CASEID ENTER THE CASE ID FOR THIS INTERVIEW.
BE SURE TO INCLUDE A OR B AT THE END OF THE CASE ID.
TOALLR3I
It is important that I do my job correctly; therefore, my supervisors will be checking on my work. Would you help me by giving me your phone number? I will enter it into this tablet. This information is kept separate from the responses that were entered so they will still be completely private.
ON TABLET RESPONDENT SELECTION SCREEN, OPEN QC FORM.
COMPLETE VERIFICATION PROCESS (PHONE, CONFIRM ADDRESS AND, IF YOUTH, WHO GAVE PERMISSION).
PRESS [ENTER] TO CONTINUE.
INCENT01 HAND RESPONDENT $30 CASH AND THEN:
COMPLETE THE INTERVIEW INCENTIVE RECEIPT:
MARK THE APPROPRIATE ‘CASH ACCEPTANCE’ BOX
SIGN AND DATE
ENTER CASE ID (IF NOT DONE ALREADY)
GIVE TOP COPY TO RESPONDENT
I have signed this form to indicate that I have given you $30 for this interview. At the bottom of this form, we have included national hotline numbers that you can call if you ever feel you need to talk to someone about mental health or drug use issues.
IF NOT DONE EARLIER, GIVE ADULT RESPONDENT OR PARENT/GUARDIAN OF YOUTH THE Q&A BROCHURE AND SAY:
For more details on the National Survey on Drug Use and Health, this brochure includes answers to common questions, website addresses and other information.
PRESS [ENTER] TO CONTINUE.
CALCULATE MICSR:
IF K6 AND WHO-DAS SCORE = MID OR HIGH, MICSR = 1
ELSE, MICSR=2
RECRUIT1 [IF MICSR=1] You have been selected to participate in one additional study for the
U.S. Department of Health and Human Services. For this research study, we would like for you to complete an interview about mental health. The interview will be conducted virtually and should take about 60 minutes to complete. Your participation in the interview is voluntary, and you can refuse to answer any questions.
If you agree to complete the interview, I will give you an additional $30 today.
HAND FOLLOW-UP STUDY DESCRIPTION TO RESPONDENT.
Please read this statement. It describes the follow-up study and the legislation that assures the confidentiality of any information you provide.
Do you agree to participate in this study?
1 – RESPONDENT AGREES TO FOLLOW-UP
2 – RESPONDENT DOES NOT AGREE TO FOLLOW-UP
REFFEAS [IF RECRUIT1=2] Since the follow-up study is designed to help us improve future
NSDUH surveys, it is important to understand why people might not want to participate. Would you please tell me the reasons why you do not want to participate?
_____________[ALLOW 100]
DK/REF
RECRUIT2 [IF RECRUIT1=1] Since another interviewer will be completing the next
interview and will need to contact you beforehand, may I have your first name, phone number, and email address?
INTERVIEWER NOTE: ADDITIONAL INFORMATION REGARDING THE FIRST NAME, PHONE NUMBER, OR EMAIL ADDRESS PROVIDED BY THE RESPONDENT SHOULD BE ENTERED IN THE NOTES FIELD. YOU MAY ENTER UP TO 50 CHARACTERS.
ENTER FIRST NAME ONLY, PHONE NUMBER, EMAIL ADDRESS, AND RE-ENTER EMAIL ADDRESS. READ THE CONTACT INFORMATION ENTERED TO THE RESPONDENT AND CONFIRM IT IS CORRECT, THEN PRESS [ENTER] TO CONTINUE.
_________________________FIRST NAME: [ALLOW 20]
_________________________PHONE NUMBER: [ALLOW 20]
_________________________EMAIL ADDRESS: [ALLOW 50]
_________________________RE-ENTER EMAIL ADDRESS: [ALLOW 50]
_________________________NOTES: [ALLOW 50]
DK/REF
RECRTXT [IF RECRUIT1=1 AND PHONE NUMBER IN RECRUIT2 NOT MISSING] May we send text messages to the phone number you provided to
contact you about the upcoming interview?
1. YES
INCENTMI [IF RECRUIT1=1]
HAND RESPONDENT $30 CASH
COMPLETE THE FOLLOW-UP INTERVIEW INCENTIVE RECEIPT:
MARK THE APPROPRIATE ‘CASH ACCEPTANCE’ BOX
SIGN AND DATE
ENTER CASE ID
GIVE TOP COPY TO RESPONDENT
PRESS [ENTER] TO CONTINUE.
RECRQR [IF RECRUIT1=1] WRITE THE RESPONDENT’S QUESTID) ON THE
SCHEDULING CARD AND THEN HAND SCHEDULING CARD TO RESPONDENT.
This card can be used to access the project’s website in one of two ways – by scanning the QR code using a smartphone or by typing the URL into an internet browser’s address bar. The password I wrote on this card will allow you to enter the online scheduling system and schedule an interview date and time.
Within a few days of scheduling, an interviewer will contact you to confirm your interview appointment and provide Zoom meeting details.
If you have any questions, you can contact the phone number or email address provided on the card.
PRESS [ENTER] TO CONTINUE
THANKR2 Thank you for your time.
[ALL CASES] BE SURE YOU HAVE YOUR
SECURITY KEY
Web Instrument
INCENTTYPE Thank you for participating in the National Survey on Drug Use and Health! To show our appreciation for completing this interview, we would like to send you $30, by either electronic pre-paid or physical Visa or MasterCard gift card. Please indicate how you would like to receive your $30.
On the next screen enter your contact information. [IF CURNTAGE < 18] If you choose an electronic gift card, we will ask for your parent or guardian’s email. This information will be kept separate from the answers to this survey, and will only be used for the purpose of sending your gift card.
Electronic Visa Gift Card (Delivered by email within two business days, can only be used for online purchases, and can only be used for purchases of equal or lesser value )
Electronic MasterCard Gift Card (Delivered by email within two business days, can only be used for online purchases, and can only be used for purchases of equal or lesser value )
Physical Visa Gift Card (Delivered by mail within 4-6 weeks and can be used in stores and online)
Physical MasterCard Gift Card (Delivered by mail within 4-6 weeks and can be used in stores and online)
No, thanks. I decline the $30
DEFINE EMAILFILL
IF CURNTAGE ≥ 18 THEN, EMAILFILL = “your”
ELSE EMAILFILL = “your parent or guardian’s”
EADDRESS [IF INCENTTYPE = 1 OR 2]
The email message will be from RTI-eIncentives@rti.org and the subject line will say “How to Redeem Your $30 [Visa OR MasterCard] Card.” If you’d like a physical gift card instead, click Back to change your selection.
Please enter [EMAILFILL] email address to receive the electronic gift card.
[EMAILADD]
Please re-enter [EMAILFILL] email address
ERROR MESSAGE: IF EMAILADD NE EMAILADD2: The email addresses do not match. Please re-enter them.
MAILINCENT [IF INCENTTYPE = 3 OR 4] Please enter the address you want us to mail the gift card to. If you’d like an electronic gift card instead, click Back to change your selection.
Street address 1: [MADDRESS]
Street address 2: [MADDRESS2]
Please enter your city.
City: [MCITY]
Please enter your state.
State: [MSTATE]
Please enter your zip code.
Zip: [MZIP]
INCENTCON [IF INCENTTYPE = 3 OR 4] Your gift card will be delivered to you in a RTI standard business sized envelope. Since we do not have your name, the letter will be directed to you using your age.
Is this information correct?
FILL:
ADDRESS/PO BOX: [MADDRESS]
[MADDRESS2]
CITY: [MCITY]
STATE: [MSTATE]
ZIP: [MZIP]
Yes
No
IF NO IS ENTERED: Please click Back to go back one screen and enter the correct information.
CALCULATE MICSR:
IF K6 AND WHO-DAS = MID OR HIGH, MICSR = 1
ELSE, MICSR = 2.
RECRINT [IF MICSR=1] You have been selected for a follow-up study to the National Survey on Drug Use and Health. This study, sponsored by the U.S. Department of Health and Human Services, will ask questions about mental health, and consists of one interview.
If you decide to participate in the follow-up interview, your first name, telephone number, and email address will be collected so we can contact you about your interview. To schedule an interview appointment, you can either select a date and time through the study’s online scheduling system or when speaking to the interviewer who contacts you.
The interview should take about 60 minutes to complete. Your participation is voluntary, you can refuse to answer any questions you do not want to answer, and you can stop the interview at any time. The interview will be conducted using Zoom. You can be in your home, office, or another private location when you complete the interview. You will be asked for permission to record the interview to ensure the interviewer administered the interview properly. You can still be interviewed even if you do not allow the interview to be recorded. Your interview recording may be used for quality or training purposes. If you agree to complete the interview, you will receive $30.
Please click NEXT to continue.
RECRUIT1 [IF MICSR=1] Federal law requires us to keep all of your answers private and confidential. Any data you provide will only be accessed by authorized personnel for statistical purposes according to the Confidential Information Protection and Statistical Efficiency Act of 2002. The only exceptions to this promise of confidentiality are if you tell the interviewer that you intend to seriously harm yourself or someone else, or if a child has been or will be seriously harmed. In this situation, the interviewer may need to notify a mental health professional or other authorities.
If you have questions about the study, call the Project Representative at 1-800-848-4079. If you have questions about your rights as a study participant, call RTI’s Office of Research Protection at 1-866-214-2043 (a toll-free number).
Do you agree to participate in this study?
1 I agree to participate in the follow-up
2 I do not agree to participate in the follow-up
REFFEAS [IF RECRUIT1=2] Since the follow-up study is designed to help us improve future
NSDUH surveys, it is important to understand why people might not want to participate. Please type in the reasons you do not want to participate.
_____________[ALLOW 100]
DK/REF
RECRUIT2 [IF RECRUIT1=1] Since an interviewer will be administering the follow-up study and will need to contact you beforehand, please type in your first name, phone number, and email address.
First Name: ____________________________ [ALLOW 20]
Phone Number:__________________________ [ALLOW 20]
Email Address:__________________________[ALLOW 50]
Re-enter email address: ___________________[ALLOW 50]
DK/REF
RECRTXT [IF RECRUIT1=1 AND PHONE NUMBER IN RECRUIT2 NOT MISSING]
May we send text messages to the phone number you provided to contact you about the upcoming interview?
1. YES
2. NO
INCNTFU1 [IF RECRUIT1= 1 AND INCENTTYPE NE 5] Thank you for your time. To show our appreciation for agreeing to participate today, we would like to send you the additional $30 [Visa or MasterCard] Gift Card to the [physical/email] address you provided earlier.
[FILL THE PHYSICAL ADDRESS FROM MAILINCENT OR EMAIL ADDRESS FROM EADDRESS.]
1 Yes, I accept the incentive
2 No, I want to receive this gift card in a different way
3 I decline the incentive
INCNTFU2 [IF INCTFU1=2] Please indicate how you would like to receive your $30.
On the next screen enter your contact information. This information will be kept separate from the answers to this survey, and will only be used for the purpose of sending your gift card.
Electronic Visa Gift Card (Delivered by email within two business days, can only be used for online purchases, and can only be used for purchases of equal or lesser value )
Electronic MasterCard Gift Card (Delivered by email within two business days, can only be used for online purchases, and can only be used for purchases of equal or lesser value )
Physical Visa Gift Card (Delivered by mail within 4-6 weeks and can be used in stores and online)
Physical MasterCard Gift Card (Delivered by mail within 4-6 weeks and can be used in stores and online)
No, thanks. I decline the $30
EMAILFU [IF INCNTFU2 = 1 OR 2]
The email message will be from RTI-eIncentives@rti.org and the subject line will say “How to Redeem Your $30 [Visa OR MasterCard] Card.” If you’d like a physical gift card instead, click Back to change your selection.
Please enter [EMAILFILL] email address to receive the electronic gift card.
[EMAILADD]
Please re-enter [EMAILFILL] email address
[EMAILADD2]
ERROR MESSAGE: IF EMAILADD NE EMAILADD2: The email addresses do not match. Please re-enter them.
PROGRAMMER: IF THE RESPONDENT GETS TO THIS SCREEN, AND THERE IS AN EMAIL ADDRESS IN EADDRESS, FILL THAT INFORMATION HERE.
MAILFU [IF INCNTFU2 = 3 OR 4] Please enter the address you want us to mail the gift card to. If you’d like an electronic gift card instead, click Back to change your selection.
Street address 1: [MADDRESS]
Street address 2: [MADDRESS2]
Please enter your city.
City: [MCITY]
Please enter your state.
State: [MSTATE]
Please enter your zip code.
Zip: [MZIP]
PROGRAMMER: IF THE RESPONDENT GETS TO THIS SCREEN, AND THERE IS AN ADDRESS IN MAILINCENT, FILL THAT INFORMATION HERE.
FIEXIT [IF RECRUIT1= 1] Please click CONTINUE.
CONTINUE
[OTHERWISE] That is all the questions we have for you. Thank you for participating in the National Survey on Drug Use and Health.
Please click FINISH to end the survey.
FINISH
POSTEXIT [IF RECRUIT1= 1]
Please click the button below to use the online scheduling system to schedule a date and time for your follow-up interview. Although the interview averages about 60 minutes to complete, the appointments are scheduled in two-hour timeframes. Please specify your time zone from the dropdown list so that we can adjust the calendar accordingly. If you modify the time zone, click the refresh scheduler button. After you launch the online scheduler, you will not need to come back to this page.
PROGRAMMER: LINK TO LAUNCH SCHEDULER
[OTHERWISE] For more details on the National Survey on Drug Use and Health, this link takes you to a downloadable document at the NSDUH website that includes answers to common questions, website addresses and other information.
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | Caspar (she/her), Rachel |
| File Modified | 0000-00-00 |
| File Created | 2023-10-25 |