Form 1 Household Screener

Population Assessment of Tobacco and Health (PATH) Study (NIDA)

Attachment 3a - English
PATH Study Data Collection Instruments:
Household Screener
June 18, 2013

PATH
Household Screener
Version 7.5
Number of
questions

Section

PATH – Wave 1
Household Screener

Enumeration

13

Tobacco Use

6

Enumeration Check and Sample Selection

2

Relationships and Residential Tenure

5

Contact information -- household respondent

8

Contact information -- sampled person

9

2

PATH
Household Screener
Version 7.5
OMB Control Number: 0925-0664

Expiration Date: 11/30/2015

Public reporting burden for this collection of information is estimated to average 14 minutes per response,
including the time for reviewing instructions, searching existing data sources, gathering and maintaining
the data needed, and completing and reviewing the collection of information. An agency may not conduct
or sponsor, and a person is not required to respond to, a collection of information unless it displays a
currently valid OMB control number. Send comments regarding this burden estimate or any other aspect
of this collection of information, including suggestions for reducing this burden, to: NIH, Project Clearance
Branch, 6705 Rockledge Drive, MSC 7974, Bethesda, MD 20892-7974, ATTN: PRA (XXXX-XXXX). Do
not return the completed form to this address.

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ENUMERATION
PATH ID:

HM0001

Screen ID:

I am going to ask some questions about the people who think of this address as their main home.
This includes people who usually stay at this address but are temporarily away on business, on vacation,
in a hospital, or living at school in a dorm, fraternity or sorority.
It does not include college students who live in off-campus housing.
Including yourself, how many people live at this address and have no other place they usually live?
{PROGRAM NOTE: IF RE-ROUTED FROM HM0051, DISPLAY THIS INTERVIEWER INSTRUCTION}
RESPONDENT INDICATED THAT THE ORIGINAL NUMBER OF PEOPLE LIVING AT THIS ADDRESS
WAS WRONG AND NEEDS TO BE CORRECTED: You said someone else lives here, so I need to
confirm the number of people who think of this address as their main home. You told me that {LIST OF
ALL HH MEMBERS} live here, for a total of {NUMBER OF PEOPLE} people. How many people live here?
|__|__|__|

NUMBER OF PEOPLE

ASK: All households.
PROGRAM: Start enumeration timing here. The following variables – name, respondent flag, gender, age,
age range, ethnicity, race, military status, twin flag, and the misreported flag (HM0002 – HM0012) – should
appear as a grid. All enumeration information is entered in this grid.
PROGRAM: LIST OF ALL HH MEMBERS – display in Title case. If two names, connect with “and”; if more
than two names, put “, and” before the last HH member name. NUMBER OF PEOPLE – fill with total
number of people reported in household.
GO TO: IF RE-ROUTED FROM HM0051, GO TO HM0002[B] AFTER THE NUMBER OF PEOPLE IS
CORRECTED.

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PATH ID:

HM0002

Screen ID:

[A]
What is {your first name | the first name of the person, or one of the persons, who lives at this
address and owns or rents this home}? ________________________________________
[PROGRAM NOTE: IF RE-ROUTED FROM HM0051, DISPLAY THIS INTERVIEWER INSTRUCTION
BEFORE QUESITON B]
YOU ARE ADDING HOUSEHOLD MEMBER(S). ASK ALL QUESTIONS ABOUT THE ADDED
HOUSEHOLD MEMBER(S)
[B]

Next, please tell me the first names of all other members of this household.

IF TWO HOUSEHOLD MEMBERS HAVE THE SAME FIRST NAME, ASK FOR A MIDDLE INITIAL OR A
SUFFIX (SUCH AS JUNIOR OR SENIOR) TO DISTINGUISH THEM.
______________________________________________________
ASK: All households.
PROGRAM:
If HM0001 = 1 then display “your first name”, else display “the first name of the person, or one of the
persons, who lives at this address and owns or rents this home”.
If HM0001 = 1, do not ask HM0002[B].
The person listed in [A] is the reference person. This variable should appear as the first column on the
nd
grid. For the 1st line on the grid, display text A. For the 2 line, display text B.
PATH ID:

HM0003

Screen ID:

ENTER 1 NEXT TO THE RESPONDENT’S NAME
[IF NOT OBVIOUS, ASK: Thank you for telling me the names of the people who live here. Now I need to
ask your name, so I know who I am talking to.]
ASK: All households with more than one person (if needed, as determined by the interviewer). Do not
ask this question of households with one member.
PROGRAM: This variable should appear as the 2nd column on the grid. Allow only 1 response to this
question.
PROGRAM: Go through items HM0005 – HM0012 (following appropriate skips), for each household
member. Complete all items for each household member before going to the next household member.
Start with reference person (person A in in HM0002) and proceed to additional household members in the
order in which they were reported by the respondent.
When there are no additional household members, go to HM0013.

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PATH ID:

HM0005

Screen ID:

What is {your / NAME’s} sex?
1

MALE

2

FEMALE

-8

DON’T KNOW

-7

REFUSED

ASK: All households about each household member.
PROGRAM: This variable should appear as the third column on the grid. Fill in NAME with the first name
of each household member, in turn from HM0002. For {Are you/Is NAME}, if asking about screener
respondent, display “your”. Else display “NAME’s”.
DISPLAY: QxQ #S1 AVAILABLE FOR “sex”.
PATH ID:

HM0006

Screen ID:

How old {are you/is NAME}?
IF PERSON IS UNDER 1 YEAR, ENTER “0”.
1

|__|__|__|

(IF <99, GO TO HM0008

-8

DON’T KNOW

GO TO HM0008

-7

REFUSED

GO TO HM0008

ASK: All households, about each household member.
PROGRAM: This variable should appear as the fourth column on the grid. For {are you/is NAME}, if
asking about screener respondent, display “are you”. Else display “is NAME” and fill with appropriate
name in Title case.
If AGE >= 0 AND AGE < 17 GO TO HM0010, IF AGE >= 17 AND AGE <= 99, GO TO HM0009.
If AGE > 99, GO TO HM0007.
PATH ID:

HM0007

Screen ID:

I just need to check that {your/NAME’s} age is {HM0006}. Is this right?
1

YES

GO TO HM0009

2

NO

GO TO HM0006

-8

DON’T KNOW

GO TO HM0009

-7

REFUSED

GO TO HM0009

ASK: All households, about each household member whose age was reported as > 99.
PROGRAM: For {your/NAME’s}, if asking about screener respondent, display “your”. Else display
“NAME’s” and fill with appropriate name in Title case.

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PATH ID:

HM0008

Screen ID:

Please look at this list. {Are you/Is NAME}…
READ RESPONSE OPTIONS ALOUD.
1

Under 9 years old,

2

9 to 11 years old,

3

12 to 17 years old,

4

18 to 24 years old,

5

25 to 29 years old, or

6

30 years old or older?

-8

DON’T KNOW

-7

REFUSED

ASK: All households, about any household member for whom exact age (HM0006) was DK or R.
PROGRAM: This variable should appear as the fifth column on the grid. For [Are you/Is NAME], if asking
about screener respondent, display “Are you”. Else display “Is NAME”.
DISPLAY: Digital showcard #1.
GO TO: ALL respondents GO TO HM0009, including those that answered DON’T KNOW and REFUSED
to HM0008 and HM0006.
PATH ID:

HM0009

Screen ID:

{Are you/Is NAME} currently serving on active duty in the U.S. Armed Forces, Military Reserves or
National Guard?
[Active duty for the Reserves or National Guard does not include the regular training for the Reserves or
Guard. It does include being activated for deployment such as for the Iraq War.]
1

YES

2

NO

-8

DON’T KNOW

-7

REFUSED

ASK: All households, about each HH member whose AGE is >= 17 years old OR each HH member where
HM0008 = 4,5,6, DK, R.
PROGRAM: Active duty military (HM0009 = 1) are ineligible for the study. This variable should appear as
the tenth column on the grid. For [Are you/Is NAME], if asking about screener respondent, display “Are
you”. Else display “Is NAME”.
GO TO: If a HH member is active duty military, ask the rest of the demographic section about them, but
do not ask the tobacco use questions.

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PATH ID:

HM0010

Screen ID:

{Are you/Is NAME} Hispanic, {Latino I Latina I Latino or Latina}, or of Spanish origin?
1

YES

2

NO

GO TO HM0011

-8

DON’T KNOW

GO TO HM0011

-7

REFUSED

GO TO HM0011

ASK: All households, about each HH member.
PROGRAM: For {Are you/Is NAME}, if asking about screener respondent, display “Are you”. Else display
“Is NAME”. If male (HM0005 = 1), display “Latino”; if female (HM0005 = 2), display “Latina”; if sex is
unknown (HM0005 = -8 or -7, display “Latino or Latina”.
PATH ID:

HM0050

Screen ID:

What is {your/NAME’s} origin? Please look at this list and choose all that apply.
READ RESPONSE OPTIONS ALOUD.
1

Mexican, Mexican American, [Chicano I Chicana I Chicano or Chicana],

2

Puerto Rican,

3

Cuban, or

4

Another Hispanic, [Latino I Latina I Latino or Latina], or Spanish origin?

-8

DON’T KNOW

-7

REFUSED

ASK: All households, about each HH member where HM0010 = 1.
PROGRAM: For {your/NAME’s}, if asking about screener respondent, display “your”. Else display
“NAME’s”. If male (HM0005=1), display “Chicano” and “Latino”; if female (HM0005=2), display “Chicana”
and “Latina”; if sex is unknown (HM0005 = -8 or -7, display “Chicano or Chicana” and “Latino or Latina”.
DISPLAY: If male (HM0005=1), display digital showcard #2M. If female (HM0005=2), display digital
showcard #2F. If sex is unknown (HM0005=-8 or -7), display digital showcard #2O.

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PATH ID:

HM0011

Screen ID:

What is {your/NAME’s} race? Please look at this list and choose all that apply.
READ RESPONSE OPTIONS ALOUD.
1

White,

2

Black or African American,

3

American Indian or Alaska Native,

4

Asian, or

5

Native Hawaiian or Other Pacific Islander?

-8

DON’T KNOW

-7

REFUSED

ASK: All households, about each HH member.
PROGRAM: For [your/NAME’s], if asking about screener respondent, display “your”. Else display
“NAME’s”.
DISPLAY: Digital showcard #3.
PATH ID:

HM0012

Screen ID:

DO NOT ASK THIS QUESTION.
WAS ANYONE IN THE HOUSEHOLD MISREPORTED AS A HOUSEHOLD MEMBER? LEAVE EMPTY
UNLESS THE RESPONDENT HAS TOLD YOU THAT SOMEONE WAS MISREPORTED. IF
MISREPORTED, ENTER ‘X’.
PRESS ENTER TO CONTINUE.
PROGRAM: This variable should appear as the eleventh column on the grid.
The default for this field is blank – it will only be filled if necessary.
BOX H1
PROGRAM:
If the household has two or more household members with AGE = the same value and AGE is >= 9 and
<= 17, go to HM0014
ELSE, go to BOX H2

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PATH ID:

HM0014

Screen ID:

You told me that there are some children who are the same age. Are { they twins | any of them twins or
other multiple births}?
Please include any type of {twins I twins or other multiple births} – identical or non-identical, who are also
called fraternal.
[Multiple Births refer to twins, triplets, quadruplets, etc.]
1

YES

GO TO HM0015

2

NO

GO TO BOX H2

-8

DON’T KNOW

GO TO BOX H2

-7

REFUSED

GO TO BOX H2

ASK: Households where two or more household members have AGE = the same value and AGE is >= 9
and <= 17.
PROGRAM: If there are 2 children who are the same age, fill with “they twins” and “twins”. If there are 3
or more children who are the same age, fill with “any of them twins or other multiple births” and “twins or
other multiple births”.
DISPLAY: QxQ #S2 AVAILABLE FOR “twins”, “multiple births”, and “identical or non-identical”.
PATH ID:

HM0015

Screen ID:

Please tell me which of the children are {twins | twins or other multiple births}. [Multiple births refers to
twins, triplets, quadruplets, etc.]
ENTER AN X NEXT TO EACH CHILD WHO IS A TWIN OR MULTIPLE BIRTH
IF NEEDED: [The children who are the same age are: {NAME/AGE, NAME/AGE, NAME/AGE…}]
WHEN YOU ARE FINISHED ENTERING ALL THE TWINS/MULTIPLE BIRTHS, ENTER 1 TO
CONTINUE
ASK: About HH twins (HM0014 = 1) whose AGE is >= 9 and <= 17.
PROGRAM: This variable should appear as the twelfth column on the grid. The default for this field is
blank – it will only be filled if necessary. If there are 2 children who are the same age, fill with “twins”. If
there are 3 or more children who are the same age, fill with “twins or other multiple births”. Fill
{NAME/AGE} with the names and ages of every child in the household that is the same age.
DISPLAY: QxQ #S3 AVAILABLE FOR “twins” and “multiple births”.

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TOBACCO USE
BOX H2

Screen ID:

{PROGRAM: IF THE HOUSEHOLD HAS ONE ADULT}. These next questions are about tobacco.
[Tobacco use questions are not asked about youth under age 18 or about adults serving on active duty
military.]
{PROGRAM: IF THE HOUSEHOLD HAS 2 OR MORE ADULTS} These next questions are about tobacco.
I am going to ask about the tobacco use of each adult you’ve told me about. [Tobacco use questions are
not asked about youth under age 18 or about adults serving on active duty military.]
PROGRAM: If HM0001=1, use the first phrase. If HM0001>1, use the second phrase.
PATH ID:

HY1003

Screen ID:

Please look at this picture. {Do you/ Does NAME} now smoke cigarettes, cigars, or pipes every day, some
days, or not at all?
1

EVERY DAY

2

SOME DAYS

3

NOT AT ALL

-8

DON’T KNOW

-7

REFUSED

ASK: All households, about each household member AGE>=18 who is not active duty military.
PROGRAM: For [Do you/Does NAME], if asking about screener respondent, display “Do you” ELSE
display “Does NAME”.
DISPLAY: Digital showcard #4.
PATH ID:

HS1003

Screen ID:

Please look at this picture. {Do you/Does NAME} now use smokeless tobacco products, such as chewing
tobacco, snuff or dip every day, some days, or not at all?
[Do not include snus, e-cigarettes or products such as a nicotine patch, gum, inhaler, nasal spray, lozenge
or pill].
1

EVERY DAY

2

SOME DAYS

3

NOT AT ALL

-8

DON’T KNOW

-7

REFUSED

ASK: All households, about each household member AGE>=18 who is not active duty military.
PROGRAM: For [Do you/Does NAME], if asking about screener respondent, display “Do you” ELSE
display “Does NAME”.
DISPLAY: Digital showcard #5.

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PATH ID:

HE1003

Screen ID:

Now please think about other tobacco products that {you may have/NAME may have} used at any point in
{your/his/her/their} life.
Please look at this picture. {Have you/Has NAME} ever used an electronic cigarette or e-cigarette, such as
NJOY, Blu, or Smoking Everywhere, even one or two times?
1

YES

2

NO

-8

DON’T KNOW

-7

REFUSED

ASK: All households, about each household member AGE>=18 who is not active duty military.
PROGRAM: If asking about screener respondent, display “you may have” and “Have you” ELSE display
“NAME may have” and “Has NAME”. For [your/his/her], if asking about screener respondent, display
“your” ELSE display “his” if NAME is male or “her” if NAME is female or “their” if NAME is DK/R.
DISPLAY: Digital showcard #6.
PATH ID:

HH1002

Screen ID:

Please look at this picture. {Have you/Has NAME} ever smoked tobacco in a hookah or waterpipe, even
one or two times?
1

YES

2

NO

-8

DON’T KNOW

-7

REFUSED

ASK: All households, about each household member AGE>=18 who is not active duty military.
PROGRAM: For {Have you/Has NAME} if asking about screener respondent, display “Have you” ELSE
display “Has NAME”.
DISPLAY: Digital showcard #7.
PATH ID:

HU1002

Screen ID:

Please look at this picture. {Have you/Has NAME} ever used snus, even one or two times?
1

YES

2

NO

-8

DON’T KNOW

-7

REFUSED

ASK: All households, about each household member AGE>=18 who is not active duty military.
PROGRAM: For {Have you/Has NAME} if asking about screener respondent, display “Have you” ELSE
display “Has NAME”.
DISPLAY: Digital showcard #8.

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PATH ID:

HD1002

Screen ID:

Please look at this picture. {Have you/Has NAME} ever used dissolvable tobacco products, such as
Ariva, Stonewall, or Camel Orbs, Sticks or Strips, even one or two times?
[Do not include e-cigarettes or products such as a nicotine patch, gum, inhaler, nasal spray, lozenge or
pill.]
1

YES

2

NO

-8

DON’T KNOW

-7

REFUSED

ASK: All households, about each household member AGE>=18 who is not active duty military.
PROGRAM: For {Have you/Has NAME} if asking about screener respondent, display “Have you” ELSE
display “Has NAME”.
DISPLAY: Digital showcard #9.

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ENUMERATION CHECK AND SAMPLE SELECTION
PROGRAM NOTE: IF RESPONDENT WAS RE-ROUTED TO CORRECT THE NUMBER OF
HOUSEHOLD MEMBERS, SKIP HM0020-HM0051 AND GO TO BOX H3.
PATH ID:

HM0020

Screen ID:

[The tobacco use questions I just asked you are not asked about youth under age 18 or about adults
serving on active duty military.]
{I just asked you questions about {NUMBER} household members: {LIST ALL HH MEMBERS}.}
Before we move on, I just want to confirm, is there anyone else who lives at this address?
1

YES

GO TO HM0051

2

NO

GO TO BOX H3

PROGRAM: Display “I just asked you questions about {NUMBER} household member(s): {LIST ALL HH
MEMBERS} only if there are two or more HH members. If one member in HH, do not display this
sentence, and only display “Before we move on, I just want to confirm, is there anyone else who lives at
this address?”
For “{NUMBER}”, display the number of household members collected in the enumeration grid.
For {LIST ALL HH MEMBERS}, display the first name of each household member collected in the grid. If
two HH members, connect names with “and”; if more than two HH members, put “, and” before last name
in list.
PATH ID:

HM0051

Screen ID:

People who live at this address consider it their main home. This might include people who are
temporarily away on business, vacation, in a hospital, or away at college.
For college students, include people who are living in a dorm, fraternity or sorority, but do not include
people who are living in off-campus housing.
You just mentioned that someone else lives at this address. Is that correct?
1

YES

GO TO HM0001

2

NO

GO TO BOX H3

ASK: If HM0020=1

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BOX H3
PROGRAM: DEFINE THE FOLLOWING VARIABLES IN THE SAMPLING ALGORITHM:
SHADOW9TO11
YOUTH12TO17
PH1ADULT
ACTDUTY
SHADOWNUM
YOUTHNUM
ADULTNUM
SHDTWINNUM
YTHTWINNUM
PH1AGE
PH1BLACK
PH1TOBEST
PH1TOBEMG
PH1TOBSTATUS
PH1TOBSTATUS2
PH1PROBSUM
SMPPH1ADLT
PH1PROBADJ
PH1PROB
PH1CUMPROB
SMPPH1ADULT
SMPPH1ADTNUM
ENTER 1 TO CONTINUE. YOU WILL NOT BE ABLE TO GO BACK AND MAKE CHANGES AFTER YOU
CONTINUE PAST THIS POINT.
{PROGRAM: Run the sampling algorithm. Eligibility is determined when the enumeration and tobacco use
identification are completed or screens below SP=Sampled Person. If an SP has been selected, GO TO
HX0014. Else if no household member is selected, end screener and DISPLAY:}
“Thank you for your time today. Based on the information you’ve given us, your household has not been
selected for participation in the study.”
GO TO DU INCENTIVE WRAPPER
PROGRAM: Set a gate–interviewer CAN NOT GO BACK after sampling algorithm is run.

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PATH ID:

HX0014

Screen ID:

PROGRAM: DISPLAY:
Based on the information you have provided, we have selected {SP FILL 1}, {SP FILL 2}, {SP FILL 3}, {SP
FILL 4}, {SP FILL 5}, {SP FILL 6}, {SP FILL 7}, {SP FILL 8}, and {SP FILL 9} to participate in the study.
PROGRAM: IF A SHADOW SAMPLE CHILD IS SELECTED, ALSO DISPLAY THE FOLLOWING:
{In addition}, we would {also} like to talk to a parent of {APPROPRIATE CHILDREN’S NAMES} about
inviting {him/her/them} to participate in the study when {he/she/they} {turn/turns} 12.
PROGRAM: IF A SHADOW SAMPLE CHILD IS THE ONLY SP SELECTED IN THE HH, ONLY DISPLAY
THE FOLLOWING:
Based on the information you have provided, we would like to talk to a parent of {APPROPRIATE
CHILDREN’S NAMES} about inviting {him/her/them} to participate in the study when {he/she/they}
{turns/turn} 12. No one else has been selected to participate in the study.
ENTER 1 TO CONTINUE
1

CONTINUE

PROGRAM: For each SP selected, NAME / AGE / GENDER. IF SPs and shadow sampled youth are
selected in this household, display words in brackets. If the household respondent is selected, display
them last as “and you”

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RELATIONSHIP AND RESIDENTIAL TENURE
BOX H4
IF THERE IS ONLY ONE PERSON IN THE HOUSEHOLD, SKIP HX0020, HX0015, HX0021, HX0018,
GO TO HX0016. Assign ‘01’ IN THE RELATIONSHIP GRID.
PATH ID:

HX0020

Screen ID:

Next, I have some questions about the relationships among the people who live here.
ENTER 1 TO CONTINUE
1

CONTINUE

ASK: All households where more than one SP was selected.
PATH ID:

HX0015

Screen ID:

What is {NAME’s/your} relationship to {you/SP}? In other words, {NAME/you} is/are {your/SP’s} {wife,
sister, daughter | husband, brother, son}....?
1

SELECTED PERSON (SP)

2

WIFE / HUSBAND

3

DOMESTIC PARTNER

4

FIANCÉ

5

BOYFRIEND / GIRLFRIEND

6

SON / DAUGHTER (BIOLOGICAL, ADOPTED, OR STEP)

7

FOSTER SON / FOSTER DAUGHTER

8

SON-IN-LAW / DAUGHTER-IN-LAW

9

GRANDSON / GRANDDAUGHTER (BIOLOGICAL, ADOPTED, OR STEP)

10

BROTHER / SISTER (BIOLOGICAL, ADOPTED, OR STEP)

11

BROTHER-IN-LAW / SISTER-IN-LAW

12

MOTHER / FATHER (BIOLOGICAL, ADOPTED, OR STEP)

13

MOTHER-IN-LAW / FATHER-IN-LAW

14

GRANDMOTHER / GRANDFATHER (BIOLOGICAL, ADOPTED, OR STEP)

15

COUSIN

16

UNCLE / AUNT

17

NEPHEW / NIECE

18

OTHER RELATIVE

19

OTHER NON-RELATIVE (ROOMMATE OR HOUSEMATE)

-8

DON’T KNOW

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-7

REFUSED

ASK: All households, about each SP and shadow sampled youth.
PROGRAM:
DISPLAY: QxQ #S4 AVAILABLE FOR ”relationship”.
If {NAME/you} is female (HM0005=2), display ‘wife, sister, daughter’; if {NAME/you} is male (HM0005=1),
display ‘husband, brother, son’; if sex of {NAME/you} is unknown (HM0005=-8, -7}, display ‘wife, brother,
niece’.
Ask HX0015 for each household member reported on enumeration grid in relation to SP #1. Repeat for SP
#2, SP #3, SP #4, SP #5, SP #6, SP #7, SP #8, SP #9 as needed.
For {NAME’s/your}, when collecting information about screener respondent’s relationship to any SP,
display “your”. Else display name of each household member collected in enumeration grid in “NAME’s”.
For {SP/you}, if screener respondent = SP, display “you”. Else display SP name in {SP}.
For response options, if HM0005 = 1, then display: 2=Husband; 3=Domestic Partner, 4=Fiancé,
5=Boyfriend; 6=Son (biological, adopted, or step); 7= Foster son; 8=Son-in-law; 9=Grandson (biological,
adopted, or step); 10=Brother (biological, adopted, or step); 11=Brother-in-law; 12=Father (biological,
adopted, or step); 13=Father-in-law; 14=Grandfather (biological, adopted, or step); 15=Cousin; 16=Uncle;
17=Nephew; 18=Other relative; 19=Roommate, housemate, or other non-relative.
Else If HM0005 = 2, then display: 2=Wife; 3=Domestic Partner, 4=Fiancé, 5=Girlfriend; 6=Daughter
(biological, adopted, or step); 7= Foster daughter; 8=Daughter-in-law; 9=Granddaughter (biological,
adopted, or step); 10=Sister (biological, adopted, or step); 11=Sister-in-law; 12=Mother (biological,
adopted, or step); 13=Mother-in-law; 14=Grandmother (biological, adopted, or step); 15=Cousin; 16=Aunt;
17=Niece; 18=Other relative; 19=Roommate, housemate, or other non-relative.
When collecting information for screener respondent, if screener respondent = SP, assign ‘01’ and go to
next name in relationship grid.
IMPLEMENT THE FOLLOWING LOGIC CHECKS:
AFTER A RESPONSE IS SELECTED, CONFIRM THE RESPOSE BY DISPLAYING THE FOLLOWING:
INTERVIEWER: I have that {NAME/you} is/are {SP’s/your} [ANSWER]? Is that right? IF THE ANSWER
IS NO, DISPLAY INSTRUCTION FOR INTERIVEWER TO GO BACK AND CHANGE ANSWER, ALLOW
THE INTERVIEWER TO CORRECT IT.
BOX H5
PROGRAM:
All households, in which for any given youth SP or shadow youth, more than 2 parents (father, mother,
step-father, step-mother) are listed in HX0015, GO TO HX0021.
All households, about sampled youth or shadow sampled youth for whom a mother/father or stepmother/step-father was not identified in HX0015, GO TO HX0018.
Else GO TO HX0016.

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Household Screener
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PATH ID:

HX0021

Screen ID:

The next question is about {SP YOUTH FIRST NAME}’s parents.
I have recorded that {FILL} are {SP YOUTH FIRST NAME}’s parents. Is that right?
1

YES

GO TO HX0016

2

NO, I NEED TO CHANGE MY ANSWER

GO TO HX0015

-8

DON’T KNOW

-7

REFUSED

ASK: All households, about sampled youth or shadow sampled youth for whom more than 2 parents
(mother/father or step-mother/step-father) are listed in HX0015.
PROGRAM: For {FILL}, fill with first names of parents identified in HX0015. If two names are listed,
connect with “and”; if more than two are listed, put “, and” before last name in list. For {SP YOUTH
NAME}, display first name of youth SP from enumeration grid.
PATH ID:

HX0018

Screen ID:

The next question is about {SP YOUTH FIRST NAME}’s parent.
Can you tell me who {SP YOUTH NAME}’s parent or guardian is?
{PROGRAM: DISPLAY LIST OF ALL PEOPLE IN HOUSEHOLD EXCEPT [SP YOUTH] ORDERED BY
AGE FROM OLDEST TO YOUNGEST}
PICK PARENT OR GUARDIAN (S) FROM LIST.
94

SP YOUTH IS EMANCIPATED

95

PARENT OR GUARDIAN IS NOT ON THE LIST
INTERVIEWER CLARIFY: _____________________

-8

DON’T KNOW

-7

REFUSED

ASK: All households, about sampled youth or shadow sampled youth for whom a mother/father or stepmother/step-father was not identified in HX0015.
PROGRAM: For {SP YOUTH NAME}, display first name of youth SP from enumeration grid.
PATH ID:

HX0016

Screen ID:

Do you own or rent your home?
1

HOME IS OWNED BY ANY HOUSEHOLD MEMBER

2

HOME IS RENTED BY ANY HOUSEHOLD MEMBER

3

OTHER

-8

DON’T KNOW

-7

REFUSED

ASK: All households.

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Household Screener
Version 7.5
PATH ID:

HX0017

Screen ID:

We want to be sure that every household in this area has been given a chance to participate in this
important study. Is there any other person or group of people you haven’t already told me about who lives
and receives mail {here/at ADDRESS}?
ALSO INCLUDE PEOPLE WHO LIVE HERE AND GET MAIL ONLY AT A P.O. BOX. A YES ANSWER
TO THIS QUESTION WILL LAUNCH THE ADDED HOUSEHOLD PROCEDURE AFTER THE CONTACT
INFORMATION SECTION.
1

YES

2

NO

-8

DON’T KNOW

-7

REFUSED

ASK: All households EXCEPT those added as multi-units at a base address and those added as a result
of the Add Household Procedure.
PROGRAM: If don’t know house number and/or street name, display “here”. Else display “at ADDRESS”
and fill ADDRESS with address.
GO TO: If yes, launch hidden DU procedure at the end of the screener. If no, do not launch the hidden
DU procedure. Do not repeat this question a second time in the launched hidden DU procedure.

BOX H6
Define the following variable: EYOUTH
If (AGE < 18 AND EMANCIPATEDYOUTHDU = 1) Then EYOUTH = 1
If (AGE < 18 AND HX0018 = 94) Then EYOUTH = 1
Else EYOUTH = 2.

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Household Screener
Version 7.5

CONTACT INFORMATION
PATH ID:

HL0001

Screen ID:

I’d like to take a brief moment and get some of your contact information for my records. {In addition, I’d like
your help in getting some basic contact information for {ADULT SPs} {and} {the} parents or guardians of
{YOUTH SPs}.
ENTER 1 TO CONTINUE
1

CONTINUE

PROGRAM: If there are any adult SPs, fill {ADULT SPs} with the first names of all adult SPs – do not list
the household respondent’s name if he or she is selected as an SP. If youth SPs have been selected,
display “and the” followed by the list of youth SP names. If only youth SPs have been selected (and no
adult SPs), omit “and” and display “the” followed by the youth SP names Separate lists of names with a
comma, and precede the last in the list with “and” as appropriate.
If a single adult household or if the screener respondent is the only SP in the household, do not display
the second sentence.
PATH ID:

HL0002

Screen ID:

Can you tell me your full name?
VERIFY ALL SPELLING. IF PERSON HAS NO MIDDLE NAME, LEAVE MIDDLE INITIAL BLANK. IF
NEEDED: [Full name includes first name, middle initial, and last name.]
NAME: ______________________________________________________________
FIRST
MI
LAST
I need to confirm your street address. Is this address correct?
{PROGRAM: DISPLAY ADDRESS FROM THE SAMPLE FILE IN AN EASY TO READ FORMAT}
READ ADDRESS. VERIFY ALL SPELLING. PROBE FOR APARTMENT NUMBER IF NEEDED. DO
NOT ENTER A PO BOX HERE.
___________________________________________________________________
STREET
APT #
___________________________________________________________________
CITY
STATE
ZIP
-8

DON’T KNOW

-7

REFUSED

ASK: Household respondent about themselves.
PROGRAM: Pre-populate name (first) field based on HM0003. Fill street address, apartment #, city,
state, zip, from sample list. If the first name is don’t know or refused, continue on to ask MI and LAST. If
Street is DON’T KNOW or REFUSED, continue on to ask the rest of the address fields.

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PATH ID:

HL0003

Screen ID:

Do you receive mail at the address you just gave me?
1

YES

2

NO

-8

DON’T KNOW

-7

REFUSED

GO TO HL0005

ASK: Household respondent about themselves.
PATH ID:

HL0004

Screen ID:

Can I please have your mailing address?
VERIFY ALL SPELLING.
__________________________________________________________________
MAILING ADDRESS
__________________________________________________________________
CITY
STATE
ZIP
ASK: Household respondent about themselves, who don’t get mail at their street address (HL0003 =
2,DK,R).
PROGRAM: If Mailing Address is DON’T KNOW or REFUSED, continue on to ask the rest of the address
fields.
PATH ID:

HL0005

Screen ID:

What is the best telephone number to reach you?
ENTER THE NUMBERS ONLY. DO NOT ENTER HYPHENS OR OTHER SYMBOLS.
__________
_________________________
_____
AREA CODE
PHONE NUMBER
EXT.
-8

DON’T KNOW

GO TO HL0009

-7

REFUSED

GO TO HL0009

ASK: Household respondent about themselves.
PROGRAM: If the area code is DON’T KNOW or REFUSED, do not ask the rest of the phone number or
the extension.

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Household Screener
Version 7.5
PATH ID:

HL0006

Screen ID:

Is this a home or cell phone number?
1

HOME

2

CELL

3

OTHER

-8

DON’T KNOW

-7

REFUSED

ASK: Household respondent about themselves, who provided a best telephone number in HL0005.
PATH ID:

HL0007

Screen ID:

Is there a second telephone number where you can be reached?
ENTER THE NUMBERS ONLY. DO NOT ENTER HYPHENS OR OTHER SYMBOLS.
__________
_________________________ _____
AREA CODE
PHONE NUMBER
EXT.
-8

DON’T KNOW

GO TO HL0009

-7

REFUSED

GO TO HL0009

ASK: Household respondent about themselves who provided a best telephone number in HL0005.
PROGRAM: If the area code is DON’T KNOW or REFUSED, do not ask the rest of the phone number or
the extension.
PATH ID:

HL0008

Screen ID:

Is this a home or cell phone number?
1

HOME PHONE

2

CELL PHONE

3

OTHER

-8

DON’T KNOW

-7

REFUSED

ASK Household respondent about themselves who provided a second telephone number in HL0007.

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Household Screener
Version 7.5
PATH ID:

HL0016

Screen ID:

Can you please give me your e-mail address?
VERIFY ALL SPELLING AND PUNCTUATION. RECORD TEXT BEFORE @ SYMBOL IN THE EMAIL
NAME FIELD. TEXT AFTER THE @ SYMBOL IS ENTERED IN THE EMAIL PROVIDER FIELD.
_____________________________@________________
E-MAIL ADDRESS
ASK: Household respondent about themselves.
DISPLAY INSTRUCTIONS:
[PROGRAMMING NOTE: FOR SPECIFICATION PURPOSES, THE PERSON FOR WHOM THE CI IS
BEING COLLECTED IS REFERRED TO AS THE “TARGET” IN HL0009 to HL0027.]
PROGRAM:
Full name is collected for all TARGETS. TARGETS are adult SP’s, parents or guardians of youth SP’s
and shadow youth, and youth SP’s and shadow youth.
For [SP ARRAY] create an array that holds the name of each adult SP and youth SP. Do not include the
household respondent. The array should hold the first name provided in (HM0002).
PATH ID:

HL0009

Screen ID:

PROGRAM NOTE: IF ADULT OR YOUTH SPs WERE SELECTED, WITH OR WITHOUT SHADOW
YOUTH, DISPLAY THE FOLLOWING:
As I mentioned, the computer has selected [LIST ALL NAMES IN SP ARRAY | and you] to be in the study.
I’d like your help in getting some basic contact information. {For [YOUTH SPs | and [SHADOW YOUTH]}, I
will ask for contact information for their parent or guardian.] [This information will be used only for the
purposes of this study.]
PROGRAM NOTE: IF NO ADULT OR YOUTH SPs WERE SELECTED, BUT SHADOW YOUTH WERE
SELECTED, DISPLAY THE FOLLOWING:
The computer has selected [SHADOW YOUTH’S NAME] to participate in the study when {he/she/they}
{turn/turns} 12 years old. I’d like your help in getting some basic contact information for their parent or
guardian. [This information will be used only for the purposes of this study.]
ENTER 1 TO CONTINUE.
1

CONTINUE

PROGRAM: Display all names, separated by commas, with “, and’ before the last name in the array. If
the household respondent is an SP, display all names separated by commas with “and you”. Include the
sentence in brackets only if there are youth SP’s AND/OR shadow youth. Display their names where
specified.
ASK: HL0010 to HL0027 about all targets. Do not ask these questions about the household respondent if
he or she is selected as an SP.

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Household Screener
Version 7.5
PATH ID:

HL0010

Screen ID:

Can I have [TARGET]’s full name?
VERIFY ALL SPELLING. [TARGET] IS [FILL] OF [YOUTH SP OR SHADOW YOUTH NAME.] IF
PERSON HAS NO MIDDLE NAME, LEAVE MIDDLE INITIAL BLANK.
NAME: ___________________________________________________________
FIRST
MI
LAST
ASK: Targets are each adult SP AND each parent, step-parent or guardian of a youth SP or shadow
sample youth AND each youth SP AND each shadow sample youth. Ask one time for each target. Do not
ask if target was the household respondent.
PROGRAM: Fill [TARGET] in the question and interviewer instruction with the first name of the target
(HM0002). To select the appropriate parent or guardian target, refer to the relationship matrix (HX0015).
If no parent/step-parent is identified in HX0015 for youth/shadow-youth SP, use response to HX0018.
Fill [FILL] in the interviewer instruction with “SELECTED AS AN ADULT” if the target is an adult SP. Fill
with “IS A PARENT OR GUARDIAN OF” if the target is the parent, step-parent or guardian of a youth SP
or shadow sample youth.
Fill [YOUTH SP OR SHADOW YOUTH NAME] with the SP youth’s or SP shadow youth’s name if the
target is a parent, step-parent or guardian.
If the first name in HL0010 is DON’T KNOW or REFUSED, continue on to ask MI and LAST.
GO TO:
IF TARGET IS YOUTH SP OR SHADOW YOUTH SP, GO TO END.
IF TARGET IS ADULT SP, PARENT, STEP-PARENT OR GUARDIAN OF A YOUTH SP OR SHADOW
YOUTH, CONTINUE TO HL0011.
PATH ID:

HL0011

Screen ID:

What is the best phone number to reach [TARGET]?
ENTER THE NUMBERS ONLY. DO NOT ENTER HYPHENS OR OTHER SYMBOLS.
__________
________________________ ______
AREA CODE
PHONE NUMBER
EXT.
-8

DON’T KNOW

GO TO HL0015

-7

REFUSED

GO TO HL0015

ASK: About each target. Do not ask about household respondent if he or she is selected as an SP. Do
not ask about youth SP’s or shadow youth. Ask one time for each target.
PROGRAM: If the area code is DON’T KNOW or REFUSED, do not ask the rest of the phone number or
the extension.

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Household Screener
Version 7.5
PATH ID:

HL0012

Screen ID:

Is this a home or cell phone number?
1

HOME PHONE

2

CELL PHONE

3

OTHER

-8

DON’T KNOW

-7

REFUSED

ASK: About each target for whom a phone number was given. Do not ask about household respondent if
he or she is selected as an SP. Do not ask about youth SP’s or shadow youth. Ask one time for each
target.
PATH ID:

HL0013

Screen ID:

Does [TARGET] have a second telephone number?
ENTER THE NUMBERS ONLY. DO NOT ENTER HYPHENS OR OTHER SYMBOLS.
__________
____________________ __________
AREA CODE
PHONE NUMBER
EXT.
-8

DON’T KNOW

GO TO HL0015

-7

REFUSED

GO TO HL0015

ASK: About each target for whom a phone number was given. Do not ask about household respondent if
he or she is selected as an SP. Do not ask about youth SP’s or shadow youth. Ask one time for each
target.
PROGRAM: If the area code is don’t know or refused, do not ask the rest of the phone number or the
extension.
PATH ID:

HL0014

Screen ID:

Is this a home or cell phone number?
1

HOME PHONE

2

CELL PHONE

3

OTHER

-8

DON’T KNOW

-7

REFUSED

ASK: About each target for whom a second telephone number was provided in HL0013. Do not ask about
household respondent if he or she is selected as an SP. Do not ask about youth SP’s or shadow youth.
Ask one time for each target.

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PATH ID:

HL0015

Screen ID:

Can you please give me [TARGET]’s e-mail address?
VERIFY ALL SPELLING AND PUNCTUATION. RECORD TEXT BEFORE @ SYMBOL IN THE EMAIL
NAME FIELD. TEXT AFTER THE @ SYMBOL IS ENTERED IN THE EMAIL PROVIDER FIELD.
_____________________________@_______________
E-MAIL ADDRESS
-8

DON’T KNOW

-7

REFUSED

ASK: About each target. Do not ask about household respondent if he or she is selected as an SP. Do
not ask about youth SP’s or shadow youth. Ask one time for each target.
PATH ID:

HM0025

Screen ID:

How well does [TARGET] speak English? Would you say very well, well, not well, or not at all?
1

VERY WELL

GO TO HM0028

2

WELL

GO TO HM0028

3

NOT WELL

4

NOT AT ALL

-8

DON’T KNOW

-7

REFUSED

GO TO HM0027

ASK: About each target. Do not ask about household respondent if he or she is selected as an SP. Do
not ask about shadow youth. Ask one time for each target.
PATH ID:

HM0026

Screen ID:

Is [TARGET] able to speak English well enough to complete an interview in English?
1

YES

GO TO HM0028

2

NO

-8

DON’T KNOW

GO TO HM0028

-7

REFUSED

GO TO HM0028

ASK: About each target that does not speak English well (HM0025=3, -8, -7). Do not ask about household
respondent if he or she is selected as an SP. Do not ask about shadow youth. Ask one time for each
target.

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PATH ID:

HM0027

Screen ID:

Would [TARGET] be able to complete the interview in Spanish?
1

YES

2

NO

-8

DON’T KNOW

-7

REFUSED

ASK: About each target that does not speak English well enough (HM0026 = 2) to complete an interview
in English. Do not ask about household respondent if he or she is selected as an SP. Do not ask about
shadow youth. Ask one time for each target.
PATH ID:

HM0028

Screen ID:

{THE SAMPLED YOUTH DOES NOT HAVE A PARENT OR GUARDIAN LIVING IN THE HOUSEHOLD.
THE PARENT INTERVIEW AND YOUTH INTERVIEW WILL NOT BE COLLECTED FOR THIS
SAMPLED YOUTH.}
Thank you for taking the time to answer these questions.
ENTER 1 TO CONTINUE. THIS IS THE END OF THE PHASE 1 SCREENER.
1

CONTINUE

ASK: All households
PROGRAM: IF HX0018=95, display “THE SAMPLED YOUTH DOES NOT HAVE A PARENT OR
GUARDIAN LIVING IN THE HOUSEHOLD. THE PARENT INTERVIEW AND YOUTH INTERVIEW WILL
NOT BE COLLECTED FOR THIS SAMPLED YOUTH.”

PATH – Wave 1
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28