18 Social Cultural

ID NUMBER:

FORM CODE: SCE VERSION: A 7/04/07

Contact Occasion

SEQ #

OMB#: 0925-XXXX

Exp. XX/XXXX

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CHS/SOL Sociocultural Questionnaire

ID NUMBER:

FORM CODE: SCE VERSION: A 7/04/07

Contact Occasion

SEQ #

Acrostic:

Administrative Information

0a. Completion Date: // 0b. Staff ID:

Month Day Year

Instructions: Mark a check in the appropriate box for the response. Unless instructed, mark ONLY one response.

A. Acculturation

Although you may speak many languages, the following questions refer to only English and Spanish.

1. In general, what language(s) do you read and speak?

Only Spanish 1

Spanish better than English 2

Both equally 3

English better than Spanish 4

Only English 5

2. What was the language(s) you used as a child?

Only Spanish 1

More Spanish than English 2

Both equally 3

More English than Spanish 4

Only English 5

3. What language(s) do you usually speak at home?

Only Spanish 1

More Spanish than English 2

Both equally 3

More English than Spanish 4

Only English 5

4. In which language(s) do you usually think?

Only Spanish 1

More Spanish than English 2

Both equally 3

More English than Spanish 4

Only English 5

5. What language(s) do you usually speak with your friends?

Only Spanish 1

More Spanish than English 2

Both equally 3

More English than Spanish 4

Only English 5

6. In general, what language(s) are the movies, T.V. and radio programs you prefer to watch and listen to?

Only Spanish 1

More Spanish than English 2

Both equally 3

More English than Spanish 4

Only English 5

7. Your close friends are…

All Hispanic/Latino 1

More Hispanic/Latino than

non-Hispanic/non-Latino 2

About half and half 3

More non-Hispanic/non-Latino than

Hispanic/Latino 4

All non-Hispanic/non-Latino 5

8. You prefer going to social gatherings/parties at which people are…

All Hispanic/Latino 1

More Hispanic/Latino than

non-Hispanic/non-Latino 2

About half and half 3

More non-Hispanic/non-Latino than

Hispanic/Latino 4

All non-Hispanic/non-Latino 5

9. The persons you visit or who visit you are…

All Hispanic/Latino 1

More Hispanic/Latino than

non-Hispanic/non-Latino 2

About half and half 3

More non-Hispanic/non-Latino than

Hispanic/Latino 4

All non-Hispanic/non-Latino 5

10. If you could choose your children’s friends you would want them to be…

All Hispanic/Latino 1

More Hispanic/Latino than

non-Hispanic/non-Latino 2

About half and half 3

More non-Hispanic/non-Latino than

Hispanic/Latino 4

All non-Hispanic/non-Latino 5

B. Familism

Please show how much you agree or disagree with these statements by choosing the answer from 1 (disagree a lot) to 5 (agree a lot) which best shows how you feel about each statement.

11. One should have the hope of living long enough to see his/her grandchildren grow up.

Disagree a lot 1

Disagree 2

Don’t disagree or agree 3

Agree 4

Agree a lot 5

12. Aging parents should live with relatives.

Disagree a lot 1

Disagree 2

Don’t disagree or agree 3

Agree 4

Agree a lot 5

13. When someone has problems he/she can count on help from his/her relatives.

Disagree a lot 1

Disagree 2

Don’t disagree or agree 3

Agree 4

Agree a lot 5

14. Much of what a son or daughter does should be done to please the parents.

Disagree a lot 1

Disagree 2

Don’t disagree or agree 3

Agree 4

Agree a lot 5

15. One should be embarrassed about the bad things done by his/her brothers and sisters.

Disagree a lot 1

Disagree 2

Don’t disagree or agree 3

Agree 4

Agree a lot 5

16. Children should live in their parents’ house until they get married.

Disagree a lot 1

Disagree 2

Don’t disagree or agree 3

Agree 4

Agree a lot 5

C. Identity

There are many different words to describe the different backgrounds or ethnic groups that people come from. These questions are about your ethnicity and your ethnic group and how you feel about it or react to it. Choose the answer to indicate how much you agree or disagree with each statement.

17. I have a strong sense of belonging to my own ethnic group.

Strongly Disagree 1

Disagree 2

Agree 3

Strongly Agree 4

18. I have a lot of pride in my ethnic group.

Strongly Disagree 1

Disagree 2

Agree 3

Strongly Agree 4

D. Religion

19. In general, how often do you attend the main worship service of your church or otherwise participate in organizational religion (such as watching services on TV, listening to services on the radio, participate in Bible study groups, etc)?

Nearly every day 1

At least once a week 2

A few times a year 3

Less than once a year 4

Not at all 5

20. What religion would you identify yourself with?

None 01

Roman Catholic 02

Baptist 03

Pentecostal 04

Methodist (or Wesleyan) 05

Jehovah's Witness 06

Mormon 07

Christian (non-specified) or

"other Christian" 08

Jewish 09

Muslim 10

Other 11

21. How important would you say that religion and religious beliefs are to you?

Not at all important 1

A little important 2

Somewhat important 3

Pretty important 4

Very important 5

E. Perceived Discrimination

22. How often have you seen friends treated unfairly because they are Hispanic/Latino?

Never 1

Sometimes 2

Often 3

Always 4

23. How often do people treat you unfairly because you are Hispanic/Latino?

Never 1

Sometimes 2

Often 3

Always 4

Sociocultural Form (SCE) Page 0 of 5