Attachment B_NSDUH 2023 In-Person Screening Questions_Clean_9-15-22

Attachment B_NSDUH 2023 In-Person Screening Questions_Clean_9-15-22.docx

2022 National Survey on Drug Use and Health (NSDUH)

Attachment B_NSDUH 2023 In-Person Screening Questions_Clean_9-15-22

OMB: 0930-0110

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2023 National Survey on Drug Use and Health (NSDUH): Final In-Person Screening Specifications for Programming

Substance Abuse and Mental Health Services Administration
Center for Behavioral Health Statistics and Quality
Rockville, Maryland

Last Revised: September 15, 2022

2023 National Survey on Drug Use and Health (NSDUH): Final In-Person Screening Specifications for Programming

Acknowledgments

This report was prepared for the Substance Abuse and Mental Health Services Administration (SAMHSA), U.S. Department of Health and Human Services (HHS), under Contract No. HHSS283201700002C with RTI International. Marlon Daniel served as the government project officer and as the contracting officer representative.

Public Domain Notice

All material appearing in this report is in the public domain and may be reproduced or copied without permission from SAMHSA. Citation of the source is appreciated. However, this publication may not be reproduced or distributed for a fee without the specific, written authorization of the Office of Communications, SAMHSA, HHS.

Electronic Access

This publication may be downloaded at https://www.samhsa.gov/data/.

Recommended Citation

Recommended Citation: Center for Behavioral Health Statistics and Quality. (2022). 2023 National Survey on Drug Use and Health (NSDUH): Final in-person screening specifications for programming. Substance Abuse and Mental Health Services Administration.

Originating Office

Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration, 5600 Fishers Lane, Room 15-E09D, Rockville, MD 20857. For questions about this report, please email CBHSQrequest@samhsa.hhs.gov.

Nondiscrimination Notice/Aviso de no discriminación

SAMHSA complies with applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. SAMHSA cumple con las leyes federales de derechos civiles aplicables y no discrimina por motivos de raza, color, nacionalidad, edad, discapacidad o sexo.

U.S. Department of Health and Human Services
Substance Abuse and Mental Health Services Administration
Center for Behavioral Health Statistics and Quality
Populations Survey Branch

Last Revised: September 15, 2022

2023 National Survey on Drug Use and Health

Screening Application Updates

The SR SEX and SEX questions for subsequent roster members were updated to clearly measure sex assigned at birth.
The SR GENDER and GENDER questions for subsequent roster members were added to measure gender identity.
SR DIFTERM and DIFTERM have been added to capture a write in response for anyone reporting using a different term to describe their gender.
Pronoun fills have been updated throughout to reflect these new gender identity questions.

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Section Page

Screening Application Updates iii

2023 NSDUH Screening Application Specifications vii

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 Refusal 5-1

6. Screening Verification 6-1

7. Interview Verification 7-1

8. FI Debriefing Questions 8-1

9. Parental Introductory Script in English and Spanish 9-1

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2023 NSDUH Screening Application Specifications

For all specification sections, the following format conventions apply:

Screen names are in bold uppercase letters.
English text to be read by FIs is shown in black font. Spanish screen text to be read by FIs follows the English text. 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 uppercase text that is not in brackets. In the screening program, FI instructions appear in red uppercase letters.
Text of any pop-up screens are provided in bracketed logic using uppercase text in quotations.
Programming logic is designated by black uppercase text in brackets.
Fills are designated by parentheses and italics.
Response categories are underlined.

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Section 1

HU Screening

The line number and address are located at the top of each screen. During the roster questions asking about age through race, touch the address line to see the 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?

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 esta 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 laws that ensure 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, each person who completes the interview will receive $30 in cash.

Por favor lea esta declaración, la cual describe la encuesta y las leyes que aseguran 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 para participar en la entrevista en su totalidad, cada persona que complete la entrevista recibirá $30 dólares en efectivo.

Next [IF APT/CONDO=NO, MISSED DUs; IF APT/CONDO=YES, SR OCCUPANCY]

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] No [SR OCCUPANCY]

[IF ADDED DU: CANNOT ADD UNIT

“YOU CANNOT ADD A MISSED DU

FROM A DU THAT HAS BEEN ADDED”

MISSED DUs]

MISSED DU ADDRESS [IF MISSED DUs = YES]

RECORD STREET ADDRESS OR DESCRIPTION OF UNIT

STREET #:

STREET:

APT.#: (APARTMENT NUMBER)

Update [Add Another DU: “DURING Cancel [CANCEL DU: “ARE YOU SURE
THIS SESSION, YOU HAVE ADDED YOU WANT TO CANCEL ADDITION
1 UNIT. YOU STILL HAVE 4 UNUSED OF THIS DU? IF Yes, SR OCCUPANCY.
ADDED LINES LEFT IN THIS SEGMENT. IF No, MISSED DU ADDRESS.]
DO YOU WANT TO ADD ANOTHER
MISSED DU?” IF Yes, MISSED DU
ADDRESS. IF No, SR OCCUPANCY.]

SR OCCUPANCY [IF MISSED DUs = NO OR APT/CONDO=YES OR MISSED DU ADDRESS = UPDATE OR CANCEL MISSED DU = YES]

(Did/Will) you live here for most of the time during the months of (CURRENT QUARTER)?

(¿Vivió/¿Vivirá) usted aquí la mayor parte del tiempo durante los meses de (CURRENT QUARTER)?

Yes [TOTAL SDU MEMBERS]

No [OCCUPANCY]

OCCUPANCY [IF SR OCCUPANCY = NO]

(Did/Will) anyone else in your household live here for most of the time during the months of (CURRENT QUARTER)?

(¿Vivió /¿Vivirá) 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]

TOTAL SDU MEMBERS [IF SR OCCUPANCY = YES OR OCCUPANCY= YES]

[IF SR 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 usted, ¿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).)

[IF OCCUPANCY = YES] 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).)

¿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 AND SR OCCUPANCY = NO AGE. IF Yes AND SR OCCUPANCY = YES, SR AGE.]

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

[IF SR OCCUPANCY = YES, SR AGE, ELSE IF SR OCCUPANCY = NO, AGE ]

[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 AND SR OCCUPANCY = NO, AGE. IF Yes, AND SR OCCUPANCY = YES SR AGE

SR AGE [IF SR OCCUPANCY = YES]

How old are you?

¿Cuántos años tiene usted?

ENTER AGE [SR SEX]

[IF SR AGE ≥ 99, ROSTER: PLEASE VERIFY: Let me confirm, are you (AGE) years old? Permítame confirmar, ¿tiene usted (AGE) años de edad? IF Yes, SR SEX. IF No, SR AGE.]

[IF SR AGE = 17 OR UNDER: OLDER ELIGIBLE SR: “YOU HAVE IDENTIFIED AN SR UNDER AGE 18. DOES AN ELIGIBLE SR 18 OR OLDER LIVE AT DU?”

IF Yes, CONTACT OLDER MEMBER: “CONDUCT SCREENING WITH SR AGED 18 OR OLDER.” OK ; CLEAR THE AGE ENTRY TO ALLOW FOR NEW SR.

If No, MINOR SR: “THIS SR IS 17 OR YOUNGER. STOP THE SCREENING AND CODE AS AN 02.” OK [SCREENING CALL RECORD] ENTERING RESULT CODE 02 SR UNAVAILABLE, AND COMMENT “SR age ineligible”.]

SR SEX [IF SR AGE NE BLANK]

What sex were you assigned at birth, on your original birth certificate?

¿Qué sexo le fue asignado al nacer, en su certificado de nacimiento original?

Male Hombre

Female Mujer

SR GENDER [IF SR SEX NE BLANK]

Do you describe yourself as male, female, transgender, or do you use a different term?

¿Se describe usted como hombre, mujer, transgénero o utiliza un término diferente?

Male Hombre

Female Mujer

Transgender Transgénero

Use a different term Utiliza un término diferente

DK/REF

(CHECK ALL THAT APPLY)

SR DIFTERM [IF SR GENDER = USE A DIFFERENT TERM]

What term do you use?

¿Qué término usa?

[ALLOW 50 CHARACTERS]

DK/REF

[IF AGE 17-65, MILITARY, OTHERWISE SR HISPANIC]

SR MILITARY [IF SR GENDER NE BLANK AND SR AGE = 17-65]

Are you currently on active duty in the United States military?

¿Está usted actualmente en servicio activo en las fuerzas armadas de los Estados Unidos?

Yes Sí

No No

Refused Se rehúsa

[HISPANIC]

SR HISPANIC [IF SR MILITARY NE BLANK OR (SR GENDER NE BLANK AND SR AGE NE 17-65) ]

Are you of Hispanic, Latino or Spanish origin?

¿Es usted de origen hispano, latino o español?

(That is, do any of these groups describe your 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, cubanoamericano, mexicano, mexicanoamericano, chicano, centro o sudamericano, o es nativo(a) de otro país donde se habla español?)

Yes Sí

No No

[SR RACE]

SR RACE [IF SR HISPANIC NE BLANK]

Are you American Indian or Alaska Native, Asian, Black or African American, Native Hawaiian or other Pacific Islander, or White?

¿Es usted de raza indígena americana o nativa de Alaska, asiática, negra o afroamericana, nativa de Hawái o de otra isla del Pacífico, o blanca?

American Indian or Alaska Native Indígena americana o nativa de Alaska

Asian Asiática

Black or African American Negra o afroamericana

Native Hawaiian/other Pacific Islander Nativa de Hawái o de otra isla del Pacífico

White Blanca

(CHECK ALL THAT APPLY)

SR CONFIRM ROSTER [IF SR RACE NE BLANK]

[IF RACE, HISPANIC, AND/OR MILITARY IS ‘BLANK’ OMIT RESPECTIVE FILLS FROM CONFIRM ROSTER SCREEN.]

CONFIRM:

I have listed you as a/an (AGE) year old (GENDER) respondent. You are (RACE), (HISPANIC), and (are/are not) on active duty in the United States military.

IF MALE: Lo he anotado a usted, un participante de (AGE) años de edad. Usted es raza (RACE: indígena americana o nativa de Alaska, asiática, negra o afroamericana, nativa de Hawái o de otra isla del Pacífico, blanca), (HISPANIC: es hispano/no es hispano) y (está/no está) en servicio activo en las fuerzas armadas de los Estados Unidos.

IF FEMALE: La he anotado a usted, una participante de (AGE) años de edad. Usted es raza (RACE: indígena americana o nativa de Alaska, asiática, negra o afroamericana, nativa de Hawái o de otra isla del Pacífico, blanca), (HISPANIC: es hispana/no es hispana) y (está/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 [SR AGE]

OTHER MEMBERS [IF SR CONFIRM ROSTER = YES AND MEMBERS 12 OR OLDER ≥ 2]

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]

NOT HOUSEHOLD MEMBER [IF SR OCCUPANCY = NO AND MEMBERS 12 OR OLDER ≥ 2]

Even though you (did/will) not live here for most of (CURRENT QUARTER), I need some general information about (the other person/all of the other people) in this household who are 12 years old or older and (did/will) live here for most of those months. Let’s start with the oldest and work down to the youngest.

Aunque usted no (vivió/vivirá) aquí la mayor parte de (CURRENT QUARTER), necesito alguna información general acerca de (la otra persona/todas las otras personas) en este hogar que tengan 12 años o más y (vivieron/vivirán) aquí la mayoría de esos meses. Empecemos con la persona mayor hasta llegar a la persona menor.

Next [AGE]

AGE [IF (OTHER MEMBERS NE BLANK) OR (CONFIRM ROSTER = NO) OR SR NOT HH MEMBER NE BLANK OR (TOTAL SDU MEMBERS = 1 AND ONLY ELIGIBLE HH MEMBER = No) OR (MEMBERS 12 OR OLDER = 1 AND ONLY ELIGIBLE HH MEMBER = No)]

[IF MEMBERS 12 OR OLDER = 1 OR 2] How old is this person?

¿Cuántos años tiene esta persona?

[IF MEMBERS 12 OR OLDER > 2 HH MEMBERS] How old is the (oldest/next oldest) person?

¿Cuántos años tiene la (persona mayor/siguiente persona)?

ENTER AGE [ROSTER SCREEN 1]

[IF AGE ≥ 99, ROSTER: PLEASE VERIFY: Let me confirm, is this person (AGE) years old? Permítame confirmar, ¿tiene esta persona (AGE) años de edad? IF Yes, ROSTER SCREEN 1. IF No, AGE.]

ROSTER SCREEN 1 [IF AGE NE BLANK]

RELATION: [IF AGE NE BLANK]

How is this person related to you?

¿Cómo está relacionada esta persona con usted?

Spouse	Esposo(a)
Child	Hijo(a) (incluye hijastro(a), hijo(a) “foster” o hijo(a) adoptivo(a))
Child-in-law	Yerno/Nuera
Sibling	Hermano(a) (incluye medio(a) hermano(a), hermanastro(a), hermano(a) “foster” o hermano(a) adoptivo(a))
Sibling-in-law	Cuñado(a)
Parent/Guardian (incl. step, foster, or adoptive)	Padre/madre/Tutor(a) (incluye padrastro/madrastra, padre/madre “foster” o padre/madre adoptivo(a))
Parent-in-law	Suegro(a)
Uncle/Aunt	Tío(a)
Nephew/Niece	Sobrino(a)
Grandparent	Abuelo(a)
Grandchild	Nieto(a)
Cousin	Primo(a)
Ex-Spouse	Ex-esposo(a)
Unmarried Partner	Pareja (sin estar casados)
Housemate or Roommate	Compañero(a) de casa o de cuarto
Tenant/Boarder/Exch Student	Inquilino(a)/Pensionista/Intercambio estudiantil
Other relative	Otro pariente
Other Non-relative	Otra persona que no es pariente
Relationship Unspecified	No se especificó el parentesco

SEX: [IF RELATION NE BLANK]

What sex was this person assigned at birth, on their original birth certificate?

¿Qué sexo le fue asignado a esta persona al nacer, en su certificado de nacimiento original?

Male Hombre

Female Mujer

Don’t Know No sabe

Refused Se rehúsa

GENDER: [IF SEX NE BLANK]

Does this person describe themself as male, female, transgender, or do they use a different term?

¿Se describe esta persona como hombre, mujer, transgénero o utiliza un término diferente?

Male Hombre

Female Mujer

Transgender Transgénero

Use a different term Utiliza un término diferente

Refused Se rehúsa

(CHECK ALL THAT APPLY)

ROSTER SCREEN 2

DIFTERM [IF GENDER = USE A DIFFERENT TERM]

What term do they use?

¿Qué término usa?

DK/REF

[ALLOW 50 CHARACTERS]

ROSTER SCREEN 3

MILITARY [QUESTION/RESPONSE ACTIVE ONLY IF AGE 17-65]

Is this person currently on active duty in the United States military?

¿Está esta persona actualmente en servicio activo en las fuerzas armadas de los Estados Unidos?

Yes Sí

No No

Refused Se rehúsa

Unknown No sabe

[IF MORE THAN ONE SPOUSE, Multiple Spouses: YOU HAVE ALREADY ENTERED A RECORD FOR SPOUSE. DOES THIS RESPONDENT HAVE MULTIPLE SPOUSES? IF Yes, ROSTER SCREEN 2. If No, ROSTER SCREEN 1.]

HISPANIC:

(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?)

(¿Es decir que su origen nacional o ascendencia se puede describir como puertorriqueño, cubano, cubanoamericano, mexicano, mexicanoamericano, chicano, centro o sudamericano, o es nativo(a) de otro país donde se habla español?)

Yes Sí

No No

Refused Se rehúsa

Unknown No sabe

RACE

(Is he/Is she/Is this person) American Indian or Alaska Native, Asian, Black or African American, Native Hawaiian or other Pacific Islander, or White?

¿Es (él/ella/esta persona) de raza indígena americana o nativa de Alaska, asiática, negra o afroamericana, nativa de Hawái o de otra isla del Pacífico, o blanca?

American Indian or Alaska Native Indígena americana o nativa de Alaska

Asian Asiática

Black or African American Negra o afroamericana

Native Hawaiian/other Pacific Islander Nativa de Hawái o de otra isla del Pacífico

White Blanca

(CHECK ALL THAT APPLY)

Refused Se rehúsa

Unknown No sabe

Next [CONFIRM ROSTER]

CONFIRM ROSTER

[IF RACE, HISPANIC, AND/OR MILITARY IS ‘BLANK,’ ‘DK’, OR ‘REF’ OMIT RESPECTIVE FILLS FROM CONFIRM ROSTER SCREEN.]

CONFIRM:

I have listed your (AGE) year old (RELATIONSHIP). They are (RACE), (HISPANIC) [IF AGE 17-65] and (are/are not) on active duty the United States military.

He anotado a su (RELATIONSHIP) de (AGE) años. Esta persona es de raza (RACE), es hispana [IF AGE 17-65] y (está/no está) en servicio activo en las fuerzas armadas de los Estados Unidos.

Is this correct?

¿Es esto correcto?

Yes Sí [AGE FOR NEXT ROSTER MEMBER, OTHERWISE VERIFY ROSTER DATA]

No No [AGE]

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 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)

PROGRAMMER NOTE: INCLUDE SR DESIGNATION BUT DO NOT ALLOW EDITING

[TOUCH AND HOLD ANY ROSTER LINE, Choose an Action: IF Show Details]

Relation: Relationship

Age: Age

Sex: M, F, DK, R

Gender: M, F, T, DT, R

Hispanic: Y, N, U, R

Race: I, A, B, P, W

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]

EDIT ROSTER MEMBER [EDIT ROSTER RECORD = YES]

SR Roster (or first person listed, if SR not rostered) version:

AGE: Age

SEX: M F DK R (with appropriate circle filled)

GENDER: (CHECK ALL THAT APPLY) M F T DT (with appropriate boxes checked)

RELATION: Relationship

HISPANIC: Y N (with appropriate circle filled)

RACE: (CHECK ALL THAT APPLY) (with appropriate boxes checked)

Am. Indian Asian Black

Hawaiian/PI White

MILITARY: Y N R (with appropriate circle filled)

ELIGIBLE: (box checked as appropriate)

SR: (box checked as appropriate) NOTE: this field cannot be edited

Roster #2 or after version: (includes unknown and refusal options)

AGE: Age

SEX: M F DK R (with appropriate circle filled)

GENDER: (CHECK ALL THAT APPLY) M F T DT R (with appropriate boxes checked)

RELATION: Relationship

HISPANIC: Y N R U (with appropriate circle filled)

RACE: (CHECK ALL THAT APPLY) (with appropriate boxes checked)

Am. Indian Asian Black

Hawaiian/PI White

Race Refused Race Unknown

MILITARY: Y N R U (with appropriate circle filled)

ELIGIBLE: (box checked, as appropriate)

SR: NOTE: this field cannot be edited

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]

[IF INTERVIEW A = BLANK, NO SELECTION: NO ONE WAS SELECTED FOR AN INTERVIEW AT THIS HOUSEHOLD. PLEASE COLLECT VERIFICATION INFORMATION.]

RESPONDENT SELECTION [START SELECTION = YES AND INTERVIEW A NE BLANK]

Interview A

Roster #: (Roster # of selected member, None)

QuestID: (7-digit Questionnaire ID, BLANK)

Relation: (Relationship to SR, BLANK)

Age: (AGE, BLANK) Gender: (M, F, T, DT, BLANK)

Race: (I, A, B, P, W, BLANK) Hispanic: (Y, N, BLANK)

Interview B

Roster #: (Roster # of selected member, None)

QuestID: (7-digit Questionnaire ID, BLANK)

Relation: (Relationship to SR, BLANK)

Age: (AGE, BLANK) Gender: (M, F, T, DT, BLANK)

Race: (I, A, B, P, W, 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]

Section 2

GQU Screening

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.

You should have received a letter explaining the study.

Usted debe 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.]

ADDRESS VERIFICATION [IF IDENTIFY SR = SR AVAILABLE]

I just need to verify -- is this

Solamente necesito confirmar que esta 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

Next [TRANSIENT]

TRANSIENT [IF INFORMED CONSENT = NEXT]

INTERVIEWER: IS THIS GQU A TRANSIENT SHELTER?

Yes [UNIT TYPE]

No [SR OCCUPANCY]

UNIT TYPE [IF TRANSIENT = YES]

ARE THE LISTED UNITS…

ROOMS [TOTAL GQU MEMBERS]

BEDS, OR [ROSTER #1 AGE]

PERSONS [ROSTER #1 AGE]

SR OCCUPANCY [IF TRANSIENT = NO]

(Did/Will) you live here for most of the time during the months of (CURRENT QUARTER)?

(¿Vivió /¿Vivirá) usted aquí la mayor parte del tiempo durante los meses de (CURRENT QUARTER)?

Yes [TOTAL GQU MEMBERS]

No [OCCUPANCY]

OCCUPANCY [IF SR OCCUPANCY = NO]

(Did/Will) anyone else in this room live here for most of the time during the months of (CURRENT QUARTER)?

(¿Vivió /¿Vivirá) alguna otra persona aquí 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 SR OCCUPANCY = YES OR 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 usted, ¿cuántas personas se quedan en esta habitación?

[IF TRANSIENT = NO and SR OCCUPANCY = YES] Including yourself, how many people (lived/will live) in this room for most of the time during (CURRENT QUARTER)?

Incluyéndose usted, ¿cuántas personas (vivieron/vivirán) en esta habitación la mayor parte del tiempo durante (CURRENT QUARTER)?

[IF TRANSIENT = NO and OCCUPANCY = YES] How many people (lived/will live) in this room for most of the time during (CURRENT QUARTER)?

¿Cuántas personas (vivieron/vivirán) en esta habitación 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 SR OCCUPANCY = YES, ROSTER #1 AGE. IF Yes AND SR OCCUPANCY = NO, NOT HOUSEHOLD MEMBER.

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 SR OCCUPANCY = YES ROSTER # 1 AGE. IF Yes AND SR OCCUPANCY = NO, NOT HOUSEHOLD MEMBER].

NOT HOUSEHOLD MEMBER [IF SR OCCUPANCY = NO AND MEMBERS 12 OR OLDER ≥ 2]

Next [ROSTER #1 AGE]

ROSTER #1 AGE [IF MEMBERS 12 OR OLDER NE BLANK OR TOTAL GQU MEMBERS = 1 OR IF UNIT TYPE = BEDS OR PERSONS]

How old (are/is) (you/this person)?

¿Cuántos años tiene (usted/esta persona)?

ENTER AGE [ROSTER #1 NAME]

[IF SR AGE ≥ 99, ROSTER: PLEASE VERIFY: Let me confirm, are you (AGE) years old?

Permítame confirmar, ¿tiene usted (AGE) años de edad? IF Yes, SR SEX. IF No, SR AGE.]

[IF SR AGE = 17 OR UNDER: OLDER ELIGIBLE SR: “YOU HAVE IDENTIFIED AN SR UNDER AGE 18. DOES AN ELIGIBLE SR 18 OR OLDER LIVE AT DU?”

IF Yes, CONTACT OLDER MEMBER: “CONDUCT SCREENING WITH SR AGED 18 OR OLDER.” OK ; CLEAR THE AGE ENTRY TO ALLOW FOR NEW SR.

If No, MINOR SR: “THIS SR IS 17 OR YOUNGER. STOP THE SCREENING AND CODE AS AN 02.” OK [SCREENING CALL RECORD] ENTERING RESULT CODE 02 SR UNAVAILABLE, AND COMMENT “SR age ineligible”.]

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 SEX]

ROSTER #1 SEX [IF ROSTER #1 NAME NE BLANK]

What sex (were/was) (you/this person) assigned at birth, on (your/their) original birth certificate?

¿Qué sexo le fue asignado a (usted/esta persona) al nacer, en su certificado de nacimiento original?

Male Hombre

Female Mujer

ROSTER #1 GENDER [IF ROSTER #1 SEX NE BLANK]

(Do you/Does this person) describe (yourself/themself) as male, female, transgender, or do (you/they) use a different term?

¿Se describe (usted/esta persona) como hombre, mujer, transgénero o utiliza un término diferente?

Male Hombre

Female Mujer

Transgender Transgénero

Use a different term Utiliza un término diferente

(CHECK ALL THAT APPLY)

ROSTER #1 DIFTERM [IF ROSTER #1 GENDER = USE A DIFFERENT TERM]

What term do (you/they) use?

¿Qué término usa?

[ALLOW 50 CHARACTERS]

DK/REF

[IF AGE 17-65, ROSTER #1 MILITARY, OTHERWISE ROSTER #1 HISPANIC]

ROSTER #1 MILITARY [IF ROSTER #1 GENDER NE BLANK AND ROSTER #1 AGE = 17-65]

(Are you /Are they) currently on active duty in the United States military?

¿Está esta persona actualmente en servicio activo en las fuerzas armadas de los Estados Unidos?

Yes Sí

No No

Refused Se rehúsa

[ROSTER #1 HISPANIC]

ROSTER #1 HISPANIC [IF ROSTER #1 MILITARY NE BLANK OR (ROSTER #1 GENDER NE BLANK AND AGE NE 17-65)]

(Are you/Are they) of Hispanic, Latino or Spanish origin?

¿Es esta persona 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?)

Yes Sí

No No

[ROSTER #1 RACE]

ROSTER #1 RACE [IF ROSTER #1 HISPANIC NE BLANK]

(Are you/Are they) American Indian or Alaska Native, Asian, Black or African American, Native Hawaiian or other Pacific Islander, or White?

¿Es esta persona de raza indígena americana o nativa de Alaska, asiática, negra o afroamericana, nativa de Hawái o de otra isla del Pacífico, o blanca?

American Indian or Alaska Native Indígena americana o nativa de Alaska

Asian Asiática

Black or African American Negra o afroamericana

Native Hawaiian/other Pacific Islander Nativa de Hawái o de otra isla del Pacífico

White Blanca

(CHECK ALL THAT APPLY)

[CONFIRM ROSTER]

CONFIRM ROSTER [IF ROSTER #1 RACE NE BLANK]

[IF RACE, HISPANIC, AND/OR MILITARY IS ‘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/They are) (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/Esta persona) es de raza (RACE: indígena americana o nativa de Alaska, asiática, negra o afroamericana, nativa de Hawái o de otra isla del Pacífico, blanca), (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 [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 [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 THEIR 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 alguna información general sobre (la otra persona que tenga/todas las otras personas que tengan) 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] How old is this person?

¿Cuántos años tiene esta persona?

[IF MEMBERS 12 OR OLDER > 2 HH MEMBERS] How old is the (oldest/next oldest) person?

¿Cuántos años tiene la (persona mayor/siguiente persona)?

ENTER AGE [NAME]

[IF AGE ≥ 99, ROSTER: PLEASE VERIFY: Let me confirm, is this person (AGE) years old? Permítame confirmar, ¿tiene esta persona (AGE) años de edad? IF Yes, NAME. 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 [SEX]

ROSTER SCREEN 1

SEX

What sex was this person assigned at birth, on their original birth certificate?

¿Qué sexo le fue asignado al nacer, en su certificado de nacimiento original?

Male Hombre

Female Mujer

Refused Se rehúsa

GENDER [IF SEX NE BLANK]

Does this person describe themself as male, female, transgender, or do they use a different term?

¿Se describe esta persona como hombre, mujer, transgénero o utiliza un término diferente?

Male Hombre

Female Mujer

Transgender Transgénero

Use a different term Utiliza un término diferente

Refused Se rehúsa

[IF AGE 17-65, MILITARY, OTHERWISE HISPANIC]

DIFTERM [IF GENDER = USE A DIFFERENT TERM]

What term do they use?

¿Qué término usa?

DK/REF

[ALLOW 50 CHARACTERS]

MILITARY [IF GENDER NE BLANK AND AGE 17-65]

Is this person currently on active duty in the United States military?

¿Está esta persona actualmente en servicio activo en las fuerzas armadas de los Estados Unidos?

Yes Sí

No No

Refused Se rehúsa

Unknown No sabe

[HISPANIC]

ROSTER SCREEN 2

HISPANIC [IF MILITARY NE BLANK OR (GENDER NE BLANK AND AGE NE 17-65)]

(Is he/Is she/Is this person) of Hispanic, Latino or Spanish origin?

¿Es (él/ella/esta persona) de origen hispano, latino o español?

Yes Sí

No No

Refused Se rehúsa

Unknown No sabe

[RACE]

RACE [IF HISPANIC NE BLANK]

(Is he/Is she/Is this person) American Indian or Alaska Native, Asian, Black or African American, Native Hawaiian or other Pacific Islander, or White?

¿Es (él/ella/esta persona) de raza indígena americana o nativa de Alaska, asiática, negra o afroamericana, nativa de Hawái o de otra isla del Pacífico, o blanca?

American Indian or Alaska Native Indígena americana o nativa de Alaska

Asian Asiática

Black or African American Negra o afroamericana

Native Hawaiian/other Pacific Islander Nativa de Hawái o de otra isla del Pacífico

White Blanca

(CHECK ALL THAT APPLY)

Refused Se rehúsa

Unknown No sabe

[CONFIRM ROSTER]

CONFIRM ROSTER [IF

RACE NE BLANK]

[IF RACE, HISPANIC, AND/OR MILITARY IS ‘DK’ OR ‘REF’ OMIT RESPECTIVE FILLS FROM CONFIRM ROSTER SCREEN.]

CONFIRM:

I have listed a/an (AGE) year old (GENDER) resident. They are (RACE), (HISPANIC) [IF AGE 17-65] and (are/are 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 que vive aquí. Esta persona es de raza (RACE: indígena americana o nativa de Alaska, asiática, negra o afroamericana, nativa de Hawái o de otra isla del Pacífico, blanca), (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 THEIR 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 NAMES AND AGES].

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)

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

Sex: M, F, DK, R

Gender: M, F, T, DT, R

Hispanic: Y, N, U, R

Race: I, A, B, P, W

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 (NAME)? IF Yes, EDIT ROSTER MEMBER. IF No, VERIFY ROSTER DATA.]

[+MEMBER OR FUNCTIONS TO ADD ROSTER MEMBERS]

Next [START SELECTION]

EDIT ROSTER MEMBER [EDIT ROSTER RECORD = YES]

SR Roster (or first person listed, if SR not rostered) version:

AGE: Age

SEX: M, F (with appropriate circle filled)

GENDER: (CHECK ALL THAT APPLY) M F T DT (with appropriate boxes checked)

RELATION: Relationship

HISPANIC: Y N (with appropriate circle filled)

RACE: (CHECK ALL THAT APPLY) (with appropriate boxes checked)

Am. Indian Asian Black

Hawaiian/PI White

MILIATRY: Y N R (with appropriate circle filled)

ELIGIBLE: (box checked as appropriate)

SR: (box checked as appropriate) NOTE: this field cannot be edited

Roster #2 or after version: (includes unknown and refusal options)

AGE: Age

SEX: M F DK R (with appropriate circle filled)

GENDER: (CHECK ALL THAT APPLY) M F T DT R (with appropriate boxes checked)

RELATION: Relationship

HISPANIC: Y N R U (with appropriate circle filled)

RACE: (CHECK ALL THAT APPLY) (with appropriate boxes checked)

Am. Indian Asian Black

Hawaiian/PI White

Race Refused Race Unknown

MILITARY: Y N R U (with appropriate circle filled)

ELIGIBLE: (box checked, as appropriate)

SR: NOTE: this field cannot be edited

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]

[IF INTERVIEW A = BLANK, NO SELECTION: NO ONE WAS SELECTED FOR AN INTERVIEW AT THIS GQU. PLEASE COLLECT VERIFICATION INFORMATION.]

RESPONDENT SELECTION [START SELECTION = YES AND INTERVIEW A NE BLANK]

Interview A

Roster #: (Roster # of selected member, None)

QuestID: (7-digit Questionnaire ID, BLANK)

Name: (First Name, BLANK)

Age: (AGE, BLANK) Gender: (M, F, T, DT, BLANK)

Race: (I, A, B, P, W, 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) Gender: (M, F, T, DT, BLANK)

Race: (I, A, B, P,W, BLANK) Hispanic: (Y, N, BLANK)

NEXT [IF INTEVIEW A = BLANK, THEN VERIFICATION]

[IF INTERVIEW A NE BLANK, THEN SELECTIONS]

Section 3

Select Case Screen Options

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

Show DU on Map

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 to Calendar

View Call Distribution

View Letters

View Participant Code

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]

VIEW SELECTIONS [SELECT CASE, VIEW SELECTIONS]

RESPONDENT SELECTION [IF CASE COMPLETED WITH FINAL

RESULT CODE = [31, 32

Interview A [QC FORM]

Roster #: (Roster # of selected member, None

QuestID: (7-digit Questionnaire ID, BLANK)

Relation: (Relationship to SR, BLANK)

Age: (AGE, BLANK) Gender: (M, F, T, DT, BLANK)

Race: (I, A, B, P, W, BLANK) Hispanic: (Y, N, BLANK)

Interview B [QC FORM]

Roster #: (Roster # of selected member, None)

QuestID: (7-digit Questionnaire ID, BLANK)

Relation: (Relationship to SR, BLANK)

Age: (AGE, BLANK) Gender: (M, F, T, DT, BLANK)

Race: (I, A, B, P, W, 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?”]

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 TO CALENDAR [SELECT CASE, ADD APPOINTMENT TO CALENDAR]

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]

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)

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].)

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

Su - - - - - - -

M - - - - - - -

Tu - - - - - - -

W - - - - - - -

Th - - - - - - -

F - - - - - - -

Sa - - - - - - -

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.

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 MATERIALS AND ANSWER THE FOLLOWING QUESTION(S):

IS THE UNIT THAT YOU ARE ATTEMPTING TO ADD

(Missed DU Street Address)

ALREADY ON THE LIST OF DWELLING UNITS?

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)

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 their 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)

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 TO CALENDAR [SELECT CASE, FUNCTIONS, ADD APPOINTMENT TO CALENDAR] (See Add Appointment explanation under Actions Menu above)

CALENDAR [SELECT CASE, FUNCTIONS, CALENDAR] (See Calendar explanation within the Add Appointment to Calendar portion under Actions Menu above)

TRANSMIT [SELECT CASE, FUNCTIONS, TRANSMIT]

TRANSMISSION LOG

Done [SELECT CASE]

Transmit [BEGINS DATA TRANSMISSION].

Section 4

Record of Calls

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]

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 to Calendar [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]

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 Appointment for Interview

51 No one at DU

52 R Unavailable

53 Pending Break-off (Partial Interview)

54 Pending Incapable

55 Pending Lang. Barrier (Spanish)

56 Pending Lang. Barrier (Other)

57 Pending Refusal

58 Pending Parental Refusal for age 12-17

59 Pending Other – Specify

70 Interview complete

71 No one at DU - Repeated

72 R Unavailable - Repeated

73 Final Break-off (Partial Interview)

74 Final Incapable

75 Final Lang. Barrier (Spanish)

76 Final Lang. Barrier (Other)

77 Final Refusal

78 Final Parental Refusal for age 12-17

79 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)

Screening and Interview Refusal

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

Requested web option

COVID-19 concerns

Need to discuss with FS

Comment: (text entry)

Done [SAVES REASON FOR REFUSALAND COMMENTS ENTERED, RECORD OF CALLS]

Screening and Interview Refusal Functions on ROC

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

Requested web option

COVID-19 concerns

Need to discuss with FS

Comment: (text entry)

Done [IF EDITED (BEFORE TRANSMISSION) SAVES REASON FOR REFUSAL AND COMMENTS ENTERED, THEN RECORD OF CALLS]

Section 6

Screening Verification

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?

Para que mi supervisor pueda revisar la calidad de mi trabajo, ¿me podría dar su primer nombre y su número de teléfono?

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 other needed clarification.)

Done [CHECKS FOR COMPLETE DATA ENTRY, RECORD OF CALLS]

Clear [VERIFICATION WITH ENTRY CLEARED]

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Section 7

Interview Verification

Following the commitment of a Screening Call Record with a final result of One Selected (Code 31) or Two Selected (Code 32), the QC Form button appears on the Respondent Selection screen for each respondent. When the QC Form button is touched, this Interview Verification module occurs.

QC PHONE

May I please have your phone number?

¿Me puede dar su número de teléfono por favor?

Phone (10 DIGIT NUMBER ENTRY FIELD)

Not available Refused

CONFIRM NUMBER WITH R

Next [IF PHONE NUMBER ENTERED, OR NOT AVAILABLE, OR REFUSED, QC ADDRESS VERIFICATION. IF NO PHONE NUMBER ENTERED, OR NOT AVAILABLE OR REFUSED NOT SELECTED, QC PHONE]

QC PHONE FIX

YOU MUST ENTER A 10 DIGIT PHONE NUMBER OR REFUSED OR NOT AVAILABLE

OK [QC PHONE]

QC ADDRESS VERIFICATION

May I please confirm your current address?

¿Me puede confirmar su dirección actual por favor?

STREET: (NUMBER AND STREET)

CITY: (CITY)

STATE: (STATE)

ZIP: (ZIP)

Address Is Correct [IF R’s AGE GREATER THAN 17, RETURN TO RESPONDENT SELECTION. IF R’s AGE 12-17, GO TO QC PARENTAL PERMISSION]

Need to Edit Address [QC EDIT ADDRESS]

QC EDIT ADDRESS [IF QC 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 QC ADDRESS VERIFICATION]

QC PARENTAL PERMISSION [IF R’s AGE = 12-17]

INDICATE WHO PROVIDED PERMISSION FOR YOUTH TO COMPLETE THE INTERVIEW

Parent

Guardian

Other, specify [DISPLAY ENTRY FIELD BELOW]

Next [RESPONDENT SELECTION]

Section 8

FI Debriefing Questions

These questions appear following the commitment of an Interview Call Record with a final result of Interview Complete (Code 70).

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

Next [IF FIDBF1=YES, GO TO FIDBF3]

FIDBF2 [IF FIDBF1=NO]

Where did you conduct this interview?

AT THE RESPONDENT’S WORKPLACE
AT THE HOME OF THE RESPONDENT’S RELATIVE OR FRIEND
IN SOME TYPE OF CONFERENCE ROOM IN A RESIDENCE HALL, SCHOOL OR APARTMENT COMPLEX
AT A LIBRARY
IN SOME TYPE OF COMMON AREA, SUCH AS A LOBBY, HALLWAY, STAIRWELL, OR LAUNDRY ROOM
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

Please estimate for how much of the ACASI interview the respondent had their headphones on.

1. NONE/R TOOK HEADPHONES OFF IMMEDIATELY

2. LESS THAN HALF OF THE ACASI INTERVIEW

3. ABOUT HALF OF THE ACASI INTERVIEW

4. MORE THAN HALF OF THE ACASI INTERVIEW

5. ALL OF THE ACASI INTERVIEW

Next [FIDBF4]

FIDBF4

How cooperative was the respondent?

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.

COMPLETELY PRIVATE – NO ONE WAS IN THE ROOM OR COULD OVERHEAR ANY PART OF THE INTERVIEW
MINOR DISTRACTIONS – PERSON(S) IN THE ROOM OR LISTENING LESS THAN 1/3 OF THE TIME
PERSON(S) IN THE ROOM OR LISTENING ABOUT 1/3 OF THE TIME
SERIOUS INTERRUPTIONS OF PRIVACY MORE THAN HALF THE TIME
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

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]

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

Next [FIDBF9]

FIDBF9

Did the respondent have trouble understanding any questions asked during the interview?

YES

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 their answers were as they completed the ACASI portion of the interview?

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

Please note anything else you think would be helpful for the interpretation and understanding of this interview.

ALLOW 250 CHARACTERS

Next [RECORD OF CALLS]

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Section 9

Parental Introductory Script in English and Spanish

Document Format:

Screen/menu names are in bold uppercase letters.
FI instructions are provided in black uppercase text that is not in brackets. In the screening program, FI instructions appear in red uppercase letters.
Fills are designated by parentheses 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 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 your child is interested, I will give both of you more information and ask for permission to complete the interview. (Are they available?)

Se seleccionó a su hijo o hija de (AGE) para una entrevista. Me gustaría hablar con él o ella para ver si tiene interés 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 o hija tiene interés, les daré a ustedes dos más información y les pediré permiso para completar la entrevista. (¿Está disponible su hijo o hija?)

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?)

Se seleccionaron a su hijo o hija de (AGE) años y a su hijo o hija de (AGE) años para una entrevista. Me gustaría hablar con ellos para ver si tienen interés 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 están interesados, les daré a todos ustedes más información y les pediré permiso para completar la entrevista. (¿Están ellos disponibles?)

File Type	application/vnd.openxmlformats-officedocument.wordprocessingml.document
File Title	NSDUH Methodological Report Template
Author	Claudia Clark
File Modified	0000-00-00
File Created	2023-10-25

Attachment B_NSDUH 2023 In-Person Screening Questions_Clean_9-15-22