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1999

Survey form view entire document: text image

ADS.120

I am going to read some reasons people might have the test for the AIDS virus infection.

FR: SHOW CARD A19.

Tell me which of these statements explain WHY YOU expect to have the test in the next 12 months?
(Anything else?)

Card A19

1. Because you want to find out if you are infected
2. Because it will be part of hospitalization or surgery you expect to have
3. Because you expect to apply for life or health insurance
4. Because you expect to apply for a job
5. Because you expect to join the military
6. Because of guidelines for health care workers
7. Because it will be a required part of some other activity that includes automatic AIDS testing
8. Because it is required in your non-health care employment
9. Because you plan to have/begin sexual relationship
10. Because you are pregnant or expect to become pregnant
11. For some other reason (Specify)

WHY12U

WHY12U
(01) Because you want to find out if you are infected (ADS.130)
(02) Because it will be part of hospitalization or surgery you expect to have (ADS.130)
(03) Because you expect to apply for life or health insurance (ADS.130)
(04) Because you expect to apply for a job (ADS.130)
(05) Because you expect to join the military (ADS.130)
(06) Because of guidelines for health care workers (ADS.130)
(07) Because it will be a required part of some other activity that includes automatic AIDS testing (ADS.130)
(08) Because it is required in your non-health care employment (ADS.130)
(09) Because you plan to have/begin sexual relationship (ADS.130)
(10) Because you are pregnant or expect to become pregnant (ADS.130)
(11) Other reason - specify (ADS.125)
(12) Other reason - specify (ADS.126)
(97) Refused (ADS.130)
(99) Don't Know (ADS.130)

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ADS.125

Specify the additional reason for the test.

W12SPEC1 First reason: _______________

ADS.126

Specify the additional reason for the test.

W12SPEC2 Second reason: _______________

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1998

Survey form view entire document: text image

ADS.120

I am going to read some reasons people might have the test for the AIDS virus infection.

FR: SHOW CARD A19.

Tell me which of these statements explain WHY YOU expect to have the test in the next 12 months?
(Anything else?)

Card A19

1. Because you want to find out if you are infected
2. Because it will be part of hospitalization or surgery you expect to have
3. Because you expect to apply for life or health insurance
4. Because you expect to apply for a job
5. Because you expect to join the military
6. Because of guidelines for health care workers
7. Because it will be a required part of some other activity that includes automatic AIDS testing
8. Because it is required in your non-health care employment
9. Because you plan to have/begin sexual relationship
10. Because you are pregnant or expect to become pregnant
11. For some other reason (Specify)

WHY12U

WHY12U
(01) Because you want to find out if you are infected (ADS.130)
(02) Because it will be part of hospitalization or surgery you expect to have (ADS.130)
(03) Because you expect to apply for life or health insurance (ADS.130)
(04) Because you expect to apply for a job (ADS.130)
(05) Because you expect to join the military (ADS.130)
(06) Because of guidelines for health care workers (ADS.130)
(07) Because it will be a required part of some other activity that includes automatic AIDS testing (ADS.130)
(08) Because it is required in your non-health care employment (ADS.130)
(09) Because you plan to have/begin sexual relationship (ADS.130)
(10) Because you are pregnant or expect to become pregnant (ADS.130)
(11) Other reason - specify (ADS.125)
(12) Other reason - specify (ADS.126)
(97) Refused (ADS.130)
(99) Don't Know (ADS.130)

[ ]
[ ]
[ ]
[ ]
[ ]
[ ]
[ ]
[ ]
[ ]
[ ]
[ ]

ADS.125

Specify the additional reason for the test.

W12SPEC1 First reason: _______________

ADS.126

Specify the additional reason for the test.

W12SPEC2 Second reason: _______________

top

1997

Survey form view entire document: text image

ADS.120

I am going to read some reasons people might have the test for the AIDS virus infection.

FR: SHOW CARD A19.

Tell me which of these statements explain WHY YOU expect to have the test in the next 12 months?
(Anything else?)

Card A19

1. Because you want to find out if you are infected
2. Because it will be part of hospitalization or surgery you expect to have
3. Because you expect to apply for life or health insurance
4. Because you expect to apply for a job
5. Because you expect to join the military
6. Because of guidelines for health care workers
7. Because it will be a required part of some other activity that includes automatic AIDS testing
8. Because it is required in your non-health care employment
9. Because you plan to have/begin sexual relationship
10. Because you are pregnant or expect to become pregnant
11. For some other reason (Specify)

WHY12U

WHY12U
(01) Because you want to find out if you are infected (ADS.130)
(02) Because it will be part of hospitalization or surgery you expect to have (ADS.130)
(03) Because you expect to apply for life or health insurance (ADS.130)
(04) Because you expect to apply for a job (ADS.130)
(05) Because you expect to join the military (ADS.130)
(06) Because of guidelines for health care workers (ADS.130)
(07) Because it will be a required part of some other activity that includes automatic AIDS testing (ADS.130)
(08) Because it is required in your non-health care employment (ADS.130)
(09) Because you plan to have/begin sexual relationship (ADS.130)
(10) Because you are pregnant or expect to become pregnant (ADS.130)
(11) Other reason - specify (ADS.125)
(12) Other reason - specify (ADS.126)
(97) Refused (ADS.130)
(99) Don't Know (ADS.130)

[ ]
[ ]
[ ]
[ ]
[ ]
[ ]
[ ]
[ ]
[ ]
[ ]
[ ]

ADS.125

Specify the additional reason for the test.

W12SPEC1 First reason: _______________

ADS.126

Specify the additional reason for the test.

W12SPEC2 Second reason: _______________

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1995

Survey form view entire document: text image

Hand card A5. Read intro and categories if telephone interview.
CARD A5

1. Because you want to find out if you are infected
2. Because it will be part of hospitalization or surgery you expect to have
3. Because you expect to apply for health or life insurance
4. Because you expect to apply for a job
5. Because you expect to join the military
6. Because of guidelines for health care workers
7. Because it will be a required part of some other activity that includes automatic AIDS testing
8. Because it is required in your non-health care employment
9. Because you plan to have / begin a sexual relationship
10. For some other reason (Please specify)

27. (I'm going to read some reasons people might have the blood test for the AIDS virus infection.)
Tell me which of these statements explain WHY YOU expect to have the blood test in the next 12 months. (Just tell me the number of your answers).
(Anything else?)
Mark (X) all that apply.

01[] Because you want to find out if you are infected
02[] Because it will be part of hospitalization or surgery you expect to have
03[] Because you expect to apply for health or life insurance
04[] Because you expect to apply for a job
05[] Because you expect to join the military
06[] Because of guidelines for health care workers
07[] Because it will be a required part of some other activity that includes automatic AIDS testing
08[] Because it is required in your non-health care employment
09[] Because you plan to have/begin a sexual relationship
10[] For some other reason - Specify
______
99[] DK/Refused

top

1994

Survey form view entire document: text image

Hand card A5. Read intro and categories if telephone interview.
CARD A5

1. Because you want to find out if you are infected
2. Because it will be part of hospitalization or surgery you expect to have
3. Because you expect to apply for health or life insurance
4. Because you expect to apply for a job
5. Because you expect to join the military
6. Because of guidelines for health care workers
7. Because it will be a required part of some other activity that includes automatic AIDS testing
8. Because it is required in your non-health care employment
9. Because you plan to have / begin a sexual relationship
10. For some other reason (Please specify)

27. (I'm going to read some reasons people might have the blood test for the AIDS virus infection.)
Tell me which of these statements explain WHY YOU expect to have the blood test in the next 12 months. (Just tell me the number of your answers).
(Anything else?)
Mark (X) all that apply.

01[] Because you want to find out if you are infected
02[] Because it will be part of hospitalization or surgery you expect to have
03[] Because you expect to apply for health or life insurance
04[] Because you expect to apply for a job
05[] Because you expect to join the military
06[] Because of guidelines for health care workers
07[] Because it will be a required part of some other activity that includes automatic AIDS testing
08[] Because it is required in your non-health care employment
09[] Because you plan to have/begin a sexual relationship
10[] For some other reason - Specify
______
99[] DK/Refused

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1993

Survey form view entire document: text image

28. Do you expect to have (a/another) blood test for the AIDS virus infection in the next 12 months, not including through blood donation?

1 [] Yes (29)
2 [] No (31)
9 [] DK (31)

HAND CARD F. Read intro and categories if telephone interview.
CARD F

01. Because you want to find out if you are infected
02. It will be part of hospitalization or surgery you expect to have
03. Because you expect to apply for life or health insurance
04. Because you expect to apply for a job
05. Because you expect to join the military
06. Because of guidelines for health care workers
07. Because it will be a required part of some other activity that includes automatic AIDS testing
08. Because it is required in your non-health care employment
98. Some other reason (Please specify what other reason or reasons)

29. (I'm going to read some reasons people might have the blood test for the AIDS virus infection.)
Tell me which of these statements explain WHY YOU expect to have the blood test in the next 12 months.
(Anything else?)
Mark (X) each that applies.

01 [] Because you want to find out if you are infected
02 [] Because it will be part of hospitalization or surgery you expect to have
03 [] Because you expect to apply for life or health insurance
04 [] Because you expect to apply for a job
05 [] Because you expect ot join the military
06 [] Because of guidelines for health care workers
07 [] Because it will be a required part of some other activity that includes automatic AIDS testing
08 [] Because it is required in your non-health care employment
98 [] For some other reason -- Specify -- ____
99 [] DK/Refused

Survey Text