CHIS 2021 Adolescent CATI Questionnaire (Interviewer-Administered) Version 1.05 Vietnamese August 5, 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 © 2021 by the Regents of the University of California CHIS 2021 CATI Teen Questionnaire Version 1.05 August 5, 2021 Guide to Questionnaire Formatting The following are from the 2021 CHIS Teen questionnaire, slightly modified and in no given order Programming note QID Var ID Lowercase text Uppercase text If Needed statement Interviewer Note Range Skip note Dynamic text Legend (each item is identified only once) Defines a skip pattern or text display for the subsequent question(s) Designates location of question, i.e ‘QT2021_A1’: Teen questionnaire, Section A, question #1 The question # in the QID denotes question order This may vary between survey cycles Unique ID of each question This generally stays the same between survey cycles This variable name correlates with the name found in the data file On CATI, this text is read to the respondent On CATI, this text is NOT read to the respondent On CATI, this text is only read if interview deems it helpful for respondent On CATI, this serves as additional instruction for the interviewer and is not read at loud On CATI, this text is not read SR: indicates soft range- allowable entry but will prompt verification message HR: indicates hard range- not an allowable entry Defines skip patterns dependent on the responses of the preceding question(s) {…} and (….) Denotes that text is automatically filled based on previous responses PROGRAMMING NOTE ‘QT2021_A1’ : SET TADATE = CURRENT DATE (YYYYMMDD) ‘QT2021_A1’ [TA1] - What is your date of birth? _ MONTH [RANGE: 1-12] JANUARY FEBRUARY MARCH APRIL MAY JUNE JULY AUGUST SEPTEMBER 10 OCTOBER 11 NOVEMBER 12 DECEMBER _ DAY [RANGE: 1-31] _ YEAR [RANGE: 2006-2009] -7 REFUSED -8 DON'T KNOW CHIS 2021 CATI Teen Questionnaire Version 1.05 August 5, 2021 ‘QT2021_A9’ [TA4B] - What is the name of the school you go to or last attended? [IF NEEDED, ASK: “Is that an elementary, middle, junior high, or high school?”] [INTERVIEWER NOTE: RECORD VERBATIM] NAME OF SCHOOL -7 REFUSED -8 DON'T KNOW TYPE OF SCHOOL TEEN NOT IN SCHOOL ELEMENTARY INTERMEDIATE JUNIOR HIGH MIDDLE SCHOOL HIGH SCHOOL SENIOR HIGH SCHOOL CONTINUATION CHARTER SCHOOL 91 OTHER (SPECIFY: ) -7 REFUSED -8 DON'T KNOW ‘QT2021_B20’ [TB52]- {Other than during pregnancy, has/Has} a doctor ever told you that you have diabetes or sugar diabetes? YES NO BORDERLINE OR PRE-DIABETES -7 REFUSED -8 DON'T KNOW If= 2, 3, -7,-8 goto ‘QT2021_C1’ CHIS 2021 CATI Teen Questionnaire Version 1.05 August 5, 2021 Table of Contents SECTION A: DEMOGRAPHICS PART I AND CIVIC ENGAGEMENT Age Gender Identity School Attendance Name of School SECTION B: HEALTH STATUS AND HEALTH CONDITIONS 10 General Health 10 Height and Weight 10 Missed School Days 10 Asthma 11 Diabetes 14 SECTION C: DIET, NUTRITION, AND FOOD ENVIRONMENT 16 Dietary Intake 16 SECTION D: PHYSICAL ACTIVITY 17 Social Cohesion 17 Gun Ownership and Violence 19 SECTION E: CIGARETTE, ALCOHOL AND DRUG USE 23 Cigarette Use 23 E-Cigarette Use 24 Alcohol Use/Abuse 25 SECTION F: MENTAL HEALTH 30 K6 Mental Health Assessment 30 Repeated K6 31 Mental Health and Technology 34 Climate Change 36 SECTION G: SEXUAL BEHAVIORS 38 SECTION H: HEALTH CARE UTILIZATION AND ACCESS 43 Usual Source of Care 43 Visits to Medical Doctor 43 Personal Doctor 44 Care Coordination 45 Delays in Care 45 Dental Health 47 SECTION J: DEMOGRAPHIC INFORMATION PART II 49 Race/Ethnicity 49 Country of Birth 55 Language Spoken at Home 57 CHIS 2021 CATI Teen Questionnaire Version 1.05 August 5, 2021 SECTION Q: ADVERSE CHILDHOOD EXPERIENCES 58 ACES Screener 58 Positive Childhood Experiences 59 Past ACEs Assessment 62 SECTION K: SUICIDE IDEATION AND ATTEMPTS 64 SECTION L: CIVIC ENGAGEMENT AND RESILIENCY 66 Voting Attitudes 67 Pre-Exposure Prophylaxis 68 HIV Testing 69 SECTION M: CLOSING 71 Follow Up and Close 71 SUICIDE RESOURCE 71 NOTE: Please consult the CHIS 2021 Data Dictionaries for additional information on variables, the population universe answering a specific question, and data file content CHIS 2021 CATI Teen Questionnaire Version 1.05 August 5, 2021 SECTION A: DEMOGRAPHICS PART I AND CIVIC ENGAGEMENT Age PROGRAMMING NOTE ‘QT2021_A1’ : SET TADATE = CURRENT DATE (YYYYMMDD) ‘QT2021_A1’ [TA1] - What is your date of birth? Ngày sanh em ngày nào? _ MONTH JANUARY FEBRUARY MARCH APRIL MAY JUNE JULY AUGUST SEPTEMBER 10 OCTOBER 11 NOVEMBER 12 DECEMBER -7 REFUSED -8 DON'T KNOW _ DAY -7 REFUSED -8 DON'T KNOW _ YEAR -7 REFUSED -8 DON'T KNOW CHIS 2021 CATI Teen Questionnaire Version 1.05 August 5, 2021 PROGRAMMING NOTE ‘QT2021_A2’ : IF ‘QT2021_A1’ = -7 OR -8 (REF/DK), CONTINUE WITH ‘QT2021_A2’ ; ELSE GO TO ‘QT2021_A4’ ‘QT2021_A2’ [TA1A] - What month and year were you born? Quý vị sanh vào tháng năm nào? _ MONTH JANUARY FEBRUARY MARCH APRIL MAY JUNE JULY AUGUST SEPTEMBER 10 OCTOBER 11 NOVEMBER 12 DECEMBER -7 REFUSED -8 DON'T KNOW _ YEAR -7 REFUSED -8 DON'T KNOW PROGRAMMING NOTE ‘QT2021_A3’ : ‘QT2021_A2’ BIRTH MONTH= INTERVIEW MONTH AND ( INTERVIEW YEAR- ‘QT2021_A2’ BIRTH YEAR= 12 OR 17), CONTINUE WITH ‘QT2021_A3’; IF ‘QT2021_A2’ = -7 OR -8 (REF/DK), CONTINUE WITH ‘QT2021_A3’ ; ELSE GO TO ‘QT2021_A4’ ‘QT2021_A3’ [TA2] - How old are you? Quý vị sanh vào tháng năm nào? _ YEARS OF AGE [SR: 12-17] -7 REFUSED -8 DON'T KNOW POST-NOTE ‘QT2021_A3’ : IF ‘QT2021_A1’ AND ‘QT2021_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 CHIS 2021 CATI Teen Questionnaire Version 1.05 August 5, 2021 ‘QT2021_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 02 FEMALE -7 REFUSED -8 DON'T KNOW ‘QT2021_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 02 FEMALE 03 TRANSGENDER 04 NONE OF THESE 05 I AM NOT SURE OF MY GENDER IDENTITY -7 REFUSED -8 DON'T KNOW If = 1, 2, 3, -7, -8 goto ‘QT2021_A7’ PROGRAMMING NOTE ‘QT2021_A6’:IF ‘QT2021_A5’ = THEN CONTINUE WITH ‘QT2021_A6’; ELSE SKIP TO ‘QT2021_A7’ ‘QT2021_A6’ [TA22] - What is your current gender identity? Hiện tại quý vị nhận diện giới gì? -1 SPECIFY: ( ) -7 REFUSED -8 DON'T KNOW School Attendance ‘QT2021_A7’ [TA4] - Did you attend school last week? Em có học tuần qua khơng? YES NO ON VACATION HOME SCHOOLED -7 REFUSED -8 DON'T KNOW If = 1, goto ‘QT2021_A9’ If = 4, goto 'SECTION B – HEALTH STATUS AND HEALTH CONDITIONS' ‘QT2021_A8’ [TA4C] - Did you attend school during the last school year? Quý vị có học năm học vừa khơng? YES NO HOME SCHOOLED LAST YEAR -7 REFUSED -8 DON'T KNOW If = 2, 3, -7, -8, goto 'SECTION B – HEALTH STATUS AND HEALTH CONDITIONS' CHIS 2021 CATI Teen Questionnaire Version 1.05 August 5, 2021 Name of School ‘QT2021_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? [IF NEEDED, ASK: ‘Is that an elementary, middle, junior high, or high school?’] [IF NEEDED, ASK: ‘Trường trường tiểu học, trung học đệ cấp, trung tiểu học, trung học đệ nhị cấp?’] [INTERVIEWER NOTE: RECORD VERBATIM] NAME OF SCHOOL -7 REFUSED -8 DON'T KNOW TYPE OF SCHOOL TEEN NOT IN SCHOOL ELEMENTARY INTERMEDIATE JUNIOR HIGH MIDDLE SCHOOL HIGH SCHOOL SENIOR HIGH SCHOOL CONTINUATION CHARTER SCHOOL 91 OTHER (SPECIFY: ) -7 REFUSED -8 DON'T KNOW CHIS 2021 CATI Teen Questionnaire Version 1.05 August 5, 2021 SECTION B: HEALTH STATUS AND HEALTH CONDITIONS General Health ‘QT2021_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 VERY GOOD GOOD FAIR POOR -7 REFUSED -8 DON'T KNOW Height and Weight ‘QT2021_B2’ [TB2] - About how tall are you without shoes? Em cao không mang giày? [IF NEEDED,SAY: ‘Your best guess is fine.’] [IF NEEDED, SAY: ‘Em đoán chừng rồi.’] _ FEET _ INCHES _ CENTIMETERS FEET, INCHES CENTIMETERS -7 REFUSED -8 DON'T KNOW ‘QT2021_B3’ [TB3] - About how much you weigh without shoes? Em nặng không mang giày? [IF NEEDED, SAY: ‘Your best guess is fine.’] [IF NEEDED, SAY: ‘Em đoán chừng rồi.’] _ POUNDS [HR:50-450] _ KILOGRAMS [HR: 20-220] -7 REFUSED -8 DON'T KNOW Missed School Days 10 .. .CHIS 2021 CATI Teen Questionnaire Version 1.05 August 5, 2021 Guide to Questionnaire Formatting The following are from the 2021 CHIS Teen questionnaire, slightly modified... KNOW CHIS 2021 CATI Teen Questionnaire Version 1.05 August 5, 2021 PROGRAMMING NOTE ‘QT2021_A2’ : IF ‘QT2021_A1’ = -7 OR -8 (REF/DK), CONTINUE WITH ‘QT2021_A2’ ; ELSE GO TO ‘QT2021_A4’ ‘QT2021_A2’... NOTE ‘QT2021_E9’: IF [‘QT2021_E1’=1 AND ‘QT2021_E5’=1] AND ‘QT2021_E2’= ‘QT2021_E6’ OR IF ‘QT2021_E2’ =-7,-8 OR IF ‘QT2021_E6’=-7,8 CONTINUE WITH ‘QT2021_E9’; ELSE GO TO ‘QT2021_E10’ ‘QT2021_E9’