing home or home care.
[CAWI RESPONSE OPTIONS:]
1 Yes
0 No
[CATI RESPONSE OPTIONS - DO NOT READ:]
1 YES
0 NO
[SHOW ALL]
[S]
PAY_PAYWORRY
If you get sick or have an accident, how worried are you that you will be able to pay your medical bills? [CATI] Are you very worried, somewhat worried, or not at all worried?
1 Very worried
2 Somewhat worried
3 Not at all worried
[CATI RESPONSE OPTIONS - DO NOT READ:]
1 VERY WORRIED
2 SOMEWHAT WORRIED
3 NOT AT ALL WORRIED
[CREATE “END_PAY_TIME” AND “END_PAY_DATE”; RECORD TIME IN HH:MM:SS; RECORD DATE IN MM:DD:YYYY]
[CREATE “START_HCU_TIME” AND “START_HCU _DATE”; RECORD TIME IN HH:MM:SS; RECORD DATE IN MM:DD:YYYY]
[SHOW ALL]
[S]
HCU_RX12MA
At any time in the past 12 months, did you take prescription medication?
[CAWI RESPONSE OPTIONS:]
1 Yes
0 No
[CATI RESPONSE OPTIONS – DO NOT READ:]
1 YES
0 NO
[SHOW ALL]
[S]
During the past 12 months, did you take prescription medication to help you with your emotions or with your concentration, behavior, or mental health?
[CAWI RESPONSE OPTIONS:]
1 Yes
0 No
[CATI RESPONSE OPTIONS - DO NOT READ:]
1 YES
0 NO
[CREATE “START_MTL_TIME” AND “START_MTL _DATE”; RECORD TIME IN HH:MM:SS; RECORD DATE IN MM:DD:YYYY]
[SHOW ALL]
[S]
MTL_MHTHRPY
During the past 12 months, did you receive counseling or therapy from a mental health professional, such as a psychiatrist, psychologist, psychiatric nurse, or clinical social worker?
[CAWI RESPONSE OPTIONS:]
1 Yes
0 No
[CATI RESPONSE OPTIONS - DO NOT READ:]
1 YES
0 NO
[SHOW IF MTL_MHTHRPY =1]
[S]
MTL_MHTPYNOW
Are you currently receiving counseling or therapy from a mental health professional?
[CAWI RESPONSE OPTIONS:]
1 Yes
0 No
[CATI RESPONSE OPTIONS - DO NOT READ:]
1 YES
0 NO
[CREATE “END_MTL_TIME” AND “END_MTL _DATE”; RECORD TIME IN HH:MM:SS; RECORD DATE IN MM:DD:YYYY]
[SHOW IF HCU_RX12MA = 1]
[S]
HCU_RXSK12MA
During the past 12 months, were any of the following true for you?
You skipped medication doses to save money.
[CAWI RESPONSE OPTIONS:]
1 Yes
0 No
[CATI RESPONSE OPTIONS - DO NOT READ:]
1 YES
0 NO
[SHOW IF HCU_RX12MA = 1]
[S]
HCU_RXLS12MA
You took less medication to save money.
[CAWI RESPONSE OPTIONS:]
1 Yes
0 No
[CATI RESPONSE OPTIONS - DO NOT READ:]
1 YES
0 NO
[SHOW IF HCU_RX12MA = 1]
[S]
HCU_RXDL12MA
You delayed filling a prescription to save money.
[CAWI RESPONSE OPTIONS:]
1 Yes
0 No
[CATI RESPONSE OPTIONS - DO NOT READ:]
1 YES
NO
[PROGRAMMER:
DISPLAY HCU_RXSK12MA–
HCU_RXDL12MA ON SAME PAGE]
[SHOW ALL]
[S]
HCU_RXDG12MA
During the past 12 months, was there any time when you needed prescription medication, but did not get it because of cost?
[CAWI RESPONSE OPTIONS:]
1 Yes
0 No
[CATI RESPONSE OPTIONS - DO NOT READ:]
1 YES
0 NO
[CREATE “END_HCU_TIME” AND “END_HCU _DATE”; RECORD TIME IN HH:MM:SS; RECORD DATE IN MM:DD:YYYY]
[CREATE “START_REC_TIME” AND “START_REC_DATE”; RECORD TIME IN HH:MM:SS; RECORD DATE IN MM:DD:YYYY]
[SHOW ALL]
[S]
Do you think you ever had a problem with your own drug or alcohol use?
[CAWI RESPONSE OPTIONS:]
1 Yes
0 No
[CATI RESPONSE OPTIONS – DO NOT READ:]
1 YES
[SHOW IF REC_CA15 = 1]
[S]
At this time do you consider yourself to be in recovery or recovered from your own problem with drugs
or alcohol use?
[CAWI RESPONSE OPTIONS:]
1 Yes
0 No
[CATI RESPONSE OPTIONS – DO NOT READ:]
1 YES
0 NO
[SHOW ALL]
[S]
REC_CA17
Do you think you ever had a problem with your own mental health?
[CAWI RESPONSE OPTIONS:]
1 Yes
0 No
[CATI RESPONSE OPTIONS – DO NOT READ:]
1 YES
0 NO
[SHOW IF REC_CA17 = 1]
[S]
REC_CA18
At this time do you consider yourself to be in recovery or recovered from your own mental health
problem?
[CAWI RESPONSE OPTIONS:]
1 Yes
0 No
[CATI RESPONSE OPTIONS – DO NOT READ:]
1 YES
0 NO
[CREATE “END_REC_TIME” AND “END_REC _DATE”; RECORD TIME IN HH:MM:SS; RECORD DATE IN MM:DD:YYYY]
MAR – MARITAL STATUS
[CREATE “START_MAR_TIME” AND “START_MAR_DATE”; RECORD TIME IN HH:MM:SS; RECORD DATE IN MM:DD:YYYY]
[SHOW ALL]
[DISP]
MAR_MARITAL
The next questions are about marriage and cohabitation.
[CAWI] Are you now: [CATI] Are you now married, living with a partner together as an unmarried couple, or neither?
[CATI] INTERVIEWER - IF RESPONDENT ANSWERS BOTH MARRIED AND LIVING WITH A DIFFERENT PARTNER TOGETHER AS AN UNMARRIED COUPLE, ENTER LIVING WITH A PARTNER
[CAWI RESPONSE OPTIONS:]
Married
Living with a partner together as an unmarried couple
Neither
[CATI RESPONSE OPTIONS – DO NOT READ:]
MARRIED
LIVING WITH A PARTNER TOGETHER AS AN UNMARRIED COUPLE
NEITHER
[SHOW IF MAR_MARITAL = 2, 3, -6,-7,-9]
[S]
MAR_EVMARRY
Have you ever been married?
[CAWI RESPONSE OPTIONS:]
1 Yes
0 No
[CATI RESPONSE OPTIONS - DO NOT READ:]
1 YES
0 NO
[SHOW IF MAR_MARITAL = 2 AND MAR_EVMARRY=1]
[S]
MAR_LEGAL
What is your current legal marital status? [CATI: Are you married, widowed, divorced, or separated?]
[CAWI RESPONSE OPTIONS:]
Married
Widowed
Divorced
Separated
[CATI RESPONSE OPTIONS – DO NOT READ:]
MARRIED
WIDOWED
DIVORCED
SEPARATED
[SHOW IF MAR_MARITAL = 3 AND MAR_EVMARRY=1]
[S]
MAR_WIDIVSEP
[CAWI] Are you… [CATI] Are you widowed, divorced, or separated?
[CAWI RESPONSE OPTIONS:]
Widowed
Divorced
Separated
[CATI RESPONSE OPTIONS – DO NOT READ:]
WIDOWED
DIVORCED
SEPARATED
[CREATE “END_MAR_TIME” AND “END_MAR_DATE”; RECORD TIME IN HH:MM:SS; RECORD DATE IN MM:DD:YYYY]
INT – INTERNET/HIT
[CREATE “START_INT_TIME” AND “START_INT_DATE”; RECORD TIME IN HH:MM:SS; RECORD DATE IN MM:DD:YYYY]
[SHOW ALL]
[DISP]
INT_DISP
These next questions are about your use of the Internet.
[SHOW IF MODE = CATI; AUTO PUNCH 1 (YES) IF MODE = CAWI]
[S]
INT_ACCESS
Do you have access to the Internet?
[CATI RESPONSE OPTIONS – DO NOT READ:]
1 YES
0 NO
[SHOW IF INT_ACCESS=1]
[S]
INT_HOMEACC
Do you have access to the Internet from your home?
Include Internet and data use through a computer, tablet, smartphone, or other electronic device.
[CAWI RESPONSE OPTIONS:]
1 Yes
0 No
[CATI RESPONSE OPTIONS – DO NOT READ:]
1 YES
0 NO
[SHOW IF INT_ACCESS=1]
INT_DSPL
During the past 12 months, have you used the Internet for any of the following reasons?
Include Internet and data use through a computer, tablet, smartphone, or other electronic device.
[SHOW IF INT_ACCESS=1]
[S]
INT_USEMED
To look for health or medical information.
[CAWI RESPONSE OPTIONS:]
1 Yes
0 No
[CATI RESPONSE OPTIONS – DO NOT READ:]
1 YES
0 NO
[SHOW IF INT_ACCESS=1]
[S]
INT_USEDOC
To communicate with a doctor or doctor’s office.
[CAWI RESPONSE OPTIONS:]
1 Yes
0 No
[CATI RESPONSE OPTIONS – DO NOT READ:]
1 YES
0 NO
[SHOW IF INT_ACCESS=1]
[S]
INT_USETEST
To look up medical test results.
[CAWI RESPONSE OPTIONS:]
1 Yes
0 No
[CATI RESPONSE OPTIONS - DO NOT READ:]
1 YES
0 NO
[PROGRAMMER: DISPLAY INT_DSPL - INT_USETEST ON SAME PAGE]
[CREATE “END_INT_TIME” AND “END_INT_DATE”; RECORD TIME IN HH:MM:SS; RECORD DATE IN MM:DD:YYYY]
LAN - LANGUAGE ITEMS
[CREATE “START_LAN_TIME” AND “START_LAN_DATE”; RECORD TIME IN HH:MM:SS; RECORD DATE IN MM:DD:YYYY]
[SHOW IF QUEX_LANGUAGE=1; AUTO PUNCH 1 (YES) IF QUEX_LANGUAGE=2]
[S]
LAN_OTHERLAN
Do you speak a language other than English at home?
[CAWI RESPONSE OPTIONS:]
1 Yes
0 No
[CATI RESPONSE OPTIONS - DO NOT READ:]
1 Yes
0 No
[SHOW IF LAN_OTHERLAN=1]
[S]
LAN_MEDIA
When you watch television, read news online or in print, or listen to the radio, which language do you use most often?
[CAWI RESPONSE OPTIONS:]
English
Spanish
Another language
[CATI RESPONSE OPTIONS – DO NOT READ:]
ENGLISH
SPANISH
ANOTHER LANGUAGE
[SHOW IF LAN_OTHERLAN=1]
[S]
LAN_DOCTOR
When you see a doctor or other health care professional, which language do you use most often?
[CAWI
RESPONSE OPTIONS:]
English
Spanish
Another language
[CATI RESPONSE OPTIONS – DO NOT READ:]
ENGLISH
SPANISH
ANOTHER LANGUAGE
[SHOW IF LAN_OTHERLAN=1]
[S]
LAN_SOCIAL
When you participate in social activities, such as visiting friends, attending clubs and meetings, or going to parties, which language do you use most often?
[CAWI RESPONSE OPTIONS:]
English
Spanish
Another language
[CATI RESPONSE OPTIONS – DO NOT READ:]
ENGLISH
SPANISH
ANOTHER LANGUAGE
[CREATE “END_LAN_TIME” AND “END_LAN_DATE”; RECORD TIME IN HH:MM:SS; RECORD DATE IN MM:DD:YYYY]
TEL - TELEPHONE USE
[CREATE “START_TEL_TIME” AND “START_TEL_DATE”; RECORD TIME IN HH:MM:SS; RECORD DATE IN MM:DD:YYYY]
[SHOW ALL]
[S]
TEL_NONCELL
Is there at least one telephone inside your home that is currently working and is not a cell phone?
[CAWI RESPONSE OPTIONS:]
1 Yes
0 No
[CATI RESPONSE OPTIONS - DO NOT READ:]
1 YES
0 NO
[SHOW ALL]
[S]
TEL_CELL
Do you have a working cell phone?
[CAWI RESPONSE OPTIONS:]
1 Yes
0 No
[CATI RESPONSE OPTIONS - DO NOT READ:]
1 YES
0 NO
[SHOW IF TEL_CELL=0 AND HHSIZE>=2]
[S]
TEL_HHCELL
Do you live with anyone at your home who has a working cell phone?
[CAWI
RESPONSE OPTIONS:]
1 Yes
0 No
[CATI RESPONSE OPTIONS - DO NOT READ:]
1 YES
0 NO
[CREATE “END_TEL_TIME” AND “END_TEL_DATE”; RECORD TIME IN HH:MM:SS; RECORD DATE IN MM:DD:YYYY]
DEM – RACE/ETHNICITY
[CREATE “START_DEM_TIME” AND “START_DEM_DATE”; RECORD TIME IN HH:MM:SS; RECORD DATE IN MM:DD:YYYY]
[SHOW ALL]
[M]
DEM_RACE
What is your race and/or ethnicity? [CATI: Tell me; CAWI: Select] all that apply.
DEM_RACEa American Indian or Alaska Native
DEM_RACEb Asian
DEM_RACEc Black or African American
DEM_RACEd Hispanic or Latino
DEM_RACEe Middle Eastern or North African
DEM_RACEf Native Hawaiian or Pacific Islander
DEM_RACEg White
[PROGRAMMER: USE MULTI-SELECT FORMAT WHERE SELECTED = 1, UNSELECTED = 0. ALL OPTIONS SHOULD DISPLAY AS SEPARATE VARIABLES IN DATASET.]
[SHOW IF DEM_RACEa=1]
[TEXTBOX]
DEM_AIAN
You said that you are American Indian or Alaska Native. Please [CAWI: enter additional details in the space below; CATI: tell me some additional details].
For example, are you Navajo Nation, Blackfeet Tribe of the Blackfeet Indian Reservation of Montana, Native Village of Barrow Inupiat Traditional Government, Nome Eskimo Community, Aztec, Maya, or some other group?
[TEXTBOX; CHARACTER LIMIT = 150]
[SHOW IF DEM_RACEb=1]
[M]
DEM_ASIAN
You said that you are Asian. Please [CAWI: select; CATI: tell me] all that apply. Are you:
1 Chinese
2 Asian Indian
3 Filipino
4 Vietnamese
5 Korean
6 Japanese
7 Another Asian group, for example Pakistani, Hmong, Afghan, etc. [TEXTBOX; CHARACTER LIMIT = 50]
[SHOW IF DEM_RACEc=1]
[M]
DEM_BLACK
You said that you are Black or African American. Please [CAWI: select; CATI: tell me] all that apply. Are you:
1 African American
2 Jamaican
3 Haitian
4 Nigerian
5 Ethiopian
6 Somali
7 Another Black or African American group, for example Trinidadian and Tobagonian, Ghanaian, Congolese, etc. [TEXTBOX; CHARACTER LIMIT = 50]
[SHOW IF DEM_RACEd=1]
[M]
DEM_HISP
You said that you are Hispanic or Latino. Please [CAWI: select; CATI: tell me] all that apply. Are you:
1 Mexican
2 Puerto Rican
3 Salvadoran
4 Cuban
5 Dominican
6 Guatemalan
7 Another Hispanic or Latino group, for example Colombian, Honduran, Spaniard, etc. [TEXTBOX; CHARACTER LIMIT = 50]
[SHOW IF DEM_RACEe=1]
[M]
DEM_MENA
You said that you are Middle Eastern or North African. Please [CAWI: select; CATI: tell me] all that apply. Are you:
1 Lebanese
2 Iranian
3 Egyptian
4 Syrian
5 Iraqi
6 Israeli
7 Another Middle Eastern or North African group, for example Moroccan, Yemeni, Kurdish, etc. [TEXTBOX; CHARACTER LIMIT = 50]
[SHOW IF DEM_RACEf=1]
[M]
DEM_NHPI
You said that you are Native Hawaiian or Pacific Islander. Please [CAWI: select; CATI: tell me] all that apply. Are you:
1 Native Hawaiian
2 Samoan
3 Chamorro
4 Tongan
5 Fijian
6 Marshallese
7 Another Native Hawaiian or Pacific Islander group, for example Chuukese, Palauan, Tahitian, etc. [TEXTBOX; CHARACTER LIMIT = 50]
[SHOW IF DEM_RACEg=1]
[M]
DEM_WHITE
You said that you are White. Please [CAWI: select; CATI: tell me] all that apply. Are you:
1 English
2 German
3 Irish
4 Italian
5 Polish
6 Scottish
7 Another White group, for example French, Swedish, Norwegian, etc. [TEXTBOX; CHARACTER LIMIT = 50]
[CREATE “END_DEM_TIME” AND “END_DEM_DATE”; RECORD TIME IN HH:MM:SS; RECORD DATE IN MM:DD:YYYY]
CIV - CIVIC ENGAGEMENT
[CREATE “START_CIV_TIME” AND “START_CIV_DATE”; RECORD TIME IN HH:MM:SS; RECORD DATE IN MM:DD:YYYY]
[SHOW ALL]
[DISP]
CIV_INTRO
The next questions are about activities you may have done in your community.
[SHOW ALL]
[S]
CIV_VOL12M
During the past 12 months, did you spend any time volunteering for any organization or association?
[CAWI RESPONSE OPTIONS:]
1 Yes
0 No
[CATI RESPONSE OPTIONS - DO NOT READ:]
1 YES
0 NO
[SHOW IF CIV_VOL12M=0]
[S]
CIV_VOLOTH
Some people don’t think of activities they do infrequently or for children’s schools or youth organizations as volunteer activities. During the past 12 months, have you done any of these types of activities?
[CAWI RESPONSE OPTIONS:]
1 Yes
0 No
[CATI RESPONSE OPTIONS - DO NOT READ:]
1 YES
0 NO
[SHOW ALL]
[S]
CIV_MEET
During the past 12 months, did you attend a public meeting, such as a zoning or school board meeting, that discussed a local issue?
[CAWI RESPONSE OPTIONS:]
1 Yes
0 No
[CATI RESPONSE OPTIONS - DO NOT READ:]
1 YES
0 NO
[SHOW ALL]
[S]
CIV_VOTELOCL
Did you vote in the last local elections, such as for mayor, councilmembers, or school board?
[CAWI RESPONSE OPTIONS:]
1 Yes
0 No
[CATI
RESPONSE OPTIONS - DO NOT READ:]
1 YES
NO
[CREATE “END_CIV_TIME” AND “END_CIV_DATE”; RECORD TIME IN HH:MM:SS; RECORD DATE IN MM:DD:YYYY]
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | Grace Medley |
| File Modified | 0000-00-00 |
| File Created | 2026-01-22 |