NCI/Office of Communications and Public Liaison |
APPENDIX 1B |
LIVE HELP QUESTIONS |
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Questions can be found at:
https://nci--tst.custhelp.com/ci/documents/detail/5/2/12/218a56af55ca6c4f61a9e9e09420e475cb004c0e
Demographic Survey Questions
What is your age?
Select to add age (text box)
I do not want to answer this question
What is your Sex?
Male
Female
What is your race and/or ethnicity? Select all that apply
American Indian or Alaska Native
Asian
Black or African American
Hispanic or Latino
Middle Eastern or North African
Native Hawaiian or Pacific Islander
White
American Indian or Native Alaskan: Please include nationality or tribe. For example, the Navajo Nation, the Blackfeet Tribe of the Blackfeet Indian Reservation of Montana, the Native Village of Barrow Inupiat Traditional Government, the Nome Eskimo Community, Aztec, Maya, etc.
Asian: Please select all that apply.
Valid Skip
Chinese
Vietnamese
Asian Indian
Korean
Filipino
Japanese
Other Asian
If "Other Asian," please include an example, like Pakastani, Hmong, Afghan, etc.
Black or African American: Please select all that apply.
Valid Skip
African American
Nigerian
Jamaican
Ethiopian
Haitian
Somali
Other Black/African American
If "Other Black African American," please include an example, such as Trinidadian and Tobagonian, Ghanaian, Congolese, etc.
Hispanic or Latino: Please select all that apply.
Valid Skip
Mexican
Cuban
Puerto Ricon
Dominican
Salvadoran
Guatemalan
Other Hispanic or Latino
If "Other Hispanic Latino," please include an example, such as Columbian, Honduran, Spaniard, etc.
Middle Eastern or Northern African: Please select all that apply.
Valid Skip
Lebanese
Syrian
Iranian
Iraqi
Egyptian
Israeli
Other Middle Eastern or Northern African
If "Other Middle Eastern Northern African," please include examples like Moroccan, Yemeni, Kurdish, etc.
Native Hawaiian or Pacific Islander: Please select all that apply.
Valid Skip
Native Hawaiian
Tongan
Samoan
Fijian
Chamorro
Marshallese
Other Native Hawaiian or Pacific Islander
If "Other Native Hawaiian or Pacific Islander," please include an example, such as Chuukese, Palauan, Tahitian, etc.
White: Please select all that apply.
Valid Skip
English
Italian
German
Polish
Irish
Scottish
Other White
If "Other White," please include examples like French, Swedish, Norwegian, etc.
What Is the Highest Level of Education You Have Completed?
Grade school
Some high school
High school graduate
Some college
College graduate
Post-graduate
I do not want to answer this question
Is There a Place You Usually Go to When You Are Sick or Need Advice About Your Health?
Yes
No
Don't Know
I do not want to answer this question
What Kind of Place Do You Go to Most Often?
A doctor’s office
A clinic, health center, or hospital clinic
The emergency room, or
Some other place
No one place
I do not want to answer this question
In the Last 12 Months, Did You Have Any Healthcare Coverage, Including Health Insurance, Prepaid Plans Such as HMOs, or Government Plans Such as Medicare?
Yes
No
Don’t know
I do not want to answer this question
Would You Say You Had This Coverage During All 12 Months or Less Than 12 Months?
All 12 months
Less than 12 months
Don’t know
I do not want to answer this question
Which Type of Coverage Did You Have?
Was it public, such as Medicare, Medicaid, or other government plans?
Was it private, such as an HMO, Blue Cross, Kaiser, or Aetna?
Or was it both public and private?
Valid skip
Don’t know
I do not want to answer this question
What Was Your Total Household Income from All Sources Before Taxes Last Year? Just Stop Me When I Get to the Right Category
Less than $10,000
$10,000 to $19,000
$20,000 to $29,000
$30,000 to $39,000
$40,000 to $59,000
$60,000 to $79,000
$80,000 or more
Don’t know
I do not want to answer this question
Including Yourself, How Many People Living in Your Household are Supported by This Total Household Income?
Select this option to enter the total (text box)
Don’t know
I do not want to answer this question
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
File Title | APPENDIX 1B |
Subject | LIVE HELP CLIENT CATEGORIES and SAMPLE TRANSCRIPT |
Author | Burstyn, Ilene (NIH/NCI) [E] |
File Modified | 0000-00-00 |
File Created | 2025-05-29 |