Participant 6-month survey (Young Adult sites)

Appendix O.1

6-Month Follow-up Survey

OMB#: 0970-0413

Expiration Date: XX/XX/XXXX

Appendix O.1

6-Month Follow-Up Survey

for Youth/Young Adult Sites

5.15.13

RARESID – RA UNIQUE IDENTIFIER FROM SAMPLE FILE

FLNAME – RESPONDENT FULL NAME

RDOB – RESPONDENT DOB

RSSN – RESPONDENT’S LAST FOUR DIGITS OF SSN

RPHONE – TELEPHONE #

RPHONE2 – RESPONDENT ALTERNATE TELEPHONE#

RAMY – RANDOM ASSIGNMENT MONTH AND YEAR (MM/YYYY)

RA_CODE: C: Control; E: Treatment

LANG – RESPONDENT PRIMARY LANGUAGE

LIMIT_ENG – RESPONDENT IDENTIFIED AS LIMITED ENGLISH SPEAKING

RSEX – RESPONDENT SEX

FULLADD – FULL ADDRESS

RCITY – CITY

RSTATE – STATE

RZIP – ZIP

STEDPRO – Local STED Program

EMAIL – RESPONDENT EMAIL ADDRESS

TEXTPHONE – RESPONDENT TELEPHONE# FOR TEXT MESSAGES

ALTCONT1 – ALTERNATE CONTACT NAME AND INFORMATION

ALTCONT2 – ALTERNATE CONTACT NAME AND INFORMATION

RACE – RESPONDENT RACE

T_PHONE1 – UPDATED TELEPHONE# FROM TRACKING

T_PHONE2 – UPDATED TELEPHONE# FROM TRACKING

T_COMMENT – TRACKING NOTES

T_UPDATE1 – UPDATED ADDRESS FROM TRACKING

T_UPDATE2 – UPDATED ADDRESS FROM TRACKING

F_PHONE1 – UPDATED TELEPHONE# FROM FIELD

F_PHONE2 – UPDATED TELEPHONE# FROM FIELD

F_CONTACT1 – UPDATED ALTERNATE CONTACT FROM FIELD

F_CONTACT2 – UPDATED ALTERNATE CONTACT FROM FIELD

F_COMMENT – FIELD NOTES

F_UPDATE1 – UPDATED ADDRESS FROM FIELD

F_UPDATE2 – UPDATED ADDRESS FROM FIELD

FIDNAME1 – FIELD LOCATOR NAME

FIDNAME2 – FIELD LOCATOR NAME

FDATE1 – DATE RELEASED TO FIELD LOCATOR 1

FDATE2 – DATE RELEASED TO FIELD LOCATOR 2

GC_CATI – GIFT CARD RELEASED CATI

GC_FIELD – GIFT CARD RELEASED FIELD

Introduction

QLANG. CHOOSE LANGUAGE

1 ENGLISH

2 SPANISH

QTYPE.

INTERVIEWER: IS THIS A FIELD LOCATOR-BASED INTERVIEW?

1 YES, FIELD LOCATOR-BASED

2 NO, RESPONDENT CALLED IN (GO TO QLINTRO)

3 NO, CALL INITIATED BY PHONE CENTER (GO TO A1_Intro)

4 ANSWERING MACHINE (GO TO QANSW)

QINTID.

INTERVIEWER: ENTER THE FIELD LOCATOR’S 4-DIGIT ID NUMBER.

_____ _______ ________ _______

CATI: ALL GO TO QLINTRO

QANSW.

ANSWERING MACHINE SCRIPT

Hello, my name is Travis/Tracy Davis and I am calling from Decision Information Resources for the [STEDPRO] program. I am trying to reach [FLNAME] for a short paid interview.

Please have [FLNAME] call us at 1-866-986-1968. Thank you.

INTERVIEWER: PRESS “NEXT” TO EXIT AND RECORD CALL DISPOSITION.

CATI: EXIT

QLINTRO.

Hello, my name is Travis/Tracy Davis.

INTERVIEWER: PLEASE PRESS “NEXT” TO CONTINUE.

CATI: IF QTYPE=2, GO TO SRCE2; ELSE GO TO Q2

SRCE2.

Are you…

1 Responding to a ‘Sorry I Missed You’ card that was left at your door? OR

2 Responding to a letter or postcard you received in the mail or voice mail message from Travis/Tracy Davis or someone else?

7 DON’T KNOW

8 REFUSED

CATI: ALL GO TO Q2

CATI: RECORD INTRO SECTION START TIME [SECQSTTM] & START DATE [SECQSTDT]

A1_Intro. Hello this is Travis/Tracy Davis. I’m calling from DIR about a program at [CBONAME]. May I please speak to [FLNAME]?

INTERVIEWER: IF NECESSARY, READ: “[FLNAME] has agreed to help with a study about work assistance.

1 RESPONDENT AVAILABLE – CONTINUE

2 RESPONDENT NOT AVAILABLE – ARRANGE CALLBACK AND ENTER CALL NOTE (GO TO RCONU)

8 REFUSED – ENTER DISPOSITION CODE AND CALL NOTE DESCRIBING SITUATION IN THE CALL RECORD TEXT BOX (GO TO END INTERVIEW)

Q2.

Thank you for taking the time to speak with me today. We are conducting interviews with people who agreed to be in a study about a program offered at [CBONAME] called [STEDPRO]. The study is called the Subsidized and Transitional Employment Demonstration or STED for short. It is funded by the U.S. Department of Health and Human Services and my company, Decision Information Resources, or DIR, is conducting this survey. You may have received a letter recently about the STED study.

We need to talk with people who got into the program and those who did not. Your participation in this study will help policy-makers better understand how to help people find and keep jobs.  This interview will include questions on your employment situation, your use of services, and your overall well being.

This interview should only take 30 minutes.  We will mail you a $25 gift card as a “thank you” for completing the interview. 

All of your responses on this survey will be kept private; the research staff has been trained in protecting private information and your name will not appear in any written reports we produce. All of the study results will be reported for groups of individuals; no results will be analyzed or reported for individuals. Your responses to these questions are also completely voluntary. That means you may choose not to answer any question, or you may stop the interview if you wish, but we hope you don’t. Your responses to these questions will in no way affect your participation in the [STEDPRO] program or affect your receipt of any kinds of public benefits or services.

According to the Paperwork Reduction Act (PRA), 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. The OMB control number for this collection is 0970-XXXX and it expires XX/XX/XXXX.

And finally, this interview might be monitored or recorded for quality control purposes. May we begin?

1 YES

2 NOT NOW (GO TO RCONU)

7 DON’T KNOW (GO TO RCONU)

8 REFUSED (GO TO END INTERVIEW)

Q2a.

I need to make sure that you are the person who agreed to join this study.

Could you please tell me your date of birth?

INTERVIEWER NOTE: DON’T KNOW 97/97/9997 REFUSED 98/98/9998.

______ ______ ______

MM DD YYYY

CATI: INCLUDE DROP DOWN BOX FOR 2-DIGIT MONTH AND 4-DIGIT YEARINCLUDE VALUES FOR DON’T KNOW AND REFUSED

MONTH RANGE: 01-12; 97; 98)

DAY RANGE: 01-31, 97, 98

YEAR RANGE: (1944-2000; 9997; 9998)

CATI: IF Q2a=RDOB IN SAMPLE FILE GO TO Q4

IF Q2a ≠ RDOB IN SAMPLE FILE, CONTINUE

Q2b.

Could you please provide the last four digits of your social security number?

____ ____ ____ ____

99997 DON’T KNOW

99998 REFUSED

CATI:

[IF Q2b=SSN FROM SAMPLE FILE GO TO Q4. (SSN matches)

IF Q2a= 97979997 OR 98989998 AND Q2b=99997 OR 99998, GO TO Q3. (Both DOB and SSN are either DK or REF)

IF (Q2a ≠ RDOB AND Q2b ≠ RSSN) AND (NOT (Q2a= 97979997 OR 98989998 AND Q2b=99997 OR 99998)), GO TO Q2c. (both DOB and SSN do not match DOB and SSN from sample file, and both are not DK/REF, which was handled in prior logic step)

Q2c.

There seems to be technical problem with your file. I will need to call you back.

Is this the best telephone number to reach you at?

[RPHONE1]

1 Yes (GO TO THANK YOU 2)

2 No (GO TO Q2c_1)

CATI: DISPLAY ORIGINAL PHONE NUMBER FOR COMPARISON PURPOSES

Q2c_1.

What number should we call?

__ __ __ - __ __ __- __ __ __ __

CATI: DISPLAY ORIGINAL PHONE NUMBER FOR COMPARISON PURPOSES

CATI: (GO TO THANK YOU 2)

Q3.

It is important to verify that you are a participant in this research study. To do this, it is important for you to tell me your date of birth OR the last four digits of your social security number. Your information is private. It will only be used for this research or related purposes. The interview will take 20-25 minutes. You can choose to answer or not answer any question. You will be sent a $25 gift card as a “thank you” if you do choose to complete the interview.

Do you wish to complete this survey?

1 Yes (GO BACK TO Q2a)

2 No (GO TO END INTERVIEW

THANK YOU 2. (TY2 on CATI)

Thank you for your time and patience. We will contact you as soon as we resolve this problem. Your information is important to us and to the success of this study. Have a nice day/evening.

(PRESS ANY KEY TO END SURVEY)

RCONU.

IF R IS CONFIRMED BUT UNAVAILABLE, READ:

Could you tell me a good time to call back to reach him/her?

Thank you, I will call back then.

IF SPEAKING WITH R, READ:

What is the best time for us to call you back to complete the survey?

IF R NO LONGER LIVES THERE, READ:

Is there a number where he/she can be reached? May I have it please?

INTERVIEWER: MAKE NOTE OF NEW NUMBER AND MAKE PERMANENT MESSAGE. THEN TRY NEW NUMBER.

ENTER NEXT AND SET APPOINTMENT.

END INTERVIEW (END2 in CATI)

Thank you for your time. We are sorry that you do not want to complete the interview. If you change your mind or have any questions, please contact DIR at 1-866-986-1968.

Have a nice day/evening.

(PLEASE PRESS NEXT TO CONTINUE)

Q4.

Are you ready to begin?

1 YES

2 NOT NOW (GO TO RCONU)

7 DON’T KNOW (GO TO RCONU)

8 REFUSED (GO TO END INTERVIEW)

CATI: RECORD INTRO SECTION END TIME [SECQEDTM] AND END DATE [SECQEDDT]

CATI: ALL GO TO A1

A. Employment and Education/Training

CATI: RECORD SECTION A START TIME [SECASTTM] & START DATE [SECASTDT]

First, I want to talk about what you’ve been doing since you joined the study on [RAD].

This is the date you agreed to participate in the study. As a result, many of the questions I ask will refer to this date. Let’s begin.

A1.

Since [RAMY], have you worked at a job for pay? This includes any job where you got paid, including self-employment, temporary work, paid internships, and work experience programs where you received wages.

1 YES

2 NO (GO TO A2)

7 DON’T KNOW (GO TO A2)

8 REFUSED (GO TO A2)

A1a.

Were any of these jobs paid internships?

1 YES

2 NO

7 DON’T KNOW

8 REFUSED

A1b.

Are you currently working at a job for pay? That is, are you working for yourself or someone else or participating in a paid internship or work experience program where you receive wages?

1 YES

2 NO (GO TO A2)

7 DON’T KNOW (GO TO A2)

8 REFUSED (GO TO A2)

A1c.

How many hours per week do you currently work?

IF VARIES: How many hours did you work last week?

INTERVIEWER: If R works at more than one job, record the total hours worked at all jobs.

__________________

Number of Hours (Range: 1 to 50; round up to nearest whole hour)

51 MORE THAN 50 HOURS PER WEEK

97 DON’T KNOW

98 REFUSED

A1d.

Are you currently working at a paid internship?

1 YES

2 NO

7 DON’T KNOW

8 REFUSED

A2.

Since [RAMY], have you done any unpaid work? This includes unpaid internships and work experience programs where you did not receive wages.

1 YES

2 NO (GO TO A3)

7 DON’T KNOW (GO TO A3)

8 REFUSED (GO TO A3)

A2a.

Are you currently doing any unpaid work such as an unpaid internship or work experience program?

1 YES

2 NO

7 DON’T KNOW

8 REFUSED

A3.

Since [RAMY] have you attended education or training programs? This includes high school courses, GED courses, ESL courses, college courses, and occupational training programs.

1 YES

2 NO (GO TO A4)

7 DON’T KNOW (GO TO A4)

8 REFUSED (GO TO A4)

A3a.

Are you currently attending school or participating in a training program?

1 YES

2 NO

7 DON’T KNOW

8 REFUSED

A4.

Since [RAMY] have you received assistance from any organization or program in your community to help you find or keep a job, or to help you deal with problems that interfered in your ability to work?

interviewer: if necessary SAY: This would include help with finding a job; dealing with child care, transportation, or housing problems; or other issues that would make it hard for you to work.

1 YES

2 NO (GO TO B3a)

7 DON’T KNOW (GO TO B3a)

8 REFUSED (GO TO B3a)

A5.

Since [RAMY] have you taken any life skills or anger management classes?

INTERVIEWER, IF NECESSARY: These classes could include topics such as time and stress management, financial literacy, parenting tips, communications skills or health and wellness).

1 YES

2 NO

7 DON’T KNOW

8 REFUSED

ATI: RECORD SECTION A END TIME [SECAEDTM] & END DATE [SECAEDDT]

B Mental Health and Self Esteem

CATI: RECORD SECTION B START TIME [SECBSTTM] & START DATE [SECBSTDT]

B1.

An important objective of this survey is to assess your overall well being. These next questions are about feelings you may have experienced over the past month.

During the past month, how often did you feel…	Often	Some-times	Hardly Ever	Never?	DON’T KNOW	REF
a. …so sad that nothing could cheer you up? Would you say you felt that way…	1	2	3	4	7	8
b. ...nervous?	1	2	3	4	7	8
c. …restless or fidgety?	1	2	3	4	7	8
d. …hopeless? Would you say you felt that way…	1	2	3	4	7	8
e. …that everything was an effort?	1	2	3	4	7	8
f. …worthless?	1	2	3	4	7	8

B2

Taken all together, how would you say things are these days? Would you say that you are…

1 very happy,

2 pretty happy, or

3 not too happy?

7 DON’T KNOW

8 REFUSED

B3.

I’m going to read you a list of statements dealing with your general feelings about yourself. Please tell me how much you agree or disagree with each one.

a. I feel that I’m a person of worth, at least on an equal plane with others. Do you …

1 strongly agree,

2 agree,

3 disagree, or

4 strongly disagree?

7 DON’T KNOW

8 REFUSED

INTERVIEWER: For B3b-B3j, only repeat answer options (“Do you …”) if necessary.

b. I feel that I have a number of good qualities. Do you …

1 strongly agree,

2 agree,

3 disagree, or

4 strongly disagree?

7 DON’T KNOW

8 REFUSED

c. All in all, I am inclined to feel that I am a failure. Do you …

1 strongly agree,

2 agree,

3 disagree, or

4 strongly disagree?

7 DON’T KNOW

8 REFUSED

d. I am able to do things as well as most other people. Do you …

1 strongly agree,

2 agree,

3 disagree, or

4 strongly disagree?

7 DON’T KNOW

8 REFUSED

e. I feel that I do not have much to be proud of.

1 strongly agree,

2 agree,

3 disagree, or

4 strongly disagree?

7 DON’T KNOW

8 REFUSED

f. I take a positive attitude towards myself. Do you …

1 strongly agree,

2 agree,

3 disagree, or

4 strongly disagree?

7 DON’T KNOW

8 REFUSED

g. On the whole, I am satisfied with myself. Do you …

1 strongly agree,

2 agree,

3 disagree, or

4 strongly disagree?

7 DON’T KNOW

8 REFUSED

h. I wish I could have more respect for myself. Do you …

1 strongly agree,

2 agree,

3 disagree, or

4 strongly disagree?

7 DON’T KNOW

8 REFUSED

i. I certainly feel useless at times. Do you …

1 strongly agree,

2 agree,

3 disagree, or

4 strongly disagree?

7 DON’T KNOW

8 REFUSED

j. At times I think I am no good at all. Do you …

1 strongly agree,

2 agree,

3 disagree, or

4 strongly disagree?

7 DON’T KNOW

8 REFUSED

CATI: RECORD SECTION B END TIME [SECBEDTM] & END DATE [SECBEDDT]

C. Locus of Control

CATI: RECORD SECTION C START TIME [SECCSTTM] & START DATE [SECCSTDT]

EC.

The next questions are about how you handle problems in life and work. Please rate your agreement with the following statements.

	Strongly Disagree	Some-What Disagree	Slightly Disagree	Slightly Agree	Some-What Agree	Strongly Agree	DON’T KNOW	REF
a. I can do just about anything I really set my mind to. Would you say you…	1	2	3	4	5	6	7	8
b. When I really want to do something, I usually find a way to succeed at it.	1	2	3	4	5	6	7	8
c. Whether or not I am able to get what I want is in my own hands.	1	2	3	4	5	6	7	8
d. What happens to me in the future mostly depends on me. Would you say you…	1	2	3	4	5	6	7	8
e. I can do the things that I want to do.	1	2	3	4	5	6	7	8

C2.

Each of the next set of questions will ask you for your best guess at the chance that something will happen in the future. You can think of the percent chance that some event will occur as the number of chances out of 100 that the event will take place. If you think that something is impossible, consider it as having a 0 percent chance. If you think the event is possible but unlikely, you might say there is a 3 percent chance or a 15 percent chance. If you think the chance is pretty even, you can say there is a 46 percent chance or perhaps a 52 percent chance. If you think the event is likely, but not certain, you might say there is a 78 percent chance or a 94 percent chance. If you think it is certain to happen, give it a 100 percent chance.

Just to make sure that you are comfortable with the scale, I'd like you to do a few practice questions, and explain your answer to me.

a. What do you think is the percent chance that you will get the flu sometime in the next year?

______________________

Percent Chance

(Range: 0 to 100)

997 DON’T KNOW

998 REFUSED

b. What do you think is the percent chance that you will eat pizza sometime in the next year?

______________________

Percent Chance

(Range: 0 to 100)

997 DON’T KNOW

998 REFUSED

c. Think about yourself one year from now. The first questions concern what you expect to be doing then, in terms of school and work. What is the percent chance that you will be a student in a regular school one year from now?

IF NECESSARY: A regular school is one that offers an academic diploma or degree like a high school diploma or a bachelor’s degree.

______________________

Percent Chance

(Range: 0 to 100)

997 DON’T KNOW

998 REFUSED

d. Suppose you are in school a year from now, what is the percent chance that you will also be working for pay more than 20 hours per week?

IF NECESSARY: By working we mean working for pay for an employer, in a family business, or working for yourself.

______________________

Percent Chance

(Range: 0 to 100)

997 DON’T KNOW

998 REFUSED

e. Suppose you are not in school a year from now, what is the percent chance that you will be working for pay more than 20 hours per week?

______________________

Percent Chance

(Range: 0 to 100)

997 DON’T KNOW

998 REFUSED

f. What is the percent chance that you will be living in the same place you are living now one year from now?

______________________

Percent Chance

(Range: 0 to 100)

997 DON’T KNOW

998 REFUSED

g. [IF FEMALE] What is the chance you will become pregnant within one year from now?

[IF MALE] What is the percent chance that you will get someone pregnant within the next year?

______________________

Percent Chance

(Range: 0 to 100)

997 DON’T KNOW

998 REFUSED

h. What is the percent chance that you will be arrested, whether rightly or wrongly, at least once in the next year?

______________________

Percent Chance

(Range: 0 to 100)

997 DON’T KNOW

998 REFUSED

i. Now think ahead to when you turn 30 years old. What is the percent chance that you will have a four-year college degree by the time you turn 30?

______________________

Percent Chance

(Range: 0 to 100)

997 DON’T KNOW

998 REFUSED

j. What is the percent chance that you will be working for pay more than 20 hours per week when you turn 30?

______________________

Percent Chance

(Range: 0 to 100)

997 DON’T KNOW

998 REFUSED

C3.

Now I’d like to talk about specifically about your future employment. How much do you agree or disagree with the following statements? (Strongly Agree, Agree, Disagree, Strongly Disagree, Don’t Know, Refused)

a. I have specific goals for my future career. Do you …

1 strongly agree,

2 agree,

3 disagree, or

4 strongly disagree?

7 DON’T KNOW

8 REFUSED

INTERVIEWER: For C3b-C3f, only repeat answer options (“Do you …”) if necessary.

b. I have a plan for achieving my future career goals. Do you …

1 strongly agree,

2 agree,

3 disagree, or

4 strongly disagree?

7 DON’T KNOW

8 REFUSED

c. Planning for a career is not worth the effort. Do you …

1 strongly agree,

2 agree,

3 disagree, or

4 strongly disagree?

7 DON’T KNOW

8 REFUSED

d. I haven’t thought much about my future career. Do you …

1 strongly agree,

2 agree,

3 disagree, or

4 strongly disagree?

7 DON’T KNOW

8 REFUSED

e. If I have a career, I won’t be able to enjoy other things in life. Do you …

1 strongly agree,

2 agree,

3 disagree, or

4 strongly disagree?

7 DON’T KNOW

8 REFUSED

f. Going to college is important to getting a good job. Do you …

1 strongly agree,

2 agree,

3 disagree, or

4 strongly disagree?

7 DON’T KNOW

8 REFUSED

CATI: RECORD SECTION C END TIME [SECCSTTM] & END DATE [SECCEDDT]

D. Life Challenges

CATI: RECORD SECTION D START TIME [SECDSTTM] & START DATE [SECDSTDT]

Section D Introductory Text

Many people have life circumstances or events that happened in their past that create problems for them in achieving their goals. I am going to read a list of life challenges that might apply to you now or in the past. For each one, please tell me if it is something that applies to you.

D1.

Not having a high school degree or GED – is this something that applies to you?

1 YES

2 NO (GO TO D2)

7 DON’T KNOW (GO TO D2)

8 REFUSED (GO TO D2)

D1a.

Is this something that holds you back or makes it difficult for you to achieve your goals?

1 YES

2 NO

7 DON’T KNOW

8 REFUSED

D2.

Problems with reading or basic math – is this something that applies to you?

1 YES

2 NO (GO TO D3)

7 DON’T KNOW (GO TO D3)

8 REFUSED (GO TO D3)

D2a.

Is this something that holds you back or makes it difficult for you to achieve your goals?

1 YES

2 NO

7 DON’T KNOW

8 REFUSED

D3.

Not a lot of work experience – is this something that applies to you?

1 YES

2 NO (GO TO D4)

7 DON’T KNOW (GO TO D4)

8 REFUSED (GO TO D4)

D3a.

Is this something that holds you back or makes it difficult for you to achieve your goals?

1 YES

2 NO

7 DON’T KNOW

8 REFUSED

D4.

Unstable housing – is this something that applies to you?

1 YES

2 NO (GO TO D5)

7 DON’T KNOW (GO TO D5)

8 REFUSED (GO TO D5)

D4a.

Is this something that holds you back or makes it difficult for you to achieve your goals?

1 YES

2 NO

7 DON’T KNOW

8 REFUSED

D5.

Experience in foster care – is this something that applies to you?

1 YES

2 NO (GO TO D6)

7 DON’T KNOW (GO TO D6)

8 REFUSED (GO TO D6)

D5a.

Is this something that holds you back or makes it difficult for you to achieve your goals?

1 YES

2 NO

7 DON’T KNOW

8 REFUSED

D6.

Pregnancy or taking care of your children – is this something that applies to you?

1 YES

2 NO (GO TO D7)

7 DON’T KNOW (GO TO D7)

8 REFUSED (GO TO D7)

D6a.

Is this something that holds you back or makes it difficult for you to achieve your goals?

1 YES

2 NO

7 DON’T KNOW

8 REFUSED

D7.

Physical or Medical disability – is this something that applies to you?

1 YES

2 NO (GO TO D8)

7 DON’T KNOW (GO TO D8)

8 REFUSED (GO TO D8)

D7a.

Is this something that holds you back or makes it difficult for you to achieve your goals?

1 YES

2 NO

7 DON’T KNOW

8 REFUSED

D8.

Mental Health difficulties – is this something that applies to you?

1 YES

2 NO (GO TO D9)

7 DON’T KNOW (GO TO D9)

8 REFUSED (GO TO D9)

D8a.

Is this something that holds you back or makes it difficult for you to achieve your goals?

1 YES

2 NO

7 DON’T KNOW

8 REFUSED

D9.

Criminal record – is this something that applies to you?

1 YES

2 NO (GO TO D10)

7 DON’T KNOW (GO TO D10)

8 REFUSED (GO TO D10)

D9a.

Is this something that holds you back or makes it difficult for you to achieve your goals?

1 YES

2 NO

7 DON’T KNOW

8 REFUSED

D10.

Alcohol or other substance abuse – is this something that applies to you?

1 YES

2 NO (GO TO D11)

7 DON’T KNOW (GO TO D11)

8 REFUSED (GO TO D11)

D10a.

Is this something that holds you back or makes it difficult for you to achieve your goals?

1 YES

2 NO

7 DON’T KNOW

8 REFUSED

D11.

Family responsibilities – is this something that applies to you?

1 YES

2 NO (GO TO D12)

7 DON’T KNOW (GO TO D12)

8 REFUSED (GO TO D12)

D11a.

Is this something that holds you back or makes it difficult for you to achieve your goals?

1 YES

2 NO

7 DON’T KNOW

8 REFUSED

D12.

Do you have other life circumstances that hold you back or make it difficult for you to achieve your goals?

1 YES

2 NO

7 DON’T KNOW

8 REFUSED

CATI: RECORD SECTION D END TIME [SECDSTTM] & END DATE [SECDEDDT]

E. Social Support and Role Models

CATI: RECORD SECTION E START TIME [SECESTTM] & START DATE [SECEEDDT]

E1.

The next set of questions is about support systems.

People sometimes look to others for companionship, assistance, or other types of support. How often is each of the following kinds of support available to you if you need it?

	None Of The Time	A Little Of The Time	Some Of The Time	Most Of The Time	All Of The Time	DON’T KNOW	REF
a. Someone you can count on to listen to you when you need to talk. Would you say that kind of support is available…	1	2	3	4	5	7	8
b. Someone to give you information to help you understand a situation….	1	2	3	4	5	7	8
c. Someone to give you good advice about a crisis….	1	2	3	4	5	7	8
d. Someone to confide in or talk to about yourself or your problems. Would you say that kind of support is available…	1	2	3	4	5	7	8
e. Someone whose advice you really want….	1	2	3	4	5	7	8
f. Someone to share your most private worries and fears with…	1	2	3	4	5	7	8
g. Someone to turn to for suggestions about how to deal with a personal problem. Would you say that kind of support is available…	1	2	3	4	5	7	8
h. Someone who understands your problems…	1	2	3	4	5	7	8

E2.

Suppose you needed a favor like a ride, or to borrow something small. Is there someone you could ask for help?

1 YES

2 NO

7 DON’T KNOW

8 REFUSED

E3.

Suppose you had a personal problem, and you wanted to talk to someone about it. Is there someone you could ask for help or advice?

1 YES

2 NO

7 DON’T KNOW

8 REFUSED

E4.

Suppose you had to borrow $250 for a few weeks because of an emergency. Is there someone you could ask for help?

1 YES

2 NO

7 DON’T KNOW

8 REFUSED

E5.

Mentors are people that take a special interest in you, providing advice and guidance to help you achieve your goals and solve problems. Is there someone in your life that you consider to be your mentor?

1 YES

2 NO (GO TO E7)

7 DON’T KNOW (GO TO E7)

8 REFUSED (GO TO E7)

E6.

How do you know that person?

1 RELATIVE (SPECIFY: ____________________)

2 SOMEONE FROM MY NEIGHBORHOOD

3 CLERGY OR CHURCH LEADER

4 SOMEONE FROM MY CURRENT/FORMER SCHOOL

5 CASEWORKER, COUNSELOR, OR PROGRAM STAFF

6 SOMETHING ELSE (SPECIFY: ________________)

E7.

Role models are people that inspire you, whose behavior and success you want to follow. Not including members of your family, is there someone you consider to be your role model?

1 YES

2 NO (GO TO E9)

7 DON’T KNOW (GO TO E9)

8 REFUSED (GO TO E9)

E8.

Who are your most important role models?

INTERVIEWER: SELECT ALL THAT APPLY.

1 TEACHER OR SOMEONE ELSE FROM CURRENT/FORMER SCHOOL

2 NEIGHBOR OR FAMILY FRIEND

3 RELIGIOUS LEADER

4 CASEWORKER, COUNSELOR, OR PROGRAM STAFF MEMBER

5 FRIEND OR ROMANTIC PARTNER

6 SOMEONE ELSE (SPECIFY: _______________________)

E9.

Thinking about everyone that you would count as a friend, not just your close friends, do you have a friend who graduated from college?

1 YES

2 NO

7 DON’T KNOW

8 REFUSED

E10.

Thinking about everyone that you would count as a friend, not just your close friends, do you have a friend who earns more than $30,000 a year?

1 YES

2 NO

7 DON’T KNOW

8 REFUSED

CATI: RECORD SECTION E END TIME [SECEEDTM] & END DATE [SECEEDDT]

F. Social Network Roster and Relationship Origin

CATI: RECORD SECTION F START TIME [SECFSTTM] & START DATE [SECFSTDT]

Now I‘m going to ask you some questions about your relationships with other people.

F1.

From time to time, most people discuss things that are important to them with others. These may include good or bad things that happen to you, problems you are having, or important concerns you may have.  I’d like to ask you about the people with whom you often discuss things that are important to you. You may refer to these people in any way you want; for example you may use just their first names or nicknames or initials. I am not interested in the identities of these people. I just need to have some way to refer to them so that when I ask you a follow-up question we both know who we are talking about.

Over the last 6 months, who are the people with whom you most often discussed things that were important to you?

interviewer prompt: This could be a person you tend to talk to about things that are important to you.

CATI:

RECORD AS MANY NAMES IN J1 AS RESPONDENT OFFERS, UP TO 10.

CAPTURE ALL NAMES IN J1 BEFORE CONTINUING WITH J2. 

CATI: IF FIRST PERSON IN J1 = 96, 97 OR 98, GO TO Z1.

CATI: WHEN PERSON 2-10 = 96, 97 or 98, GO TO J2.

interviewer: enter names in order in which they are identified by respondent.

interviewer: After each name, prompt: Who else?

1 NAME GIVEN, SPECIFY_________________

96 NO ONE ELSE

97 DON’T KNOW

98 REFUSED

F2.

People can have many different connections to others. For example, a woman can be your co-worker and also be your neighbor. Or a man could be your brother and also a member of your church. Now, I would like to go through the names you just gave me. Please list all the ways that person is connected to you. How is [NAME FROM LIST] connected to you?

CATI:

FOR EACH NAME OFFERED IN J1, ALLOW UP TO FOUR CONNECTIONS IN J2. 

PRESENT EACH NAME ONE AT A TIME IN THE ORDER IT WAS COLLECTED.

ALSO PRESENT INTERVIEWER A CHECK BOX TO INDICATE “DONE” WITH A NAME.

WHEN INTERVIEWER CHECKS “DONE”, PRESENT NEXT NAME.

WHEN INTERVIEWER CHECKS “DONE” AND NO MORE NAMES ARE AVAILABLE, GO TO Z1.

INTERVIEWER: AFTER EACH CONNECTION, PROBE: What other ways is [NAME FROM LIST] connected to you?......What else?

INTERVIEWER: MARK UP TO FOUR CONNECTIONS FOR A NAME. CHECK “DONE” BOX TO START NEXT NAME.

FAMILY OR SEXUAL PARTNER

1 SPOUSE

2 EX-SPOUSE

3 ROMANTIC/SEXUAL PARTNER

4 PARENT

5 PARENT IN-LAW

6 OTHER IN-LAW

7 CHILD

8 STEP-CHILD

9 BROTHER OR SISTER

10 OTHER RELATIVE

FRIEND/NEIGHBOR

11 FRIEND

12 NEIGHBOR

OTHER CONNECTION

13 CO-WORKER OR BOSS

14 MINISTER, PRIEST, OR OTHER CLERGY

15 MEMBER OF THE SAME CONGREGATION

16 MEMBER OF THE SAME CLUB OR ACTIVITY GROUP

17 PSYCHIATRIST, PSYCHOLOGIST, COUNSELOR, OR THERAPIST

18 CASEWORKER/SOCIAL WORKER

19 JOB PLACEMENT/TRAINING PROGRAM STAFF

20 OTHER

97 DON’T KNOW

98 REFUSED

CATI: RECORD SECTION F END TIME [SECFEDTM] & END DATE [SECFEDDT]

SECTION Z: CONTACT INFORMATION

CATI: RECORD START DATE (SECZSTDT) AND TIME (SECZSTTM)

Z1.

Those are all the questions I have to ask you today. Thank you for the time you’ve spent talking with me and for your participation in this study. In order to send your gift card, I need to confirm your name and address.

I have your name listed as [FLNAME] and spelled as (INTERVIEWER: SPELL NAME). Is that correct?

1 YES (GO TO Z4)

2 NO (GO TO Z3)

3 REFUSED (GO TO Z2)

Z2.

In order to send your gift card, I am required to verify the spelling of

your name. I have your name listed as [FLNAME] and spelled as

(INTERVIEWER: SPELL NAME). Is that correct?

1 YES (GO TO Z4)

2 NO (GO TO Z3)

3 REFUSED (GO TO Z4)

CATI: PROVIDE TEXT BOX FOR ENTRY OF CORRECTED NAME WHILE ORIGINAL NAME IS DISPLAYED FOR COMPARISON PURPOSES

Z3.

INTERVIEWER: ENTER CORRECTED NAME.

[FLNAME]

Z4. Is this your current address? [FULLADD, RCITY, RSTATE, RZIP]

INTERVIEWER: READ ADDRESS TO R, SPELLING EACH WORD.

INTERVIEWER, IF R REFUSES SAY: We won’t be able to send your gift card without an address.

1 YES (GO TO Z6)

2 NO (GO TO Z5)

3 REFUSED (GO TO Z6)

CATI: PROVIDE TEXT BOX FOR ENTRY OF CORRECTED ADDRESS WHILE ORIGINAL ADDRESS IS DISPLAYED FOR COMPARISON PURPOSES

CATI: CREATE CDMO USING DATA ENTERED AT Z5 TO REPLACE:

FULLADD – FULL ADDRESS

RCITY – CITY

RSTATE – STATE

RZIP – ZIP

Z5. Please tell me your address.

ADDRESS ____________

CITY ________________

STATE _______________

ZIP __________________

8 REFUSED

INTERVIEWER: ENTER CORRECTED ADDRESS. READ BACK

THE ADDRESS INFORMATION TO R, SPELLING THE WORDS.

INTERVIEWER, IF R REFUSES SAY: We won’t be able to send your gift card without an address.

Z6. Is there another address you would like me to use to send your $25 gift card?

1 YES

2 NO (GO TO Z8)

8 REFUSED (GO TO Z8)

CATI: PROVIDE TEXT BOX FOR ENTRY OF SUPPLEMENTAL ADDRESS

Z7.

What address would you like me to use?

Street: ________________________

City:__________________________

State: _________________________

Zip: __________________________

Z8.

I also need to confirm your phone number in case we have any questions

about the interview. [CATI: DISPLAY RPHONE]

INTERVIEWER: READ THE PHONE NUMBER. Is this correct?

1 YES (GO TO Z10)

2 NO (GO TO Z9)

8 REFUSED (GO TO Z11)

CATI: PROVIDE TEXT BOX FOR ENTRY OF CORRECTED PHONE NUMBER. DISPLAY ORIGINAL PHONE NUMBER FOR COMPARISON PURPOSES

Z9.

INTERVIEWER: ENTER CORRECTED PHONE NUMBER. READ BACK TO R

TO CONFIRM.

Z10.

Is this a home, work, or cell phone number?

1. Home

2 Work

3 Cell

8 REFUSED

Z11.

This study will be going on for a few more years. We are interested in learning what helps people improve their circumstances and what gets in the way of making that happen. We may need to contact you again in the future. If you happen to move between now and then, it would help if we could gather some additional information.

CATI: If Z8=8 OR Z10=8, GO TO Z16,

IF Z8 ≠ 8 AND Z10≠8, GO TO Z12.

 

Z12. Is there an additional phone number or cell phone we could reach you at?

1 YES (GO TO Z13)

2 NO

8 REFUSED (GO TO Z15)

CATI: IF Z12 = 2 AND Z10 = 3 (No additional phone # and 1^st # is cell phone), GO TO Z15; IF Z12 = 2 AND Z10 ≠3, GO TO Z16.

Z13.

CATI: PROVIDE TEXT BOX FOR ENTRY OF SECOND PHONE NUMBER

INTERVIEWER: ENTER PHONE NUMBER. READ BACK TO R TO CONFIRM.

Z14.

Is this a home, work, or cell phone number?

1. Home

2 Work

3 Cell

8 REFUSED

Z15.

CATI: IF Z10 = 3 OR Z14 = 3, ASK Z15,

IF Z10 ≠ 3 AND Z14 ≠ 3, GO TO Z16.

In the future, may we call or send a text message to the cell phone number you provided?

1 YES

2 NO

8 REFUSED

Z16.

Is there an e-mail address you could provide?

1 YES (GO TO Z17)

2 NO (GO TO Z18)

8 REFUSED (GO TO Z18)

Z17.

CATI: PROVIDE TEXT BOX FOR ENTRY OF EMAIL ADDRESS; IF Z17=2 DISPLAY: “PLEASE CORRECT EMAIL ADDRESS AND CONFIRM WITH RESPONDENT. ONCE THE EMAIL IS CONFIRMED AS CORRECT, CHOOSE 1 AND CONTINUE.”

INTERVIEWER: ENTER EMAIL ADDRESS. READ THE EMAIL ADDRESS. Is this correct?

1 YES

2 NO

8 REFUSED

Z18.

We would like to get the name of one or two other people who would probably know where we could reach you. Many people give their mother’s or sister’s name. Others give the name of a very close friend. Who would be a good person for us to contact if we were trying to find you for an interview in the future?

(PROMPT: “Who else?” AFTER EACH CONTACT).

INTERVIEWER: TRY TO GET THREE REFERENCES. CONTINUE PROMPT UNTIL R INDICATES THERE IS NO ONE ELSE.

CATI: PROVIDE THE SERIES Z19-Z22 FOR UP TO THREE OTHER CONTACTS. PROGRAM SO THAT THESE FIELDS CAN BE LEFT BLANK IF NECESSARY. USE THE LABELING CONVENTION OF “_1”, “_2”, OR “_3” TO DIFFERENTIATE BETWEEN THE THREE CONTACTS. FOR EXAMPLE, THE FIRST CONTACT NAME WOULD BE “Z19_1’.

Z19.

What is their name? Would you spell that for me?

NAME_____________________________

Z20.

And what is their relationship to you?

RELATIONSHIP____________________

Z21.

Where would we contact him/her?

STREET

CITY

STATE

ZIPCODE

Z22.

Is there a phone number?

PHONE NUMBER ____________________

THANK.

Thank you very much for your time and assistance. You should receive your gift card in

about 3 weeks.

If you have any questions about the study or your gift card, you can contact Jim Cooper at DIR, the company in charge of conducting this survey. His toll-free number is 1-888-864-1425, ext 138.

INTERVIEWER: PRESS NEXT TO END SURVEY.

CATI: RECORD END DATE (SECTZEDDT) AND TIME (SECZEDTM)

CATI: CALCULATE SECTION TIMES