Study Survey Questions

Enclosure 2: Study

SurveyMonkey will be used to display the test survey and to collect data. Included in this document are the survey pages/questions for the participants.

I. Introduction (page 1):

Header: Introduction

Text:

Thank you for agreeing to participate in this survey.  On the next screens, you will be asked a few questions about things you may do each week.  After each question, you will be asked a follow up question.  Please answer each question to the best of your abilities, providing detailed responses whenever requested. Remember that your answers will be anonymous. This survey will take 10 minutes or less to complete.

 

Your responses will not be shared with anyone in a way that could personally identify you.  Your participation in this study is voluntary.  The legal authority under which this information is being collected is Title 13 U.S.C Chapter 5 Sections 141 and 193.  This data collection is approved under OMB No. 0690-0030 and the approval expires 06/30/17.  This data collection uses a third party web site to collect data.  This survey does not collect personally identifiable information.  The results from this survey will be used to conduct primary research to enhance planning efforts for current and future surveys and censuses.

II. “Typical Week” Question Block (pages 2-5, randomized):

Header: None

Questions on Each Page:

In a TYPICAL WEEK, how many days do you [leave your home to go to work? / have trouble going to sleep or staying asleep? / eat fruit? Count fresh, frozen, or canned fruit. / watch television?]

○ No days

○ 1 day

○ 2 days

○ 3 days

○ 4 days

○ 5 days

○ 6 days

○ 7 days

Please explain how you arrived at your answer.

[TEXT BOX SET TO LENGTH OF 4 LINES, MAX WIDTH OF 100 CHARACTERS]

III. Review Questions (page 6)

Header: None

Questions:

In the previous questions, what did “TYPICAL WEEK” mean to you?

[TEXT BOX SET TO LENGTH OF 4 LINES, MAX WIDTH OF 100 CHARACTERS]

Did you apply the same meaning of “TYPICAL WEEK” for each question?

○ Yes

○ No

IV. “Last Week” Question Block (pages 7-10, randomized):

Header: None

Questions on Each Page:

LAST WEEK, how many days did you [leave your home to go to work? / have trouble going to sleep or staying asleep? / eat fruit? Count fresh, frozen, or canned fruit. / watch television?]

○ No days

○ 1 day

○ 2 days

○ 3 days

○ 4 days

○ 5 days

○ 6 days

○ 7 days

Please explain how you arrived at your answer and include the days of the week you [left your home to go to work / had trouble going to sleep or staying asleep / ate fruit watched television].

[TEXT BOX SET TO LENGTH OF 4 LINES, MAX WIDTH OF 100 CHARACTERS]

V. Comparison Question Block (pages 11-14, randomized):

Header: None

Questions on Each Page:

For the number of days you [leave your home to go to work / have trouble going to sleep or staying asleep / eat fruit / watch television], did you find answering for a TYPICAL WEEK to be as easy as answering for LAST WEEK? 

○ Yes

○ No

Please explain.

[TEXT BOX SET TO LENGTH OF 4 LINES, MAX WIDTH OF 100 CHARACTERS]

Do you [leave your home to go to work / have trouble going to sleep or staying asleep / eat fruit / watch television] the same number of days each week? 

○ Yes

○ No

Please explain.

[TEXT BOX SET TO LENGTH OF 4 LINES, MAX WIDTH OF 100 CHARACTERS]

VI. Demographics (page 15)

Header: Demographics

Questions:

Are you male or female?

○ Male

○ Female

What is your age?

○ Less than 18 years old

○ 18-24

○ 25-34

○ 35-44

○ 45-54

○ 55-64

○ 65-74

○ 75 or older

Are you of Hispanic, Spanish, or Latino origin?

○ Yes

○ No

What is your race? You may select more than one answer.

□ White

□ Black or African American

□ American Indian or Alaska Native

□ Asian

□ Native Hawaiian or other Pacific Islander

What is the highest level of school you have completed or the highest degree you have received?

○ Less than high school degree

○ High school degree or equivalent (e.g., GED)

○ Some college but no degree

○ Associate’s degree

○ Bachelor’s degree

○ Graduate degree

VII. Closeout/Thank You Page (page 16)

Header: None

Text:

Thank you for participating in this survey. 

Please click Done to submit your answers.

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