Screening Form Screening and Instruction

2019 NSDUH, Supporting Statement
Attachment I – Screening Questions

2019 NATIONAL SURVEY ON DRUG
USE AND HEALTH (NSDUH): DRAFT
SCREENER SPECIFICATIONS FOR
PROGRAMMING

Substance Abuse and Mental Health Services Administration
Center for Behavioral Health Statistics and Quality
Rockville, Maryland 20857
Last Revised: January 22, 2018

2019 NATIONAL SURVEY ON DRUG
USE AND HEALTH (NSDUH): FINAL
SCREENER SPECIFICATIONS FOR
PROGRAMMING
Contract No. HHSS283201700002C
RTI Project No. 0215638.019.018.102.001
RTI Authors:
Emily Geisen
Gretchen McHenry
Tennyson Chen

RTI Project Director:
David Hunter
SAMHSA Project Officer:
Peter Tice

For questions about this report, please email Peter.Tice@samhsa.hhs.gov.
Prepared for Substance Abuse and Mental Health Services Administration,
Rockville, Maryland
Prepared by RTI International, Research Triangle Park, North Carolina
Last Revised: January 22, 2018
Recommended Citation: Center for Behavioral Health Statistics and Quality.
(2018). 2019 National Survey on Drug Use and Health (NSDUH): Screener
Specifications for Programming. Substance Abuse and Mental Health
Services Administration, Rockville, MD.

Acknowledgments
This publication was developed for the Substance Abuse and Mental Health Services
Administration (SAMHSA), Center for Behavioral Health Statistics and Quality (CBHSQ),
by RTI International, a trade name of Research Triangle Institute, Research Triangle Park,
North Carolina, under Contract No. HHSS283201000003C. Significant other contributors to
this document at RTI include Christine Clark and Allison McKamey who were reviewers.
Contributors to this report from CBHSQ include Barbara Forsyth and Grace Medley.

2019 NATIONAL SURVEY ON DRUG USE AND HEALTH
SCREENING APPLICATION UPDATES
The following updates have been made to the 2019 National Survey on Drug Use and
Health (NSDUH) screening specifications.
•

i

Table of Contents
Screening Application Updates............................................................................................ i
Section

Page

1.

HU Screening ......................................................................................................... 1-1

2.

GQU Screening ...................................................................................................... 2-1

3.

Select Case Screen Options .................................................................................... 3-1

4.

Record of Calls ....................................................................................................... 4-1

5.

Screening and Interview Refusals .......................................................................... 5-1

6.

Verification............................................................................................................. 6-1

7.

FI Debriefing Questions ......................................................................................... 7-1

8.

Parental Introductory Script in English and Spanish ............................................. 8-1

This page intentionally left blank

NSDUH Screening Application Specifications
Section 1
HU Screening
Document Format:
• Screen names are in bold, upper-case letters.
• English text to be read by FIs is shown in black font. Spanish screen text to be read by FIs is
shown in blue font. In the screening program, FIs can toggle between English and Spanish text by
pressing the SPAN/ENG button on the tablet.
• FI instructions are provided in black, upper-case text that is not in brackets. In the screening
program, FI instructions appear in red, upper-case letters.
• Text of any pop-up screens are provided in bracketed logic using upper-case text in quotations.
• Programming logic is designated by black, upper-case text in brackets.
• Fills are designated by parenthesis and italics.
• Response categories are underlined.

The line number and address are located at the top of each screen. During the roster questions asking
about age through military, touch the address line to see DU LINE box, an enlarged display of the
CaseID and address. If a case is an Added DU, the DU LINE box displays the link line number.

STUDY INTRODUCTION
Hello, my name is (FI NAME) with RTI International in North Carolina. We are conducting a
nationwide study sponsored by the U.S. Department of Health and Human Services.
(Buenas noches/Buenas tardes/Buenos días). Mi nombre es (FI NAME) y trabajo para RTI
International en Carolina del Norte. Estamos llevando a cabo un estudio nacional patrocinado por
el Departamento de Salud y Servicios Humanos de los Estados Unidos.
[IF NOT ADDED DU] You should have received a letter explaining the study.
Usted debe haber recibido una carta explicándole el estudio.
[IF NOT ADDED DU] HAND R COPY OF LETTER IF NEEDED
[IF ADDED DU] HAND R LEAD LETTER, ALLOW TIME TO READ
Next [IDENTIFY SR]

IDENTIFY SR [IF STUDY INTRODUCTION = NEXT]
First, just let me verify: do you live here?
Primero, déjeme verificar: ¿vive usted aquí?
IF NOT OBVIOUS:
And are you 18 or older?
Y ¿tiene 18 años o más de edad?

1-1

IF NO TO EITHER, ASK FOR AN ADULT RESIDENT, TOUCH “PREVIOUS”, AND BEGIN
AGAIN.
SR Available [ADDRESS VERIFICATION]
SR Not Available [EXIT SCREENING: “ARE YOU SURE YOU WANT TO EXIT
SCREENING?” IF Yes, RECORD OF CALLS. IF No, IDENTIFY SR.]

ADDRESS VERIFICATION [IF IDENTIFY SR = SR AVAILABLE]
I just need to verify -- is this
Solamente necesito confirmar que ésta es
STREET: (NUMBER AND STREET)
CITY: (CITY)
STATE: (STATE)
ZIP: (ZIP)
Address Is Correct [INFORMED CONSENT]
Need to Edit Address [EDIT ADDRESS]
FI At Wrong Address [SELECT CASE]

EDIT ADDRESS [IF ADDRESS VERIFICATION = NEED TO EDIT ADDRESS]
TOUCH THE ITEM YOU NEED TO EDIT
STREET # (NUMBER)
STREET: (STREET)
APT.#: (APARTMENT NUMBER)
CITY: (CITY)
STATE: (STATE)
ZIP: (ZIP)
Update [SAVE UPDATED ADDRESS, THEN ADDRESS VERIFICATION]

INFORMED CONSENT [IF ADDRESS VERIFICATION = ADDRESS IS CORRECT]
GIVE PERSON STUDY DESCRIPTION AND SAY
Please read this statement. It describes the survey and the legislation that assures the
confidentiality of any information you provide. It also explains that your answers are used for
statistical purposes only and that your participation is voluntary. If anyone is selected for the full
interview, that person will receive $30 in cash after the interview is completed.
Por favor lea esta declaración, la cual describe la encuesta y la legislación que asegura la
confidencialidad de cualquier información que usted nos dé. También explica que sus respuestas
son usadas con propósitos estadísticos únicamente y que su participación es voluntaria. Si
alguien es seleccionado(a) para participar en la entrevista en su totalidad, dicha persona recibirá
$30 dólares en efectivo después de haber completado la entrevista.
Next [IF APT/CONDO=NO, MISSED DUs; IF APT/CONDO=YES, OCCUPANCY]

1-2

MISSED DUs [IF INFORMED CONSENT = NEXT AND APT/CONDO=NO]
Are there any other living quarters within this structure or on this property, such as a separate
apartment with a separate entrance?
¿Hay alguna otra vivienda dentro de esta casa o propiedad, tal como un apartamento separado con
entrada aparte?
Yes [MISSED DU ADDRESS]
[IF ADDED DU: CANNOT ADD UNIT
“YOU CANNOT ADD A MISSED DU
FROM A DU THAT HAS BEEN ADDED”
MISSED DUs]

No [OCCUPANCY]

MISSED DU ADDRESS [IF MISSED DUs = YES]
RECORD STREET ADDRESS OR DESCRIPTION OF UNIT
STREET #:
STREET:
APT.#: (APARTMENT NUMBER)
Update [Add Another DU: “DURING
THIS SESSION, YOU HAVE ADDED
1 UNIT. YOU STILL HAVE 4 UNUSED
ADDED LINES LEFT IN THIS SEGMENT.
DO YOU WANT TO ADD ANOTHER
MISSED DU?” IF Yes, MISSED DU
ADDRESS. IF No, OCCUPANCY.]

Cancel [CANCEL DU: “ARE YOU SURE
YOU WANT TO CANCEL ADDITION
OF THIS DU? IF Yes, OCCUPANCY.
IF No, MISSED DU ADDRESS.]

OCCUPANCY [IF MISSED DUs = NO OR APT/CONDO=YES OR MISSED DU ADDRESS =
UPDATE OR CANCEL MISSED DU = YES]
(Have/Will) you or anyone else in this household (lived/live) here for most of the time during the
months of (CURRENT QUARTER)?
(¿Ha vivido /¿Vivirá) usted o alguna otra persona en esta vivienda la mayor parte del tiempo
durante los meses de (CURRENT QUARTER)?
Yes [TOTAL SDU MEMBERS]

No [OCCUPANCY – CONFIRMATION: YOUR
‘NO’ RESPONSE WILL CONCLUDE THIS
SCREENING AND FINALIZE THIS CASE. DO YOU
WANT TO CHANGE YOUR ANSWER? (‘YES’
WILL CONTINUE SCREENING. ‘NO’ WILL
FINALIZE THE CASE.) IF Yes, OCCUPANCY. IF
No, OCCUPANCY-CLOSE CASE: ARE YOU SURE
YOU WANT TO CLOSE OUT THIS CASE? IF Yes,
VERIFICATION. IF No, OCCUPANCY]

1-3

TOTAL SDU MEMBERS [IF OCCUPANCY= YES]
(Including yourself), how many people in this household (lived/will live) here for most of the time
during (CURRENT QUARTER)? (Do not include anyone who (lived/will live) at school or
somewhere else for most of the time during (CURRENT QUARTER).)
(Incluyéndose a sí mismo), ¿cuántas personas (vivieron/vivirán) en esta vivienda la mayor parte
del tiempo durante (CURRENT QUARTER)? (No incluya a nadie que (vivió/vivirá) en la escuela
o en otro lugar la mayor parte del tiempo durante (CURRENT QUARTER).)

ENTER NUMBER 1-20 [MEMBERS 12 OR OLDER]
[IF 1 TOTAL SDU MEMBERS = 1, ONLY HOUSEHOLD MEMBER: “CONFIRM
RESPONSE: IS THERE ONLY 1 PERSON IN THIS HOUSEHOLD?” IF No, TOTAL
SDU MEMBERS. IF Yes, ONLY ELIGIBLE HH MEMBER: “Is that you?” IS
THIS SCREENING RESPONDENT THE ONE ELIGIBLE RESIDENT OF THE DU?
IF No, HOUSEHOLDER AGE USING ‘THIS PERSON’ FILL. IF Yes,
HOUSEHOLDER AGE USING ‘YOUR’ FILL.]

MEMBERS 12 OR OLDER [IF TOTAL SDU MEMBERS NE BLANK AND >1]
Of these (TOTAL SDU MEMBERS) people, how many are now age 12 or older?
De estas (TOTAL SDU MEMBERS) personas, ¿cuántas tienen 12 años o más actualmente?
ENTER SUBSET OF TOTAL SDU MEMBERS [ROSTER INTRO]
[IF MEMBERS 12 OR OLDER = 1, ONLY ELIGIBLE MEMBER: “CONFIRM
RESPONSE: IS THERE ONLY 1 PERSON AGE 12 OR OLDER IN THIS
HOUSEHOLD?” IF No, MEMBERS 12 OR OLDER. IF Yes, ONLY ELIGIBLE
HH MEMBER: “(Is that you?) IS THIS SCREENING RESPONDENT THE ONE
ELIGIBLE RESIDENT OF THE DU?” IF No, HOUSEHOLDER AGE USING ‘THIS
PERSON’ FILL. IF Yes, HOUSEHOLDER AGE USING ‘YOUR’ FILL.]

ROSTER INTRO [IF MEMBERS 12 OR OLDER NE 1 OR BLANK]
Next I'll ask a few questions about the people who live here. Let's start with the person or one of
the persons living here who owns or rents this home. We'll refer to this person as the
householder.
Ahora le haré unas cuantas preguntas acerca de las personas que viven aquí. Empecemos con la
persona o una de las personas que vive aquí, quien es el dueño o la dueña de la casa o que paga
por el alquiler de la misma. Nos referiremos a esta persona como la cabeza de la familia.
Next [HOUSEHOLDER AGE]

HOUSEHOLDER AGE [IF ROSTER INTRO NE BLANK OR ROSTER NE BLANK OR
CONFIRM ROSTER FOR HOUSEHOLDER = NO]
Please tell me the age of this person on his or her last birthday.
Por favor dígame la edad de esta persona en su último cumpleaños.
IF SR IS HOUSEHOLDER:

1-4

Please tell me your age on your last birthday.
Por favor dígame su edad en su último cumpleaños.
ENTER AGE [SCREENING RESPONDENT]
[IF HOUSEHOLDER AGE ≥ 99, ROSTER: PLEASE VERIFY: IS (AGE) THE CORRECT
AGE FOR THIS PERSON? IF Yes, RELATION. IF No, HOUSEHOLDER AGE.]
[TO CHANGE THE SR, TOUCH FUNCTIONS MENU, CHANGE SR: DO YOU WANT TO
CHANGE THE SR, IF No, HOUSEHOLDER AGE. IF Yes, THIS PERSON: IS THIS
PERSON THE SR? IF Yes OR No, CONFIRM CHANGE: PLEASE CONFIRM RESPONSE.
IS THIS PERSON THE SR? IF RESPONSE CHANGES, CONFIRM CHANGE: PLEASE
CONFIRM RESPONSE. IS THIS PERSON THE SR? IF RESPONSE DOES NOT CHANGE
AND = No, PERSON NE SCREENING RESPONDENT. IF RESPONSE DOES NOT
CHANGE AND = Yes, PERSON = SCREENING RESPONDENT.]

SCREENING RESPONDENT [IF HOUSEHOLDER AGE NE BLANK OR IF
AGE NE BLANK AND SCREENING RESPONDENT NE YES]
“IS THIS (HOUSEHOLDER AGE/AGE) YEAR OLD PERSON THE SCREENING
RESPONDENT? IF UNSURE ASK: Is that you?”
¿Es usted esta persona?
Yes [SETS LANGUAGE FOR SUBSEQUENT ROSTER QUESTIONS USING
‘YOU/YOUR’]
No [SETS LANGUAGE FOR SUBSEQUENT ROSTER QUESTIONS USING
‘THIS PERSON.’]
[IF HOUSEHOLDER, HOUSEHOLDER GENDER OTHERWISE, RELATION]

HOUSEHOLDER GENDER [IF SCREENING RESPONDENT NE BLANK FOR
HOUSEHOLDER]
ASK ONLY IF NOT OBVIOUS
(Are you/Is this person) male or female?
¿Es (usted/esta persona) hombre o mujer?
Male
Female

Hombre
Mujer

[HOUSEHOLDER HISPANIC]
[TO CHANGE THE SR, TOUCH FUNCTIONS MENU, CHANGE SR: DO YOU WANT TO
CHANGE THE SR, IF No, HOUSEHOLDER GENDER. IF Yes, THIS PERSON: IS THIS
PERSON THE SR? IF Yes OR No, CONFIRM CHANGE: PLEASE CONFIRM RESPONSE.
IS THIS PERSON THE SR? IF RESPONSE CHANGES, CONFIRM CHANGE: PLEASE
CONFIRM RESPONSE. IS THIS PERSON THE SR? IF RESPONSE DOES NOT CHANGE
AND = No, PERSON NE SCREENING RESPONDENT. IF RESPONSE DOES NOT
CHANGE AND = Yes, PERSON = SCREENING RESPONDENT.]

HOUSEHOLDER HISPANIC [IF HOUSEHOLDER GENDER NE BLANK]
(Are you/Is he/Is she) of Hispanic, Latino or Spanish origin?

1-5

¿Es (usted/él/ella) de origen hispano, latino o español?
(That is, do any of these groups describe (your/his/her) national origin or ancestry – Puerto Rican,
Cuban, Cuban-American, Mexican, Mexican-American, Chicano, Central or South American, or
origin in some other Spanish-speaking country?)
(Es decir que su origen nacional o ascendencia se puede describir como puertorriqueño, cubano,
cubano-americano, mexicano, mexicano-americano, chicano, centro o sudamericano, o es
nativo(a) de otro país donde se habla español?)
Yes
No

Sí
No

[HOUSEHOLDER RACE]
[TO CHANGE THE SR, TOUCH FUNCTIONS MENU, CHANGE SR: DO YOU WANT TO
CHANGE THE SR, IF No, HOUSEHOLDER HISPANIC. IF Yes, THIS PERSON: IS THIS
PERSON THE SR? IF Yes OR No, CONFIRM CHANGE: PLEASE CONFIRM RESPONSE.
IS THIS PERSON THE SR? IF RESPONSE CHANGES, CONFIRM CHANGE: PLEASE
CONFIRM RESPONSE. IS THIS PERSON THE SR? IF RESPONSE DOES NOT CHANGE
AND = No, PERSON NE SCREENING RESPONDENT. IF RESPONSE DOES NOT
CHANGE AND = Yes, PERSON = SCREENING RESPONDENT.]

HOUSEHOLDER RACE [IF HOUSEHOLDER HISPANIC NE BLANK]
(Are you/Is he/Is she) White, Black or African American, American Indian or Alaska Native,
Native Hawaiian or other Pacific Islander, or Asian?
¿Es (usted/él/ella) de raza blanca, negra o afro-americana, indígena americana o nativo(a) de
Alaska, nativo(a) de Hawaii o de otra isla del Pacífico, o asiática?
White
Black or African American
American Indian or Alaska Native
Native Hawaiian/other Pacific Islander
Asian
Other

Blanca
Negra o afro-americana
Indígena americana o nativo(a) de Alaska
Nativo(a) de Hawaii o de otra isla del Pacífico
Asiática
Otra raza

(CHECK ALL THAT APPLY)
[HOUSEHOLDER MILITARY OR IF HOUSEHOLDER AGE NE 17-65 CONFIRM
ROSTER]
[TO CHANGE THE SR, TOUCH FUNCTIONS MENU, CHANGE SR: DO YOU WANT TO
CHANGE THE SR, IF No, HOUSEHOLDER RACE. IF Yes, THIS PERSON: IS THIS
PERSON THE SR? IF Yes OR No, CONFIRM CHANGE: PLEASE CONFIRM RESPONSE.
IS THIS PERSON THE SR? IF RESPONSE CHANGES, CONFIRM CHANGE: PLEASE
CONFIRM RESPONSE. IS THIS PERSON THE SR? IF RESPONSE DOES NOT CHANGE
AND = No, PERSON NE SCREENING RESPONDENT. IF RESPONSE DOES NOT
CHANGE AND = Yes, PERSON = SCREENING RESPONDENT.]

HOUSEHOLDER MILITARY [IF HOUSEHOLDER RACE NE BLANK AND
1-6

HOUSEHOLDER AGE = 17-65]
(Are you/Is he/Is she) currently on active duty in the United States military?
¿Está (usted/él/ella) actualmente en servicio activo en las fuerzas armadas de los Estados Unidos?
Yes
No
Refused

Sí
No
Se rehúsa

[CONFIRM ROSTER]
[TO CHANGE THE SR, TOUCH FUNCTIONS MENU, CHANGE SR: DO YOU WANT TO
CHANGE THE SR, IF No, HOUSEHOLDER MILITARY. IF Yes, THIS PERSON: IS
THIS PERSON THE SR? IF Yes OR No, CONFIRM CHANGE: PLEASE CONFIRM
RESPONSE. IS THIS PERSON THE SR? IF RESPONSE CHANGES, CONFIRM CHANGE:
PLEASE CONFIRM RESPONSE. IS THIS PERSON THE SR? IF RESPONSE DOES NOT
CHANGE AND = No, PERSON NE SCREENING RESPONDENT. IF RESPONSE DOES
NOT CHANGE AND = Yes, PERSON = SCREENING RESPONDENT.]

CONFIRM ROSTER [IF HOUSEHOLDER MILITARY NE BLANK OR IF
HOUSEHOLDER AGE NE 17-65 AND HOUSEHOLDER RACE NE BLANK]
[IF RACE, HISPANIC, AND/OR MILITARY IS ‘OTHER’, ‘DK’, OR ‘REF’ OMIT
RESPECTIVE FILLS FROM CONFIRM ROSTER SCREEN.]
CONFIRM:
I have listed (a/an, IF SR: you as a/an) (AGE) year old (GENDER) householder. (She is/He is/IF
SR: You are) (RACE), (HISPANIC), and (is/is not/IF SR: are/are not) on active duty in the
United States military.
He (IF SR: MALE: Lo he/FEMALE: La he) anotado (IF SR: a usted) (un/una) (GENDER:
hombre/mujer) de (AGE) años de edad, quien es la cabeza de la familia. (Él es/Ella es/IF SR:
Usted es) de raza (RACE: blanca, negra o afro-americana, indígena americana o nativo(a) de
Alaska, nativo(a) de Hawaii o de otra isla del Pacífico, asiática) (HISPANIC: es /y es hispana /
es / y es hispano/ no es / y no es hispana / no es / y no es hispano) (MILITARY: y está en servicio
activo en las fuerzas armadas de los Estados Unidos. / y no está en servicio activo en las fuerzas
armadas de los Estados Unidos.)

Is this correct?
¿Es esto correcto?
Yes [OTHER MEMBERS] [IF ROSTER NE BLANK , THEN VERIFY ROSTER DATA]
No [HOUSEHOLDER AGE]
[IF MEMBERS 12 OR OLDER=1 AND SR=NO, NO SR: “INTERVIEWER: YOU HAVE NOT
IDENTIFIED A SCREENING RESPONDENT. IF THE SCREENING RESPONDENT IS A
MEMBER OF THE HOUSEHOLD, EDIT HIS/HER ROSTER RECORD AND MARK THE
APPROPRIATE ITEM.”]

1-7

OTHER MEMBERS [IF CONFIRM ROSTER = YES AND MEMBERS 12 OR OLDER ≥ 2]
READ TO RESPONDENT:
Now I need some general information about (the other person/all of the other people) in this
household who (is/are) 12 years old or older. [IF MEMBERS 12 OR OLDER >2] Let's start with
the oldest and work down to the youngest.
Ahora necesito información general sobre la otra persona en este hogar que tenga 12 años de edad
o más. [IF MEMBERS 12 OR OLDER >2] Empecemos con la persona mayor hasta llegar a la
persona menor.
Next [AGE]

AGE [IF OTHER MEMBERS NE BLANK OR CONFIRM ROSTER = NO]
[IF MEMBERS 12 OR OLDER = 2] Please tell me the age of this person on his or her last
birthday.
Por favor dígame la edad de esta persona en su último cumpleaños.
[IF MEMBERS 12 OR OLDER > 2 HH MEMBERS] Please tell me the age of the (oldest/next
oldest) person on his or her last birthday.
Por favor dígame la edad de la (persona mayor/siguiente persona) en su último cumpleaños.
ENTER AGE [IF ANY SCREENING RESPONDENT = YES, RELATION. IF ALL
SCREENING RESPONDENT = BLANK OR NO, SCREENING
RESPONDENT]
[IF AGE ≥ 99, ROSTER: PLEASE VERIFY: IS (AGE) THE CORRECT AGE FOR THIS
PERSON? IF Yes, RELATION. IF No, AGE.]
[TO CHANGE THE SR, TOUCH FUNCTIONS MENU, CHANGE SR: DO YOU WANT TO
CHANGE THE SR, IF No, AGE. IF Yes, THIS PERSON: IS THIS PERSON THE SR? IF
Yes OR No, CONFIRM CHANGE: PLEASE CONFIRM RESPONSE. IS THIS PERSON
THE SR? IF RESPONSE CHANGES, CONFIRM CHANGE: PLEASE CONFIRM
RESPONSE. IS THIS PERSON THE SR? IF RESPONSE DOES NOT CHANGE AND = No,
PERSON NE SCREENING RESPONDENT. IF RESPONSE DOES NOT CHANGE AND =
Yes, PERSON = SCREENING RESPONDENT.]

RELATION [IF AGE NE BLANK AND ANY SCREENING RESPONDENT =YES]
[IF SCREENING RESPONDENT = YES FOR THIS MEMBER] How are you related to the
householder?
¿Cuál es su parentesco con la cabeza de la familia?
[IF SCREENING RESPONDENT = YES FOR HOUSEHOLDER] How is this person related to
you, the householder?
¿Qué parentesco tiene esta persona con usted, la cabeza de la familia?

1-8

[IF SCREENING RESPONDENT = NO FOR THIS MEMBER AND SCREENING
RESPONDENT = NO FOR HOUSEHOLDER] How is this person related to the householder?
¿Qué parentesco tiene esta persona con la cabeza de la familia?
Husband
Wife
Son (includes step, foster, or adoptive)
Daughter (includes step, foster, or
adoptive)
Son-in-law/Daughter-in-law
Brother (includes half, step, foster, or
adoptive)
Sister (includes half, step, foster, or
adoptive)
Brother-in-law/Sister-in-law
Parent/Guardian (incl. step, foster, or
adoptive)
Parent-in-law
Aunt/Uncle
Nephew/Niece
Grandparent
Grandchild
Cousin
Ex-Spouse
Unmarried Partner
Housemate or Roommate
Tenant/Boarder/Exch Student
Other relative
Other Non-relative
Relationship Unspecified

Esposo
Esposa
Hijo (incluye hijastro, hijo “foster” o de crianza, o
hijo adoptivo)
Hija (incluye hijastra, hija “foster” o de crianza, o
hija adoptiva)
Yerno/Nuera
Hermano (incluye medio hermano, hermanastro,
hermano “foster” o de crianza, o hermano adoptivo)
Hermana (incluye media hermana, hermanastra,
hermana “foster” o de crianza, o hermana adoptiva)
Cuñado(a)
Padre o madre/Tutor(a) (incluye
padrastro/madrastra, padre/madre “foster” o de
crianza, o padre/madre adoptivo(a))
Suegro(a)
Tío(a)
Sobrino(a)
Abuelo(a)
Nieto(a)
Primo(a)
Ex-esposo(a)
Pareja (sin estar casados)
Compañero(a) de casa o de cuarto
Inquilino(a)/Pensionista/Intercambio estudiantil
Otro pariente
Otra persona que no es pariente
No se especificó el parentesco

[IF (HH=FEMALE AND RELATION=WIFE) OR IF (HH=MALE AND
RELATION=HUSBAND), RELATION VERIFICATION: YOU HAVE INDICATED THAT
THIS PERSON IS THE [WIFE/HUSBAND] OF THE HOUSEHOLDER WHO IS
[FEMALE/MALE]. IS THAT CORRECT? If Yes, HISPANIC OR GENDER. If No,
HOUSEHOLD GENDER: IS THE HOUSEHOLDER’S GENDER CORRECT
(FEMALE/MALE)? (ANSWERING ‘NO’ WILL CHANGE THE HOUSEHOLDER’S
GENDER). If Yes, ROSTER: PLEASE MAKE THE NECESSARY CORRECTIONS TO THE
RELATIONSHIP AND/OR GENDER OF THE PERSON YOU ARE CURRENTLY
ROSTERING. If No, ROSTER: THE HOUSEHOLDER’S GENDER HAS BEEN CHANGED
TO MALE.]
[IF MORE THAN ONE HUSBAND or MORE THAN ONE WIFE, Multiple Spouses: YOU
HAVE ALREADY ENTERED A RECORD FOR SPOUSE. DOES THIS HOUSEHOLDER
HAVE MULTIPLE [WIVES/HUSBANDS]? IF Yes, HISPANIC. If No, RELATION.]
[IF RELATION = HUSBAND, WIFE, SON, DAUGHTER, BROTHER OR SISTER
HISPANIC, OTHERWISE GENDER]

1-9

[TO CHANGE THE SR, TOUCH FUNCTIONS MENU, CHANGE SR: DO YOU WANT TO
CHANGE THE SR, IF No, RELATION. IF Yes, THIS PERSON: IS THIS PERSON THE
SR? IF Yes OR No, CONFIRM CHANGE: PLEASE CONFIRM RESPONSE. IS THIS
PERSON THE SR? IF RESPONSE CHANGES, CONFIRM CHANGE: PLEASE CONFIRM
RESPONSE. IS THIS PERSON THE SR? IF RESPONSE DOES NOT CHANGE AND = No,
PERSON NE SCREENING RESPONDENT. IF RESPONSE DOES NOT CHANGE AND =
Yes, PERSON = SCREENING RESPONDENT.]

GENDER [IF RELATION NE HUSBAND, WIFE, SON, DAUGHTER, BROTHER OR SISTER]
ASK ONLY IF NOT OBVIOUS
(Are you/Is this person) male or female?
¿Es (usted/esta persona) hombre o mujer?
Male
Female
Refused

Hombre
Mujer
Se rehúsa

[HISPANIC]
[TO CHANGE THE SR, TOUCH FUNCTIONS MENU, CHANGE SR: DO YOU WANT TO
CHANGE THE SR, IF No, GENDER. IF Yes, THIS PERSON: IS THIS PERSON THE SR?
IF Yes OR No, CONFIRM CHANGE: PLEASE CONFIRM RESPONSE. IS THIS PERSON
THE SR? IF RESPONSE CHANGES, CONFIRM CHANGE: PLEASE CONFIRM
RESPONSE. IS THIS PERSON THE SR? IF RESPONSE DOES NOT CHANGE AND = No,
PERSON NE SCREENING RESPONDENT. IF RESPONSE DOES NOT CHANGE AND =
Yes, PERSON = SCREENING RESPONDENT.

HISPANIC [IF GENDER NE BLANK]
(Are you/Is he/Is she/Is this person) of Hispanic, Latino or Spanish origin?
¿Es (usted/él/ella/esta persona) de origen hispano, latino o español?
(That is, do any of these groups describe (your/his/her/their) national origin or ancestry – Puerto
Rican, Cuban, Cuban-American, Mexican, Mexican-American, Chicano, Central or South
American, or origin in some other Spanish-speaking country?)
(¿Es decir que su origen nacional o ascendencia se puede describir como puertorriqueño, cubano,
cubano-americano, mexicano, mexicano-americano, chicano, centro o sudamericano, o es
nativo(a) de otro país donde se habla español?)
Yes
No
Refused
Unknown

Sí
No
Se rehúsa
No sabe

[RACE]
[TO CHANGE THE SR, TOUCH FUNCTIONS MENU, CHANGE SR: DO YOU WANT TO
CHANGE THE SR, IF No, HISPANIC. IF Yes, THIS PERSON: IS THIS PERSON THE SR?
IF Yes OR No, CONFIRM CHANGE: PLEASE CONFIRM RESPONSE. IS THIS PERSON
THE SR? IF RESPONSE CHANGES, CONFIRM CHANGE: PLEASE CONFIRM

1-10

RESPONSE. IS THIS PERSON THE SR? IF RESPONSE DOES NOT CHANGE AND = No,
PERSON NE SCREENING RESPONDENT. IF RESPONSE DOES NOT CHANGE AND =
Yes, PERSON = SCREENING RESPONDENT.]

RACE [IF HISPANIC NE BLANK]
(Are you/Is he/Is she/Is this person) White, Black or African American, American Indian or
Alaska Native, Native Hawaiian or other Pacific Islander, or Asian?
¿Es (usted/él/ella/esta persona) de raza blanca, negra o afro-americana, indígena americana o
nativo(a) de Alaska, nativo(a) de Hawaii o de otra isla del Pacífico, o asiática?
White
Black or African American
American Indian or Alaska Native
Native Hawaiian/other Pacific Islander
Asian
Other

Blanca
Negra o afro-americana
Indígena americana o nativo(a) de Alaska
Nativo(a) de Hawaii o de otra isla del Pacífico
Asiática
Otra raza

(CHECK ALL THAT APPLY)
Refused
Unknown

Se rehúsa
No sabe

[IF AGE 17-65, MILITARY, OTHERWISE CONFIRM ROSTER]
[TO CHANGE THE SR, TOUCH FUNCTIONS MENU, CHANGE SR: DO YOU WANT TO
CHANGE THE SR, IF No, RACE. IF Yes, THIS PERSON: IS THIS PERSON THE SR? IF
Yes OR No, CONFIRM CHANGE: PLEASE CONFIRM RESPONSE. IS THIS PERSON
THE SR? IF RESPONSE CHANGES, CONFIRM CHANGE: PLEASE CONFIRM
RESPONSE. IS THIS PERSON THE SR? IF RESPONSE DOES NOT CHANGE AND = No,
PERSON NE SCREENING RESPONDENT. IF RESPONSE DOES NOT CHANGE AND =
Yes, PERSON = SCREENING RESPONDENT.]

MILITARY [IF RACE NE BLANK AND AGE 17-65 AND SCREENING RESPONDENT = NO
FOR THIS MEMBER]
(Are you/Is he/Is she/Is this person) currently on active duty in the United States military?
¿Está (usted/él/ella/esta persona) actualmente en servicio activo en las fuerzas armadas de los
Estados Unidos?
Yes
No
Refused
Unknown

Sí
No
Se rehúsa
No sabe

[CONFIRM ROSTER]
[TO CHANGE THE SR, TOUCH FUNCTIONS MENU, CHANGE SR: DO YOU WANT TO
CHANGE THE SR, IF No, MILITARY. IF Yes, THIS PERSON: IS THIS PERSON THE

1-11

SR? IF Yes OR No, CONFIRM CHANGE: PLEASE CONFIRM RESPONSE. IS THIS
PERSON THE SR? IF RESPONSE CHANGES, CONFIRM CHANGE: PLEASE CONFIRM
RESPONSE. IS THIS PERSON THE SR? IF RESPONSE DOES NOT CHANGE AND = No,
PERSON NE SCREENING RESPONDENT. IF RESPONSE DOES NOT CHANGE AND =
Yes, PERSON = SCREENING RESPONDENT.

CONFIRM ROSTER [IF AGE 17-65 AND MILITARY IS NE BLANK, OTHERWISE
RACE NE BLANK]
[IF RACE, HISPANIC, AND/OR MILITARY IS ‘OTHER’, ‘DK’, OR ‘REF’ OMIT
RESPECTIVE FILLS FROM CONFIRM ROSTER SCREEN.]
CONFIRM:
I have listed a/an (AGE) year old (RELATIONSHIP). (He/She) is (RACE), (HISPANIC) [IF AGE
17-65] and (is/is not) on active duty the United States military.
He anotado (a usted/el/la/al/a la/un/una (RELATIONSHIP) (GENDER IF UNKNOWN/NEUTRAL
RELATIONSHIP: una joven/una mujer/un joven/un hombre/una persona) de (AGE) años de
edad. (Ella /Él /Esta persona) es de raza (RACE: blanca, negra o afro-americana, indígena
americana o nativo(a) de Alaska, nativo(a) de Hawaii o de otra isla del Pacífico, asiática)
(HISPANIC: es / y es hispana / es / y es hispano/Esta persona es hispana / no es / y no es hispana
/ no es / y no es hispano/Esta persona no es hispana) (MILITARY: y está en servicio activo en
las fuerzas armadas de los Estados Unidos. / y no está en servicio activo en las fuerzas armadas
de los Estados Unidos).
Is this correct?
¿Es esto correcto?

Yes
No

Sí [AGE FOR NEXT HH MEMBER, OTHERWISE VERIFY ROSTER DATA]
No [AGE]

[IF ALL MEMBERS ROSTERED AND NO SCREENING RESPONDENT, NO SR:
“INTERVIEWER: YOU HAVE NOT IDENTIFIED A SCREENING RESPONDENT. IF THE
SCREENING RESPONDENT IS A MEMBER OF THE HOUSEHOLD, EDIT HIS/HER
ROSTER RECORD AND MARK THE APPROPRIATE ITEM.”]

VERIFY ROSTER DATA [IF CONFIRM ROSTER = YES ]
[IF CONFIRM ROSTER = YES AND MEMBERS 12 OR OLDER=1]
DO NOT READ TO RESPONDENT. WHEN READY, TOUCH NEXT TO MAKE
SELECTION.
TO MAKE CORRECTIONS: TOUCH AND HOLD THE ROSTER LINE THAT YOU WANT
TO EDIT, THEN TOUCH 'EDIT' FROM THE POP-UP MENU.
[IF CONFIRM ROSTER = YES AND MEMBERS 12 OR OLDER>=2]
I need to make sure this list is accurate. I have listed...
Necesito asegurarme que la lista está correcta. He anotado...

1-12

[READ AGES AND RELATIONSHIPS ROSTERED].
TO MAKE CORRECTIONS: TOUCH AND HOLD THE ROSTER LINE THAT YOU WANT
TO EDIT, THEN TOUCH 'EDIT’ FROM THE POP-UP MENU.
Relation (Relationship)
AGE (Age)
SR (Y for Screening Respondent)
[TOUCH AND HOLD ANY ROSTER LINE, Choose an Action: IF Show Details]
Relation: Relationship
Age: Age
Gender: M, F, R
Hispanic: Y, N, U, R
Race: W, B, I, P, A, O
Military: Y, N, U, R
Eligible: E, I)
[TOUCH AND HOLD ANY ROSTER LINE, Choose an Action: IF Edit. EDIT ROSTER RECORD:
DO YOU WANT TO EDIT THE ROSTER INFORMATION FOR THE (AGE) YEAR OLD
(RELATION)? IF Yes, EDIT ROSTER MEMBER. IF No, VERIFY ROSTER DATA.]
[+MEMBER OR FUNCTIONS TO ADD ROSTER MEMBERS]
Next [START SELECTION]

START SELECTION
THE PROGRAM WILL START THE SELECTION PROCESS. ARE YOU SURE YOU ARE
READY TO MAKE THE SELECTIONS?
Yes [RESPONDENT SELECTION]
No [VERIFY ROSTER DATA]

RESPONDENT SELECTION [START SELECTION = YES]
Interview A
Roster #: (Roster # of selected member, None)
QuestID: (7-digit Questionnaire ID, BLANK)
Relation: (Relationship to householder, BLANK)
Age: (AGE, BLANK)
Race: (W, B, I, P, A, O, BLANK)

Sex: (M, F, BLANK)
Hispanic: (Y, N, BLANK)

Interview B
Roster #: (Roster # of selected member, None)
QuestID: (7-digit Questionnaire ID, BLANK)
Relation: (Relationship to householder, BLANK)

1-13

Age: (AGE, BLANK)
Race: (W, B, I, P, A, O, BLANK)

Sex: (M, F, BLANK)
Hispanic: (Y, N, BLANK)

ALL INELIGIBLE [START SELECTION = YES AND ALL ROSTER MEMBERS MILITARY OR
INELIGIBLE]
ALL MEMBER(S) WERE INDICATED AS MILITARY OR INELIGIBLE. NO ONE IS
ELIGIBLE FOR SELECTION.
OK [VERIFICATION]

1-14

NSDUH Screening Application Specifications
Section 2
GQU Screening
Document Format:
• Screen names are in bold, upper-case letters.
• English text to be read by FIs is shown in black font. Spanish screen text to be read by FIs is
shown in blue font. In the screening program, FIs can toggle between English and Spanish text by
pressing the SPAN/ENG button on the tablet.
• FI instructions are provided in black, upper-case text that is not in brackets. In the screening
program, FI instructions appear in red, upper-case letters.
• Text of any pop-up screens are provided in bracketed logic using upper-case text in quotations.
• Programming logic is designated by black, upper-case text in brackets.
• Fills are designated by parenthesis and italics.
• Response categories are underlined.

STUDY INTRODUCTION
Hello, my name is (FI NAME) with RTI International in North Carolina. We are conducting a
nationwide study sponsored by the U.S. Department of Health and Human Services.
(Buenas noches/ Buenas tardes/Buenos días). Mi nombre es (FI NAME) " y trabajo para RTI
International en Carolina del Norte. Estamos llevando a cabo un estudio nacional patrocinado por
el Departamento de Salud y Servicios Humanos de los Estados Unidos.
You should have received a letter explaining the study.
Usted ha de haber recibido una carta explicándole el estudio.
HAND R COPY OF LETTER IF NEEDED
Next [IDENTIFY SR]

IDENTIFY SR [IF STUDY INTRODUCTION = NEXT]
First, just let me verify: do you live here?
Primero, déjeme verificar: ¿vive usted aquí?
IF NOT OBVIOUS:
And are you 18 or older?
Y ¿tiene 18 años o más de edad?
IF NO TO EITHER, ASK FOR AN ADULT RESIDENT, TOUCH “PREVIOUS”, AND BEGIN
AGAIN.
SR Available [ADDRESS VERIFICATION]
SR Not Available [EXIT SCREENING: “ARE YOU SURE YOU WANT TO EXIT
SCREENING?” IF Yes, RECORD OF CALLS. IF No,
IDENTIFY SR.]

2-1

ADDRESS VERIFICATION [IF IDENTIFY SR = SR AVAILABLE]
I just need to verify -- is this
Solamente necesito confirmar que ésta es
STREET: (NUMBER AND STREET)
CITY: (CITY)
STATE: (STATE)
ZIP: (ZIP)
Address Is Correct [INFORMED CONSENT]
Need to Edit Address [EDIT ADDRESS]
FI At Wrong Address [SELECT CASE]

EDIT ADDRESS [IF ADDRESS VERIFICATION = NEED TO EDIT ADDRESS]
TOUCH THE ITEM YOU NEED TO EDIT
STREET #: (NUMBER)
STREET: (STREET)
APT.#: (APARTMENT NUMBER)
CITY: (CITY)
STATE: (STATE)
ZIP: (ZIP)
Update [SAVE UPDATED ADDRESS, THEN ADDRESS VERIFICATION]

INFORMED CONSENT [IF ADDRESS VERIFICATION = ADDRESS IS CORRECT]
GIVE PERSON STUDY DESCRIPTION AND SAY
Please read this statement. It describes the survey and the legislation that assures the
confidentiality of any information you provide. It also explains that your answers are used for
statistical purposes only and that your participation is voluntary. If anyone is selected for the full
interview, that person will receive $30 in cash after the interview is completed.
Por favor lea esta declaración, la cual describe la encuesta y la legislación que asegura la
confidencialidad de cualquier información que usted nos dé. También explica que sus respuestas
son usadas con propósitos estadísticos únicamente y que su participación es voluntaria. Si
alguien es seleccionado(a) para participar en la entrevista en su totalidad, dicha persona recibirá
$30 dólares en efectivo después de haber completado la entrevista.
Next [TRANSIENT]

TRANSIENT [IF INFORMED CONSENT = NEXT]
INTERVIEWER: IS THIS GQU A TRANSIENT SHELTER?
Yes [UNIT TYPE]

2-2

No [OCCUPANCY]

UNIT TYPE [IF TRANSIENT = YES]
ARE THE LISTED UNITS…
ROOMS [TOTAL GQU MEMBERS]
BEDS, OR [ROSTER #1 AGE]
PERSONS [ROSTER #1 AGE]

OCCUPANCY [IF TRANSIENT = NO]
(Did/Will) you or anyone else in this room live here for most of the time during the
months of (CURRENT QUARTER)?
(¿Ha vivido / ¿Vivirá) usted o alguna otra persona en este cuarto la mayor parte del tiempo
durante los meses de (CURRENT QUARTER)?
Yes [TOTAL GQU MEMBERS]

No [OCCUPANCY – CONFIRMATION:
YOUR ‘NO’ RESPONSE WILL
CONCLUDE THIS SCREENING
AND FINALIZE THIS CASE. DO
YOU WANT TO CHANGE YOUR
ANSWER? (‘YES’ WILL CONTINUE
SCREENING. ‘NO’ WILL FINALIZE THE
CASE.) IF Yes, OCCUPANCY. IF No,
OCCUPANCY-CLOSE CASE: ARE YOU SURE
YOU WANT TO CLOSE OUT THIS CASE? IF
Yes, VERIFICATION. IF No, OCCUPANCY]

TOTAL GQU MEMBERS [IF OCCUPANCY = YES OR IF UNIT TYPE = ROOMS]
[IF TRANSIENT = YES AND UNIT TYPE = ROOMS] (Including yourself) How many people
are staying in this room?
(Incluyéndose a sí mismo), ¿cuántas personas viven en este cuarto?
[IF TRANSIENT = NO] (Including yourself) How many people (lived/will live) in this room for
most of the time during (CURRENT QUARTER)?
(Incluyéndose a sí mismo), ¿cuántas personas (vivieron/vivirán) en este cuarto la mayor parte del
tiempo durante (CURRENT QUARTER)?
ENTER NUMBER 1-20 [MEMBERS 12 OR OLDER]
[IF TOTAL GQU MEMBERS = 1, ONLY MEMBER: CONFIRM RESPONSE: IS
THERE ONLY 1 PERSON LIVING HERE? IF No, TOTAL GQU MEMBERS. IF
Yes AND UNIT TYPE = ROOMS, ROSTER #1 AGE. IF Yes AND TRANSIENT =
NO, ROSTER: IS THIS SCREENING RESPONDENT THE ONE ELIGIBLE
RESIDENT OF THE DU? IF Yes, ROSTER #1 AGE USING ‘YOUR’ FILL. IF No,
ROSTER #1 AGE USING ‘THIS PERSON’ FILL].

2-3

MEMBERS 12 OR OLDER [IF TOTAL GQU MEMBERS NE BLANK AND >1]
[IF TRANSIENT = YES] How many of these [TOTAL GQU MEMBERS] people are now age 12
or older.
¿Cuántas de estas [TOTAL GQU MEMBERS] personas tienen 12 años o más de edad
actualmente?
[IF TRANSIENT = NO] Of these [TOTAL GQU MEMBERS] people, how many are now age 12
or older?
De estas [TOTAL GQU MEMBERS] personas, ¿cuántas tienen 12 años o más actualmente?
ENTER SUBSET OF TOTAL GQU MEMBERS ROSTER # AGE
[IF MEMBERS 12 OR OLDER = 1, ONLY ELIGIBLE MEMBER: “CONFIRM
RESPONSE: IS THERE ONLY 1 PERSON AGE 12 OR OLDER IN THIS UNIT?” IF
No, MEMBERS 12 OR OLDER. IF Yes AND UNIT TYPE = ROOMS ROSTER # 1
AGE. IF Yes AND TRANSIENT = NO, Only Eligible HH Member: “(Is that you?)”
IS THIS SCREENING RESPONDENT THE ONE ELIGIBLE RESIDENT OF THE
DU? IF Yes, ROSTER #1 AGE USING ‘YOUR’ FILL. IF No, ROSTER #1 AGE
USING ‘THIS PERSON’ FILL].

ROSTER #1 AGE [IF MEMBERS 12 OR OLDER NE BLANK OR TOTAL GQU MEMBERS = 1
OR IF UNIT TYPE = BEDS OR PERSONS]
Please tell me (your age/the age of this person) on (your/his or her) last birthday.
Por favor dígame (su edad/la edad de esta persona) en su último cumpleaños.
ENTER AGE [ROSTER #1 NAME]
[IF ROSTER #1 AGE ≥ 99, ROSTER: PLEASE VERIFY: IS (AGE) THE CORRECT AGE FOR THIS
PERSON? IF Yes, RELATION. IF No, ROSTER #1 AGE.]

[IF ONLY ELIGIBLE HH MEMBER=NO, SCREENING RESPONDENT: IS THIS (AGE) YEAR
OLD PERSON THE SCREENING RESPONDENT? IF UNSURE, ASK: Is that you?]

ROSTER #1 NAME [IF ROSTER #1 AGE NE BLANK]
What is (your/this person’s) first name?
¿Cuál es (su nombre/el nombre) (sin apellido) (de esta persona)?
ENTER FIRST NAME [ROSTER #1 GENDER]

ROSTER #1 GENDER [IF ROSTER #1 NAME NE BLANK]
ASK ONLY IF NOT OBVIOUS

2-4

(Are you/Is this person) male or female?
¿Es (usted/esta persona) hombre o mujer?
Male
Female

Hombre
Mujer

[ROSTER #1 HISPANIC]

ROSTER #1 HISPANIC [IF ROSTER #1 GENDER NE BLANK]
(Are you/Is he/Is she) of Hispanic, Latino or Spanish origin?
¿Es (usted/él/ella) de origen hispano, latino o español?
(That is, do any of these groups describe (your/his/her) national origin or ancestry – Puerto Rican,
Cuban, Cuban-American, Mexican, Mexican-American, Chicano, Central or South American, or
origin in some other Spanish-speaking country?)
(¿Es decir que su origen nacional o ascendencia se puede describir como puertorriqueño, cubano,
cubano-americano, mexicano, mexicano-americano, chicano, centro o sudamericano, o es
nativo(a) de otro país donde se habla español?)
Yes
No

Sí
No

[ROSTER #1 RACE]

ROSTER #1 RACE [IF ROSTER #1 HISPANIC NE BLANK]
(Are you/Is he/Is she) White, Black or African American, American Indian or Alaska Native,
Native Hawaiian or other Pacific Islander, or Asian?
White
Black or African American
American Indian or Alaska Native
Native Hawaiian/other Pacific Islander
Asian
Other

Blanca
Negra o afro-americana
Indígena americana o nativo(a) de Alaska
Nativo(a) de Hawaii o de otra isla del Pacífico
Asiática
Otra raza

(CHECK ALL THAT APPLY)

[ROSTER #1 MILITARY OR IF ROSTER #1 AGE NE 17-65 CONFIRM ROSTER]

ROSTER #1 MILITARY [IF ROSTER #1 RACE NE BLANK AND ROSTER #1 AGE = 17-65]
(Are you/Is he/Is she) currently on active duty in the United States military?

2-5

Yes
No
Refused

Sí
No
Se rehúsa

[CONFIRM ROSTER]

CONFIRM ROSTER [IF ROSTER #1 MILITARY NE BLANK OR IF
ROSTER #1 AGE NE 17-65 AND ROSTER #1 RACE NE
BLANK]
[IF RACE, HISPANIC, AND/OR MILITARY IS ‘OTHER’, ‘DK’, OR ‘REF’ OMIT
RESPECTIVE FILLS FROM CONFIRM ROSTER SCREEN.]
CONFIRM:
I have listed (you as) a/an (AGE) year old (GENDER) resident. (You are/He is/She is) (RACE),
(HISPANIC) [IF AGE =17-65] and (are/are not) on active duty in the United States military.
(Lo he anotado a usted/La he anotado a usted/He anotado), (GENDER: una joven/una mujer/un
joven/un hombre/una persona) de (AGE) años de edad. (Usted/ Ella /Él /Esta persona) es de
raza (RACE: blanca, negra o afro-americana, indígena americana o nativo(a) de Alaska,
nativo(a) de Hawaii o de otra isla del Pacífico, asiática) (HISPANIC: es /y es hispana / es / y es
hispano/ no es / y no es hispana / no es / y no es hispano) [IF AGE =17-65] y está en servicio
activo en las fuerzas armadas de los Estados Unidos. / y no está en servicio activo en las fuerzas
armadas de los Estados Unidos).
Is this correct?
¿Es esto correcto?
Yes Sí [IF MEMBERS 12 OR OLDER ≥ 2 OTHER MEMBERS. IF UNIT TYPE = BEDS
OR PERSONS OR UNIT TYPE = ROOMS AND TOTAL GQU MEMBERS OR
MEMBERS 12 OR OLDER =1 VERIFY ROSTER DATA]
No No [ROSTER #1 AGE]
[IF MEMBERS 12 OR OLDER=1 AND SR=NO, NO SR: “INTERVIEWER: YOU HAVE NOT
IDENTIFIED A SCREENING RESPONDENT. IF THE SCREENING RESPONDENT IS A
MEMBER OF THE HOUSEHOLD, EDIT HIS/HER ROSTER RECORD AND MARK THE
APPROPRIATE ITEM.”]

OTHER MEMBERS [IF CONFIRM ROSTER = YES AND MEMBERS 12 OR OLDER ≥ 2]
READ TO RESPONDENT:
Now I need some general information about (the other person/all of the other people) who
(is/are) 12 years old or older. [IF MEMBERS 12 OR OLDER >2] Let's start with the oldest and
work down to the youngest.
Ahora necesito información general sobre la otra persona que tenga 12 años de edad o más. [IF
MEMBERS 12 OR OLDER >2] Empecemos con la persona mayor hasta llegar a la persona
menor.

2-6

Next [AGE]

AGE [IF OTHER MEMBERS NE BLANK OR CONFIRM ROSTER = NO]
[IF MEMBERS 12 OR OLDER = 2] Please tell me the age of this person on his or her last
birthday.
Por favor dígame la edad de esta persona en su último cumpleaños.
[IF MEMBERS 12 OR OLDER > 2 HH MEMBERS] Please tell me the age of the (oldest/next
oldest) person on his or her last birthday.
Por favor dígame la edad de la (persona mayor/siguiente persona) en su último cumpleaños.
ENTER AGE [NAME]
[IF AGE ≥ 99, ROSTER: PLEASE VERIFY: IS (AGE) THE CORRECT AGE FOR THIS
PERSON? IF Yes, RELATION. IF No, AGE.]

NAME [IF AGE NE BLANK]
What is this person’s first name?
¿Cuál es el nombre (sin apellido) de esta persona?
ENTER FIRST NAME [GENDER]

GENDER [IF NAME NE BLANK]
ASK ONLY IF NOT OBVIOUS
Is this person male or female?
¿Es esta persona hombre o mujer?
Male
Female
Refused

Hombre
Mujer
Se rehúsa

[HISPANIC]

HISPANIC [IF GENDER NE BLANK]
(Is he/Is she/Is this person) of Hispanic, Latino or Spanish origin?
¿Es (él/ella/esta persona) de origen hispano, latino o español?
(That is, do any of these groups describe (his/her/their) national origin or ancestry – Puerto
Rican, Cuban, Cuban-American, Mexican, Mexican-American, Chicano, Central or South
American, or origin in some other Spanish-speaking country?)

2-7

(¿Es decir que su origen nacional o ascendencia se puede describir como puertorriqueño, cubano,
cubano-americano, mexicano, mexicano-americano, chicano, centro o sudamericano, o es
nativo(a) de otro país donde se habla español?)
Yes
No
Refused
Unknown

Sí
No
Se rehúsa
No sabe

[RACE]

RACE [IF HISPANIC NE BLANK]
(Is he/Is she/Is this person) White, Black or African American, American Indian or Alaska
Native, Native Hawaiian or other Pacific Islander, or Asian?
¿Es (él/ella/esta persona) de raza blanca, negra o afro-americana, indígena americana o nativo(a)
de Alaska, nativo(a) de Hawaii o de otra isla del Pacífico, o asiática?
White
Black or African American
American Indian or Alaska Native
Native Hawaiian/other Pacific Islander
Asian
Other

Blanca
Negra o afro-americana
Indígena americana o nativo(a) de Alaska
Nativo(a) de Hawaii o de otra isla del Pacífico
Asiática
Otra raza

(CHECK ALL THAT APPLY)
Refused
Unknown

Se rehúsa
No sabe

[IF AGE 17-65, MILITARY, OTHERWISE CONFIRM ROSTER]

MILITARY [IF RACE NE BLANK AND AGE 17-65]
(Is he/Is she/Is this person) currently on active duty in the United States military?
¿Está (él/ella/esta persona) actualmente en servicio activo en las fuerzas armadas de los Estados
Unidos?
Yes
No

Sí
No

Refused
Unknown

Se rehúsa
No sabe

[CONFIRM ROSTER]

2-8

CONFIRM ROSTER [IF AGE 17-65 AND MILITARY IS NE BLANK, OTHERWISE
RACE NE BLANK]
[IF RACE, HISPANIC, AND/OR MILITARY IS ‘OTHER’, ‘DK’, OR ‘REF’ OMIT
RESPECTIVE FILLS FROM CONFIRM ROSTER SCREEN.]
CONFIRM:
I have listed a/an (AGE) year old (GENDER) resident. (He/She) is (RACE), (HISPANIC) [IF
AGE 17-65] and (is/is not) on active duty in the United States military.
He anotado (GENDER: una joven/una mujer/un joven/un hombre/una persona) de (AGE) años
de edad. (Ella /Él /Esta persona) es de raza (RACE: blanca, negra o afro-americana, indígena
americana o nativo(a) de Alaska, nativo(a) de Hawaii o de otra isla del Pacífico, asiática)
(HISPANIC: es / y es hispana / es / y es hispano/Esta persona es hispana / no es hispana /no es /
y no es hispano/Esta persona no es hispana) [IF AGE 17-65] (y está en servicio activo en las
fuerzas armadas de los Estados Unidos. / y no está en servicio activo en las fuerzas armadas de
los Estados Unidos).
Is this correct?
¿Es esto correcto?
Yes Sí [AGE FOR NEXT GQU MEMBER, OTHERWISE VERIFY ROSTER DATA]
No No [AGE]
[IF ALL MEMBERS ROSTERED AND NO SCREENING RESPONDENT, NO SR:
“INTERVIEWER: YOU HAVE NOT IDENTIFIED A SCREENING RESPONDENT. IF THE
SCREENING RESPONDENT IS A MEMBER OF THE HOUSEHOLD, EDIT HIS/HER
ROSTER RECORD AND MARK THE APPROPRIATE ITEM.”]

VERIFY ROSTER DATA [IF CONFIRM ROSTER = YES]
[IF CONFIRM ROSTER = YES AND MEMBERS 12 OR OLDER=1]
DO NOT READ TO RESPONDENT. WHEN READY, TOUCH NEXT TO MAKE
SELECTION.
TO MAKE CORRECTIONS: TOUCH AND HOLD THE ROSTER LINE THAT YOU WANT
TO EDIT, THEN TOUCH 'EDIT' FROM THE POP-UP MENU.
[IF CONFIRM ROSTER = YES AND MEMBERS 12 OR OLDER>=2]
I need to make sure this list is accurate. I have listed...
Necesito asegurarme que la lista está correcta. He anotado...
[READ LIST OF OCCUPANTS’ AGES AND NAMES].
TO MAKE CORRECTIONS: TOUCH AND HOLD THE ROSTER LINE THAT YOU WANT
TO EDIT, THEN TOUCH 'EDIT' FROM THE POP-UP MENU.
Name (First Name)
AGE (Age)

2-9

SR (Y for Screening Respondent)
[UPON TOUCHING ON ANY ROSTER LINE, Choose an Action: IF Show Details SELECT SHOW
DETAILS]
Name: First Name
Age: Age
Gender: M, F, R
Hispanic: Y, N, U, R
Race: W, B, I, P, A, O
Military: Y, N, U, R
Eligible: E, I
[TOUCH AND HOLD ANY ROSTER LINE, Choose an Action: IF Edit. EDIT ROSTER RECORD:
DO YOU WANT TO EDIT THE ROSTER INFORMATION FOR THE (AGE) YEAR OLD
(RELATION)? IF Yes, EDIT ROSTER MEMBER. IF No, VERIFY ROSTER DATA.]
[+MEMBER OR FUNCTIONS TO ADD ROSTER MEMBERS]
Next [START SELECTION]

START SELECTION
THE PROGRAM WILL START THE SELECTION PROCESS. ARE YOU SURE YOU ARE
READY TO MAKE THE SELECTIONS?
Yes [RESPONDENT SELECTION]
No [VERIFY ROSTER DATA]

RESPONDENT SELECTION [START SELECTION = YES]
Interview A
Roster #: (Roster # of selected member, None)
QuestID: (7-digit Questionnaire ID, BLANK)
Name: (First Name, BLANK)
Age: (AGE, BLANK)
Race: (W, B, I, P, A, O, BLANK)

Sex: (M, F, BLANK)
Hispanic: (Y, N, BLANK)

Interview B
Roster #: (Roster # of selected member, None)
QuestID: (7-digit Questionnaire ID, BLANK)
Name: (First Name, BLANK)
Age: (AGE, BLANK)
Race: (W, B, I, P, A, O, BLANK)

Sex: (M, F, BLANK)
Hispanic: (Y, N, BLANK)

2-10

NSDUH Screening Application Specifications
Section 3
Select Case Screen Options
Document Format:
• Screen/menu names are in bold, upper-case letters.
• FI instructions are provided in black, upper-case text that is not in brackets. In the screening
program, FI instructions appear in red, upper-case letters.
• Text of any pop-up screens are provided in bracketed logic using upper-case text in quotations.
• Programming logic is designated by black, upper-case text in brackets.
• Fills are designated by parenthesis and italics.
• Response categories are underlined.
• Explanatory text in italics.

Select Case screen contains the date, time, battery level, CaseID, (list of cases), Address, Results for S
(Screening), A (Interview A), and B (Interview) and menus detailed below.

ACTIONS MENU [ TOUCH AND HOLD CASE UNTIL ACTIONS MENU APPEARS]
Items on the Actions Menu are case specific. First a case is selected on the screen, then the action from
the Actions Menu is selected.
Screen DU/Re-Open Case
Go To Record Of Calls
View Selections
View Roster
Edit Address
Add Missed DU
Place Case On Hold/Take Case Off Hold
View Verification Information
Add Appointment
View Call Distribution

View Letters
SCREEN DU [SELECT CASE, SCREEN DU]
[IF SCREENING COMPLETED, RE-OPEN CASE DISPLAYS ON ACTIONS
MENU. IF CODE 25, 26, 30-32, 70-79, RE-OPENING CONFIRMATION: “CASE
(CASEID) HAS ALREADY BEEN COMPLETED. DO YOU WISH TO RE-OPEN
THIS CASE? IF No, SELECT CASE. IF Yes, CASE RE-OPEN CODE: “ENTER
THE CODE TO RE-OPEN THIS CASE, THEN TOUCH ‘OK’ TO CONTINUE.”
ENTER CORRECT CODE, OK, STUDY INTRODUCTION. IF CODE 10-23, 29,
CANNOT RE-OPEN CASE: “FINAL SCREENER CODES 10-23 AND 29 CANNOT
BE OPENED WITH THIS METHOD. PLEASE CONTACT YOUR FS.”]

GO TO RECORD OF CALLS [SELECT CASE, GO TO RECORD OF CALLS – FOR
DETAILS SEE SECTION 6]

3-1

VIEW SELECTIONS [SELECT CASE, VIEW SELECTIONS]
RESPONDENT SELECTION [IF CASE COMPLETED WITH FINAL
RESULT CODE = [31, 32]
Interview A
Roster #: (Roster # of selected member, None)
QuestID: (7-digit Questionnaire ID, BLANK)
Relation: (Relationship to householder, BLANK)
Age: (AGE, BLANK)
Race: (W, B, I, P, A, O, BLANK)

Sex: (M, F, BLANK)
Hispanic: (Y, N, BLANK)

Interview B
Roster #: (Roster # of selected member, None)
QuestID: (7-digit Questionnaire ID, BLANK)
Relation: (Relationship to householder, BLANK)
Age: (AGE, BLANK)
Race: (W, B, I, P, A, O, BLANK)

Sex: (M, F, BLANK)
Hispanic: (Y, N, BLANK)

Done [SELECT CASE]
Roster [VERIFY ROSTER DATA]
ROC [RECORD OF CALLS]

VIEW ROSTER [SELECT CASE, VIEW ROSTER]
[IF CASE COMPLETED WITH FINAL RESULT CODE = 30, 31, 32, VERIFY
ROSTER DATA]
[VERIFY ROSTER DATA – FOR DETAILS, SEE SECTIONS 1& 2]
Done [SELECT CASE]
Selections [RESPONDENT SELECTION]
ROC [RECORD OF CALLS]

EDIT ADDRESS [SELECT CASE, EDIT ADDRESS]
[EDIT ADDRESS – FOR DETAILS, SEE SECTIONS 1 & 2]

ADD MISSED DU [SELECT CASE, ADD MISSED DU]
[MISSED DU ADDRESS – FOR DETAILS, SEE SECTION 1]
[IF CASE SELECTED IS ADDED DU: CANNOT ADD UNIT: “YOU CANNOT ADD
A MISSED DU FROM A DU THAT HAS BEEN ADDED.” OK, SELECT CASE.]
[IF ATTEMPTING TO ADD A DU TO A GQU: MISSED GQU: “YOU CANNOT
ADD MISSED GROUP QUARTERS UNITS (GQUS). YOU CAN ONLY ADD A
MISSED HOUSING UNIT THAT IS ASSOCIATED WITH A SELECTED LINE IN A
GROUP QUARTERS STRUCTURE. ARE YOU CERTAIN THE UNIT YOU WANT
TO ADD IS A HOUSING UNIT AND NOT A GROUP QUARTERS UNIT?”]

3-2

Yes [READY TO ADD: “DO YOU WANT TO ADD AN HU LINKED TO CASE
(CASEID)?” IF Yes, MISSED DU ADDRESS. IF No, SELECT CASE]
No [CALL FS: “IF THERE ARE MISSED GROUP QUARTERS UNITS IN THE
STRUCTURE, OBTAIN INFORMATION ABOUT ALL MISSED UNITS THEN
CALL YOUR FS.” OK, SELECT CASE.]

PLACE CASE ON HOLD [SELECT CASE, PLACE CASE ON HOLD]
This menu option toggles between “Place Case On Hold” and “Take Case Off Hold,”
depending on the on-hold status of the case. When a case is on hold, data for that case are
transmitted, but are not pulled into the control system—the data is maintained in a separate
location to be accessed, as necessary. This allows putting a case ‘On Hold’ for
troubleshooting.
[IF CASE NOT ON HOLD, PLACE CASE ON HOLD: “ARE YOU SURE YOU
WANT TO PUT CASE (CASEID) ON HOLD?” IF No, SELECT CASE WITH CASE
NOT ON HOLD. IF Yes, SELECT CASE WITH ‘On Hold’ NEXT TO CASEID.]
[IF CASE ON HOLD, TAKE CASE OFF HOLD: “ARE YOU SURE YOU WANT TO
TAKE CASE (CASEID) OFF HOLD?” IF No, SELECT CASE WITH CASE ON
HOLD. IF Yes, SELECT CASE WITH ‘On Hold” REMOVED AND CASE NOT ON
HOLD.]

VIEW VERIFICATION INFORMATION [SELECT CASE, VIEW VERIFICATION
INFORMATION]
[IF VERIFICATION INFORMATION AVAILABLE, VERIFICATION.]
[IF NO VERIFICATION INFORMATION AVAILABLE: “No Verification data found”
OK, SELECT CASE]

ADD APPOINTMENT [SELECT CASE, ADD APPOINTMENT]
This optional calendar can be used to post work and personal appointments to help with time
management and scheduling of interview appointments.

NEW APPOINTMENT
SHOW CALENDAR WHEN DONE? (check box)
CASE: (Case ID)
FROM: (current date with link to calendar to select a beginning date) (time of day)
[IF SELECT A DIFFERENT DATE, Set CHANGES DATE,
Cancel MAINTAINS CURRENT DATE]
IF SELECT A DIFFERENT TIME, Set CHANGES TIME,
Cancel MAINTAINS CURRENT TIME]
TO: (current date with link to calendar to select a ending date) (time of day)
[IF SELECT A DIFFERENT DATE, Set CHANGES DATE,
Cancel MAINTAINS CURRENT DATE]
IF SELECT A DIFFERENT TIME, Set CHANGES TIME,
Cancel MAINTAINS CURRENT TIME]

3-3

ALL DAY? (check box)
REMINDER: (Drop-down box with incremental time choices)
TYPE: (Drop-down box with: Select Type, Screening, Interview A, Interview B, S/I
Other, Other)
DESCRIPTION: (text entry with comments describing appointment)
Done [Detail View containing appointment information, then side arrow to display
CALENDAR.] This calendar is an interactive stock tablet tool that allows calendar
viewing by day, week, month and list. Touching the day on the calendar will show any
entered appointments. New appointments can be added, and appointments for the
current day display at the bottom of the screen.
Back Arrow [SELECT CASE]

VIEW CALL DISTRIBUTION [SELECT CASE, VIEW CALL DISTRIBUTION]
This optional case management feature can be used to view past work patterns based on ROC
data and to determine the times/days when contact has not been attempted at SDUs.
CALL DISTRIBUTION
Link: (line number and address of link line case)

SELECT A CASE OR SEGMENT (Drop-down list of cases and segments
that have associated ROC data entered. FI chooses desired selection
criteria.) [IF SELECT ALL CASES ROC INFORMATION ON ALL
CASES IS DISPLAYED. IF SELECT AN INDIVIDUAL CASE, ONLY
ROC DATA FROM THAT CASE DISPLAYED. IF SELECT AN
INDIVIDUAL SEGMENT, ROC DATA FROM CASES WITHIN THAT
SEGMENT ONLY IS DISPLAYED.]
ALL ROC TYPE RECORDS (Drop-down list of selection criteria to
customize ROC data displayed.) [IF SELECT ALL ROC TYPE
RECORDS, ALL ROCS ENTERED DISPLAY. IF SELECT
SCREENING RECORDS ONLY, ONLY SCREENING RECORDS
DISPLAY. IF SELECT INTERVIEW RECORDS ONLY, ONLY
INTERVIEW ROCS DISPLAY.]
SELECT A STATUS (Drop-down list of selection criteria as shown
below. FI chooses desired selection criteria.)
All (includes all cases)
Not at Home (includes Screening codes: 01, 02, 03 and Interview
codes: 51, 52)
Pending (includes Screening codes: 01-09 and Interview codes:
50-59)
Completed (includes Screening codes: 30, 31, 32 and Interview
code: 70)
Finalized (includes Screening codes: 10 – 32 and Interview codes:
70 – 79)
Refusals (includes Screening codes: 07 and Interview codes: 57,
58)
3-4

Choose ROC code(s) (A DROP DOWN LIST OF ALL ROC
CODES APPEARS TO CHOOSE FROM)
DATE RANGE (INCLUSIVE)
BEGIN DATE: [SELECT A DATE] Date appears allowing beginning
date selection to narrow down the ROC results SET chooses the date
entered [CALL DISTRIBUTION], CANCEL, [CALL
DISTRIBUTION].)
END DATE: [SELECT A DATE] Date appears allowing beginning
date selection to narrow down the ROC results SET chooses the date
entered [CALL DISTRIBUTION], CANCEL, [CALL
DISTRIBUTION].)

Su
M
Tu
W
Th
F
Sa
All

6A-10A 10A-12P 12P-4P 4P-6P 6P-10P 10P-6A All
-

Done [SELECT CASE]
Refresh (Refreshes displayed data based on most recent selection criteria
entered.) [IF NO CASE SELECTED, “PLEASE SELECT A CASE OR
SEGMENT FROM THE LIST THEN TOUCH “REFRESH”]
OK [CALL DISTRIBUTION]
ROC [IF CASE SELECTED, RECORD OF CALLS]
VIEW LETTERS [SELECT CASE, VIEW LETTERS]
[IF LETTER SENT, LETTERS. IF NO LETTER SENT, “NO LETTERS
FOUND” OK, SELECT CASE]
LETTERS [IF REFUSAL LETTER HAS BEEN SENT
AND IF RECORD OF CALLS = CALL RECORD SELECTED,
FUNCTIONS, VIEW LETTERS]
(Date letter requested – letter code – result code – FS that submitted
request)
ADMINISTRATIVE TOOLS MENU [SELECT CASE, FUNCTIONS, ADMINISTRATIVE
TOOLS]

Items on Administrative Tools Menu are administrative.
3-5

Set Name and Id
Reconcile Missed DUs
Reload Training Cases
Erase Training Cases

SET NAME AND ID [SELECT CASE, FUNCTIONS, ADMINISTRATIVE TOOLS, SET
NAME AND ID]

NSDUH SYSTEM IDENTIFICATION [SELECT CASE, ADMINISTRATIVE
TOOLS, SET NAME AND ID]
Government ID: (Government ID issued to iPAQ)
FIID: (RTI FI ID Number)
First Name: (FI First Name to be used on Study Introduction screen)
Last Name: (FI Last Name to be used on Study Introduction screen)
Save [SELECT CASE]
Cancel [SELECT CASE]

RECONCILE MISSED DUS [SELECT CASE, FUNCTIONS, ADMINISTRATIVE
TOOLS, RECONCILE MISSED DUS]
[IF NO MISSED DUs TO BE RECONCILED, NO MISSED DUs: “THERE ARE NO
MISSED DUs TO RECONCILE.” OK, SELECT CASE.]
[IF MISSED DUs TO BE RECONCILED, SEGMENTS AND MISSED DUs]

SEGMENTS AND MISSED DUs [SELECT CASE, FUNCTIONS,
ADMINISTRATIVE TOOLS, RECONCILE MISSED DUs]
SEGMENT (SEGID)
STREET ADDRESS (MISSED DU STREET ADDRESS)
TO RECONCILE A SEGMENT: TOUCH AND HOLD ON THE LINE, THEN
TOUCH ‘RECONCILE’ FROM THE POP-UP MENU.
Reconcile [RECONCILATION CONFIRMATION: “YOU WILL
BE REQUIRED TO RECONCILE ALL DUs WITHIN THE
SELECTED SEGMENTS. ARE YOU READY TO PROCEED?” IF
No, SEGMENTS AND MISSED DUs. IF Yes, MDU-SEGMENT
KIT CHECK.]
Exit [SELECT CASE]

MDU-SEGMENT KIT CHECK [SEGMENTS AND MISSED DUs =
RECONCILE AND RECONCILATION CONFIRMATION = YES]
Link: (line number and address of link line case)
INTERVIEWER: CONSULT YOUR SEGMENT KIT AND ANSWER THE
FOLLOWING QUESTION(S):

3-6

IS THE UNIT THAT YOU ARE ATTEMPTING TO ADD
(Missed DU Street Address)
ALREADY ON THE HANDWRITTEN LIST OF DWELLING UNITS?
(MAKE SURE YOU ARE LOOKING AT THE FULL LIST OF DWELLING
UNITS, NOT THE SELECTED DU LIST.)
Yes (UNIT NOT ADDED) [IF ANOTHER MISSED DU, NEXT
MISSED DU: “PLEASE ANSWER THE FOLLOWING QUESTIONS
TO RECONCILE THE NEXT MISSED DU.” OK, MDU-SEGMENT
KIT CHECK FOR NEXT MISSED DU.]
[IF NO OTHER MISSED DU, SELECT CASE]
No [MDU SDU CHECK]
Exit [SELECT CASE]

MDU SDU CHECK [MDU-SEGMENT KIT CHECK = NO]
Link: (line number and address of link line case)
IS THE MISSED UNIT LOCATED WITHIN THE SDU OR ON THE SDU
PROPERTY, AS WELL AS LOCATED WITHIN THE SEGMENT
BOUNDARIES?
REFER TO YOUR FI MANUAL AND YOUR SEGMENT MAPS OR CALL
YOUR FS IF YOU ARE UNSURE WHETHER THIS UNIT SHOULD BE
ADDED. IF YOU CANNOT DO THAT RIGHT NOW, TOUCH THE Exit
BUTTON TO EXIT THIS SCREEN. YOU CAN RECONCILE THIS DU
LATER.
Yes (UNIT ADDED) [MDU-ADDRESS VERIFICATION]
No (UNIT NOT ADDED) [IF ANOTHER MISSED DU, NEXT
MISSED DU: “PLEASE ANSWER THE FOLLOWING QUESTIONS
TO RECONCILE THE NEXT MISSED DU.” OK, MDU-SEGMENT
KIT CHECK FOR NEXT MISSED DU.]
[IF NO OTHER MISSED DU, SELECT CASE]
Exit [SELECT CASE]

MDU-ADDRESS VERIFICATION
Link: (line number and address of link line case)
THIS UNIT WILL BE ADDED TO THE SAMPLE. PLEASE VERIFY THE
INFORMATION BELOW. TOUCH ANY LINE TO EDIT IT.
STREET #: (street number)
STREET: (street name)
APT.#: (APARTMENT NUMBER)
CITY: (city)
STATE: (state)

3-7

ZIP: (zip code)
CASE #: (CaseID assigned to Added DU)
Update [IF ADDITIONAL MISSED DUs TO RECONCILE,
RECONCILE NEXT: “THE ADDED DU HAS BEEN
SUCCESFULLY RECONCILED. PLEASE ANSWER THE
FOLLOWING
QUESTIONS TO RECONCILE THE NEXT MISSED DU.” OK,
MDU-SEGMENT KIT CHECK FOR NEXT MISSED DU]
[IF NO ADDITIONAL MISSED DUs TO RECONCILE, SELECT
CASE]
Exit [SELECT CASE, WITH RECONCILIATION PENDING]

RELOAD TRAINING CASES [SELECT CASE, FUNCTIONS, ADMINISTRATIVE
TOOLS,RELOAD TRAINING CASES]
RE-LOAD TRAINING CASES: “ARE YOU SURE YOU WANT TO REMOVE
AND RELOAD ALL TRAINING CASES?” IF No, SELECT CASE. IF Yes,
SELECT CASE WITH TRAINING CASES REMOVED AND RELOADED.

ERASE TRAINING CASES [SELECT CASE, FUNCTIONS, ADMINISTRATIVE
TOOLS, ERASE TRAINING CASES]
ERASE TRAINING CASES: “ARE YOU SURE YOU WANT TO ERASE ALL
TRAINING CASES?” IF No, SELECT CASE. IF Yes, SELECT CASE WITH
TRAINING CASES REMOVED.

VIEW/SORT MENU [SELECT CASE, FUNCTIONS, VIEW/SORT]
View/Sort is a case management feature that allows an FI to view and sort cases in his/her assignment by
subgroups and varying orders on the Select Case screen. The View and Sort options can be used in a
variety of combinations.

VIEW/SORT PREFERENCES
The current VIEW, SEGMENT and SORT selections are shown in quotes below.
To change, touch VIEW, SEGMENT or SORT, then select an option from the list.
When finished, touch Done.
View – “CURRENT VIEW” [VIEW]
Segment – “CURRENT SEGMENT” [SEGMENT]
Sort – “CURRENT SORT” [SORT]
Done [SELECT CASE]

VIEW
All Cases (All Cases)
Pending Cases (All Screening and Interview cases with Result Codes 00-09, 50-59)
Pending Screenings (All Screening cases with Result Codes 00-09)
Pending Interviews (All Interview cases with Result Codes 50-59)

3-8

Pending Youth Interviews (All Interview cases with Result Codes 50-59 and 12-17 year old
respondent)
Pending Cases with Refusal (All Screening and Interview cases with Result Codes 00-09, 50-59
and at least one Result Code 07 or 57)
Cases not visited, 2 weeks (All Screening and Interview cases with no new ROC in the previous
two weeks)
Unactivated Cases (All Screening and Interview cases without at least one ROC)
Group Quarters Units (All GQU cases)
Final Screenings (Screening cases with Result Codes 10-32)
Final Interviews (Interview cases with Result Codes 70-79)
Added DUs (All added DUs)
On Hold Cases (All cases on hold)
Cancel [VIEW/SORT PREFERENCES]

SEGMENT
All Segments (All cases)

DISPLAY LIST OF SEGMENTS (Cases by segment)
Cancel [VIEW/SORT PREFERENCES]

SORT
By Case ID (Alphanumerical order by CaseID)
By Street (Alphanumerical order by street name within segment and number)
By Screening Code (Numerical order by Screening Result Code)
By ROC Date, Ascending (Ascending date order using most recent Record of Calls entry)
By ROC Date, Descending (Descending date order using most recent Record of Calls entry)
Cancel [VIEW/SORT PREFERENCES]

CALL DISTRIBUTION [SELECT CASE, FUNCTIONS, CALL DISTRIBUTION] (See Call
Distribution explanation under Actions Menu above)

ADD APPOINTMENT [SELECT CASE, FUNCTIONS, ADD APPOINTMENT] (See Add
Appointment explanation under Actions Menu above)
CALENDAR [SELECT CASE, FUNCTIONS, CALENDAR] (See Calendar explanation within the Add
Appointment portion under Actions Menu above)
TRANSMIT [SELECT CASE, FUNCTIONS, TRANSMIT]
TRANSMISSION LOG
Done [SELECT CASE]
Transmit [BEGINS DATA TRANSMISSION].

3-9

NSDUH Screening Application Specifications
Section 4
Record of Calls
Document Format:
• Screen/menu names are in bold, upper-case letters.
• FI instructions are provided in black, upper-case text that is not in brackets. In the screening
program, FI instructions appear in red, upper-case letters.
• Text of any pop-up screens are provided in bracketed logic using upper-case text in quotations.
• Programming logic is designated by black, upper-case text in brackets.
• Fills are designated by parenthesis and italics.
• Response categories are underlined.
• Explanatory text in italics

RECORD OF CALLS [SELECT CASE, GO TO RECORD OF CALLS
OR ON ANY SUBSEQUENT SCREEN EXIT OR VERIFICATION, DONE OR
RESPONDENT SELECTION, DONE]
Type (Data Type: S, A, B)
Result (Result Code)
Date/time (Date, time, and day of the week ROC entered)
Done [IF ADDED DU, Reconcile Missed DUs: “There are missed DUs, would you like to
reconcile now?” IF Yes, Segments and Missed DUs. IF No, SELECT CASE. IF NO ADDED
DUs, SELECT CASE]
Add [IF CODE = PENDING SCREENING CODE, SCREENING CALL RECORD. FOR
PENDING INTERVIEW CODES, IF CODE 31 OR IF CODE 32 AND ONE
INTERVIEW CASE FINAL, INTERVIEW [fill with A or B] CALL RECORD, IF
CODE = 32 AND BOTH INTERVIEW CASES NOT FINAL, CHOOSE ROC TYPE]
CD [IF CALL RECORD ENTERED, CALL DISTRIBUTION FOR DETAILS SEE
SECTION 5]
Roster [IF CODE = 22, 25, 26, 30, 31, OR 32, VERIFY ROSTER DATA FOR DETAILS
SEE SECTION 1]
Selections [If CODE = 31 or 32, RESPONDENT SELECTION]

ACTIONS MENU [RECORD OF CALLS, TOUCH AND HOLD ROC EVENT UNTIL
ACTIONS MENU APPEARS]
Edit [IF UNTRANSMITTED ROC EVENT SELECTED, SCREENING CALL
RECORD or INTERVIEW CALL RECORD]
Delete [IF UNTRANSMITTED, NON-SYSTEM-GENERATED ROC EVENT (NE 26,
30, 31, 32), DELETES EVENT, RECORD OF CALLS]
View Refusal [IF CODE 07, 17, 57, 58, 77, 78, REFUSAL REPORT -FOR DETAILS
SEE SECTION 7]
View Comment [IF COMMENTS ENTERED, COMMENT]

4-1

View Other Specify [IF CODE 09, 23, 59, or 79, CODE [fill with 09, 23, 59, or 79]:
OTHER SPECIFY CATEGORIES]

FUNCTIONS MENU [RECORD OF CALLS, FUNCTIONS]
Add Appointment [NEW APPOINTMENT]
Calendar [CALENDAR]
View Verification Information [IF CODE 10, 13, 18, 22, 25, 26, OR 30, VERIFICATION]
Help [HELP INFORMATION]

CHOOSE ROC TYPE [IF CODE = 32, AND BOTH INTERVIEW CASES NOT FINAL, RECORD
OF CALLS, ADD]
WHICH TYPE OF CALL RECORD DO YOU WANT TO ENTER?
Screening [Option listed but not available as screening is final]
Interview A [INTERVIEW A CALL RECORD]
Interview B [INTERVIEW B CALL RECORD]
Cancel [RECORD OF CALLS]

SCREENING CALL RECORD [IF AT COMPLETION OF SCREENING PROCESS
RESPONDENT SELECTION = DONE OR IF VERIFICATION = DONE AND CODE = 22, 25,
26 OR 30 OR IF RECORD OF CALLS = ADD]
RESULT (01-23, 26, 29)
01 No one at DU
02 SR Unavailable
03 Neighbor Indicates Occupancy
04 Pending Incapable
05 Pending Lang. Barrier (Spanish)
06 Pending Lang. Barrier (Other)
07 Pending Refusal
08 Unable to Locate SDU
09 Pending Other – Specify
10 Vacant
11 No one at DU - Repeated
12 SR Unavailable - Repeated
13 Not Primary Residence
14 Final Incapable
15 Final Lang. Barrier (Spanish)
16 Final Lang. Barrier (Other)
17 Final Refusal
18 Not a Dwelling Unit
19 GQU Listed as HU [IF DU IS NOT A GQU]
20 HU Listed as GQU [IF DU IS NOT AN HU]
21 Denied Access
22 All Military [CODED AUTOMATICALLY IF SCREENING COMPLETED AND ALL
ROSTER MEMBERS=MILITARY]
23 Final Other – Specify
26 R in DU Less Than ½ Quarter [CODED AUTOMATICALLY IF SCREENING
COMPLETED AND OCCUPANCY=NO]

4-2

29 Listing Error
RESULT (25, 30-32) [CANNOT BE SELECTED; CODED AUTOMATICALLY]
25 No Eligible Members [CODED AUTOMATICALLY IF SCREENING COMPLETED AND
ALL ROSTER MEMBERS=INELIGIBLE]
30 No one selected [CODED AUTOMATICALLY IF SCREENING COMPLETED AND NO
ONE SELECTED]
31 One person selected [CODED AUTOMATICALLY IF SCREENING COMPLETED AND
ONE PERSON SELECTED]
32 Two persons selected [CODED AUTOMATICALLY IF SCREENING COMPLETED AND
TWO PERSONS SELECTED]
COMMENTS: (text entry)
DO NOT CHANGE ROC DATE/TIME UNLESS INSTRUCTED BY TECH SUPPORT
OR FS.
DAY/DATE: (Day of week and Date ROC event entered)
TIME: HOUR (1-12) MINUTE (00-59) AM/PM (AM, PM)
Commit [IF CODE = 32, INTERVIEW EVENT: “REMEMBER TO ENTER CALL
RECORDS FOR INTERVIEWS A AND B.” OK, RECORD OF CALLS.]
[IF CODE = 31, INTERVIEW EVENT: “REMEMBER TO ENTER INTERVIEW
CALL RECORD FOR INTERVIEW A.” OK, RECORD OF CALLS]
[IF CODE = 10, 13, 18, 26, OR 30, VERIFICATION]
[IF 07 OR 17, REFUSAL REPORT -FOR DETAILS SEE SECTION 7]
[IF 09 OR 23, OTHER, SPECIFY]
[IF 6 OR 16, OTHER LANGUAGE]
[IF 04, 14, 54 OR 74, INCAPABLE, SPECIFY]
Cancel [ARE YOU SURE?: “ARE YOU SURE YOU WANT TO CANCEL THIS CALL
RECORD?” IF Yes, SELECT CASE. IF No, SCREENING CALL RECORD]

INTERVIEW CALL RECORD [RECORD OF CALLS, ADD, IF CODE 32 AND BOTH
INTERVIEW CASES NOT FINAL, CHOOSE ROC TYPE, A OR B]
RESULT (50-59, 70-79)
50
51
52
53
54
55
56
57
58
59
70
71
72

Appointment for Interview
No one at DU
R Unavailable
Pending Break-off (Partial Interview)
Pending Incapable
Pending Lang. Barrier (Spanish)
Pending Lang. Barrier (Other)
Pending Refusal
Pending Parental Refusal for age 12-17
Pending Other – Specify
Interview complete
No one at DU - Repeated
R Unavailable - Repeated

4-3

73
74
75
76
77
78
79

Final Break-off (Partial Interview)
Final Incapable
Final Lang. Barrier (Spanish)
Final Lang. Barrier (Other)
Final Refusal
Final Parental Refusal for age 12-17
Final Other - Specify

COMMENTS: (text entry)
DO NOT CHANGE ROC DATE/TIME UNLESS INSTRUCTED BY TECHNICAL SUPPORT
OR FS.
DAY/DATE: (Day of week and Date ROC event entered)
TIME: HOUR (1-12) MINUTE (00-59) AM/PM (AM, PM)
Relation (HU) or Name (GQU), Gender, Age, Race of selected respondent displays
Commit [SAVES DATA, RECORD OF CALLS]
[IF 57, 58, 77, 78, REFUSAL REPORT -FOR DETAILS SEE SECTION 7]
[IF 59 OR 79, OTHER, SPECIFY]
Cancel [ARE YOU SURE?: “ARE YOU SURE YOU WANT TO CANCEL THIS CALL
RECORD?” Yes, SELECT CASE, No, INT. CALL RECORD-A OR B]

CODE 09: OTHER SPECIFY CATEGORIES [SCREENING CALL RECORD =
RESULT CODE 09]
OTHER SPECIFY CATEGORIES
Screening breakoff
Selected wrong line number
Added in error
Safety issue
Controlled access
Possible vacant
Possible vacation/not primary residence
GQU is institution (ONLY ACTIVE FOR GQU CASES)
Other listing problem
Need to discuss with FS
Something else, Specify
Done [RECORD OF CALLS]

CODE 23: OTHER SPECIFY CATEGORIES [SCREENING CALL RECORD = FINAL
RESULT CODE 23]
OTHER SPECIFY CATEGORIES
Added in error
Safety issue
GQU is institution (ONLY ACTIVE FOR GQU CASES)
Something else, Specify
Done [RECORD OF CALLS]

4-4

CODE 59: OTHER SPECIFY CATEGORIES [INTERVIEW A CALL RECORD OR
INTERVIEW B CALL RECORD = RESULT CODE 59]
OTHER SPECIFY CATEGORIES
R moved
R under age 12
R in military
R rostered in error
R deceased
Interviewed wrong person
Screened wrong line
Safety issue
Controlled access
Need to discuss with FS
Something else, Specify
Done [RECORD OF CALLS]

CODE 79: OTHER SPECIFY CATEGORIES [INTERVIEW A CALL RECORD OR
INTERVIEW B CALL RECORD = RESULT CODE 79]
OTHER SPECIFY CATEGORIES
R moved
R under age 12
R in military
R rostered in error
R deceased
Interviewed wrong person
Screened wrong line
Safety issue
Controlled access
Something else, Specify
Done [RECORD OF CALLS]

OTHER LANGUAGE [SCREENING CALL RECORD = 06 OR 16, INTERVIEW A CALL
RECORD OR INTERVIEW B CALL RECORD = 56 OR 76]
LANGUAGE CATEGORIES
Arabic
Chinese
French
German
Italian
Korean
Polish
Portuguese
Russian
Tagalog
Vietnamese

4-5

Other, Specify
Specify other language or comments: (text entry)
Done [RECORD OF CALLS]
INCAPABLE, SPECIFY [SCREENING CALL RECORD = 04 OR 14, INTERVIEW A CALL
RECORD OR INTERVIEW B CALL RECORD = 54 OR 74]
CODE [fill with 04 or 14 or 54 or 74]: INCAPABLE CATEGORIES
Physically Incapable
Mentally Incapable
Done [RECORD OF CALLS]

4-6

NSDUH Screening Application Specifications
Section 5
Screening and Interview Refusal
Document Format:
• Screen/menu names are in bold, upper-case letters.
• FI instructions are provided in black, upper-case text that is not in brackets. In the screening
program, FI instructions appear in red, upper-case letters.
• Text of any pop-up screens are provided in bracketed logic using upper-case text in quotations.
• Programming logic is designated by black, upper-case text in brackets.
• Fills are designated by parenthesis and italics.
• Response categories are underlined.
• Explanatory text in italics

REFUSAL REPORT [IF SCREENING CALL RECORD = 07 P REFUSAL OR
IF SCREENING CALL RECORD = 17 F REFUSAL AND ALREADY HAS A PENDING
REFUSAL ENTERED OR IF INTERVIEW CALL RECORD = 57 P REFUSAL OR IF
INTERVIEW CALL RECORD = 58 P PARENTAL REFUSAL OR IF INTERVIEW CALL
RECORD = 77 F REFUSAL AND ALREADY HAS A PENDING REFUSAL ENTERED OR
IF INTERVIEW CALL RECORD = 78 F PARENTAL REFUSAL AND ALREADY HAS A
PENDING REFUSAL ENTERED]
[IF SCREENING CALL RECORD = 17 F REFUSAL AND DOES NOT ALREADY HAVE A
PENDING REFUSAL ENTERED: RESULT CODE ERROR: “TRY AT LEAST ONE
MORE TIME BEFORE ASSIGNING THIS FINAL CODE.” OK. SCREENING CALL
RECORD]
[IF INTERVIEW CALL RECORD = 77 F REFUSAL AND DOES NOT ALREADY HAVE A
PENDING REFUSAL ENTERED, OR IF INTERVIEW CALL RECORD = 78 F PARENTAL
REFUSAL AND DOES NOT ALREADY HAVE A PENDING REFUSAL ENTERED:
RESULT CODE ERROR: “TRY AT LEAST ONE MORE TIME BEFORE ASSIGNING
THIS FINAL CODE.” OK. INTERVIEW CALL RECORD]
Reason for refusal
Too busy / no time / did too many already
Surveys / Government invasive / teen exposure
Clarify confidentiality, legitimacy, selection
“Nothing in it for me” / Uncooperative
Gatekeeper / Parent/HH member disallow
Welfare / INS / ICE / USCIS concern
Too ill / house messy / not dressed
Need to discuss with FS
Comment: (text entry)
Done [SAVES REASON FOR REFUSALAND COMMENTS ENTERED, RECORD OF
CALLS]

5-1

Screening and Interview Refusal Functions on ROC
1. View refusal report or edit refusal report prior to transmission:
REFUSAL REPORT [IF RECORD OF CALLS = TOUCH AND HOLD CALL RECORD, ACTION
MENU, VIEW REFUSAL]
Reason for refusal
Too busy / no time / did too many already
Surveys / Government invasive / teen exposure
Clarify confidentiality, legitimacy, selection
“Nothing in it for me” / Uncooperative
Gatekeeper / Parent/HH member disallow
Welfare / INS / ICE / USCIS concern
Too ill / house messy / not dressed
Need to discuss with FS
Comment: (text entry)
Done [IF EDITED (BEFORE TRANSMISSION) SAVES REASON FOR REFUSAL AND
COMMENTS ENTERED, THEN RECORD OF CALLS]

5-2

NSDUH Screening Application Specifications
Section 6
Verification
Document Format:
• Screen/menu names are in bold, upper-case letters.
• FI instructions are provided in black, upper-case text that is not in brackets. In the
screening program, FI instructions appear in red, upper-case letters.
• Text of any pop-up screens are provided in bracketed logic using upper-case text in
quotations.
• Programming logic is designated by black, upper-case text in brackets.
• Fills are designated by parenthesis and italics.
• Response categories are underlined.
• Explanatory text in italics

VERIFICATION [IF SCREENING RESULT CODE = 10, 13, 18, 22, 26 OR IF
RESPONDENT SELECTION = ‘NONE’ FOR BOTH A AND B INTERVIEW
OR IF OCCUPANCY = ‘NO’ OR IF ALL ROSTER MEMBERS = INELIGIBLE]
So that my supervisor may check the quality of my work, may I please have your
first name and telephone number?
FIRST NAME: (Screening Respondent’s first name)
Not Avail.
Ref.
PHONE: (Area code and phone number)
Home
Cell
Work
Not Avail.
Ref.
CONFIRM NUMBER WITH R.
NOTES TO VERIFICATION CALLER: (Text field for notes about best
times to call screening respondent or clarification about work number if
caller has to go through an operator.)

Done [CHECKS FOR COMPLETE DATA ENTRY, RECORD OF CALLS]
Clear [VERIFICATION WITH ENTRY CLEARED]
Span [Question text appears in Spanish “Para que mi supervisor pueda revisar la calidad
de mi trabajo, ¿me podría dar su primer nombre y su número de teléfono?” and button
changes to Eng]

6-1

This page intentionally left blank.

6-2

NSDUH Screening Application Specifications
Section 7
FI Debriefing Questions
Document Format:
•
•
•
•
•
•
•

Screen/menu names are in bold, upper-case letters.
FI instructions are provided in black, upper-case text that is not in brackets. In the screening
program, FI instructions appear in red, upper-case letters.
Text of any pop-up screens are provided in bracketed logic using upper-case text in quotations.
Programming logic is designated by black, upper-case text in brackets.
Fills are designated by parenthesis and italics.
Response categories are underlined.
Explanatory text in italics

INTERVIEW DEBRIEFING QUESTIONS:
THESE QUESTIONS ARE FOR YOU TO ANSWER. DO NOT READ TO THE R.
FIDBF1
Did you conduct this interview at the respondent’s home, either inside or outside?
YES
NO
Next [IF FIDBF1=YES, GO TO FIDBF3]
FIDBF2 [IF FIDBF1=NO]
Where did you conduct this interview?
1. AT THE RESPONDENT’S WORKPLACE
2. AT THE HOME OF THE RESPONDENT’S RELATIVE OR FRIEND
3. IN SOME TYPE OF CONFERENCE ROOM IN A RESIDENCE HALL, SCHOOL OR
APARTMENT COMPLEX
4. AT A LIBRARY
5. IN SOME TYPE OF COMMON AREA, SUCH AS A LOBBY, HALLWAY, STAIRWELL, OR
LAUNDRY ROOM
6. SOME OTHER PLACE
Next [IF FIDBF2=6, GO TO FIDBF2a]
FIDBF2a [IF FIDBF2=6]
Where did the interview take place?
ALLOW 140 CHARACTERS
Next [FIDBF3]
FIDBF3

7-1

Please estimate for how much of the ACASI interview the respondent had their headphones on.
1.
2.
3.
4.
5.

NONE/R TOOK HEADPHONES OFF IMMEDIATELY
LESS THAN HALF OF THE ACASI INTERVIEW
ABOUT HALF OF THE ACASI INTERVIEW
MORE THAN HALF OF THE ACASI INTERVIEW
ALL OF THE ACASI INTERVIEW

Next [FIDBF4]
FIDBF4
How cooperative was the respondent?
1.
2.
3.
4.

VERY COOPERATIVE
FAIRLY COOPERATIVE
NOT VERY COOPERATIVE
OPENLY HOSTILE

Next [FIDBF5]
FIDBF5
Please indicate how private the interview was. Do not count yourself or a project observer as another
person in the room.
1. COMPLETELY PRIVATE – NO ONE WAS IN THE ROOM OR COULD OVERHEAR ANY
PART OF THE INTERVIEW
2. MINOR DISTRACTIONS – PERSON(S) IN THE ROOM OR LISTENING LESS THAN 1/3 OF
THE TIME
3. PERSON(S) IN THE ROOM OR LISTENING ABOUT 1/3 OF THE TIME
4. SERIOUS INTERRUPTIONS OF PRIVACY MORE THAN HALF THE TIME
5. CONSTANT PRESENCE OF OTHER PERSON(S)
Next [IF FIDBF5=1, GO TO FIDBF8; IF FIDBF5 NE1, GO TO FIDBF6]
FIDBF6 [IF FIDBF5 NE1]
Not including yourself or project observers, who were the other people present or listening to the
interview?
Check all that apply
1.
2.
3.
4.
5.
6.
7.

PARENT(S)
SPOUSE
LIVE-IN PARTNER/BOYFRIEND/GIRLFRIEND
OTHER ADULT RELATIVE(S)
OTHER ADULT(S)
CHILD(REN) UNDER 18
OTHER

Next [IF FIDBF6=1, 2, 3, 4, 5, OR 6, GO TO FIDBF8]

7-2

FIDBF7 [IF FIDBF6=7]
Please enter a description of the other person(s) present or listening to the interview. This description may
be relationship to the respondent if you have this information, or simply the gender and estimated age.
ALLOW 140 CHARACTERS
Next [FIDBF8]
FIDBF8 [IF FIDBF5=1; OR IF FIDBF6=1, 2, 3, 4, 5, OR 6; OR IF FIDBF7 NE BLANK]
Did the respondent make any comments about the interview being too long?
YES
NO
Next [FIDBF9]
FIDBF9
Did the respondent have trouble understanding any questions asked during the interview?
YES
NO
Next [IF FIDBF9=NO, GO TO FIDBF10]
FIDBF9a [IF FIDBF9=YES]
Enter the screen name and a brief description of what the respondent found confusing. If you do not
know the screen name, please provide as much information as possible.
ALLOW 140 CHARACTERS
Next [FIDBF10]
FIDBF10
How often did this respondent let you know what his or her answers were as he or she completed the
ACASI portion of the interview?
1.
2.
3.
4.
5.

NONE OF THE TIME – I DO NOT KNOW WHAT ANY OF THE ANSWERS ARE
A LITTLE OF THE TIME – I KNOW WHAT A FEW OF THE ANSWERS ARE
SOME OF THE TIME – I KNOW WHAT SOME OF THE ANSWERS ARE
A LOT OF THE TIME – I KNOW WHAT A LOT OF THE ANSWERS ARE
ALL OF THE TIME – I KNOW WHAT ALL OF THE ANSWERS ARE

Next [FIDBF11]
FIDBF11

7-3

Please note anything else you think would be helpful for the interpretation and understanding of this
interview.
ALLOW 250 CHARACTERS
Next [RECORD OF CALLS]

7-4

NSDUH Screening Application Specifications
Section 8
Parental Introductory Script in English and Spanish
Document Format:
•
•
•

Screen/menu names are in bold, upper-case letters.
FI instructions are provided in black, upper-case text that is not in brackets. In the screening
program, FI instructions appear in red, upper-case letters.
Fills are designated by parenthesis and italics.

INTRODUCE YOURSELF/STUDY AS NECESSARY:
Hello, I’m ________with RTI International. We are conducting a nationwide study sponsored by
the U.S. Department of Health and Human Services. You should have received a letter about this
study. (SHOW LEAD LETTER, IF NECESSARY.)
(Buenos/as días/tardes/noches), mi nombre es _____ y trabajo para RTI International. Estamos
realizando un estudio a nivel nacional patrocinado por el Departamento de Salud y Servicios
Humanos de los Estados Unidos. Usted debe haber recibido una carta acerca de este estudio.
(SHOW LEAD LETTER, IF NECESSARY.)
ONE YOUTH IS SELECTED:
Your (AGE) year-old child has been selected for an interview. I would like to talk with
him/her to see if he/she is interested in participating in this study which asks about tobacco,
alcohol, and drug use and non-use and other health related issues.
If your child is interested, I will give both of you more information and ask for permission to
complete the interview. (Is [he/she] available?)
Su hijo(a) de (AGE) años ha sido seleccionado(a) para una entrevista. Me gustaría hablar con
él/ella para ver si está interesado(a) en participar en este estudio que hace preguntas sobre el
uso y no uso de tabaco, alcohol y drogas, así como otros temas sobre la salud.
Si su hijo(a) está interesado(a), les daré a ustedes dos más información y les pediré permiso para
completar la entrevista. (¿Está [él/ella] disponible?)
TWO YOUTHS ARE SELECTED:
Your (AGE) year-old and (AGE) year-old children have been selected for an interview. I would
like to talk with them to see if they are interested in participating in this study which asks
about tobacco, alcohol, and drug use and non-use and other health related issues.
If they are interested, I will give all of you more information and ask for permission to complete
the interview. (Are they available?)
8-1

Su hijo(a) de (AGE) años y su hijo(a) de (AGE) años han sido seleccionados(as) para una
entrevista. Me gustaría hablar con ellos(as) para ver si están interesados(as) en participar en
este estudio que hace preguntas sobre el uso y no uso de tabaco, alcohol y drogas, así como
otros temas sobre la salud.
Si ellos(as) están interesados(as), les daré a todos ustedes más información y les pediré permiso
para completar la entrevista. (¿Están [ellos/ellas] disponibles.)

8-2