Form 0920-0214 Re-Designed Re-Interview Survey

Attachment 5: REINTERVIEW QUESTIONNAIRE

Assurance of confidentiality – We take your privacy very seriously. All information that relates to or describes identifiable characteristics of individuals, a practice, or an establishment will be used only for statistical purposes. NCHS staff, contractors, and agents will not disclose or release responses in identifiable form without the consent of the individual or establishment in accordance with section 308(d) of the Public Health Service Act (42 U.S.C. 242m(d)) and the Confidential Information Protection and Statistical Efficiency Act of 2002 (CIPSEA, Title 5 of Public Law 107-347). In accordance with CIPSEA, every NCHS employee, contractor, and agent has taken an oath and is subject to a jail term of up to five years, a fine of up to $250,000, or both if he or she willfully discloses ANY identifiable information about you.

Notice – 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, MS D-74, Atlanta, GA 30333. ATTN: PRA

(0920-0214).

Form Approved OMB No. 0920-0214

Exp. Date: 12/31/2020

2020 Reinterview

Procedure for finding respondent for Redesigned Reinterview:

If there’s a Sample Adult interview then we will attempt to contact the Sample Adult for Reinterview. If there’s no Sample Adult interview, but there is a Sample Child interview then we will attempt to contact the Sample Child Proxy for Reinterivew. If there is no Sample Child interview, then we will attempt to contact the Household Respondent.

In the rare case that the Sample Adult interview was completed by a proxy, we will not attempt to contact the Sample Adult or Sample Adult proxy for the reinterview. We will move to trying to contact the Sample Child Proxy (therefore sample adult questions will be skipped), and if there is no Sample Child proxy, then we will attempt to contact the Household Respondent.

The content verification questions are specific to the respondent who answered the original question (either Sample Adult or Sample Child proxy). These questions are only asked when there was a response from the related question in the original interview. Respondents will not be reinterviewed on topics they weren’t asked about originally. All responses are dichotomous “Yes” or “No”

START OF REINTERVIEW QUESTIONNAIRE

Read to respondent - Now I am going to ask you a few questions to verify that the survey was administered correctly. Each person can be asked different questions, so please answer questions according to your memory.

Note: only read if there is a Sample Adult or Sample Child proxy to administer the following questions to:

Adult Annual Content

Q1. Did the interviewer ask you questions about whether you or someone you live with has a cell phone? (SACELL)

Universe: Sample adults 18+ (IF TELCEL_A has a valid response: 1,2, dk,rf)

Q2. Did the interviewer ask whether you had difficulty with self-care such as washing all over or dressing? (SASLFCARE)

Universe: Sample adults 18+ (If UPPSLFCR_A has a valid response 1,2,dk,rf)

Q3. Did the interviewer ask whether you were covered by health insurance or some other kind of health care plan? (SAHINS)

Universe: Sample adults 18+ (If HICOV_A has a valid response, 1,2, dk,rf)

Q4. Did the interviewer ask you about the amount of your total family income? (SAINC, note: previously called FAM3)

Universe: Sample adults 18+ or Sample children < 18 (If INCWRKO_A has a valid response 1,2,dk,rf OR INCWRKO_C has a valid response 1,2,dk,rf)

Note: If the total family income question was asked as part of the Sample Adult interview, then ask this question of the Sample Adult in reinterview. Else, if the total family income question was asked as part of the Sample Child interview, then ask this question of the Sample Child respondent in reinterview.

Q5. Did the interviewer ask whether your house has a functioning smoke detector? (SMKDET) Universe:

Sample adults 18+ or proxy for Sample Child (NOTE: This is a control item; we do not ask about smoke

detectors)

Q6. Did the interviewer ask you whether there is a place that you usually go to when you are sick or need advice about your health? (SAAUSUAL)

Universe: Sample adults 18+ (If USUALPL_A has a valid response 1,2,3,dk,rf)

Q7. Did the interviewer ask whether you consider yourself to be gay, straight, bisexual, or something else? (SAORIENT)

Universe: Sample adults 18+ (If ORIENT_A has a valid response 1,2,3,4,5,rf)

Q8. Did the interviewer ask for the last four digits of your social security number? (SASOC) Universe: Sample adults 18+ (If SSN4_A has a valid response string, N (doesn’t have SSN), dk,rf)

2020 Rotating Adult Core Content:

Q9. Did the interviewer ask if you had any accident or injury where any part of your body was hurt in the past 3 months? (RCINJURY)

Universe: Sample adults 18+ (If [ANYINJURY_A] has a valid response 1,2,dk,rf)

Q10. Did the interviewer ask you how long it had been since you last had a dental examination or cleaning? (RCDENTAL)

Universe: Sample adults 18+ (If DENPREV_A has a valid response 0-6,dk.rf)

2020 Supplemental Content:

Q11. Did the interviewer ask you how many times you had a sunburn in the past 12 months? (SUPSUN)

Universe: Sample adults 18+ (If SUNBURNS_A had a valid response (0-365,dk,rf)

Read to respondent –Thank you. These next two questions are to make sure that the interviewer recorded the correct responses in the original interview:

Note: Should this only be read if PREDIB_A or SMKEV_A were not empty.

Adult Annual Content

Q12. Has a doctor or other health professional EVER told you that you had prediabetes or borderline diabetes? (SAPREDIB)

Universe: Sample adults 18+

Note: We are now going to open this question up to all sample adults with a valid response to assess response variance. Therefore ask if there is a valid response to PREDIB_A (1,2,dk,rf).

Q13. Have you smoked at least 100 cigarettes in your ENTIRE LIFE? (SASMKEV)

Universe: Sample adults 18+

Note: We are now going to open this question up to all sample adults with a valid response to assess response variance. Therefore ask if there is a valid response to SMKEV_A (1,2,dk,rf).

Read to respondent –[Fill: Now] I am going to ask about two questions you were asked to answer on behalf of the following child in your family: ^SCNAME.

Note: This should only be read if the Sample Adult is also the Sample Child respondent.

Child Annual Content

Note: This should only be read if the reinterview respondent was Sample Child Respondent (RIRESP = LNO_SCRESP or Sample Adult received question first SARESPSC_FLG=1).

Q14. Did the interviewer ask you if ^SCNAME was ever diagnosed with asthma? (SCASTHMA)

Universe: (If ASEV_C has a valid response 1,2,dk,rf)

2020 Rotating Child Core Content:

Note: This should only be read if the reinterview respondent was Sample Child Respondent (RIRESP = LNO_SCRESP).

Q15. Did the interviewer ask you if ^SCNAME had any accident or injury where any part of [hisher_C] body was hurt in the past 3 months? (RCSCINJURY)

Universe: (If ANYINJURY_C has a valid response 1,2,dk,rf)