CHIS 2020 Adolescent CAWI Questionnaire (Self-Administered) Version 1.02 Vietnamese July 15, 2021 (Adolescent Respondents Ages 12-17) Collaborating Agencies: • UCLA Center for Health Policy Research • California Department of Health Care Services • California Department of Public Health Contact: California Health Interview Survey UCLA Center for Health Policy Research 10960 Wilshire Blvd, Suite 1550 Los Angeles, CA 90024 Telephone: (866) 275-2447 Fax: (310) 794-2686 Web: www.chis.ucla.edu Copyright © 2020 by the Regents of the University of California CHIS 2020 CAWI Teen Questionnaire Version 1.02 July 15, 2021 Table of Contents SECTION A: DEMOGRAPHICS PART I AND CIVIC ENGAGEMENT Age Gender Identity Name of School SECTION B: HEALTH STATUS AND HEALTH CONDITIONS General Health Missed School Days Asthma 10 SECTION C: DIET, NUTRITION, AND FOOD ENVIRONMENT 14 Dietary Intake 14 SECTION D: PHYSICAL ACTIVITY 15 Commute from School to Home 15 Park and Neighborhood Safety 15 Sedentary Time 18 Section E: Cigarette, Alcohol and Drug Use 19 Cigarette Use 19 E-Cigarette Use 19 Alcohol Use/Abuse 22 SECTION F: MENTAL HEALTH 26 K6 Mental Health Assessment 26 SECTION G: SEXUAL BEHAVIORS 34 SECTION H: HEALTH CARE UTILIZATION AND ACCESS 41 Usual Source of Care 41 Emergency Room Visits 41 Visits to medical doctor 41 Personal Doctor 42 Care Coordination 43 Dental Health 45 SECTION J: DEMOGRAPHIC INFORMATION PART II 47 Race/Ethnicity 47 Country of Birth 54 Language Spoken at Home 57 SECTION K: SUICIDE IDEATION AND ATTEMPTS 58 SECTION L: CIVIC ENGAGEMENT AND RESILIENCY 60 Voting Attitudes 61 Pre-Exposure Prophylaxis 62 HIV Testing 63 CHIS 2020 CAWI Teen Questionnaire Version 1.02 July 15, 2021 SECTION M: CLOSING 64 Follow Up and Close 64 SUICIDE RESOURCE 64 NOTE: Each question in the CHIS questionnaires (adult, child, and adolescent) has a unique, sequential question number by section that follows the administration of the survey In addition, the variable name (in the CHIS data file) associated with a question, appears in a box beneath the question number Please consult the CHIS 2020 Data Dictionaries for additional information on variables, the population universe answering a specific question, and data file content CHIS 2020 CAWI Teen Questionnaire Version 1.02 July 15, 2021 SECTION A: DEMOGRAPHICS PART I AND CIVIC ENGAGEMENT Age PROGRAMMING NOTE ‘QT2020_A1’ : SET TADATE = CURRENT DATE (YYYYMMDD) ‘QT2020_A1’ [TA1] - What is your date of birth? Ngày sinh quý vị ngày nào? _ Month January Tháng February Tháng March Tháng April Tháng May Tháng June Tháng July Tháng August Tháng September Tháng 10 October 10 Tháng 10 11 November 11 Tháng 11 12 December 12 Tháng 12 -7 REFUSED -8 DON'T KNOW _ Day -7 REFUSED -8 DON'T KNOW _ Year -7 REFUSED -8 DON'T KNOW CHIS 2020 CAWI Teen Questionnaire Version 1.02 PROGRAMMING NOTE ‘QT2020_A2’ : IF ‘QT2020_A1’ = -3, CONTINUE WITH ‘QT2020_A2’ ; ELSE GO TO ‘QT2020_A4’ ‘QT2020_A2’ [TA1A] - What month and year were you born? Quý vị sanh vào tháng năm nào? _ Month _ Tháng January Tháng February Tháng March Tháng April Tháng May Tháng June Tháng July Tháng August Tháng September Tháng 10 October 10 Tháng 10 11 November 11 Tháng 11 12 December 12 Tháng 12 -7 REFUSED -8 DON'T KNOW _ Year _ Năm -7 REFUSED -8 DON'T KNOW July 15, 2021 CHIS 2020 CAWI Teen Questionnaire Version 1.02 July 15, 2021 PROGRAMMING NOTE ‘QT2020_A3’ : IF ‘QT2020_A2’ = -3, CONTINUE WITH ‘QT2020_A3’ ; ELSE GO TO ‘QT2020_A4’ ‘QT2020_A3’ [TA2] - How old are you? Quý vị sanh vào tháng năm nào? _ Years of age [SR: 12-17] _ Năm -7 REFUSED -8 DON'T KNOW POST-NOTE ‘QT2020_A3’ : IF ‘QT2020_A1’ AND ‘QT2020_A3’ ARE NOT KNOWN, USE CHILD ROSTER AGE (ENUM.AGE); IF TEENAGE is less than 12 OR TEENAGE greater than 17, THEN TERMINATE INTERVIEW AND CODE INELIGIBLE (IT) Gender Identity ‘QT2020_A4’ [TA20] - On your original birth certificate, was your sex assigned as male or female? Trên giấy khai sinh gốc, giới tính quý vị xác định nam, nữ hay chuyển giới? 01 Male 01 Nam 02 Female 02 Nữ ‘QT2020_A5’ [TA21] - Do you currently describe yourself as male, female, or transgender? Hiện tại quý vị tự nhận mình nam, nữ, hay chuyển giới? 01 Male 01 Nam 02 Female 02 Nữ 03 Transgender 03 Chuyển Giới None of these Không chủng tộc PROGRAMMING NOTE ‘QT2020_A6’: IF ‘QT2020_A5’ = THEN CONTINUE WITH ‘QT2020_A6’; ELSE SKIP TO ‘QT2020_A7’ ‘QT2020_A6’ [TA22] - What is your current gender identity? Hiện tại quý vị nhận diện giới gì? Specify: ( ) (Hãy Nêu Rõ: _) CHIS 2020 CAWI Teen Questionnaire Version 1.02 ‘QT2020_A7’ [TA4] - Did you attend school last week? Em có học tuần qua không? 01 Yes 01 Có 02 No 02 Không I am on vacation Tôi nghỉ học I am home schooled Tôi học tại nhà If = 1, go to ‘QT2020_A9’ ‘QT2020_A8’ [TA4C] - Did you attend school during the last school year? Quý vị có học năm học vừa không? 01 Yes 01 Có 02 No 02 Khơng I am on vacation Tôi nghỉ học I am home schooled Tôi học tại nhà If = 2, -3, go to 'SECTION B – HEALTH STATUS AND HEALTH CONDITIONS' Name of School July 15, 2021 CHIS 2020 CAWI Teen Questionnaire Version 1.02 ‘QT2020_A9’ [TA4B] - What is the name of the school you go to or last attended? Xin cho biết tên trường mà quý vị học học gì? NAME OF SCHOOL -7 REFUSED -8 DON'T KNOW TYPE OF SCHOOL Elementary Tiểu học Intermediate Trung học Junior high Trung học sở Middle school Trường cấp High school Trung học sở Senior high school Trung học phổ thông Continuation Trường bổ tú Charter school Trường bán công 91 Other (Specify: ) 91 Khác (Hãy nêu rõ: ) 00 I am not in school 00 Bé không học July 15, 2021 CHIS 2020 CAWI Teen Questionnaire Version 1.02 July 15, 2021 SECTION B: HEALTH STATUS AND HEALTH CONDITIONS General Health ‘QT2020_B1’ [TB1] – Now I’m going to ask about your health Bây giờ, xin hỏi sức khỏe em In general, would you say your health is excellent, very good, good, fair or poor? Nói chung, em cho sức khỏe tuyệt, tốt, tốt, hay yếu? Excellent Xuất sắc Very good Rất giỏi Good Giỏi Fair Khá Poor Kém ‘QT2020_B2’ [TB2] - About how tall are you without shoes? Em cao không mang giày? Your best guess is fine You may answer in feet and inches or meters and centimeters Em đoán chừng Quý vị trả lời feet inch mét hay centimét _ Feet (Range 3-7) _ Feet (Range 3-7) _ Inches (Range 0-11) _ Inch (Range 0-11) _ Meters (Range 1-2) _ Mét (Range 1-2) _ Centimeters (Range 0-300) _ Centimét (Range 0-300) Feet, inches Feet, inch Meters, Centimeters Mét, Centimét ‘QT2020_B3’ [TB3] - About how much you weigh without shoes? Em nặng không mang giày? Your best guess is fine You may answer in pounds or kilograms Em đoán chừng _ Pounds (Range 50 - SR: 450 HR: 999) _ Pound _ Kilograms (Range 20-220) _ Kilogam Missed School Days CHIS 2020 CAWI Teen Questionnaire Version 1.02 July 15, 2021 PROGRAMMING NOTE ‘QT2020_B4’ : IF ‘QT2020_A7’ = (ATTENDED SCHOOL LAST WEEK) OR (HOME SCHOOLED), CONTINUE WITH ‘QT2020_B4’ ; ELSE GO TO ‘QT2020_B5’ ‘QT2020_B4’ [TB4] - During the last four school weeks, how many days of school did you miss because of a health problem? Trong bốn tuần học vừa qua, em phải bỏ học ngày tình trạng sức khỏe mình? _ Days_[HR: 0-20] _ Ngày Asthma ‘QT2020_B5’ [TB5] - Has a doctor ever told you or your parents that you have asthma? Bác sĩ có cho em cha mẹ biết em bị bệnh suyễn không? 01 Yes 01 Có 02 No 02 Khơng If = 2, -3, go to ‘QT2020_C1’ ‘QT2020_B6’ [TB17] - Do you still have asthma? Em bị bệnh suyễn chứ? 01 Yes 01 Có 02 No 02 Khơng ‘QT2020_B7’ [TB18] - During the past 12 months, have you had an episode of asthma or an asthma attack? Trong vịng 12 tháng qua, em có bị lên suyễn ngắn lên suyễn nặng không? 01 Yes 01 Có 02 No 02 Khơng PROGRAMMING NOTE ‘QT2020_B8’ : IF ‘QT2020_B6’ = (YES, STILL HAVE ASTHMA) OR ‘QT2020_B7’ = (YES, EPISODE IN PAST 12 MONTHS) CONTINUE WITH ‘QT2020_B8’; ELSE GO TO ‘QT2020_B11’ ‘QT2020_B8’ [TB19] - During the past 12 months, have you had to visit a hospital emergency room because of your asthma? Trong 12 tháng qua, em có đến phịng cấp cứu tại bệnh viện bệnh suyễn khơng 01 Yes 01 Có 02 No 02 Không If = 2, -3 go to ‘QT2020_B11’ 10 ... REFUSED -8 DON'T KNOW CHIS 2020 CAWI Teen Questionnaire Version 1.02 PROGRAMMING NOTE ‘QT2020_A2’ : IF ‘QT2020_A1’ = -3, CONTINUE WITH ‘QT2020_A2’ ; ELSE GO TO ‘QT2020_A4’ ‘QT2020_A2’ [TA1A] - What... July 15, 2021 CHIS 2020 CAWI Teen Questionnaire Version 1.02 July 15, 2021 PROGRAMMING NOTE ‘QT2020_A3’ : IF ‘QT2020_A2’ = -3, CONTINUE WITH ‘QT2020_A3’ ; ELSE GO TO ‘QT2020_A4’ ‘QT2020_A3’ [TA2]... rõ: ) IF [‘QT2020_E1’=1 AND ‘QT2020_E5’=1] AND ‘QT2020_E2’= ‘QT2020_E6’ OR IF ‘QT2020_E2’ =-3 OR IF ‘QT2020_E6’=-3, CONTINUE WITH ‘QT2020_E9’; ELSE GO TO ‘QT2020_E10’ ‘QT2020_E9’ [TE83] -