10/03/03

INTERVIEWERS OBSERVATION (IO)

*IO1. INTERVIEWER: THANK THE RESPONDENT FOR THEIR TIME AND (LEAVE THE DOORSTEP/
HANG-UP THE PHONE)

*IO1a. Was anyone else present during any portion of the interview?
YES ...................................................1
NO.....................................................5

GO TO *IO5

*IO2. Who was present?

CIRCLE ALL THAT APPLY
PARENT(S) ......................................1
SPOUSE/PARTNER ........................2
CHILD(REN) UNDER AGE 6 .........3
PERSON(S) AGE 6 - 17 ...................4
OTHER ADULT(S) ..........................5

*IO3. During how much of the interview was one of these persons present?
ALL...................................................1
MOST ...............................................2
ABOUT HALF .................................3
ABOUT ONE QUARTER................4
LESS THAN ONE QUARTER ........5

*IO4. How much was R distracted by (this person/ these persons)?

A LOT...............................................1
SOME ...............................................2
A LITTLE .........................................3
NONE ...............................................4

*IO5. How well did R understand the questions?

EXCELLENT....................................1
GOOD ...............................................2
FAIR .................................................3
POOR................................................4

*IO6. How was Rs cooperation during the interview?

EXCELLENT....................................1
GOOD ...............................................2
FAIR .................................................3
POOR................................................4

500

*IO7. How much effort did R put into answering the questions?
A LOT .............................................1
SOME..............................................2
VERY LITTLE ...............................3
NONE..............................................4

*IO8.

Did R behave as if (he/she) was hallucinating? (e.g., as if hearing voices or seeing visions, lips move
soundlessly, giggles to self not just from embarrassment or shyness, glances over shoulder, as if
distracted by a voice.)
YES .................................................1
NO...................................................5

*IO9. Did R have any other type of behavioral or emotional responses that struck you as very inappropriate or very
unusual? (For example, laughed at odd times; became angry or fearful at times you would not have
expected; talked to him/herself/ acted overly familiar, acted hostile.)
YES ...................................................1
NO.....................................................5

501

*IO10. THUMBNAIL SKETCH.

502

*IO11. INTERVIEWER: RECORD HOUSEHOLD LISTING FROM COVERSHEET BY RELATIONSHIP TO R

HOUSEHOLD RESIDENTS
(a)

(b)

(c)

(d)

RELATIONSHIP TO RESPONDENT

SEX

AGE

Eligible for the

Study

1.

RESPONDENT

2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
*IO12. INTERVIEWER QUERY: AT WHAT TIME OF DAY WAS THE INTERVIEW COMPLETED?
__________ HOUR

__________ MINUTES

A.M. .......................1

P.M.............................. 2

*IO13. INTERVIEWER QUERY: ON WHAT DATE WAS THE INTERVIEW COMPLETED?

__________ DAY

__________ MONTH

__________ YEAR

503