Eligibility Screener - English

Form Approved

OMB No: 0920-XXXX

OMB Exp. Date: XX/XX/XXXX

Barriers and Facilitators to Expanding the NHBS to Conduct HIV Behavioral Surveillance Among Transgender Women (NHBS-Trans)

Attachment #5a (English)

Eligibility Screener (English)

Privacy Act Statement:

This information is collected under the authority of the Public Health Service Act, Section 301, "Research and Investigation," (42 U.S.C. 241); and Sections 304, 306 and 308(d) which discuss authority to maintain data and provide assurances of confidentiality for health research and related activities (42 U.S.C. 242 b, k, and m(d)).  This information is also being collected in conjunction with the provisions of the Government Paperwork Elimination Act and the Paperwork Reduction Act (PRA). This information will only be used by the Centers for Disease Control and Prevention (CDC) staff to field test a needs assessment regarding HIV risk behaviors, gaps and barriers to services, and other experiences of transgender women within racial and ethnic minority populations in 9 U.S. cities with high burden of HIV.

Public reporting burden of this collection of information is estimated to average 5 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. 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: OMB-PRA (0920-New)

NHBS TRANS QUESTIONNAIRE

ELIGIBILITY SCREENER (ES)

Variables from prior section(s) used in this section of the questionnaire
Section	Question #	Variable name	Variable label
Preloaded variables	--	CYCLE	NHBS Cycle
Preloaded variables	--	IDATE	Interview date
Preloaded variables	--	QYR	Current Questionnaire Year
Interviewer Entered Information	IE2	CITY	City
Interviewer Entered Information	IE5	ISEED	Respondent is a seed

Universe_ES.

All Rs.

INTRO_ES.

DISPLAY: "READ: I'd like to thank you again for your interest in this health survey. Remember that all information you give me will be kept private and I will not ask for your name. First, I will ask you a few questions about yourself and then the computer will determine if you have been selected to participate in the health survey."

CALC_BEGSCR.
BEGSCR	Time at beginning of screener	BEGSCR = Current time

ES1.		What is your month and year of birth?
DOB		Date of birth
		__ __ / __ __ __ __ (MM/YYYY)
		Range (Year)	1900-2100
		Don't Know (Year)	9999
		Refuse to Answer (Year)	7777

Check_CALC_AGE.

If R did not provide date of birth (ES1 EQ DK or REF), go to ES2. Else, go to HardEdit_ES1.

HardEdit_ES1.

If date of birth is on or after interview date (ES1 GE IDATE), DISPLAY: "INTERVIEWER: Date of birth cannot be TODAY or later." Then, go back to ES1. Else, go to CALC_AGE1.

CALC_AGE1.
AGE1	QDS calculated age today	Calculate age from date of birth (DOB)

CALC_AGE2.
AGE2	QDS calculated age today minus 1 year	Calculate age from date of birth (DOB), then subtract 1 year

ES1a.		So, you are [fill with calculated age (AGE1)] years old. Is that correct?
C_AGE1		Confirm AGE1
		No	0
		Yes	1

HardEdit_ES1a.

If calculated AGE1 NOT correct (ES1a EQ 0) and month of birth does not equal month of interview (DOBM NE IDATEM), DISPLAY: “INTERVIEWER: Please hit ‘ok’ to re-enter the date of birth.” Then, go back to ES1. Else, go to Check_ES1b.

Check_ES1b.

If calculated AGE1 NOT correct (ES1a EQ 0) and month of birth equals month of interview (DOBM EQ IDATEM), go to ES1b. Else, go to CALC_AGE.

ES1b.		So, you are [fill with calculated age (AGE2)] years old. Is that correct?
C_AGE2		Confirm AGE2
		No	0
		Yes	1

HardEdit_ES1b.

If calculated AGE2 NOT correct (ES1b EQ 0), DISPLAY: "INTERVIEWER: Please hit ‘ok’ to re-enter the date of birth." Then, go back to ES1. If calculated AGE2 is correct (ES1b EQ 1), go to CALC_AGE.

CALC_AGE
AGE	QDS calculated age, confirmed by R	IF(ES1a EQ 1, AGE1), IF(ES1b EQ1, AGE2), 0)

Check_ES2.

If R LT 18 years old (AGE LT 18), go to INTRO_CALC_EL_TRANS. Else, go to ES2.

ES2.		Did you already complete at least part of the health survey that (Insert Project Name) is conducting? It could have been here or at another location.
E_PART		Eligibility, previous participant
		No	0
		Yes	1
		Don't Know	9
		Refuse to Answer	7

Race and ethnicity

ES2a.		Do you consider yourself to be of Hispanic, Latino/a, or Spanish origin? [INTERVIEWER: If necessary, say "Just tell me Yes or No."]
HISPANIC		Latino ethnicity
		No	0
		Yes	1
		Don't Know	9
		Refuse to Answer	7

Check_ES2a.

If R is Latino (ES2a EQ 1), go to ES2b. Else, go to ES2c.

ES2b.		Which of the following describes your Hispanic, Latino/a, or Spanish origin? You may choose more than one. [READ choices. CHECK ALL that apply.]
HSPTYP		Hispanic Ancestry (number reported)
	HSPTYPA	Mexican
	HSPTYPB	Puerto Rican
	HSPTYSC	Cuban
	HSPTYPD	Dominican
	HSPTYPE	Another Hispanic, Latino/a, or Spanish origin
		Don't Know	9
		Refuse to Answer	7

Check_ES2b.

If R reports 'Another' Hispanic origin (HSPTYPE EQ 1), go to ES2b.spec. Else, go to ES2c.

ES2b.spec.		What is your Hispanic, Latino/a, or Spanish origin?
SPECHSP		Other specified Latino origin
		__ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __
		{text response; max length = 100 characters}
		Don't Know	9
		Refuse to Answer	7

ES2c.		[Give Respondent Flashcard A.] Which racial group or groups do you consider yourself to be in? You may choose more than one option. [READ choices. CHECK ALL that apply.]
RACE		Racial group (number reported)
	RACEA	American Indian or Alaska Native
	RACEB	Asian
	RACEC	Black or African American
	RACED	Native Hawaiian or Other Pacific Islander
	RACEE	White
		Don't Know	9
		Refuse to Answer	7
		Not Applicable	8

INTRO_ES3

DISPLAY: "READ: The following questions are about your gender identity, which is the way you describe your gender, and sex listed at birth, which is the sex listed on your original birth certificate.”

ES3.		[Give Respondent Flashcard B.] How do you describe your current gender identity? You may choose more than one answer. [READ choices, CHECK ALL that apply.]
	GEND	Gender identity
	GENDA	Woman
	GENDB	Man
	GENDC	Transgender woman
	GENDD	Transgender man
	GENDE	A gender not listed here
		Don’t Know	9
		Refuse to Answer	7

Check_ES3spec.

If R is other gender (GENDE EQ 1), go to ES3spec. Else, go to ES4.

ES3spec.			INTERVIEWER: Specify other gender identity/ies. Separate multiple reported identities with commas.
SPECGEND			Specified other gender identity
		__ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __
			{text response; max length = 100 characters}
			Don’t Know	9
			Refuse to Answer	7

ES4.		What was your sex listed at birth? [DO NOT read choices.]
SXBRTH		Sex listed at birth
		Male	1
		Female	2
		Intersex/ambiguous	3
		Don’t Know	9
		Refuse to Answer	7

INTRO_ES5.

DISPLAY: "READ: The next questions are about languages you speak.”

ES5.		How well do you speak English? [READ choices.]
ENGPFCY		English proficiency
		Very well	1
		Well	2
		Not well	3
		Not at all	4
		Don't Know	9
		Refuse to Answer	7

ES6.		How well do you speak Spanish? [READ choices.]
SPNPFCY		Spanish proficiency
		Very well	1
		Well	2
		Not well	3
		Not at all	4
		Don't Know	9
		Refuse to Answer	7

Check_CountyofResidence.

If IE2 EQ 1, go to ES7_ATL1. If IE2 EQ 2, go to ES7_BLT. If IE2 EQ 3, go to ES7_BOS. If IE2 EQ 4, go to ES7_CHI. If IE2 EQ 5, go to ES7_DAL. If IE2 EQ 6, go to ES7_DEN. If IE2 EQ 7, go to ES7_DET. If IE2 EQ 9, go to ES7_HOU. If IE2 EQ 10, go to ES7_LAX. If IE2 EQ 11, go to ES7_MIA. If IE2 EQ 12, go to ES7_MEM. If IE2 EQ 13, go to ES7_NAU. If IE2 EQ 14 go to ES7_NEW. If IE2 EQ 15, go to ES7_NOL. If IE2 EQ 16, go to ES7_NYC. If IE2 EQ 17, go to ES7_NOR. If IE2 EQ 18, go to ES7_PHL. If IE2 EQ 19, go to ES7_PTL. If IE2 EQ 21, go to ES7_SDG. If IE2 EQ 22, go to ES7_SFO. If IE2 EQ 23, go to ES7_SJN1. If IE2 EQ 24, go to ES7_SEA. If IE2 EQ 25, go to ES7_WDC.

County of Residence

ES7_ATL1.		What county do you currently live in? [DO NOT read choices.]
ATLCTYR5		Eligibility, Atlanta county of residence
		Barrow, Bartow, or Butts County	1
		Carroll County	4
		Cherokee County	5
		Clayton County	6
		Cobb County	7
		Coweta County	8
		Dawson County	9
		DeKalb County	10
		Douglas County	11
		Fayette County	12
		Forsyth County	13
		Fulton County	14
		Gwinnett County	15
		Haralson, Heard, or Henry County	16
		Jasper County	19
		Lamar County	20
		Meriwether or Morgan County	21
		Newton County	23
		Paulding, Pickens, or Pike County	24
		Rockdale County	27
		Spalding County	28
		Walton County	29
		Other	88
		Don't Know	999
		Refuse to Answer	777

Check_ES7_ATL2.

If R lives in Barrow, Bartow, Butts, Haralson, Heard, Henry, Meriwether, Morgan, Paulding, Pickens, or Pike counties (ES7_ATL1 EQ 1, 16, 21, or 24), go to ES7_ATL2. Else, go to CALC_ATLELR5.

ES7_ATL2.		INTERVIEWER: Please indicate which of the following counties the respondent lives in. If the respondent does not live in one of these counties, return to prior screen and correct the county entered. [DO NOT read choices.]
ATLBR5		Atlanta Counties live in
		Barrow County	1
		Bartow County	2
		Butts County	3
		Haralson County	16
		Heard County	17
		Henry County	18
		Meriwether County	21
		Morgan County	22
		Paulding County	24
		Pickens County	25
		Pike County	26

CALC_ATLELR5.
ATLELR5	Eligible county resident: ATL	ATLELR5 = if ((ATLCTYR5=1 OR ATLCTYR5=4 OR ATLCTYR5=5 OR ATLCTYR5=6 OR ATLCTYR5=7 OR ATLCTYR5=8 OR ATLCTYR5=9 OR ATLCTYR5=10 OR ATLCTYR5=11 OR ATLCTYR5=12 OR ATLCTYR5=13 OR ATLCTYR5=14 OR ATLCTYR5=15 OR ATLCTYR5=16 OR ATLCTYR5=19 OR ATLCTYR5=20 OR ATLCTYR5=21 OR ATLCTYR5=23 OR ATLCTYR5=24 OR ATLCTYR5=27 OR ATLCTYR5=28 OR ATLCTYR5=29), 1,0)

Check_ES7_BLT.

Go to CALC_E_CITY.

ES7_BLT.	What county do you currently live in? [DO NOT read choices.]
BLTCTYR5	Eligibility, Baltimore county of residence
	Baltimore City	1
	Anne Arundel	2
	Baltimore	3
	Carroll	4
	Harford	5
	Howard	6
	Queen Anne's	7
	Other	88
	Don't Know	999
	Refuse to Answer	777

CALC_BLTELR5.
BLTELR5	Eligible county resident: BLT	BLTELR5 = if ((BLTCTYR5=1 OR BLTCTYR5=2 OR BLTCTYR5=3 OR BLTCTYR5=4 OR BLTCTYR5=5 OR BLTCTYR5=6 OR BLTCTYR5=7), 1,0)

Check_ES7_BOS.

Go to CALC_E_CITY.

ES7_BOS.		What county/city/town do you currently live in? [DO NOT read choices.]
BOSCTYR5		Eligibility, Boston city or town of residence
		Allston	1
		Back Bay	2
		Brookline	7
		Cambridge	8
		Chelsea	10
		Dorchester	12
		East Boston	14
		Fenway / Kenmore	15
		Jamaica Plain	17
		Lynn	18
		Malden	20
		Medford	21
		Revere	26
		Roxbury	28
		Somerville	29
		South Boston	30
		South End	31
		Boston (other)	37
		Essex County (other)	38
		Middlesex County (other)	39
		Norfolk County (other)	40
		Plymouth County (other)	41
		Suffolk County (other)	42
		Other	88
		Don't Know	999
		Refuse to Answer	777

CALC_BSTELR5.
BSTELR5	Eligible county resident: BOS	BSTELR5 = if ((BOSCTYR5=1 OR BOSCTYR5=2 OR BOSCTYR5=7 OR BOSCTYR5=8 OR BOSCTYR5=10 OR BOSCTYR5=12 OR BOSCTYR5=14 OR BOSCTYR5=15 OR BOSCTYR5=17 OR BOSCTYR5=18 OR BOSCTYR5=20 OR BOSCTYR5=21 OR BOSCTYR5=26 OR BOSCTYR5=28 OR BOSCTYR5=29 OR BOSCTYR5=30 OR BOSCTYR5=31 OR BOSCTYR5=37 OR BOSCTYR5=38 OR BOSCTYR5=39 OR BOSCTYR5=40 OR BOSCTYR5=41 OR BOSCTYR5=42), 1,0)

Check_ES7_CHI.

Go to CALC_E_CITY.

ES7_CHI.	What county do you currently live in? [DO NOT read choices.]
CHICTYR5	Eligibility, Chicago county of residence
	Cook County	1
	DuPage County	3
	Grundy County	4
	Kendall County	6
	McHenry County	7
	Will County	8
	Other	88
	Don't Know	999
	Refuse to Answer	777

CALC_CHIELR5.
CHIELR5	Eligible county resident: CHI	CHIELR5 = if ((CHICTYR5=1 OR CHICTYR5=3 OR CHICTYR5=4 OR CHICTYR5=6 OR CHICTYR5=7 OR CHICTYR5=8), 1,0)

Check_ES7_DAL.

Go to CALC_E_CITY.

ES7_DAL.	What county do you currently live in? [DO NOT read choices.]
DALCTYR5	Eligibility, Dallas county of residence
	Collin County	1
	Dallas County	2
	Denton County	4
	Ellis County	5
	Hunt County	6
	Kaufman County	7
	Rockwall County	8
	Other	88
	Don't Know	999
	Refuse to Answer	777

CALC_DALELR5.
DALELR5	Eligible county resident: DAL	DALELR5 = if ((DALCTYR5=1 OR DALCTYR5=2 OR DALCTYR5=4 OR DALCTYR5=5 OR DALCTYR5=6 OR DALCTYR5=7 OR DALCTYR5=8), 1,0)

Check_ES7_DEN.

Go to CALC_E_CITY.

ES7_DEN.	What county do you currently live in? [DO NOT read choices.]
DENCTYR5	Eligibility, Denver county of residence
	Adams County	1
	Arapahoe County	2
	Broomfield County	3
	Clear Creek County	4
	Denver County	5
	Douglas County	6
	Elbert County	7
	Gilpin County	8
	Jefferson County	9
	Park County	10
	Other	88
	Don't Know	999
	Refuse to Answer	777

CALC_DENELR5.
DENELR5	Eligible county resident: DEN	DENELR5 = if ((DENCTYR5=1 OR DENCTYR5=2 OR DENCTYR5=3 OR DENCTYR5=4 OR DENCTYR5=5 OR DENCTYR5=6 OR DENCTYR5 =7 OR DENCTYR5=8 OR DENCTYR5=9 OR DENCTYR5=10), 1,0)

Check_ES7_DET.

Go to CALC_E_CITY.

ES7_DET.	What county do you currently live in? [DO NOT read choices.]
DETCTYR5	Eligibility, Detroit county of residence
	Macomb County	0
	Oakland County	1
	Wayne County	2
	Other	88
	Don't Know	999
	Refuse to Answer	777

CALC_DETELR5.
DETELR5	Eligible county resident: DET	DETELR5 = if ((DETCTYR5=0 OR DETCTYR5=1 OR DETCTYR5=2), 1,0)

Check_ES7_HOU.

Go to CALC_E_CITY.

ES7_HOU.	What county do you currently live in? [DO NOT read choices.]
HOUCTYR5	Eligibility, Houston county of residence
	Austin County	1
	Brazoria County	2
	Chambers County	3
	Fort Bend County	4
	Galveston County	5
	Harris County	6
	Liberty County	7
	Montgomery County	8
	Waller County	10
	Other	88
	Don't Know	999
	Refuse to Answer	777

CALC_HOUELR5.
HOUELR5	Eligible county resident: HOU	HOUELR5= if ((HOUCTYR5=1 OR HOUCTYR5=2 OR HOUCTYR5=3 OR HOUCTYR5=4 OR HOUCTYR5=5 OR HOUCTYR5=6 OR HOUCTYR5=7 OR HOUCTYR5=8 OR HOUCTYR5=10), 1,0)

Check_ES7_LAX.

Go to CALC_E_CITY.

ES7_LAX.		What county do you currently live in? [DO NOT read choices.]
LAXCTYR5		Eligibility, Los Angeles county of residence
		Los Angeles County	1
		Other	88
		Don't Know	999
		Refuse to Answer	777

CALC_LAXELR5.
LAXELR5	Eligible county resident: LAX	LAXELR5 = if ((LAXCTYR5=1), 1,0)

Check_ES7_MIA.

Go to CALC_E_CITY.

ES7_MIA.		What county do you currently live in? [DO NOT read choices.]
MIACTYR5		Eligibility, Miami county of residence
		Miami-Dade County	1
		Other	88
		Don't Know	999
		Refuse to Answer	777

CALC_MIAELR5.
MIAELR5	Eligible county resident: MIA	MIAELR5 = if ((MIACTYR5=1), 1,0)

Check_ES7_MEM.

Go to CALC_E_CITY.

ES7_MEM.		What county do you currently live in? [DO NOT read choices.]
MEMCTYR5		Eligibility, Memphis county of residence
		Fayette County, TN	1
		Shelby County, TN	2
		Tipton County, TN	3
		Benton County, MS	4
		DeSoto County, MS	5
		Marshall County, MS	6
		Tate County, MS	7
		Tunica County, MS	8
		Crittendon County, AR	9
		Other	88
		Don't Know	999
		Refuse to Answer	777

CALC_MEMELR5.
MEMELR5	Eligible county resident: MEM	MEMELR5 = if ((MEMCTYR5=1 OR MEMCTYR5=2 OR MEMCTYR5=3 OR MEMCTYR5=4 OR MEMCTYR5=5 OR MEMCTYR5=6 OR MEMCTYR5=7 OR MEMCTYR5=8 OR MEMCTYR5=9 ), 1,0)

Check_ES7_NAU.

Go to CALC_E_CITY.

ES7_NAU.	What county do you currently live in? [DO NOT read choices.]
NAUCTYR5	Eligibility, Nassau county of residence
	Nassau County	1
	Suffolk County	2
	Other	88
	Don't Know	999
	Refuse to Answer	777

CALC_NAUELR5.
NAUELR5	Eligible county resident: NAU	NAUELR5 = if ((NAUCTYR5=1 OR NAUCTYR5=2), 1,0)

Check_ES7_NEW.

Go to CALC_E_CITY.

ES7_NEW.		What county do you currently live in? [DO NOT read choices.]
NEWCTYR5		Eligibility, Newark county of residence
		Essex County, NJ	1
		Hunterdon County, NJ	2
		Hudson County, NJ	3
		Morris County, NJ	4
		Somerset County, NJ	5
		Sussex County, NJ	6
		Union County, NJ	7
		Pike County, PA	8
		Other	88
		Don't Know	999
		Refuse to Answer	777

CALC_NEWELR5.
NEWELR5	Eligible county resident: NEW	NEWELR5 = if ((NEWCTYR5=1 OR NEWCTYR5=2 OR NEWCTYR5=3 OR NEWCTYR5=4 OR NEWCTYR5=5 OR NEWCTYR5=6 OR NEWCTYR5=7 OR NEWCTYR5=8), 1,0)

Check_ES7_NOL.

Go to CALC_E_CITY.

ES7_NOL.	What parish do you currently live in? [DO NOT read choices.]
NOLCTYR5	Eligibility, New Orleans parish of residence
	Jefferson Parish	1
	Orleans Parish	2
	Plaquemines Parish	3
	St. Bernard Parish	4
	St. Charles Parish	5
	St. James Parish	6
	St. John the Baptist Parish	7
	St. Tammany Parish	8
	Other	88
	Don't Know	999
	Refuse to Answer	777

CALC_NOLEL.
NOLELR5	Eligible parish resident: NOL	NOLELR5 = if ((NOLCTYR5=1 OR NOLCTYR5=2 OR NOLCTYR5=3 OR NOLCTYR5=4 OR NOLCTYR5=5 OR NOLCTYR5=6 OR NOLCTYR5=7 OR NOLCTYR5=8), 1,0)

Check_ES7_NYC.

Go to CALC_E_CITY.

ES7_NYC.	What county do you currently live in? [DO NOT read choices.]
NYCCTYR5	Eligibility, New York City county of residence
	Bronx County, NY	1
	Kings County, NY	2
	New York County, NY	3
	Orange County, NY	4
	Queens County, NY	5
	Richmond County, NY	6
	Rockland County, NY	7
	Westchester County, NY	8
	Bergen County, NJ	9
	Middlesex County, NJ	11
	Monmouth County, NJ	12
	Ocean County, NJ	13
	Passaic County, NJ	14
	Other	88
	Don't Know	999
	Refuse to Answer	777

CALC_NYCELR5.
NYCELR5	Eligible county resident: NYC	NYCELR5 = if ((NYCCTYR5=1 OR NYCCTYR5=2 OR NYCCTYR5=3 OR NYCCTYR5=4 OR NYCCTYR5=5 OR NYCCTYR5=6 OR NYCCTYR5=7 OR NYCCTYR5=8 OR NYCCTYR5=9 OR NYCCTYR5=11 OR NYCCTYR5=12 OR NYCCTYR5=13 OR NYCCTYR5=14), 1,0)

Check_ES7_NOR.

Go to CALC_E_CITY.

ES7_NOR.	What county do you currently live in? [DO NOT read choices.]
NORCTYR5	Eligibility, Norfolk county of residence
	Chesapeake City, VA	1
	Gloucester County, VA	2
	Hampton City, VA	3
	Isle of Wight County, VA	4
	James City County, VA	5
	Mathews County, VA	6
	Newport News City, VA	7
	Norfolk City, VA	8
	Poquoson City, VA	9
	Portsmouth City, VA	10
	Suffolk City, VA	11
	Virginia Beach City, VA	13
	Williamsburg City, VA	14
	York County, VA	15
	Currituck County, NC	16
	Gates County, NC	20
	Other	88
	Don't Know	999
	Refuse to Answer	777

CALC_NORELR5.
NORELR5	Eligible county resident: NOR	NORELR5 = if ((NORCTYR5=1 OR NORCTYR5=2 OR NORCTYR5=3 OR NORCTYR5=4 OR NORCTYR5=5 OR NORCTYR5=6 OR NORCTYR5=7 OR NORCTYR5=8 OR NORCTYR5=9 OR NORCTYR5=10 OR NORCTYR5=11 OR NORCTYR5=13 OR NORCTYR5=14 OR NORCTYR5=15 OR NORCTYR5=16 OR NORCTYR5=20), 1,0)

Check_ES7_PHL.

Go to CALC_E_CITY.

ES7_PHL.	What county do you currently live in? [DO NOT read choices.]
PHLCTYR5	Eligibility, Philadelphia county of residence
	Delaware County	3
	Philadelphia County	5
	Other	88
	Don't Know	999
	Refuse to Answer	777

CALC_PHLELR5.
PHLELR5	Eligible county resident: PHL	PHLELR5 = if ((PHLCTYR5=3 OR PHLCTYR5=5), 1,0)

Check_ES7_PTL.

Go to CALC_E_CITY.

ES7_PTL.	What county do you currently live in? [DO NOT read choices.]
PTLCTYR5	Eligibility, Portland county of residence
	Clackamas County, OR	1
	Columbia County, OR	2
	Multnomah County, OR	3
	Washington County, OR	4
	Yamhill County, OR	5
	Clark County, WA	6
	Skamania County, WA	7
	Other	88
	Don't Know	999
	Refuse to Answer	777

CALC_PTLELR5.
PTLELR5	Eligible county resident: PTL	PTLELR5 = if ((PTLCTYR5=1 OR PTLCTYR5=2 OR PTLCTYR5=3 OR PTLCTYR5=4 OR PTLCTYR5=5 OR PTLCTYR5=6 OR PTLCTYR5=7), 1,0)

Check_ES7_SDG.

Go to CALC_E_CITY.

ES7_SDG.	What county do you currently live in? [DO NOT read choices.]
SDGCTYR5	Eligibility, San Diego county of residence
	San Diego County	1
	Other	88
	Don't Know	999
	Refuse to Answer	777

CALC_SDGELR5.
SDGEL	Eligible county resident: SDG	SDGELR5 = if ((SDGCTYR5=1), 1,0)

Check_ES7_SFO.

Go to CALC_E_CITY.

ES7_SFO.	What county do you currently live in? [DO NOT read choices.]
SFOCTYR5	Eligibility, San Francisco county of residence
	San Francisco County	2
	San Mateo County	3
	Other	88
	Don't Know	999
	Refuse to Answer	777

CALC_SFOELR5.
SFOELR5	Eligible county resident: SFO	SFOELR5 = if ((SFOCTYR5=2 OR SFOCTYR5=3), 1,0)

Check_ES7_SJN1.

Go to CALC_E_CITY.

ES7_SJN1.	What municipality (county) do you currently live in? [DO NOT read choices.]
SJNCTYR5	Eligibility, San Juan county (municipio) of residence
	San Juan	1
	Bayamón	2
	Caguas	3
	Canóvanas	4
	Carolina	5
	Cataño	6
	Guaynabo	7
	Loíza	8
	Toa Alta	9
	Toa Baja	10
	Trujillo Alto	11
	Aguas Buenas or Aibonito	12
	Barceloneta or Barranquitas	13
	Cayey, Ceiba, or Ciales	14
	Cidra, Comerío, or Corozal	15
	Dorado, Fajardo, or Florida	16
	Gurabo or Humacao	17
	Juncos, Las Piedras, or Luquillo	18
	Manatí, Maunabo, or Morovis	19
	Naguabo or Naranjito	20
	Orocovis	21
	Río Grande or San Lorenzo	22
	Vega Alta, Vega Baja, or Yabucoa	23
	Other	88
	Don't Know	999
	Refuse to Answer	777

Check_ES7_SJN2.

If R lives in 'other' San Juan municipio or does not report municipio of residence (ES7_SJN1 EQ 88, DK, or REF), go to CALC_SJNELR5. If single county response entered (ES7_SJN1 EQ 1-11 or 21), go to CALC_SJNELR5. If ES7_SJN1 EQ 12-17, go to ES7_SJN2. If ES7_SJN1 EQ 18-20 or 22-23, go to ES7_SJN3.

ES7_SJN2.		INTERVIEWER: Please indicate which of the following municipalities the respondent lives in. If the respondent does not live in one of these municipalities, return to prior screen and correct the municipality entered. [DO NOT read choices.]
SJNAR5		San Juan Municipalities live in: A
		Aguas Buenas	1
		Aibonito	2
		Barceloneta	4
		Barranquitas	5
		Cayey	6
		Ceiba	7
		Ciales	8
		Cidra	9
		Comerío	10
		Corozal	11
		Dorado	12
		Fajardo	13
		Florida	14
		Gurabo	15
		Humacao	16

Check_ES7_SJN3.

Go to CALC_SJNELR5.

ES7_SJN3.		INTERVIEWER: Please indicate which of the following municipalities the respondent lives in. If the respondent does not live in one of these municipalities, return to prior screen and correct the municipality entered. [DO NOT read choices.]
SJNBR5		San Juan Municipalities live in: B
		Juncos	2
		Las Piedras	3
		Luquillo	4
		Manatí	5
		Maunabo	6
		Morovis	7
		Naguabo	8
		Naranjito	9
		Río Grande	12
		San Lorenzo	13
		Vega Alta	14
		Vega Baja	15
		Yabucoa	16

CALC_SJNELR5.
SJNELR5	Eligible municipality resident: SJN	SJNELR5 = if ((SJNCTYR5=1 OR SJNCTYR5=2 OR SJNCTYR5=3 OR SJNCTYR5=4 OR SJNCTYR5=5 OR SJNCTYR5=6 OR SJNCTYR5=7 OR SJNCTYR5=8 OR SJNCTYR5=9 OR SJNCTYR5=10 OR SJNCTYR5=11 OR SJNCTYR5=12 OR SJNCTYR5=13 OR SJNCTYR5=14 OR SJNCTYR5=15 OR SJNCTYR5=16 OR SJNCTYR5=17 OR SJNCTYR5=18 OR SJNCTYR5=19 OR SJNCTYR5=20 OR SJNCTYR5=21 OR SJNCTYR5=22 OR SJNCTYR5=23), 1,0)

Check_ES7_SEA.

Go to CALC_E_CITY.

ES7_SEA.		What county do you currently live in? [DO NOT read choices.]
SEACTYR5		Eligibility, Seattle county of residence
		King County	1
		Snohomish County	2
		Other	88
		Don't Know	999
		Refuse to Answer	777

CALC_SEAELR5.
SEAELR5	Eligible county resident: SEA	SEAELR5 = if ((SEACTYR5=1 OR SEACTYR5=2), 1, 0)

Check_ES7_WDC.

Go to CALC_E_CITY.

ES7_WDC.		What county do you currently live in? [DO NOT read choices.]
WDCCTYR5		Eligibility, Washington DC county of residence
		District of Columbia	1
		Calvert County, MD	2
		Charles County, MD	3
		Prince George's County, MD	4
		Alexandria City, VA	5
		Fairfax City, VA	6
		Falls Church City, VA	7
		Fredericksburg City, VA	8
		Manassas City, VA	9
		Manassas Park City, VA	10
		Arlington County, VA	11
		Clarke County, VA	12
		Culpeper County, VA	13
		Fairfax County, VA	14
		Fauquier County, VA	15
		Loudoun County, VA	16
		Prince William County, VA	17
		Rappahannock County, VA	18
		Spotsylvania County, VA	19
		Stafford County, VA	20
		Warren County, VA	21
		Jefferson County, WV	22
		Other	88
		Don't Know	999
		Refuse to Answer	777

CALC_WDCELR5.
WDCELR5	Eligible county resident: WDC	WDCELR5 = if ((WDCCTYR5=1 OR WDCCTYR5=2 OR WDCCTYR5=3 OR WDCCTYR5=4 OR WDCCTYR5=5 OR WDCCTYR5=6 OR WDCCTYR5=7 OR WDCCTYR5=8 OR WDCCTYR5=9 OR WDCCTYR5=10 OR WDCCTYR5=11 OR WDCCTYR5=12 OR WDCCTYR5=13 OR WDCCTYR5=14 OR WDCCTYR5=15 OR WDCCTYR5=16 OR WDCCTYR5=17 OR WDCCTYR5=18 OR WDCCTYR5=19 OR WDCCTYR5=20 OR WDCCTYR5=21 OR WDCCTYR5=22), 1,0)

CALC_E_CITY.
E_CITY	Eligible city resident	E_CITY = if ((ATLELR5=1 or BLTELR5=1 or BSTELR5=1 or CHIELR5=1 or DALELR5=1 or DENELR5=1 or DETELR5=1 or HOUELR5=1 or LAXELR5=1 or MEMELR5=1 or MIAELR5=1 or NAUELR5=1 or NEWELR5=1 or NOLELR5=1 or NORELR5=1 or NYCELR5=1 or PHLELR5=1 or PTLELR5=1 or SDGELR5=1 or SFOELR5=1 or SJNELR5=1 or SEAELR5=1 or WDCELR5=1),1,0)

Check_ES7spec.

If R is resident of 'other' county (ES5_ATL1 EQ 88 or ES5_BLT EQ 88 or ES5_BOS EQ 88 or ES5_CHI EQ 88 or ES5_DAL EQ 88 or ES5_DEN EQ 88 or ES5_DET EQ 88 or ES5_HOU EQ 88 or ES5_LAX EQ 88 or ES5_MEM EQ 88 or ES5_MIA EQ 88 or ES5_NAU EQ 88 or ES5_NEW EQ 88 or ES5_NOL EQ 88 or ES5_NOR EQ 88 or ES5_NYC EQ 88 or ES5_PHL EQ 88 or ES5_PTL EQ 88 or ES5_SDG EQ 88 or ES5_SFO EQ 88 or ES5_SJN1 EQ 88 or ES5_SEA EQ 88 or ES5_WDC EQ 88), go to ES7spec. Else, go to INTRO_ES8.

ES7spec.			INTERVIEWER: Specify other county (If Boston, Specify other city or town):
SPECCNTY			Specify other county
		__ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __
			{text response; max length = 100 characters}

Interviewer assessment

ES8a.		INTERVIEWER: Is this person alert and capable of completing the survey in English or Spanish?
E_CAP		Eligibility: able to complete
		No	0
		Yes	1

Check_ES8b.

If R is not able to complete the survey (ES8a EQ 0), go to ES8b. Else, go to ES8c.

ES8b.		INTERVIEWER: Specify reason person not able to complete the interview: [CHECK ALL THAT APPLY.]
E_CAPA		Eligibility: Reason not able to complete
	E_CAPAA	Not able to understand or consent
	E_CAPAB	Cannot speak and understand English or Spanish

ES8c.		INTERVIEWER: Did your field supervisor tell you that this person cannot complete the survey for some other reason?
E_FS		Eligibility: field supervisor reason
		No	0
		Yes	1

Check_ES8d.

If field supervisor stated that R is not able to complete the survey for some other reason (ES8c EQ 1), go to ES8d. Else, go to INTRO_CALC_EL_TRANS.

ES8d.		INTERVIEWER: Specify other reason person not able to complete the interview: [CHECK ALL THAT APPLY.]
E_FSA		Eligibility: cannot complete
	E_FSAA	Known previous participant
	E_FSAB	Reported age not plausible (<18 years old)

INTRO_CALC_EL_TRANS.

DISPLAY: “READ: We’ve finished the first series of questions. Now the computer will determine whether you’ve been selected to participate in the survey.”

Cycle Eligibility Calculation

CALC_EL_TRANS.
EL_TRANS	Eligible: TRANS cycle	EL_TRANS = IF((DOB^=.DK AND DOB^=.REF AND AGE>17 AND E_PART=0 AND E_CITY=1 AND E_CAP=1 AND E_FS=0 AND ((SXBRTH=1 AND GENDA=1) OR (SXBRTH=1 AND GENDC=1) OR (SXBRTH=3 AND GENDC=1) OR (SXBRTH=1 AND GENDE=1)), 1, 0)

CALC_ENDSCR.
ENDSCR	Time eligibility screener ended	ENDSCR = Current time

END_ES.

If R NOT eligible for cycle (CYCLE EQ 4 & EL_TRANS EQ 0), go to END Section (END). If R eligible for cycle (CYCLE EQ 4 & EL_TRANS EQ 1) DISPLAY: "READ: Congratulations! The computer has selected you to participate in the health survey. Let me tell you about it. [INTERVIEWER: Proceed with the consent process.]" Then, go to Consent Section (CN).

NHBS-Trans Eligibility Screener CRQ

December 18^th, 2018 TRANS CAPI V1 - ENGLISH Page 1 of 27