0920-0572 Audience Segmentation Survey

Form Approved

OMB No. 0920-0572

Exp. Date 08/31/2021

CDC Enhanced Message Development Audience Segmentation Survey

Public reporting burden of this collection of information is estimated to average 15 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. 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 Reports Clearance Officer, 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA 0920-0572

[INTRO LANGUAGE]

We would like to ask you some questions to determine your eligibility to participate in a survey sponsored by the Centers for Disease Control and Prevention (CDC). This eligibility survey should take about one minute to complete. Throughout the survey, please do not use your browser’s back button to view previous questions. This may invalidate your responses and end your survey.

[TERMINATION LANGUAGE]

Thank you for completing this eligibility survey. Unfortunately, based on the responses you provided, you do not meet the specifications we are looking for in this study. We appreciate your time today answering these questions.

Section 1: Screener

Question Type: Single Punch

Variable Name: Q1

Variable Label: Q1: Sex

Variable Text: What is your sex?

Value	Value Label
1	Male
2	Female
99	Refused

// If Q1= 99 then SOFT PROMPT: Please provide an answer to this question. //

// If Q1 =1, then skip to Q3 //

Question Type: Single Punch

Name: Q2

Variable Label: Q2: Pregnancy Status

Variable Text: To your knowledge are you currently pregnant?

Value	Value Label
1	Yes
2	No
3	Not sure
99	Refused

// If Q2 = 1 OR 3 OR 99 then TERMINATE. //

Question Type: Drop Down

Variable Name: Q3

Variable Label: Q3: Age

Variable Text: What is your age in years?

Value	Value Label
1	Under 18
2	18
3	19
…	…
xx	75
xx	76 or older
99	Refused

//TERMINATE If Q3=17–20 or Q3= 65–76//

// If Q3= 99 then SOFT PROMPT: Please provide an answer to this question. //

Question Type: Drop Down

Variable Name: Q4

Variable Label: Q4: Days of Drinking

Variable Text: During the past 30 days, how many days did you have at least one drink of any alcoholic beverage such as beer, wine, a malt beverage, or liquor?

Value	Value Label
1	0 days
2	1 day
3	2 days
4	3 days
…	…
31	30 days
99	Refused

//TERMINATE if Q4=1 //

// If Q4= 99 then SOFT PROMPT: Please provide an answer to this question. //

Question Type: Drop Down

Variable Name: Q5

Variable Label: Q5: Average Drinks

Variable Text: One drink is equivalent to a 12-ounce beer, a 5-ounce glass of wine, or a drink with one shot of liquor. During the past 30 days, on the days when you drank, about how many drinks did you drink on average?

NOTE: A pitcher of beer counts as five drinks, or a cocktail drink with two shots counts as two drinks.

Value	Value Label
1	1 drink
2	2 drinks
3	3 drinks
4	4 drinks
5	5 drinks
6	6 drinks
7	7 drinks
8	8 drinks
9	9 drinks
10	10 drinks
11	11 drinks
12	12 drinks
13	13 drinks
14	14 drinks
15	15 drinks
16	More than 15 drinks
99	Refused

// If Q5= 99 then SOFT PROMPT: Please provide an answer to this question. //

// If Q5= 1 then program to show Q6A, if Q5= 2 then program to show Q6B. //

///If respondent selected Q1 = 1, then only show them Q6A.

If respondent selected Q1 = 2, then only show them Q6B. ///

Question Type: Drop Down

Variable Name: Q6A

Variable Label: Q6A: MALE: Frequency of Binge Drinking

Variable Text: Considering all types of alcoholic beverages, how many times during the past 30 days did you have five or more drinks on an occasion? An “occasion” is defined as period of two to three hours.

Value	Value Label
1	0 times
2	1 time
3	2 times
4	3 times
…	…
31	30 times
99	Refused
100	Valid Skip

// // If Q6A= 99 then SOFT PROMPT: Please provide an answer to this question. //

Question Type: Drop Down

Variable Name: Q6B

Variable Label: Q6B: FEMALE: Frequency of Binge Drinking

Variable Text: Considering all types of alcoholic beverages, how many times during the past 30 days did you have four or more drinks on an occasion? An “occasion” is defined as period of two to three hours.

Value	Value Label
1	0 times
2	1 time
3	2 times
4	3 times
…	…
31	30 times
99	Refused
100	Valid Skip

// // If Q6B= 99 then SOFT PROMPT: Please provide an answer to this question. //

Question Type: Drop Down

Variable Name: Q7

Variable Label: Q7: Largest Volume of Drinking

Variable Text: During the past 30 days, what was the largest number of drinks you had on any one occasion? An “occasion” is defined as period of two to three hours.

Value	Value Label
1	1 drink
2	2 drinks
3	3 drinks
4	4 drinks
5	5 drinks
6	6 drinks
7	7 drinks
8	8 drinks
9	9 drinks
10	10 drinks
11	11 drinks
12	12 drinks
13	13 drinks
14	14 drinks
15	15 drinks
16	More than 15 drinks
99	Refused

Survey Eligibility

		ELIGIBLE	INELIGIBLE, TERMINATE
Q#	Item/Calculation	EXCESSIVE DRINKERS	NON-EXCESSIVE DRINKERS	REFUSALS
Q4 * Q5	COMPOSITE SCORE for heavy drinking	>60 for males (Q1 = 1) >30 for females (Q1 = 2)	≤60 for males (Q1 = 1) ≤30 for females (Q1 = 2)	Refuses any item Q1 – 5
		OR	AND
Q6A	Male Binge Frequency	1 or more times	0 times
Q6B	Female Binge Frequency	1 or more times	0 times

//If Eligible = 1, CONTINUE; If Eligible =0, TERMINATE//

//PAGE BREAK//

We are inviting you to take part in a research study. This will involve completing a web-based survey that asks questions about your knowledge and attitudes about consuming alcohol. It should take you about 10–12 minutes to complete. This study is sponsored by the Centers for Disease Control and Prevention (CDC).

There are neither risks nor benefits to you taking part in this survey. Any compensation you receive is a small token to thank you for taking part, if you choose to do so.

Your participation is voluntary. This means that you are free to choose not to take part or to skip certain questions. There is no penalty if you choose not to respond. However, your complete participation will help enhance messages and materials for adult drinkers. It is important that as many adults respond to this survey as possible so that the information we get is complete.

Your personal information will be kept separate from your survey responses. Government personnel will not have access to your name, address, or email address; they will only have access to your responses. Government personnel will not be able to trace your responses back to you. Responses will be reported only for the whole group. If you have any questions about this survey at any time, please contact the survey administrator by emailing pi@forsmarshgroup.com. Please include the subject “Alcohol Attitudes Study.”

Value	Value Label
1	I wish to continue
0	I do not wish to continue
99	Refused

//If 0 or 99, TERMINATE.////If 1, Proceed to next page.//

Section 2: Knowledge Attitudes and Beliefs About Excessive Drinking

Consider this information:

//PROGRAM IMAGE¹ //

*

*An “occasion” is defined as period of two to three hours.

Question Type: Randomized Grid

Variable Text: To what extent do you agree or disagree with the following statements?

Variable Name	Variable Text	Variable Label
Q8A	Excessive drinking is harmful to your health.	Q8A: Risk: Harm to Individual
Q8B	Excessive drinking increases the risk of cancer.	Q8B: Risk: Cancer
Q8C	Excessive drinking increases the risk of violence.	Q8C Risk: Violence
Q8D	People who drink excessively put themselves at risk for serious health problems.	Q8D Risk: Serious Health Problems
Q8E	Excessive drinking is dangerous.	Q8E: Risk: Danger
Q8F	Excessive drinking is an important public health problem.	Q8F Risk: Public Health Problem

Value	Value Label
1	Strongly Disagree
2	Disagree
3	Neither Agree or Disagree
4	Agree
5	Strongly Agree
99	Refused

Question Type: Randomized Grid

Variable Text: To what extent do you agree or disagree with the following statements?

Variable Name	Variable Text	Variable Label
Q9A	Excessive drinking is acceptable as long as you are not doing something dangerous.	Q9A Acceptable: Not Dangerous
Q9B	Excessive drinking is acceptable during a social occasion, like a party, wedding, or sports game.	Q9B Acceptable: Social Occasion
Q9C	As long as you are not harming other people, I don’t see a problem with excessive drinking.	Q9C: Acceptable: Not Harming Others
Q9D	In my opinion, excessive drinking is not a problem as long as you’re not putting other people at risk.	Q9D: Acceptable: Others Not at Risk
Q9E	In my opinion, it is acceptable for adults of drinking age to drink excessively as long as it is in an appropriate setting.	Q9E: Acceptable: Appropriate Setting
Q9F	Excessive drinking is acceptable when your friends and/or family are drinking excessively, too.	Q9F: Friends and Family Drinking Excessively

Value	Value Label
1	Strongly Disagree
2	Disagree
3	Neither Agree or Disagree
4	Agree
5	Strongly Agree
99	Refused

Section 3: Motivators or Drivers for Excessive Drinking

One drink is equivalent to a 12-ounce beer, a 5-ounce glass of wine, or a drink with one shot of liquor. An occasion is defined as a period of two to three hours.

Question Type: Randomized Grid

Variable Text: To what extent do you agree or disagree with the following statements?

Variable Name	Variable Text	Variable Label
Q10A	I never turn down a free drink.	Q10A: Economics: Accept Free Drink
Q10B	I consume more drinks when there are deals or discounts on alcohol, such as during happy hour or with an offer of bottomless drinks.	Q10C: Economics: Drink More During Deals

Value	Value Label
1	Strongly Disagree
2	Disagree
3	Neither Agree or Disagree
4	Agree
5	Strongly Agree
99	Refused

Question Type: Randomized Grid

Variable Text: Think about times in the past when you drank too much. To what extent do you agree or disagree with the following statements?

Variable Name	Variable Text	Variable Label
Q11A	I drank to feel at ease in a group.	Q11A: Social: Confidence in a Group
Q11B	I drank to feel more self-confident.	Q11B: Social: Self-Confidence
Q11C	I drank to ease conversations with someone I was romantically interested in.	Q11C: Social: Romance
Q11D	I drank to celebrate a special occasion.	Q11D: Social: Celebration
Q11E	I drank because it made social gatherings more fun.	Q11E: Social: Fun
Q11F	I drank to feel included.	Q11F: Social: Fear of Being Left Out
Q11G	I drank because I was with family or friends who were drinking, too.	Q11G: Social: Friends/Family

Value	Value Label
1	Strongly Disagree
2	Disagree
3	Neither Agree or Disagree
4	Agree
5	Strongly Agree
99	Refused

Question Type: Randomized Grid

Variable Text: Again, think about times in the past when you drank too much. To what extent do you agree or disagree with the following statements?

Variable Name	Variable Text	Variable Label
Q12A	I drank to relax.	Q12A: Emotions: Relax
Q12B	I drank because I was sad.	Q12B: Emotions Sad
Q12C	I drank because I was angry.	Q12C: Emotions: Angry
Q12D	I drank to escape from my everyday problems.	Q12D: Emotions: Escape Problems
Q12E	I drank to deal with feelings of despair.	Q12E: Emotions: Despair
Q12F	I drank to dull pain and discomfort.	Q12F: Emotions: Pain
Q12G	I drank because I was bored.	Q12G: Emotions: Boredom

Value	Value Label
1	Strongly Disagree
2	Disagree
3	Neither Agree or Disagree
4	Agree
5	Strongly Agree
99	Refused

Question Type: Randomized Grid

Variable Text: Once more, think about times in the past when you drank too much. To what extent do you agree or disagree with the following statements?

Variable Name	Variable Text	Variable Label
Q13A	I drank because I enjoyed the feeling of getting drunk or buzzed.	Q13A: Enjoyment: Feeling Buzzed
Q13B	I drank because I enjoyed trying out new drinks.	Q13B: Enjoyment: New Drinks
Q13C	I drank because I enjoyed the experience of visiting new wineries, distilleries, or breweries.	Q13C: Enjoyment: New Places with Alcohol
Q13D	I drank because I enjoyed the taste.	Q13D: Enjoyment: Taste

Section 4: Evaluation of Personal Health Status and Drinking Behavior

Question Type: Randomized Grid

Variable Text: How likely are you to drink too much in the following contexts?

Variable Name	Variable Text	Variable Label
Q14A	At your home	Q14A: Context: Home
Q14B	In public (e.g., at bars, restaurants, at parties)	Q14B: Context: Public
Q14C	During meals	Q14C: Context: Meals
Q14D	When alone	Q14D: Context: Alone
Q14E	With others	Q14E: Context: With Others

Value	Value Label
1	Very Unlikely
2	Unlikely
3	Neither Likely or Unlikely
4	Likely
5	Very Likely
99	Refused

Question Type: Grid

Variable Text: How likely are you to drink too much alcohol on a…?

Variable Name	Variable Text	Variable Label
Q15A	Monday	Q15A: Day of the Week: Monday
Q15B	Tuesday	Q15B: Day of the Week: Tuesday
Q15C	Wednesday	Q15C: Day of the Week: Wednesday
Q15D	Thursday	Q15D: Day of the Week: Thursday
Q15E	Friday	Q15E: Day of the Week: Friday
Q15F	Saturday	Q15F: Day of the Week: Saturday
Q15G	Sunday	Q15G: Day of the Week: Sunday

Value	Value Label
1	Very Unlikely
2	Unlikely
3	Neither Likely or Unlikely
4	Likely
5	Very Likely
99	Refused

Question Type: Randomized Grid

Variable Text: Think about times in the past when you drank too much. How frequently did you drink each of the following types of alcohol?

Variable Name	Variable Text	Variable Label
Q16A	Wine	Q16A: Alcohol Type: Wine
Q16B	Beer	Q16B: Alcohol Type: Beer
Q16C	Liquor/distilled spirits only (i.e., no chaser or mixer included)	Q16C: Alcohol Type: Liquor
Q16D	Cocktails or mixed drinks	Q16D: Alcohol Type: Cocktails or Mixed Drinks
Q16E	Malt beverages (e.g., hard lemonade, alcopops)	Q16E: Alcohol Type: Malt beverages
Q16F	Other (please specify): _____	Q16Q16F: Alcohol Type: Other

Value	Value Label
1	Never
2	Rarely
3	Sometimes
4	Very Often
5	Always
99	Refused

Question Type: Randomized Grid

Variable Text: To what extent do you agree or disagree with the following statements?

Variable Name	Variable Text	Variable Label
Q17A	I don’t think I drink too much.	Q17A: Precon: Not too much
Q17B	Pressure from my peers to drink too much would make it hard for me to drink less.	Q17B: Precon: Pressure from peers
Q17C	There is no need for me to think about drinking less.	Q17CD: Precon: No need to change
Q17D	Drinking less alcohol would be pointless for me.	Q17D: Precon: Less drinking pointless
Q17E	I enjoy my drinking, but sometimes I drink too much.	Q17E: Contem: Enjoy but too much
Q17F	Sometimes I think I should cut down on my drinking.	Q17F: Contem: Cut down
Q17G	I am at a stage where I should think about drinking less alcohol.	Q17G: Contem: Think about less
Q17H	My drinking is a problem sometimes.	Q17H: Contem: Drinking problem
Q17I	I am trying to drink less than I used to.	Q17I: Act: Trying Less
Q17J	I am actually decreasing my drinking right now	Q17J: Act: Actually changing

Value	Value Label
1	Strongly Disagree
2	Disagree
3	Neither Agree or Disagree
4	Agree
5	Strongly Agree
99	Refused

Question Type: Randomized Grid

Variable Text: The following list includes some problems associated with excessive drinking or drinking too much. Please tell us how important each reason is to you for limiting your drinking.

Variable Name	Variable Text	Variable Label
Q18A	Drinking is bad for my health.	Q18A: Limiting Your Drinking: Bad for my health
Q18B	Alcohol is expensive.	Q18B: Limiting Your Drinking: Expensive
Q18C	Family/friends get upset.	Q18C: Limiting Your Drinking: Friends upset
Q18D	Drinking negatively impacts my career.	Q18D: Limiting Your Drinking: Bad for career
Q18E	Drinking is against my basic values or beliefs.	Q18E: Limiting Your Drinking: Basic Values
Q18F	I am labeled an alcoholic.	Q18F: Limiting Your Drinking: Alcoholic
Q18G	I do things I regret.	Q18G: Limiting Your Drinking: Regret
Q18H	Drinking can make me throw up.	Q18H: Limiting Your Drinking: Throw Up
Q18I	Drinking can give me a hangover.	Q18I: Limiting Your Drinking: Hangover
Q18J	I get in trouble with the police.	Q18J: Limiting Your Drinking: Police
Q18K	I am losing control over my life.	Q18K: Limiting Your Drinking: Lose control
Q18L	Drinking damages personal relationships.	Q18L: Limiting Your Drinking: Relationships
Q18M	Drinking causes motor vehicle accidents.	Q18M: Limiting Your Drinking: Car Accident
Q18N	Drinking causes death.	Q18N: Limiting Your Drinking: Death
Q18O	Drinking causes divorce.	Q18O: Limiting Your Drinking: Divorce
Q18P	I could accidentally hurt someone.	Q18P: Limiting Your Drinking: Accidental harm
Q18Q	I embarrass myself.	Q18Q: Limiting Your Drinking: Embarrassment
Q18R	I make bad decisions.	Q18R: Limiting Your Drinking: Bad decisions
Q18S	Drinking causes reckless sexual behavior.	Q18S: Limiting Your Drinking: Risky sex
Q18T	I am a poor role model.	Q18T: Limiting Your Drinking: Poor role model
Q18U	A DUI is very expensive.	Q18U: Limiting Your Drinking: DUI cost
Q18V	I could lose my driver’s license.	Q18W: Limiting Your Drinking: Lose license
Q18W	Drinking damages my reputation.	Q18Y: Limiting Your Drinking: Damaged Rep.
Q18X	Drinking could cause an unplanned pregnancy.	Q18Z: Limiting Your Drinking: Get pregnant
Q18Y	I post drunken photos on the internet.	Q18AA: Limiting Your Drinking: Drunk photos
Q18Z	I could get physically hurt.	Q18BB: Limiting Your Drinking: Injury
Q18AA	Drinking causes long-term health problems.	Q18CC: Limiting Your Drinking: Long term health problems

Value	Value Label
1	Not at all Important
2	Not very Important
3	Somewhat Important
4	Very Important
99	Refused

Think about your alcohol consumption during the past 12 months as you answer these next few questions.

Question Type: Single Punch

Variable Name: Q19

Variable Label: Q19: Alcohol Dependence: Month Plus Drinking

Variable Text: During the past 12 months, was there a month or more when you spent a lot of your time obtaining or drinking alcohol?

Value	Value Label
1	Yes
2	No

Question Type: Single Punch

Variable Name: Q20

Variable Label: Q20: Alcohol Dependence: Month Plus Recovering from Drinking

Variable Text: During the past 12 months, was there a month or more when you spent a lot of time getting over the effects of the alcohol you drank?

Value	Value Label
1	Yes
2	No

Question Type: Single Punch

Variable Name: Q21

Variable Label: Q21: Alcohol Dependence: Tried to Set Drinking Limits

Variable Text: During the past 12 months, did you try to set limits on how often or how much alcohol you drink?

Value	Value Label
1	Yes
2	No

Question Type: Single Punch

Variable Name: Q22

Variable Label: Q22: Alcohol Dependence: Failed to Set Drinking Limits

Variable Text: Were you able to keep within the limits you set, or did you often drink more than you intended to?

Value	Value Label
1	I usually kept to the limits I set.
2	I often drank more than intended.

Question Type: Single Punch

Variable Name: Q23

Variable Label: Q23: Alcohol Dependence: Need to drink more to feel drunk

Variable Text: During the past 12 months, did you need to drink more alcohol than you used to in order to get the effect you wanted?

Value	Value Label
1	Yes
2	No

Question Type: Single Punch

Variable Name: Q24

Variable Label: Q24: Alcohol Dependence: Drinking has less of an effect

Variable Text: During the past 12 months, did you notice that drinking the same amount of alcohol had less effect on you than it used to?

Value	Value Label
1	Yes
2	No

Question Type: Single Punch

Variable Name: Q25

Variable Label: Q25: Alcohol Dependence: Tried to Cut Down Drinking

Variable Text: During the past 12 months, did you want to or try to cut down or stop drinking alcohol?

Value	Value Label
1	Yes
2	No

Section 5: Demographics

Question Type: Multi-Punch

Variable Name: Q26A

Variable Label: Q26A: Ethnicity

Variable Text: What best describes your ethnicity?

Value	Value Label
1	Hispanic or Latino
2	Not Hispanic or Latino
99	Refused

Question Type: Multi-Punch

Variable Name: Q26B

Variable Label: Q26B: Race

Variable Text: What best describes your race?

Value	Value Label
1	White or Caucasian
2	Black or African American
3	Hispanic or Latino
4	Asian
5	Native American or Alaska Native
6	Native Hawaiian or Other Pacific Islander
99	Refused

Question Type: Single Punch, Other Open-End Essay

Variable Name: Q27

Variable Label: Q27: Education

Variable Text: What is the highest level of education you have completed?

Value	Value label
1	Grade School
2	Less than high school graduate/some high school
3	High school graduate or completed GED
4	Some college or technical school
5	Received four-year college degree
6	Some postgraduate studies
7	Received advanced degree
8	Other:____________
99	Refused

Question Type: Single Punch

Variable Name: Q28

Variable Label: Q28: Labor Status

Variable Text: Which of the following best describes what you are currently doing? Please mark all that apply.

Value	Value label
1	Employed full-time
2	Employed part-time
3	Unemployed
4	Homemaker
5	Student
6	Retired
7	Disabled
8	Other:__________
99	Refused

Question Type: Single Punch

Variable Name: Q29

Variable Label: Q29: Income

Variable Text: What is your total household income?

Value	Value Label
1	$20,000/year or less
2	$20,001–$30,000/year
3	$30,001–$40,000/year
4	$40,001–$50,000/year
5	$50,001–$60,000/year
6	$60,001–$80,000/year
7	$80,001–$100,000/year
8	More than $100,000/year
99	Refused

Question Type: Single Punch

Variable Name: Q30

Variable Label: Q30: Marital Status

Variable Text: What is your marital status?

Value	Value Label
1	Single
2	Married
3	In a relationship
4	Divorced or Widowed
99	Refused

Question Type: Alphabetical Drop-Down List

Variable Name: Q31

Variable Label: Q31: Zip Code

Variable Text: Where do you live? Please type your 5-digit zip code below.

[POST SURVEY COMPLETION PSA]

If you would like to learn more about how alcohol use affects your health, consider visiting the Centers of Disease Control and Prevention’s Alcohol and Health information page: https://www.cdc.gov/alcohol/fact-sheets/alcohol-use.htm.

If you or someone you know suffers from excessive drinking, you can call the Substance Abuse and Mental Health Services Administration’s (SAMHSA) National Helpline at 1-800-622-HELP (4357). SAMHSA’s National Helpline is a confidential, free information service that is available 24 hours a day, 365 days a year in English and Spanish. SAMHSA serves individuals and family members facing mental and/or substance use disorders and provides referrals to local treatment facilities, support groups, and community-based organizations. Callers can also order free publications and other information.

1 Source: https://www.cdc.gov/alcohol/pdfs/alcoholyourhealth.pdf