APPENDIX A2:
ENGLISH LANGUAGE
QUESTIONNAIRE
VERSION 2
|
SCHULMAN, RONCA AND BUCUVALAS, INC. 145 EAST 32ND STREET NEW YORK, NEW YORK 10016 |
STUDY NUMBER 7759 NOV. 06, 1998 OMB No. 2127-0596 Expiration Date:12/31/99 |
SAMPLE READ-IN
State: ____________ County: _____________________ Metro Status: _____
Date: ________________ CATI ID: ____________________
Interviewer:_________________________________________
Telephone Number: __________________________________________________________
Time Start: _____________ Time End: _____________ TOTAL TIME: ___________
____________________________________________________________________________
INTRODUCTION
Hello, I'm _______________ calling for the U.S. Department of Transportation. We are conducting a national study of Americans' driving habits and their attitudes about current driving laws.
DUMMY QUESTION FOR BIRTHDAY QUESTIONS
IF SAMPLE TYPE EQ 1, ASK A, ELSE ASK B.
A. In order to select just one person to interview, could I speak to the person in your household, 16 or older, who (has had the most recent/will have the next) birthday?
Respondent is the person.................1 SKIP TO Q.1
Other respondent comes to phone..............2 SKIP TO D
Respondent is not available..............3 ARRANGE CALLBACK
IF SAMPLE TYPE EQ 2 ASK B
B. Is there anyone aged 16 to 39 years old living in your household?
Yes..................1
No........................2 THANK AND SCREEN OUT
C. Could I speak to the person aged 16 to 39 years old living in your household who (has had the most recent/will have the next) birthday?
Respondent is the person...............1
Other respondent comes to phone............2
Respondent not available...............3 ARRANGE CALLBACK
D. Hello, I'm __________________ calling for the U.S. Department of Transportation. We are conducting a national study of Americans' driving habits and their attitudes about current driving laws. The interview is completely confidential. It takes fifteen to twenty minutes. Could we begin now?
CONTINUE INTERVIEW............1 SKIP TO Q1
Arrange Callback....................2 CALLBACK
Refused.......................3
D1. Would you please tell me why you do not want to do the interview?
__________________________________________________________
Q.1 How often do you drive a motor vehicle? Almost every day, a few days a week, a few days a month, a few days a year, or do you never drive?
Almost every day.............1
Few days a week..................2
Few days a month.............3
Few days a year..................4
Never........................5 SKIP TO Q.12B
Other............................6
___________________________
Q.2 Is the vehicle you drive most often a car, van, motorcycle, sport utility vehicle, pickup truck, or other type of truck? (NOTE: IF RESPONDENT DRIVES MORE THAN ONE VEHICLE OFTEN, ASK:) "What kind of vehicle did you LAST drive?"
Car...................................................1
Van or minivan............................................2
Motorcycle............................................3 SKIP TO Q.12B
Pickup truck..............................................4
Sport utility vehicle (Jeep/Explorer/Trooper/etc).....5
Other (SPECIFY _____________________________________......10
Other truck (SPECIFY).................................11
______________________________________________________
NQ2b. What year is the (car/van/truck) you normally drive?
INTERVIEWER INSTRUCTION: SEATBELT QUESTIONS REFER TO DRIVER SIDE SEATBELTS.
Q.3 For the next series of questions, please answer only for the (car/truck/van) you said you usually drive. Do the seat belts in the front seat of the (car/truck/van) go across your shoulder only, across your lap only, or across both your shoulder and lap?
Across shoulder......................1 SKIP TO Q.6
Across lap................................2 SKIP TO Q.9
Across both..........................3
Vehicle has no belts......................4 SKIP TO Q.12B
Q.4 Are the shoulder and lap belt one piece or are they two separate belts?
One piece..........................1 SKIP TO Q.6
Two separate belts.......................2
Q.5 Are both the shoulder and lap belt automatic, is only the shoulder belt automatic or is neither the shoulder or lap belt automatic?
Both are automatic......................1 SKIP TO Q.7
Only shoulder is automatic....................2 SKIP TO Q.7
Neither are automatic...................3 SKIP TO Q.8
Q.6 Is the shoulder belt automatic or do you have to fasten it?
Automatic.....................1
Manual..............................2 SKIP TO Q.8
Q.7 When you drive, do you always wear your automatic belt or is it ever disconnected, disabled, or placed behind you?
Always wear it....................1
Disconnected............................2
Disabled..........................3
Placed behind me........................4
IF Q3=1 OR 3 ASK Q8, ELSE SKIP TO Q9
Q.8 When driving this (car/truck/van) how often do you wear your shoulder belt... (READ LIST)
ALL OF THE TIME.........1
MOST OF THE TIME.............2 < BR>
SOME OF THE TIME........3
RARELY OR....................4
NEVER...................5
IF Q.3=2 OR 3 ASK Q.9, ELSE SKIP TO Q.10a
Q.9 When driving this (car/truck/van), how often do you wear your lap belt...(READ LIST)
ALL OF THE TIME..........1
MOST OF THE TIME.............2
SOME OF THE TIME.........3
RARELY OR....................4
NEVER....................5
IF Q.8=1-4 OR Q.9=1-4 ASK Q.10a, ELSE SKIP TO Q.12B
Q.10a When was the last time you did NOT wear your seat belt (neither lap nor shoulder belt) when driving?
Today................1
Within past week...........2
Within past month....3
Within past 12 months......4
A year or more ago/
I always wear it...5
ASK Q.10b IF DON'T KNOW/REFUSED IN Q.10a
Q.10b Has there been any occasion in the past 12 months when you did not wear your seat belt(neither lap nor shoulder belt) when driving?
Yes..............1
No...................2
Q11 and 12a MOVED TO DEMOGRAPHICS
Q.12b To ask the next series of questions, I need to know how many children AGE 15 OR YOUNGER are living in your household at least half of the time or consider it their primary residence?
________ NONE=0 REFUSED=99
IF ONE OR MORE IN Q.12b, ASK Q.13a, ELSE GO TO Q.17
NOTE: TWINS (TRIPLETS, ETC.) MUST EACH BE ENTERED SEPARATELY, YOUNGEST FIRST
Q.13a What is the age of the YOUNGEST CHILD (15 or younger) living in the household? (ENTER TO THE NEAREST YEAR)
Newborn/less
Than 1 year old.....1
1 year old.................2
2 year old...........3
3 year old.................4
4 year old...........5
5 year old.................6
6 year old...........7
7 year old.................8
8 year old...........9
9 year old.................10
10 year old..........11
11 year old................12
12 year old..........13
13 year old................14
14 year old..........15
15 year old................16
Q.13b Is the (AGE) a boy or a girl?
Boy..................1
Girl......................2
Q.13c How is the (AGE) related to you?
Child/Stepchild................1
Grandchild...........................2
Sibling (brother/sister).......3
Other relative.......................4
Not related....................5
IF MORE THAN ONE IN Q.12b, ASK Q.14a, ELSE GO TO Q.17
Q.14a What is the age of the NEXT OLDEST CHILD (15 or younger) living in the household? (ENTER TO THE NEAREST YEAR)
Less than 1 year.....1
1 year old.................2
2 year old...........3
3 year old.................4
4 year old...........5
5 year old.................6
6 year old...........7
7 year old.................8
8 year old...........9
9 year old.................10
10 year old..........11
11 year old................12
12 year old..........13
13 year old................14
14 year old..........15
15 year old................16
Q.14b Is the (AGE) a boy or a girl?
Boy....................1
Girl........................2
Q.14c How is the (AGE) related to you?
Child/Stepchild...............1
Grandchild..........................2
Sibling (brother/sister)......3
Other relative......................4
Not related...................5
IF Q.1=NEVER, SKIP TO Q.51
ALL RESPONDENTS WHO HAVE SONS/DAUGHTERS UNDER AGE 6 GO TO Q.20
IF CHILDREN IN HOUSEHOLD UNDER 6 BUT NONE ARE SONS/DAUGHTERS ASK Q.15
Q.15 Do you ever drive with (the child/ at least one of the children under 6)that you just mentioned in your (car/truck/van)?
Yes, one child in household....1 SKIP TO Q.20
Yes, more than one child.............2
No.............................3 SKIP TO Q.17
Q.16 Which of the children under six do you ever drive with? (ENTER AGE OF EACH CHILD DRIVE AT LEAST SOMETIMES BELOW )
Age of child #1 ______
Age of child #2 ______
Age of child #3 ______
Age of child #4 ______
Age of child #5 ______
Age of child #6 ______
ALL WHO DRIVE WITH CHILDREN UNDER SIX GO TO Q20
IF NO CHILDREN UNDER AGE 6 ASK Q.17
Q.17 In the past 12 months, have you driven with any children under age 6?
Yes........................1
No..............................2 SKIP TO Q.51
Q.18a How often do you drive with children under six?
Is it.......
Almost every day.............1
Few days a week..................2
Few days a month.............3
Few days a year..................4
Never........................5 SKIP TO Q.51
Other.________________________...6
Q.18b What is your relationship to the child or children under age 6 that you at least sometimes drive with? MULTIPLE RECORD
Child/stepchild....................1 ASK AGE OF CHILDREN (Q18A1)
Brother/sister..........................2
Grandchild.........................3
Other relative..........................4
Teacher/bus driver.................5
Other non-relative......................6
Q.19 When you are driving and children under age 6 are riding with you, would you say that they are in a child car seat or a seat belt all of the time, most of the time, some of the time, rarely or never?
All of the time...............1 SKIP TO Q.51
Most of the time...................2 SKIP TO Q.51
Some of the time..............3 SKIP TO Q.51
Rarely.............................4 SKIP TO Q.51
Never.........................5 SKIP TO Q.51
DRIVERS WITH CHILDREN UNDER SIX IN THE HOUSEHOLD CONTINUE
RANDOM SELECTION OF ONE ELIGIBLE CHILD: DUMMY WITH SELECTED AGE
Q.20 The following questions are for (your/the) (AGE), only.
How much does (he/she) weigh?
(NOTE: IGNORE REFERENCES TO OUNCES; ONLY RECORD POUNDS).
________ lb. (Range=5-60 lbs)
(IF DON'T KNOW/REFUSED, PROBE: N.20b Is he/she....)
Less than 20 pounds......1
20 to 29 pounds..............2
30 to 39 pounds..........3
40 pounds or more............4
Q.21 How tall is he/she? (RECORD BOTH FEET AND INCHES)
_________ FEET (Range: 1-4 feet)
_________ INCHES (Range: 0-12 inches)
COMPUTE DUMMY HEIGHT IN INCHES AS (FEET X 12) + INCHES.
CONSISTENCY CHECK BETWEEN HEIGHT IN INCHES AND WEIGHT.
IF HEIGHT LT 13 INCHES, REPEAT HEIGHT QUESTION
IF HEIGHT 13-24 INCHES, WEIGHT=( 5-19 LBS)
IF HEIGHT 25-36 INCHES, WEIGHT=(20-39 LBS)
IF HEIGHT 37-48 INCHES, WEIGHT=(40-60 LBS)
IF HEIGHT GT 48 INCHES, REPEAT HEIGHT QUESTION
IF FAILS CONSISTENCY CHECK THEN RECHECK WEIGHT AND HEIGHT
Q.22 When you are driving and (AGE) rides in the vehicle with you, how often does (he/she) ride in a child car seat. Child car seats include infant seats, toddler seats and booster seats. Would you say (he/she) rides in a child car seat... (READ LIST)
ALL OF THE TIME....................1
MOST OF THE TIME........................2
SOME OF THE TIME...................3
RARELY, OR..............................4
NEVER..............................5 SKIP TO Q.46
Q.23a When was the last time (he/she) did not ride in a child car seat when you were driving? READ LIST OF NECESSARY
Today................1
Within past week...........2
Within past month....3
Within past 12 months......4
A year or more ago/
always wears it....5
ASK IF DON'T KNOW IN Q.23a
Q.23b Has there been any occasion in the past 12 months when (he/she) did not ride in a car seat when you were driving?
Yes..................1
No.......................2
Q.24 When (he/she) is fastened in the child car seat, are there straps over both shoulders, a strap across only one shoulder, or are there no straps over either shoulder?
Two straps................1
One strap.......................2
No straps.................3
Q.25 S When you are driving and (he/she) rides in the child car seat, is it usually in the front seat or the back seat?
Front seat.............1 SKIP TO Q.27
Back seat...................2
Q.26 Is the child car seat usually behind the driver, behind the passenger or in the middle of the back seat?
Behind the driver.........1
Behind the passenger..........2
In the middle.............3
IF Q.24 IS ONE OR NO STRAPS, GO TO N28b
Q.27 When you are driving and (he/she) is riding in the child car seat, is it usually front facing or rear facing?
Front....................1
Rear..........................2
LOGIC CHECK: IF KID AGE GE 1 AND Q.27=2, REPEAT Q27.
IF STILL "REAR FACING" ASK THE CHILD'S AGE AND ENTER IN NOTES.
Q.28a Can the seat be used in a front facing position only, a rear facing position only, or can it be used in either position?
Front facing only...............1
Rear facing only.....................2
Either front or rear facing.....3
N28b. How many days out of the past thirty days did your (AGE) ride in a vehicle that you drove?
________ DAYS (Range=0-30) NOT SURE=31 REFUSED=32Q.28b During the past thirty days, has your (AGE) ridden in a vehicle where someone outside of your household was driving (includes school buses, taxis and other private vehicle)?
Yes.......1
No.............2 SKIP TO Q.29
Q.28c How many days out of the past thirty days did this child ride in a vehicle driven by someone outside of your household?
____________ (Range=0-30)
Q.28d Who were those drivers? (What is their relationship to the child? (MULTIPLE RECORD)
Parent/step-parent........1
Brother/sister................2
Grandparent...............3
Other relative................4
Teacher/Bus driver........5
Parent of friends.............6
Other non-relative........7
Q.29 Where would you say it is safest to place a child car seat in the vehicle...in the front seat or in the back seat?
Front seat....................................1
Back seat..........................................2
Q.30 Some child car seats are designed so that the child faces backward, to the rear of the motor vehicle. Suppose a child is riding in a child car seat facing backward. If the vehicle has a passenger side airbag, is it safe or unsafe to have the child car seat in the front seat?
Safe...............................1
Unsafe.................................2
Have no idea how air bags work.....3
Q.31 Now thinking again about the child car seat the (AGE) usually rides in, did you get the child car seat new or used?
New........................1
Used............................2
Q.32 Did you purchase the child car seat, did you get it as a gift or
loaner from a relative or friend or did you get it from a loaner program?
(NOTE: IF RESPONDENT HAD USED THE CHILD CAR SEAT PREVIOUSLY, PROBE
TO DETERMINE WHERE CHILD CAR SEAT ORIGINALLY CAME FROM)
Purchased.................1
Gift/Loan......................2
Loaner program............3
Other (SPECIFY)................9
____________________________
IF Q.32=PURCHASED ASK Q.33, ELSE GO TO Q.34
Q.33 Where did you purchase it from?
Retail store...........................1
Second-hand store/consignment shop.........2
Garage sale/neighborhood sale..........3
Other(SPECIFY).............................4
___________________________________
Q.34 When you are driving and (he/she) is riding in the child car seat, are there ever any times when the child car seat is not attached to the car's seat belt?
Yes.....................1
No...........................2
Q.35 Did you ever read or hear of any information or receive any advice about the need to use child car seats from any of the following sources? Did you get any information...
| YES | NO | [VOL] NOT SURE |
[VOL] REFUSED |
||
| a. | FROM A DOCTOR OR NURSE................. | 1 | 2 | 3 | 4 |
| b. | FROM A BOOK OR ARTICLE ON CHILD CARE... | 1 | 2 | 3 | 4 |
| c. | FROM ANY OTHER KIND OF BOOK OR ARTICLE............................ |
1 | 2 | 3 | 4 |
| d. | FROM INFORMATION ON TV OR RADIO........ | 1 | 2 | 3 | 4 |
| e. | FROM A FAMILY MEMBER OR FRIEND........ | 1 | 2 | 3 | 4 |
| f. | FROM A SAFETY HOTLINE.................. | 1 | 2 | 3 | 4 |
IF YES IN Q35f ASK Q35g, ELSE SKIP TO Q35h
Q.35g Whose safety hotline?
_______________________________________________
Q.35h Did you hear or read about the need to use child car seats from anywhere else?
Yes....................1
No..........................2 SKIP TO Q.36
Q.35i Where?
_______________________________________________________
Q.36 How did you learn to attach the child car seat to the vehicle? (MULTIPLE RECORD)
Read the instructions...............1
Relative or friend showed me..............2
Loaner program showed me............3
Health professional showed me.............4
Figured it out myself...............5
Car seat came attached to car.............6 SKIP TO Q.39C
IF Q.36=1 or 6, THEN GO TO N37c ELSE GO TO Q.37
Q.37 Did you ever read the instructions?
Yes...............................1 SKIP TO N37c
No....................................2
N37b. Were any instructions available?
Yes...............................1 SKIP TO Q38
No....................................2 SKIP TO Q38
N37c. How easy or difficult were the instructions to understand. Would you say that the instructions were very easy, somewhat easy, somewhat difficult, or very difficult to understand?
Very easy............1
Somewhat easy.............2
Somewhat difficult...3
Very difficult............4
Q.38 How easy is it for you to attach the child car seat to the vehicle you usually drive...(READ LIST)
VERY EASY...............................1 SKIP TO Q.39b
SOMEWHAT EASY OR.............................2
NOT EASY AT ALL.........................3
Q.39a What is difficult about attaching the child car seat to the vehicle? (RECORD VERBATIM RESPONSES ON SAF NEXT TO Q.39a, THEN ENTER "1" TO CONTINUE)
Gave response to Q.39a.............1
Don't know/not sure/no answer...........2
Q.39b How confident are you that the car seat is securely attached to the vehicle that you usually drive? Are you usually........
Very confident............1
Fairly confident..............2
Not too confident.........3
Q.39c Have you ever driven with the child in the car seat and later found that the car seat was not securely attached?
Yes.................1
No......................2 SKIP TO Q40
N39d. Why did this happen?
__________________________________________________
Q.40 How easy is it for you to properly buckle your child into the child car seat? (READ LIST)
VERY EASY.....................1 SKIP TO Q.41b
SOMEWHAT EASY OR................2
NOT EASY AT ALL...............3
Q.41a What is difficult about buckling your child into the child car seat? (RECORD VERBATIM RESPONSES ON SAF NEXT TO Q.41a, THEN ENTER "1" TO CONTINUE)
Gave response to Q.41a.................1
Don't know/not sure/no answer................2
Q.41b How confident are you that the child is properly buckled into the seat? Are you usually........
Very confident............1
Fairly confident..............2
Not too confident.........3
Q.42 Has the (AGE) ever gotten himself/herself out of that child car seat when riding with you?
Yes....................1
No..........................2
IF Q.22=ALL THE TIME & Q.23a=>1 YR AGO/ALWAYS SKIP TO Q.50b ELSE Q.43
Q.43 Please answer yes or no to each of the following statements. When my (AGE) doesn't ride in a child car seat, it is sometimes because...)
| YES | NO | [VOL] NOT SURE |
[VOL] REFUSED |
||
| a. | HE/SHE IS TOO BIG..................... | 1 | 2 | 3 | 4 |
| b. | HE/SHE DOESN'T LIKE IT................ | 1 | 2 | 3 | 4 |
| c. | HE/SHE WON'T STAY IN IT............... | 1 | 2 | 3 | 4 |
| d. | THERE IS NO ROOM FOR THE SEAT IN THE CAR............................ |
1 | 2 | 3 | 4 |
| e. | HE/SHE WILL ONLY BE IN THE CAR A SHORT TIME.......................... |
1 | 2 | 3 | 4 |
| f. | WE ARE IN A HURRY..................... | 1 | 2 | 3 | 4 |
| g. | THE CHILD CAR SEAT ISN'T AVAILABLE.... | 1 | 2 | 3 | 4 |
Q.43h Are there any other reasons why (he/she) doesn't ride in a child car seat?
Yes....................1
No............................2
____________________________________________________________________
Q.44 When the (AGE) doesn't ride in the child car seat, when riding with you does he/she usually sit on someone's lap, sit by him/herself in the front seat or sit in the back seat?
Lap of passenger.....................1
Front seat................................2
Back seat............................3
Back of station wagon or truck (VOL)......4
Q.45a When the (AGE) doesn't ride in the child car seat, when riding with you, how often is he/she buckled in a seat belt? (READ LIST)
ALL OF THE TIME........1
MOST OF THE TIME.............2
SOME OF THE TIME.......3
RARELY OR....................4
NEVER..................5
CONDITIONAL: IF Q.44=1 AND Q.45a LE 4, ASK Q.45b ELSE GO TO Q.50b:
Q.45b Is he/she buckled in a seatbelt when riding in someone's lap?
Yes......................1
No............................2
IF Q22=NEVER CONTINUE WITH Q46, ELSE GO TO Q50b
Q.46 Please answer yes or no to each of the following statements to indicate if this
is a reason why the (AGE) does not ride in a child car seat.
My (AGE) doesn't ride in a child car seat because...
| YES | NO | [VOL] NOT SURE |
[VOL] REFUSED |
||
| a. | HE/SHE DOESN'T HAVE ONE............... | 1 | 2 | 3 | 4 |
| b. | HE/SHE IS TOO BIG..................... | 1 | 2 | 3 | 4 |
| c. | HE/SHE DOESN'T LIKE IT................ | 1 | 2 | 3 | 4 |
| d. | HE/SHE WON'T STAY IN IT............... | 1 | 2 | 3 | 4 |
| e. | HE/SHE USES A SEAT BELT............... | 1 | 2 | 3 | 4 |
| f. | THERE ISN'T ENOUGH ROOM IN THE CAR.... | 1 | 2 | 3 | 4 |
Q.46g Are there any other reasons why he/she doesn't ride in a child car seat?
Yes......................1
No............................2
IF Q.46a=1, ASK Q.47, ELSE SKIP TO Q.48
Q.47 Is there any particular reason why you don't have one?
Yes.......................1
No..............................2
Q.48 How often does he/she use a seat belt? (READ LIST)
ALL OF THE TIME............1
MOST OF THE TIME.................2
SOME OF THE TIME...........3
RARELY OR........................4
NEVER......................5
N48b. Where does (AGE)usually sit in the vehicle when you are driving -- the front seat or the back seat?
Front seat.............1
Back seat....................2
About equal............3
Other (SPECIFY)..............4 _____________
Q.49 Did the (AGE) ever ride in a child car seat during the first year of life?
Yes.....................1
No..........................2 SKIP TO Q.51
Q.50a How often did he/she use the child car seat during that first year? Would you say...(READ LIST)
ALL OF THE TIME................1
MOST OF THE TIME....................2
SOME OF THE TIME OR............3
RARELY..............................4
Q.50b Before today, had you ever seen or heard of a type of car seat called a booster seat?
Yes.......................1
No..............................2 SKIP TO Q.50e
Q.50c Have you ever used a booster seat when driving with your (child/children)?
Yes.......................1
No..............................2SKIP TO N50d1
Q.50d At what age did you begin using a booster seat for your children?
_______ AGE AT FIRST USE OF BOOSTER SEAT
N50d1. Do you have any concerns about the safety of boosters seats?
Yes.......................1
No..............................2 SKIP TO Q.50e
N50d2. What are those concerns (about the safety of booster seats)?
_________________________________________________
IF Q.22=5, SKIP TO Q.51
Q.50e When your (AGE) outgrows his/her current child car seat, do you expect him/her to use a different type of car seat, a seat belt or something else?
Different seat............1
Seat belts....................2
Other (SPECIFY)
____________________......3
Q.51 How do you personally feel about the police enforcement of child car seat laws? On a scale of 1 to 10, where 1 means police should hardly ever give tickets and 10 means police should give a ticket at every opportunity for violations of child car seat laws, how strict should police enforcement be?
1=Police hardly ever give a ticket for violations
2
3
4
5
6
7
8
9
10=Police give a ticket at every opportunity
11..........(VOL) Don't know
12..........(VOL) Refused
Q.52 What do you think the minimum fine should be for violation of child car seat laws?
$__________ (Range=1-1000)
No fine/warning...........0
Not sure..................1001
Q.53. What about when children outgrow a child car seat? Do you agree or disagree that they should be required by law to wear seat belts when riding in a vehicle?
Agree..................1
Depends on age.............2
Disagree...............3 SKIP TO N55a
Q.54 How old do you think children should be before they are not
required by law to wear seat belts or do you think all children
should be required to wear them?
__________ AGE (Range: 0-21) 0=SHOULD NOT BE REQUIRED AT ANY AGE
DELETED Q.55
ASK N55a IF Q13a LE 15, ELSE GO TO Q56a
N55a. There are a few questions I would like to ask you about child injury prevention in general. During the past two years, have you received any training in CPR, specifically for infants and children? CPR is how you press down on a child's chest to get their blood flowing while you are also giving the child artificial respiration. (IF TRAINING IN MOUTH-TO-MOUTH RESUSCITATION ONLY, CODE NO)
Yes.................1
No......................2
N55b. During the past two years, have you received any other training in first aid specifically for infants or children?
Yes.................1
No......................2
IF YES IN EITHER N55a OR N55b ASK N55c, ELSE SKIP TO N55d
N55c. Who provided the (CPR/and/first aid training)? MULTIPLE RECORD
Work.........................1
School...........................2
Doctor/health professional...3
Other (SPECIFY)..................4 _____________________
N55d. Have you ever had a doctor or nurse talk to you about ways in which you could prevent injuries from happening to your child(ren) -- either over the phone, during an office visit, at a lecture, or anywhere else?
Yes.................1
No......................2SKIP TO N55f
N55e. How long ago did this happen (most recently)? Has it been within the past month, within the past 12 months, within the past five years or more than five years ago?
Past month..................1
Past 12 months..................2
Past five years.............3
More than five years ago........4
N55f. Have you ever had a doctor or nurse tell you what signs or symptoms to look for to determine if your child is having a medical emergency, a life-threatening situation, that needs immediate attention?
Yes.................1
No......................2 SKIP TO N55h
N55g. How long ago did this happen (most recently)? Has it been within the past month, within the past 12 months, within the past five years or more than five years ago?
Past month..................1
Past 12 months..................2
Past five years.............3
More than five years ago........4
N55h. If your child was having a medical emergency, a life-threatening situation that needed immediate attention, which of the following would you do first? Would you.......
Call your doctor's office.......................1
Take your child to the emergency room................2
Call 9-1-1 or another local emergency number....3
Do something else (SPECIFY)..........................4
Now, I'd like to ask you a few questions about airbags.
Q.56a Does the (car/truck/van) you normally (drive/ride in) have an airbag?
Yes.................1
No......................2 SKIP TO Q.56c
Q.56b Is the airbag for the driver only, or is there also a passenger side airbag?
Driver only.............1
Driver and passenger........2
Q.56c Based on what you know or have heard, how likely is it that an adult sitting in the front seat would be injured by an airbag when it opens normally? Are they ... (READ)?
Very likely to be injured............1
Somewhat likely to be injured............2
Somewhat unlikely....................3
Very unlikely............................4
Q.56d How likely is it that a small child sitting in the front seat would be injured by an airbag when it opens normally? Are they... (READ LIST)?
Very likely to be injured............1
Somewhat likely to be injured............2
Somewhat unlikely....................3
Very unlikely............................4
DELETED Q.56e AND Q.56f AND Q.56g AND Q.56h AND Q.56i
IF Q56a EQ 1 ASK N56e, ELSE SKIP TO Q57a.
N56e. Are there any warning labels about airbags in the (car/truck/van) you normally drive?
Yes................1
No.....................2 SKIP TO Q57a
N56f. Where in the (car/van/truck) are the warning labels?
DO NOT READ LIST. MULTIPLE RECORD.
Sun visor.............1
Dashboard.................2
Other (SPECIFY).......3 __________________________
N56g. As best as you can remember, what are the warnings listed on the warning label? DO NOT READ LIST. MULTIPLE RECORD.
Airbags can kill children under 12....................1
Back seat is safest for children...........................2
Never put rear facing child seat in front.............3
Sit as far back from airbag as possible....................4
Do not sit or lean unnecessarily close to airbag......5
Always use seatbelts and child restraints..................6
Do not place objects over the airbag or
between the airbag and yourself.....................7
See the owners manual......................................8
Other (SPECIFY: ___________________________)..........9
Q.57a Now I would like to ask you some questions about bicycle use. Have you ridden a bicycle at all during the past 30 days? Do NOT include stationary or exercise bikes.ude
Yes....................1
No..........................2 SKIP TO Q.58
Q.57b How many days in the last 30 days did you ride a bicycle?
________ (Range: 0-30) DON'T KNOW=31 REFUSED=32
ALL ANSWERS IN Q57b SKIP TO Q.59
Q.58 Have you ridden a bicycle at all during the past 12 months? Do not include stationary or exercise bikes.
Yes....................1
No..........................2 SKIP TO Q.62
Q.59 Do you usually wear a bicycle helmet when you ride a bike?
Yes....................1
No..........................2
DELETE Q.60 AND Q.61
IF Q.13=AT LEAST 1 CHILD 4-12 ASK Q.62 FOR 1 RANDOMLY SELECTED CHILD
IF Q.13=NO CHILDREN 4-12 SKIP TO Q.65
Q.62 During the past 12 months, has the (AGE) ridden a bicycle? Do NOT include tricycles; DO include two-wheelers with training wheels.
Yes....................1
No..........................2 SKIP TO Q.65
Q.63 Does he/she have a bicycle helmet?
Yes....................1
No..........................2 SKIP TO Q.65
Q.64a Does he/she usually wear it?
Yes....................1 SKIP TO Q.65
No..........................2
Q.64b Why not?(RECORD VERBATIM RESPONSES ON SAF NEXT TO Q.64b, THEN ENTER "1" TO CONTINUE)
Gave response to Q.64b....................1
No reason/don't know/not sure/refused.........2
Q.65 Do you favor or oppose laws which require children to wear bicycle helmets? (DO NOT READ LIST)
Favor.......................1
Oppose...........................2
Depends on age of child.....3
Depends on where they
ride/type of street............4
DELETE Q.66
Q.67a Now I'd like to ask you some questions about a subject you may not know much about. Can you tell me what the initials "EMS" stand for?
Yes, Emergency Medical
Services/Systems..............1
Yes, wrong answer....................2
No............................3
Q.67b Other response to what "EMS" stands for
________________________________________________
IF GAVE WRONG ANSWER ON Q.67a READ THIS STATEMENT, ELSE GO TO Q.68a Lots of people don't know it, but EMS stands for Emergency Medical Services. This includes ambulance and rescue squads and hospital emergency services
Q.68a If someone was experiencing a medical emergency and you needed to get help for that person, who would you call first? (NOTE: MEDICAL EMERGENCY MEANS A LIFE-THREATENING SITUATION)
911................................1 SKIP TO Q.71
Telephone operator.....................2
Police.............................3
Friend.................................4
Spouse/Relative....................5
Doctor.................................6
EMS (Emergency Medical Services)...7
Other (SPECIFY)........................8 ________________
Q.69 Is there a particular telephone number to call for medical emergencies in your community?
Yes......................1
No.............................2 SKIP TO Q.71
Q.70 What is that telephone number?
911..........................1
Other (SPECIFY)....................7
_____________________________
Q.71 If there was a medical emergency in your neighborhood and you called an ambulance, how long do you think it would take for the ambulance to arrive? (ENTER IN MINUTES)
___________ MINUTES (Range: 1-60)
MORE THAN AN HOUR=61 DON'T KNOW=62 REFUSED=63
Q.72a. Regardless of the type of medical emergency, how confident are you that the ambulance or other emergency workers would know what to do? (READ LIST)
VERY CONFIDENT...............1
SOMEWHAT CONFIDENT OR.............2
NOT CONFIDENT................3
Q.72b Have you, personally, ever called 911 or another emergency number for help?
Yes..........1
No...............2 SKIP TO Q.73
Q.72c How long ago did that occur (the last time)?
Today................1
Within past week...........2
Within past month....3
Within past 12 months......4
A year or more ago...5
Q.72d Did you call for police, fire, an ambulance or something else? MULTIPLE RECORD
Police.....................................1
Fire............................................2
Ambulance..................................3
Other (SPECIFY).................................4 _________________
DELETED Q.72e
IF YES TO N55a OR N55b, SKIP TO Q75
Q.73 In the past 5 years, have you taken any kind of emergency or first aid training?
Yes.......................1
No............................2 SKIP TO Q.75
Q.74 Who provided the training? MULTIPLE RECORD
Work...........................1
School...............................2
Doctor/Health professional.....3
Other................................9
____________________________
Q.75 Assuming it was at low cost and in a convenient location, how interested would you be in taking training on how to assist injured persons in vehicle crashes? (READ LIST)
VERY INTERESTED.....................1
SOMEWHAT INTERESTED OR....................2
NOT INTERESTED......................3 SKIP TO Q.77
Q.76 If the training took no more than two hours in a single class session, how likely would you be to take such a class? (READ LIST)
VERY LIKELY............1
SOMEWHAT LIKELY.............2
SOMEWHAT UNLIKELY......3
VERY UNLIKELY...............4
Q.77 Suppose that you are driving, you see an accident happen and no one is there at the scene to help. What concerns might you have about stopping to help? Anything else? DO NOT READ LIST. MULTIPLE RECORD.
No concerns..............................1
Lawsuits/liability............................2
Not knowing what to do/how to help.......3
Trick to get you to stop......................4
Causing further injury to victim.........5
Personal safety...............................6
Other (SPECIFY)
_________________________________.......13
Q.78 How likely would you be to stop? Do you think that you... (READ)?
Definitely would stop.......1 SKIP TO Q.80
Probably would stop.............2
Probably would not stop.....3
Definitely would not stop.......4
Q.79 What would prevent you from stopping?
Nothing..........................................1
Fear of Lawsuits/liability............................2
Not knowing what to do/how to help...............3
Fear that it was trick to get you to stop.............4
Fear of causing further injury to victim.........5
Personal safety.......................................6
Other (SPECIFY)
_________________________________...........13
Q.80 Suppose you are driving, you see an accident and think that someone might be injured, but it is too dangerous to pull over and help at the scene. How likely would you be to call for help from the nearest available phone (if no one else was on the scene)? Do you think that you...(READ)?
Definitely would call.......1 SKIP TO Q.82A
Probably would call.............2
Probably would not call.....3
Definitely would not call.......4
Q.81 What, if anything, would prevent you from telephoning for help? _______________________________________________________________
Nothing........00
ASK IF DRIVER ONLY, ELSE SKIP TO Q83a
Q.82a Do you have a car phone or (ever) carry a cellular phone in the motor vehicle you usually drive.....?
Yes..........1
No................2 SKIP TO Q.83a
DELETE Q.82b
N82b1. Is it a hands free phone?
Yes..........1
No................2
N82b2. Please answer yes or no to the following items about your car phone's features. Does your car phone have... ?
| YES | NO | NOT SURE |
|
| FAX....................... | 1 | 2 | 3 |
| E-mail ................... | 1 | 2 | 3 |
| Internet access........... | 1 | 2 | 3 |
| Paging ................... | 1 | 2 | 3 |
FOR EACH YES IN N82b2, ASK:
N82b3. Do you ever use the (FAX/e-mail/internet/paging) on your car phone while driving?
| YES | NO | NOT SURE |
|
| FAX....................... | 1 | 2 | 3 |
| E-mail ................... | 1 | 2 | 3 |
| Internet access........... | 1 | 2 | 3 |
| Paging ................... | 1 | 2 | 3 |
Q.82c How often do you talk on your car phone when you are driving? Do you talk on your car phone.....
On most trips in your motor vehicle........1
On about half of your trips.....................2
On less than half of your trips............3
On very few trips, or...........................4
Never......................................5
Q.82d Have you ever used a car phone or cellular phone to report an emergency while you were driving or riding in a motor vehicle?
Yes............1
No..................2 SKIP TO Q.83A
Q.82e What kind of emergency did you call about?
______________________________________________
Q.83a Have YOU ever been injured in a vehicle accident? Only count injuries that required medical attention.
Yes.......................1 SKIP TO Q.83b
No.............................2
N83a1. Have you ever been injured in a motor vehicle accident when you were a passenger, or have you ever been hit and injured by a motor vehicle when you were walking or riding a bike? Only count injuries that required medical attention.
Yes.......................1
No.............................2 SKIP TO Q90
Q.83b How many times has this happened to you?
______________________________ DON'T KNOW=98 REFUSED=99
DELETE Q.83c
Q.83d How long ago did (that/your most recent) accident occur?
________________________ NUMBER OF YEARS AGO
WITHIN THE PAST 12 MONTHS=0 NOT SURE=98 REFUSED=99
DELETE Q.83e
Q.83f Were you a driver or a passenger in that accident?
Driver..............1
Passenger...............2
(VOL) Pedestrian....3
(VOL) Bicyclist.........4
Other (SPECIFY)
______________.......5
IF Q83f=3 OR 4, SKIP TO Q.85
Q.84 Were you wearing your seat belt at the time of the accident?
Yes..................................1
No.......................................2
Q.85 At which of the following were you treated for your injuries? Were you treated at ..(READ LIST. MULTIPLE RECORD)?
A hospital emergency room........1
A doctor's office....................2
A clinic.........................3
The accident scene...................4
Somewhere else (SPECIFY).........5 ____________________________
Did not need treatment.........6 SKIP TO Q.87b
Q.86 Were you transported from the accident scene by ambulance or helicopter?
Yes, ambulance (or other rescue vehicle)....1
Yes, helicopter..................................2
No, neither.................................3
Q.87a Were you hospitalized?
Yes.......................1
No.............................2 SKIP TO NQ87b
N87a1. How long were you hospitalized?
______ DAYS or ______ HOURS (1-23)
NQ87b. Did you receive any continuing or follow-up treatment for your injuries?
Yes.......................1
No.............................2 SKIP TO Q87b (VOL) Don't know..........3 SKIP TO Q87b
NQ87c. Where did you receive this (follow-up) treatment? Was it at ... (READ LIST AND MULTIPLE RECORD)?
A doctor's office................1
A physical therapist.................2
A clinic.........................3
Somewhere else (SPECIFY).............4_____________________
Q.87b Did your injuries from that accident prevent you from performing any of your normal activities (work, school, household) for at least a week?
Yes.......................1
No.............................2 SKIP TO Q.88
Q.87c Were there any activities that you were unable to resume because of your injuries even a year after the accident?
Yes.......................................1
No.............................................2
Happened less than 1 year ago.............3
IF YES IN Q.87b or Q.83b=1 SKIP TO Q.90
Q.88 Have you EVER received injuries from a vehicle accident that prevented you from performing any of your normal activities (work, school, household) for at least a week?
Yes.......................1
No.............................2 SKIP TO Q.90
Q.89 Were there any activities that you were unable to resume because of your injuries even a year after the accident?
Yes.......................................1
No.............................................2
Happened less than 1 year ago.............3
Q.90 Now I'm going to ask you a few questions about alcohol use. During the past 30 days have you had at least one drink of any alcoholic beverage, including liquor, beer, wine or wine coolers?
Yes......................1 SKIP TO Q.92
No............................2
Q.91 Did you drink any alcoholic beverages at all during the past 12 months?
Yes.......................1 SKIP TO Q.93
No............................2 SKIP TO Q.11
Q.92 How many days out of the past 30 days did you drink alcoholic beverages?
_______________ (Range: 0-30) NOT SURE=31 REFUSED=32
Q.93 On the average, how many drinks did you typically have on the days you drank?
__________ (Range: 1-12) MORE THAN 12=13 NOT SURE=14 REFUSED=15
IF Q.1=NEVER OR Q.90=NO, SKIP TO Q.11. ELSE ASK Q.94
Q.94 During the past 30 days, have you driven a vehicle after you had been drinking alcohol?
Yes....................1
No...........................2 SKIP TO Q.11
Q.95 How many days out of the past 30 days did you drive after drinking alcoholic beverages?
_____________(Range: 0-30) NOT SURE=31 REFUSED=32
Q.96 During the past 30 days, have you driven a vehicle when you might have consumed too much alcohol to drive safely?
Yes....................1
No...........................2
Now I would like to ask you just a few more questions about yourself and then we will be done.
Q.11 What is your age?
__________ AGE REFUSED=99
Q.12a Including yourself, how many persons, AGE 16 OR OLDER, are living in your household at least half of the time or consider it their primary residence?
________ IF NO OTHER ADULTS 16+, ENTER "0" REFUSED=99
Q.97 Do you consider yourself to be Hispanic or Latino?
Yes....................1
No.........................2
Q.98 Which of the following racial categories describes you? You may select more than one. READ LIST AND MULTIPLE RECORD
American Indian or Alaskan Native...........1
Asian...........................................2
Black or African-American...................3
Native Hawaiian or Other Pacific Islander.......4
White.......................................5
Other (SPECIFY).................................10 __________________________________________
Q.99 Are you married, divorced, widowed, separated or have you never been married?
Married..............................1
Divorced....................................2
Widowed..............................3
Separated...................................4
Never been married...................5
A member of an unmarried couple.............6
Q.100 What is the highest grade or year of school you completed?
8th grade or less.............8
9th grade...........................9
10th grade....................10
11th grade..........................11
12th grade/GED................12
Some college........................13
College graduate or higher....14
Q.101 Which of the following categories best describes your total household income before taxes in 1997? (Include the income of all persons in the household.) Was your total household income [READ LIST]
Less than $5,000.............1
$5,000 to $14,999..........2
$15,000 to $29,999...........3
$30,000 to $49,999.........4
$50,000 to $74,999...........5
$75,000 to $99,999.........6
$100,000 or more.............7
Q.102 Are you currently employed for wages, self-employed, out of work, a homemaker, a student, retired or unable to work? MULTIPLE RECORD
Employed for wages.........1
Self-employed....................2
Out of work................3
Homemaker........................4
Student....................5
Retired..........................6
Unable to work.............7
Q103. Not including beepers and pagers, do you have more than one telephone number in your household at which you normally can receive in-coming phone calls?
Yes...............1
No.....................2 SKIP TO Q.105
Q.104 How many different telephone numbers do you have at this residence at which you can normally receive incoming phone calls?
___________ 10 OR MORE=10 DON'T KNOW=11 REFUSED=12
Q.105 Finally, could you tell me the zip code where you live?
______________________ REFUSED=99999
Q.106 FROM OBSERVATION, ENTER SEX OF RESPONDENT
Male.......1
Female............2
Q107. INTERVIEW WAS CONDUCTED IN:
ENGLISH........1
SPANISH...........2
That completes the survey.
Thank you very much for your time and cooperation.
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