Survey 30 adult individuals? Assure respondents that data will be used only for academic purposes. Names, street addresses are not even recorded.? Survey them on health variables including vaccination questions and demographic variables. ? Can be from any state or can even be all from Florida? List of questions are already made. This is found in the excel file. An alternative in word format is also available if you want to hand them out individually.? Input answers in the excel file (template with questions is given). Below the questions 3 sample rows of input is provided to serve as examples of format. I can also provide information to log i and view the sample or to see further instructions.
(8) Employment
1 = unemployed
looking for work; 2
(7) Marital = retired;
3=
(3)
Status
1=
W(white),
unemployed not
Residential MALE
B(black),
married = M,
looking for work;
area type:
2=
H(hispanic),
Single = S,
4 = employed part
(6) Divorced = D,
(1)
(2) 1 = Urban, 0= Female
A(asian),
time;
Rural
3
=other
O(others)
Widowed
=
W
City State
Age
5= employed fulltime
(4)
Gender (5) Race =
Respondent
Number
sample 1
Okeechobee FL
0
2
B
73
M
2
sample 2
New York
NY
1
1
W
26
M
2
sample 3
Athens
GA
0
1
A
43
S
3
1
2
(8) Employment
1 = unemployed
looking for work; 2
(7) Marital = retired;
3=
(3)
Status
1=
W(white),
unemployed not
Residential MALE
B(black),
married = M,
looking for work;
area type:
2=
H(hispanic),
Single = S,
4 = employed part
(6) Divorced = D,
(1)
(2) 1 = Urban, 0= Female
A(asian),
time;
Rural
3
=other
O(others)
Widowed
=
W
City State
Age
5= employed fulltime
(4)
Gender (5) Race =
Respondent
Number
3
4
5
6
7
(8) Employment
1 = unemployed
looking for work; 2
(7) Marital = retired;
3=
(3)
Status
1=
W(white),
unemployed not
Residential MALE
B(black),
married = M,
looking for work;
area type:
2=
H(hispanic),
Single = S,
4 = employed part
(6) Divorced = D,
(1)
(2) 1 = Urban, 0= Female
A(asian),
time;
Rural
3
=other
O(others)
Widowed
=
W
City State
Age
5= employed fulltime
(4)
Gender (5) Race =
Respondent
Number
8
9
10
11
12
(8) Employment
1 = unemployed
looking for work; 2
(7) Marital = retired;
3=
(3)
Status
1=
W(white),
unemployed not
Residential MALE
B(black),
married = M,
looking for work;
area type:
2=
H(hispanic),
Single = S,
4 = employed part
(6) Divorced = D,
(1)
(2) 1 = Urban, 0= Female
A(asian),
time;
Rural
3
=other
O(others)
Widowed
=
W
City State
Age
5= employed fulltime
(4)
Gender (5) Race =
Respondent
Number
13
14
15
16
17
(8) Employment
1 = unemployed
looking for work; 2
(7) Marital = retired;
3=
(3)
Status
1=
W(white),
unemployed not
Residential MALE
B(black),
married = M,
looking for work;
area type:
2=
H(hispanic),
Single = S,
4 = employed part
(6) Divorced = D,
(1)
(2) 1 = Urban, 0= Female
A(asian),
time;
Rural
3
=other
O(others)
Widowed
=
W
City State
Age
5= employed fulltime
(4)
Gender (5) Race =
Respondent
Number
18
19
20
21
22
(8) Employment
1 = unemployed
looking for work; 2
(7) Marital = retired;
3=
(3)
Status
1=
W(white),
unemployed not
Residential MALE
B(black),
married = M,
looking for work;
area type:
2=
H(hispanic),
Single = S,
4 = employed part
(6) Divorced = D,
(1)
(2) 1 = Urban, 0= Female
A(asian),
time;
Rural
3
=other
O(others)
Widowed
=
W
City State
Age
5= employed fulltime
(4)
Gender (5) Race =
Respondent
Number
23
24
25
26
27
(8) Employment
1 = unemployed
looking for work; 2
(7) Marital = retired;
3=
(3)
Status
1=
W(white),
unemployed not
Residential MALE
B(black),
married = M,
looking for work;
area type:
2=
H(hispanic),
Single = S,
4 = employed part
(6) Divorced = D,
(1)
(2) 1 = Urban, 0= Female
A(asian),
time;
Rural
3
=other
O(others)
Widowed
=
W
City State
Age
5= employed fulltime
(4)
Gender (5) Race =
Respondent
Number
28
29
30
(8) Employment
1 = unemployed
looking for work; 2
(7) Marital = retired;
3=
(3)
Status
1=
W(white),
unemployed not
Residential MALE
B(black),
married = M,
looking for work;
area type:
2=
H(hispanic),
Single = S,
4 = employed part
(6) Divorced = D,
(1)
(2) 1 = Urban, 0= Female
A(asian),
time;
Rural
3
=other
O(others)
Widowed
=
W
City State
Age
5= employed fulltime
(4)
Gender (5) Race =
Respondent
Number
(8) Employment
1 = unemployed
looking for work; 2
(7) Marital = retired;
3=
(3)
Status
1=
W(white),
unemployed not
Residential MALE
B(black),
married = M,
looking for work;
area type:
2=
H(hispanic),
Single = S,
4 = employed part
(6) Divorced = D,
(1)
(2) 1 = Urban, 0= Female
A(asian),
time;
Rural
3
=other
O(others)
Widowed
=
W
City State
Age
5= employed fulltime
(4)
Gender (5) Race =
Respondent
Number
(8) Employment
1 = unemployed
looking for work; 2
(7) Marital = retired;
3=
(3)
Status
1=
W(white),
unemployed not
Residential MALE
B(black),
married = M,
looking for work;
area type:
2=
H(hispanic),
Single = S,
4 = employed part
(6) Divorced = D,
(1)
(2) 1 = Urban, 0= Female
A(asian),
time;
Rural
3
=other
O(others)
Widowed
=
W
City State
Age
5= employed fulltime
(4)
Gender (5) Race =
Respondent
Number
(8) Employment
1 = unemployed
looking for work; 2
(7) Marital = retired;
3=
(3)
Status
1=
W(white),
unemployed not
Residential MALE
B(black),
married = M,
looking for work;
area type:
2=
H(hispanic),
Single = S,
4 = employed part
(6) Divorced = D,
(1)
(2) 1 = Urban, 0= Female
A(asian),
time;
Rural
3
=other
O(others)
Widowed
=
W
City State
Age
5= employed fulltime
(4)
Gender (5) Race =
Respondent
Number
(9)
(12) How do you
describe your
Health Status?
YES = 1, NO = 0
Household Income
Respondent
Number
sample 1
1
0
0
0
0
1
4
0
1
0
sample 2
0
0
0
1
0
1
2
1
0
0
sample 3
0
1
0
0
0
1
1
0
1
0
1
2
$35,000 $69,999 $70,000 ? (yes = $119,999
1, no = ? (yes =
0)
1, no = 0)
$120,000
to
$179,999
? (yes =
1, no = 0)
(10)
Below
$35,000
? (yes
= 1, no
= 0)
$180,000
Home
and
(11) No. of
above ? Owner ?
(yes = 1, YES = 1, household
NO = 0
members?
no = 0)
BAD = FAIR = GOOD =
1,
1,
1,
otherwi otherwi otherwi
se = 0
se = 0
se = 0
(9)
Respondent
Number
3
4
5
6
7
Below
$35,000
? (yes
= 1, no
= 0)
(12) How do you
describe your
Health Status?
YES = 1, NO = 0
Household Income
$35,000 $69,999 $70,000 ? (yes = $119,999
1, no = ? (yes =
0)
1, no = 0)
$120,000
to
$179,999
? (yes =
1, no = 0)
(10)
$180,000
Home
and
(11) No. of
above ? Owner ?
(yes = 1, YES = 1, household
NO = 0
members?
no = 0)
BAD = FAIR = GOOD =
1,
1,
1,
otherwi otherwi otherwi
se = 0
se = 0
se = 0
(9)
Respondent
Number
8
9
10
11
12
Below
$35,000
? (yes
= 1, no
= 0)
(12) How do you
describe your
Health Status?
YES = 1, NO = 0
Household Income
$35,000 $69,999 $70,000 ? (yes = $119,999
1, no = ? (yes =
0)
1, no = 0)
$120,000
to
$179,999
? (yes =
1, no = 0)
(10)
$180,000
Home
and
(11) No. of
above ? Owner ?
(yes = 1, YES = 1, household
NO = 0
members?
no = 0)
BAD = FAIR = GOOD =
1,
1,
1,
otherwi otherwi otherwi
se = 0
se = 0
se = 0
(9)
Respondent
Number
13
14
15
16
17
Below
$35,000
? (yes
= 1, no
= 0)
(12) How do you
describe your
Health Status?
YES = 1, NO = 0
Household Income
$35,000 $69,999 $70,000 ? (yes = $119,999
1, no = ? (yes =
0)
1, no = 0)
$120,000
to
$179,999
? (yes =
1, no = 0)
(10)
$180,000
Home
and
(11) No. of
above ? Owner ?
(yes = 1, YES = 1, household
NO = 0
members?
no = 0)
BAD = FAIR = GOOD =
1,
1,
1,
otherwi otherwi otherwi
se = 0
se = 0
se = 0
(9)
Respondent
Number
18
19
20
21
22
Below
$35,000
? (yes
= 1, no
= 0)
(12) How do you
describe your
Health Status?
YES = 1, NO = 0
Household Income
$35,000 $69,999 $70,000 ? (yes = $119,999
1, no = ? (yes =
0)
1, no = 0)
$120,000
to
$179,999
? (yes =
1, no = 0)
(10)
$180,000
Home
and
(11) No. of
above ? Owner ?
(yes = 1, YES = 1, household
NO = 0
members?
no = 0)
BAD = FAIR = GOOD =
1,
1,
1,
otherwi otherwi otherwi
se = 0
se = 0
se = 0
(9)
Respondent
Number
23
24
25
26
27
Below
$35,000
? (yes
= 1, no
= 0)
(12) How do you
describe your
Health Status?
YES = 1, NO = 0
Household Income
$35,000 $69,999 $70,000 ? (yes = $119,999
1, no = ? (yes =
0)
1, no = 0)
$120,000
to
$179,999
? (yes =
1, no = 0)
(10)
$180,000
Home
and
(11) No. of
above ? Owner ?
(yes = 1, YES = 1, household
NO = 0
members?
no = 0)
BAD = FAIR = GOOD =
1,
1,
1,
otherwi otherwi otherwi
se = 0
se = 0
se = 0
(9)
Respondent
Number
28
29
30
Below
$35,000
? (yes
= 1, no
= 0)
(12) How do you
describe your
Health Status?
YES = 1, NO = 0
Household Income
$35,000 $69,999 $70,000 ? (yes = $119,999
1, no = ? (yes =
0)
1, no = 0)
$120,000
to
$179,999
? (yes =
1, no = 0)
(10)
$180,000
Home
and
(11) No. of
above ? Owner ?
(yes = 1, YES = 1, household
NO = 0
members?
no = 0)
BAD = FAIR = GOOD =
1,
1,
1,
otherwi otherwi otherwi
se = 0
se = 0
se = 0
(9)
Respondent
Number
Below
$35,000
? (yes
= 1, no
= 0)
(12) How do you
describe your
Health Status?
YES = 1, NO = 0
Household Income
$35,000 $69,999 $70,000 ? (yes = $119,999
1, no = ? (yes =
0)
1, no = 0)
$120,000
to
$179,999
? (yes =
1, no = 0)
(10)
$180,000
Home
and
(11) No. of
above ? Owner ?
(yes = 1, YES = 1, household
NO = 0
members?
no = 0)
BAD = FAIR = GOOD =
1,
1,
1,
otherwi otherwi otherwi
se = 0
se = 0
se = 0
(9)
Respondent
Number
Below
$35,000
? (yes
= 1, no
= 0)
(12) How do you
describe your
Health Status?
YES = 1, NO = 0
Household Income
$35,000 $69,999 $70,000 ? (yes = $119,999
1, no = ? (yes =
0)
1, no = 0)
$120,000
to
$179,999
? (yes =
1, no = 0)
(10)
$180,000
Home
and
(11) No. of
above ? Owner ?
(yes = 1, YES = 1, household
NO = 0
members?
no = 0)
BAD = FAIR = GOOD =
1,
1,
1,
otherwi otherwi otherwi
se = 0
se = 0
se = 0
(9)
Respondent
Number
Below
$35,000
? (yes
= 1, no
= 0)
(12) How do you
describe your
Health Status?
YES = 1, NO = 0
Household Income
$35,000 $69,999 $70,000 ? (yes = $119,999
1, no = ? (yes =
0)
1, no = 0)
$120,000
to
$179,999
? (yes =
1, no = 0)
(10)
$180,000
Home
and
(11) No. of
above ? Owner ?
(yes = 1, YES = 1, household
NO = 0
members?
no = 0)
BAD = FAIR = GOOD =
1,
1,
1,
otherwi otherwi otherwi
se = 0
se = 0
se = 0
(9)
Respondent
Number
Below
$35,000
? (yes
= 1, no
= 0)
(12) How do you
describe your
Health Status?
YES = 1, NO = 0
Household Income
$35,000 $69,999 $70,000 ? (yes = $119,999
1, no = ? (yes =
0)
1, no = 0)
$120,000
to
$179,999
? (yes =
1, no = 0)
(10)
$180,000
Home
and
(11) No. of
above ? Owner ?
(yes = 1, YES = 1, household
NO = 0
members?
no = 0)
BAD = FAIR = GOOD =
1,
1,
1,
otherwi otherwi otherwi
se = 0
se = 0
se = 0
(12) How do you
describe your
Health Status?
YES = 1, NO = 0
(13) Highest
educational
level
attained:
(14) Health
Problems
(16) NOTE: If
the answer in
(15) is no, why
not? 1 = too
(17)
Insurance T
Respondent
Number
EXCELLENT
= 1,
otherwise =
0
1=
elementary;
2 = high
school;
3 = some
college;
4 = college
graduate;
5 = post
baccalaureate
sample 1
0
1
1
0
1
0
1
0
sample 2
0
2
0
1
0
2
0
0
sample 3
0
5
1
1
1
0
0
0
1
2
Do you
have Heart
Problems/
Cancer/diab
etes,other
debilitating
disease?
YES = 1,
NO = 0
Do you
have a
Family
History of
Heart Problem,
Cancer,
diabetes,
debilitating
disease ?
YES = 1,
NO = 0
(15)
expensive; 2 = I
Do you
am healthy I do
have
not need it; 3 =
Health
other reason
Insurance (please state the
? YES = 1, reason) GO to
NO = 0.
Question 18
If YES, GO after answering
to 17
this question
1=employer based
(choose this if
you are getting
your insurance
from your
employer or if you
are a dependent
getting your
insurance from
your employed
1=
parents) 1 = yes
MEDICAR
E; 0 = no
0 = no
(12) How do you
describe your
Health Status?
YES = 1, NO = 0
Respondent
Number
3
4
5
6
7
EXCELLENT
= 1,
otherwise =
0
(13) Highest
educational
level
attained:
1=
elementary;
2 = high
school;
3 = some
college;
4 = college
graduate;
5 = post
baccalaureate
(14) Health
Problems
Do you
have Heart
Problems/
Cancer/diab
etes,other
debilitating
disease?
YES = 1,
NO = 0
Do you
have a
Family
History of
Heart Problem,
Cancer,
diabetes,
debilitating
disease ?
YES = 1,
NO = 0
(16) NOTE: If
the answer in
(15) is no, why
not? 1 = too
(15)
expensive; 2 = I
Do you
am healthy I do
have
not need it; 3 =
Health
other reason
Insurance (please state the
? YES = 1, reason) GO to
NO = 0.
Question 18
If YES, GO after answering
to 17
this question
(17)
Insurance T
1=employer based
(choose this if
you are getting
your insurance
from your
employer or if you
are a dependent
getting your
insurance from
your employed
1=
parents) 1 = yes
MEDICAR
E; 0 = no
0 = no
(12) How do you
describe your
Health Status?
YES = 1, NO = 0
Respondent
Number
8
9
10
11
12
EXCELLENT
= 1,
otherwise =
0
(13) Highest
educational
level
attained:
1=
elementary;
2 = high
school;
3 = some
college;
4 = college
graduate;
5 = post
baccalaureate
(14) Health
Problems
Do you
have Heart
Problems/
Cancer/diab
etes,other
debilitating
disease?
YES = 1,
NO = 0
Do you
have a
Family
History of
Heart Problem,
Cancer,
diabetes,
debilitating
disease ?
YES = 1,
NO = 0
(16) NOTE: If
the answer in
(15) is no, why
not? 1 = too
(15)
expensive; 2 = I
Do you
am healthy I do
have
not need it; 3 =
Health
other reason
Insurance (please state the
? YES = 1, reason) GO to
NO = 0.
Question 18
If YES, GO after answering
to 17
this question
(17)
Insurance T
1=employer based
(choose this if
you are getting
your insurance
from your
employer or if you
are a dependent
getting your
insurance from
your employed
1=
parents) 1 = yes
MEDICAR
E; 0 = no
0 = no
(12) How do you
describe your
Health Status?
YES = 1, NO = 0
Respondent
Number
13
14
15
16
17
EXCELLENT
= 1,
otherwise =
0
(13) Highest
educational
level
attained:
1=
elementary;
2 = high
school;
3 = some
college;
4 = college
graduate;
5 = post
baccalaureate
(14) Health
Problems
Do you
have Heart
Problems/
Cancer/diab
etes,other
debilitating
disease?
YES = 1,
NO = 0
Do you
have a
Family
History of
Heart Problem,
Cancer,
diabetes,
debilitating
disease ?
YES = 1,
NO = 0
(16) NOTE: If
the answer in
(15) is no, why
not? 1 = too
(15)
expensive; 2 = I
Do you
am healthy I do
have
not need it; 3 =
Health
other reason
Insurance (please state the
? YES = 1, reason) GO to
NO = 0.
Question 18
If YES, GO after answering
to 17
this question
(17)
Insurance T
1=employer based
(choose this if
you are getting
your insurance
from your
employer or if you
are a dependent
getting your
insurance from
your employed
1=
parents) 1 = yes
MEDICAR
E; 0 = no
0 = no
(12) How do you
describe your
Health Status?
YES = 1, NO = 0
Respondent
Number
18
19
20
21
22
EXCELLENT
= 1,
otherwise =
0
(13) Highest
educational
level
attained:
1=
elementary;
2 = high
school;
3 = some
college;
4 = college
graduate;
5 = post
baccalaureate
(14) Health
Problems
Do you
have Heart
Problems/
Cancer/diab
etes,other
debilitating
disease?
YES = 1,
NO = 0
Do you
have a
Family
History of
Heart Problem,
Cancer,
diabetes,
debilitating
disease ?
YES = 1,
NO = 0
(16) NOTE: If
the answer in
(15) is no, why
not? 1 = too
(15)
expensive; 2 = I
Do you
am healthy I do
have
not need it; 3 =
Health
other reason
Insurance (please state the
? YES = 1, reason) GO to
NO = 0.
Question 18
If YES, GO after answering
to 17
this question
(17)
Insurance T
1=employer based
(choose this if
you are getting
your insurance
from your
employer or if you
are a dependent
getting your
insurance from
your employed
1=
parents) 1 = yes
MEDICAR
E; 0 = no
0 = no
(12) How do you
describe your
Health Status?
YES = 1, NO = 0
Respondent
Number
23
24
25
26
27
EXCELLENT
= 1,
otherwise =
0
(13) Highest
educational
level
attained:
1=
elementary;
2 = high
school;
3 = some
college;
4 = college
graduate;
5 = post
baccalaureate
(14) Health
Problems
Do you
have Heart
Problems/
Cancer/diab
etes,other
debilitating
disease?
YES = 1,
NO = 0
Do you
have a
Family
History of
Heart Problem,
Cancer,
diabetes,
debilitating
disease ?
YES = 1,
NO = 0
(16) NOTE: If
the answer in
(15) is no, why
not? 1 = too
(15)
expensive; 2 = I
Do you
am healthy I do
have
not need it; 3 =
Health
other reason
Insurance (please state the
? YES = 1, reason) GO to
NO = 0.
Question 18
If YES, GO after answering
to 17
this question
(17)
Insurance T
1=employer based
(choose this if
you are getting
your insurance
from your
employer or if you
are a dependent
getting your
insurance from
your employed
1=
parents) 1 = yes
MEDICAR
E; 0 = no
0 = no
(12) How do you
describe your
Health Status?
YES = 1, NO = 0
Respondent
Number
28
29
30
EXCELLENT
= 1,
otherwise =
0
(13) Highest
educational
level
attained:
1=
elementary;
2 = high
school;
3 = some
college;
4 = college
graduate;
5 = post
baccalaureate
(14) Health
Problems
Do you
have Heart
Problems/
Cancer/diab
etes,other
debilitating
disease?
YES = 1,
NO = 0
Do you
have a
Family
History of
Heart Problem,
Cancer,
diabetes,
debilitating
disease ?
YES = 1,
NO = 0
(16) NOTE: If
the answer in
(15) is no, why
not? 1 = too
(15)
expensive; 2 = I
Do you
am healthy I do
have
not need it; 3 =
Health
other reason
Insurance (please state the
? YES = 1, reason) GO to
NO = 0.
Question 18
If YES, GO after answering
to 17
this question
(17)
Insurance T
1=employer based
(choose this if
you are getting
your insurance
from your
employer or if you
are a dependent
getting your
insurance from
your employed
1=
parents) 1 = yes
MEDICAR
E; 0 = no
0 = no
(12) How do you
describe your
Health Status?
YES = 1, NO = 0
Respondent
Number
EXCELLENT
= 1,
otherwise =
0
(13) Highest
educational
level
attained:
1=
elementary;
2 = high
school;
3 = some
college;
4 = college
graduate;
5 = post
baccalaureate
(14) Health
Problems
Do you
have Heart
Problems/
Cancer/diab
etes,other
debilitating
disease?
YES = 1,
NO = 0
Do you
have a
Family
History of
Heart Problem,
Cancer,
diabetes,
debilitating
disease ?
YES = 1,
NO = 0
(16) NOTE: If
the answer in
(15) is no, why
not? 1 = too
(15)
expensive; 2 = I
Do you
am healthy I do
have
not need it; 3 =
Health
other reason
Insurance (please state the
? YES = 1, reason) GO to
NO = 0.
Question 18
If YES, GO after answering
to 17
this question
(17)
Insurance T
1=employer based
(choose this if
you are getting
your insurance
from your
employer or if you
are a dependent
getting your
insurance from
your employed
1=
parents) 1 = yes
MEDICAR
E; 0 = no
0 = no
(12) How do you
describe your
Health Status?
YES = 1, NO = 0
Respondent
Number
EXCELLENT
= 1,
otherwise =
0
(13) Highest
educational
level
attained:
1=
elementary;
2 = high
school;
3 = some
college;
4 = college
graduate;
5 = post
baccalaureate
(14) Health
Problems
Do you
have Heart
Problems/
Cancer/diab
etes,other
debilitating
disease?
YES = 1,
NO = 0
Do you
have a
Family
History of
Heart Problem,
Cancer,
diabetes,
debilitating
disease ?
YES = 1,
NO = 0
(16) NOTE: If
the answer in
(15) is no, why
not? 1 = too
(15)
expensive; 2 = I
Do you
am healthy I do
have
not need it; 3 =
Health
other reason
Insurance (please state the
? YES = 1, reason) GO to
NO = 0.
Question 18
If YES, GO after answering
to 17
this question
(17)
Insurance T
1=employer based
(choose this if
you are getting
your insurance
from your
employer or if you
are a dependent
getting your
insurance from
your employed
1=
parents) 1 = yes
MEDICAR
E; 0 = no
0 = no
(12) How do you
describe your
Health Status?
YES = 1, NO = 0
Respondent
Number
EXCELLENT
= 1,
otherwise =
0
(13) Highest
educational
level
attained:
1=
elementary;
2 = high
school;
3 = some
college;
4 = college
graduate;
5 = post
baccalaureate
(14) Health
Problems
Do you
have Heart
Problems/
Cancer/diab
etes,other
debilitating
disease?
YES = 1,
NO = 0
Do you
have a
Family
History of
Heart Problem,
Cancer,
diabetes,
debilitating
disease ?
YES = 1,
NO = 0
(16) NOTE: If
the answer in
(15) is no, why
not? 1 = too
(15)
expensive; 2 = I
Do you
am healthy I do
have
not need it; 3 =
Health
other reason
Insurance (please state the
? YES = 1, reason) GO to
NO = 0.
Question 18
If YES, GO after answering
to 17
this question
(17)
Insurance T
1=employer based
(choose this if
you are getting
your insurance
from your
employer or if you
are a dependent
getting your
insurance from
your employed
1=
parents) 1 = yes
MEDICAR
E; 0 = no
0 = no
(12) How do you
describe your
Health Status?
YES = 1, NO = 0
Respondent
Number
EXCELLENT
= 1,
otherwise =
0
(13) Highest
educational
level
attained:
1=
elementary;
2 = high
school;
3 = some
college;
4 = college
graduate;
5 = post
baccalaureate
(14) Health
Problems
Do you
have Heart
Problems/
Cancer/diab
etes,other
debilitating
disease?
YES = 1,
NO = 0
Do you
have a
Family
History of
Heart Problem,
Cancer,
diabetes,
debilitating
disease ?
YES = 1,
NO = 0
(16) NOTE: If
the answer in
(15) is no, why
not? 1 = too
(15)
expensive; 2 = I
Do you
am healthy I do
have
not need it; 3 =
Health
other reason
Insurance (please state the
? YES = 1, reason) GO to
NO = 0.
Question 18
If YES, GO after answering
to 17
this question
(17)
Insurance T
1=employer based
(choose this if
you are getting
your insurance
from your
employer or if you
are a dependent
getting your
insurance from
your employed
1=
parents) 1 = yes
MEDICAR
E; 0 = no
0 = no
(17)
Respondent
Number
(18) Are you vaccinated? Why or why not? (
Insurance Type
1=
1=
obamacare
MEDICAI or ACA
D; 0 = no 01 = no
1=
TriCare or
VA
0=
no
1 = other
(state the
source); 0
= no
(A) YES, Because an
infectious disease is
a public health
concern:
1=
describes my
situation; 0 = does
not describe my
situation
(B) YES, it is required
at work but I will get
vaccinated even if it is
not required:
1=
describes my
situation; 0 = does
not describe my
situation
(C) YES, only because
it is required at work
otherwise I will not
get vaccinated:
1= describes my
situation; 0 = does
not describe my
situation
sample 1
0
0
0
0
1
0
0
sample 2
0
0
0
0
0
0
0
sample 3
0
1
0
0
1
1
0
1
2
(17)
Respondent
Number
3
4
5
6
7
(18) Are you vaccinated? Why or why not? (
Insurance Type
1=
1=
obamacare
MEDICAI or ACA
D; 0 = no 01 = no
1=
TriCare or
VA
0=
no
1 = other
(state the
source); 0
= no
(A) YES, Because an
infectious disease is
a public health
concern:
1=
describes my
situation; 0 = does
not describe my
situation
(B) YES, it is required
at work but I will get
vaccinated even if it is
not required:
1=
describes my
situation; 0 = does
not describe my
situation
(C) YES, only because
it is required at work
otherwise I will not
get vaccinated:
1= describes my
situation; 0 = does
not describe my
situation
(17)
Respondent
Number
8
9
10
11
12
(18) Are you vaccinated? Why or why not? (
Insurance Type
1=
1=
obamacare
MEDICAI or ACA
D; 0 = no 01 = no
1=
TriCare or
VA
0=
no
1 = other
(state the
source); 0
= no
(A) YES, Because an
infectious disease is
a public health
concern:
1=
describes my
situation; 0 = does
not describe my
situation
(B) YES, it is required
at work but I will get
vaccinated even if it is
not required:
1=
describes my
situation; 0 = does
not describe my
situation
(C) YES, only because
it is required at work
otherwise I will not
get vaccinated:
1= describes my
situation; 0 = does
not describe my
situation
(17)
Respondent
Number
13
14
15
16
17
(18) Are you vaccinated? Why or why not? (
Insurance Type
1=
1=
obamacare
MEDICAI or ACA
D; 0 = no 01 = no
1=
TriCare or
VA
0=
no
1 = other
(state the
source); 0
= no
(A) YES, Because an
infectious disease is
a public health
concern:
1=
describes my
situation; 0 = does
not describe my
situation
(B) YES, it is required
at work but I will get
vaccinated even if it is
not required:
1=
describes my
situation; 0 = does
not describe my
situation
(C) YES, only because
it is required at work
otherwise I will not
get vaccinated:
1= describes my
situation; 0 = does
not describe my
situation
(17)
Respondent
Number
18
19
20
21
22
(18) Are you vaccinated? Why or why not? (
Insurance Type
1=
1=
obamacare
MEDICAI or ACA
D; 0 = no 01 = no
1=
TriCare or
VA
0=
no
1 = other
(state the
source); 0
= no
(A) YES, Because an
infectious disease is
a public health
concern:
1=
describes my
situation; 0 = does
not describe my
situation
(B) YES, it is required
at work but I will get
vaccinated even if it is
not required:
1=
describes my
situation; 0 = does
not describe my
situation
(C) YES, only because
it is required at work
otherwise I will not
get vaccinated:
1= describes my
situation; 0 = does
not describe my
situation
(17)
Respondent
Number
23
24
25
26
27
(18) Are you vaccinated? Why or why not? (
Insurance Type
1=
1=
obamacare
MEDICAI or ACA
D; 0 = no 01 = no
1=
TriCare or
VA
0=
no
1 = other
(state the
source); 0
= no
(A) YES, Because an
infectious disease is
a public health
concern:
1=
describes my
situation; 0 = does
not describe my
situation
(B) YES, it is required
at work but I will get
vaccinated even if it is
not required:
1=
describes my
situation; 0 = does
not describe my
situation
(C) YES, only because
it is required at work
otherwise I will not
get vaccinated:
1= describes my
situation; 0 = does
not describe my
situation
(17)
Respondent
Number
28
29
30
(18) Are you vaccinated? Why or why not? (
Insurance Type
1=
1=
obamacare
MEDICAI or ACA
D; 0 = no 01 = no
1=
TriCare or
VA
0=
no
1 = other
(state the
source); 0
= no
(A) YES, Because an
infectious disease is
a public health
concern:
1=
describes my
situation; 0 = does
not describe my
situation
(B) YES, it is required
at work but I will get
vaccinated even if it is
not required:
1=
describes my
situation; 0 = does
not describe my
situation
(C) YES, only because
it is required at work
otherwise I will not
get vaccinated:
1= describes my
situation; 0 = does
not describe my
situation
(17)
Respondent
Number
(18) Are you vaccinated? Why or why not? (
Insurance Type
1=
1=
obamacare
MEDICAI or ACA
D; 0 = no 01 = no
1=
TriCare or
VA
0=
no
1 = other
(state the
source); 0
= no
(A) YES, Because an
infectious disease is
a public health
concern:
1=
describes my
situation; 0 = does
not describe my
situation
(B) YES, it is required
at work but I will get
vaccinated even if it is
not required:
1=
describes my
situation; 0 = does
not describe my
situation
(C) YES, only because
it is required at work
otherwise I will not
get vaccinated:
1= describes my
situation; 0 = does
not describe my
situation
(17)
Respondent
Number
(18) Are you vaccinated? Why or why not? (
Insurance Type
1=
1=
obamacare
MEDICAI or ACA
D; 0 = no 01 = no
1=
TriCare or
VA
0=
no
1 = other
(state the
source); 0
= no
(A) YES, Because an
infectious disease is
a public health
concern:
1=
describes my
situation; 0 = does
not describe my
situation
(B) YES, it is required
at work but I will get
vaccinated even if it is
not required:
1=
describes my
situation; 0 = does
not describe my
situation
(C) YES, only because
it is required at work
otherwise I will not
get vaccinated:
1= describes my
situation; 0 = does
not describe my
situation
(17)
Respondent
Number
(18) Are you vaccinated? Why or why not? (
Insurance Type
1=
1=
obamacare
MEDICAI or ACA
D; 0 = no 01 = no
1=
TriCare or
VA
0=
no
1 = other
(state the
source); 0
= no
(A) YES, Because an
infectious disease is
a public health
concern:
1=
describes my
situation; 0 = does
not describe my
situation
(B) YES, it is required
at work but I will get
vaccinated even if it is
not required:
1=
describes my
situation; 0 = does
not describe my
situation
(C) YES, only because
it is required at work
otherwise I will not
get vaccinated:
1= describes my
situation; 0 = does
not describe my
situation
(17)
Respondent
Number
(18) Are you vaccinated? Why or why not? (
Insurance Type
1=
1=
obamacare
MEDICAI or ACA
D; 0 = no 01 = no
1=
TriCare or
VA
0=
no
1 = other
(state the
source); 0
= no
(A) YES, Because an
infectious disease is
a public health
concern:
1=
describes my
situation; 0 = does
not describe my
situation
(B) YES, it is required
at work but I will get
vaccinated even if it is
not required:
1=
describes my
situation; 0 = does
not describe my
situation
(C) YES, only because
it is required at work
otherwise I will not
get vaccinated:
1= describes my
situation; 0 = does
not describe my
situation
nated? Why or why not? (choose all that apply)
Respondent
Number
(D) NO,
because I
choose not to:
1= describes my
situation; 0 =
does not
describe my
situation
(E) NO, only because I do
not have time to schedule
it because of my work
and other obligations:
1= describes my
situation; 0 = does not
describe my situation
(F), NO, because it is
not required at work
otherwise I will get
vaccinated:
1=
describes my
situation; 0 = does
not describe my
situation
sample 1
1
0
0
sample 2
0
0
1
sample 3
1
0
1
1
2
nated? Why or why not? (choose all that apply)
Respondent
Number
3
4
5
6
7
(D) NO,
because I
choose not to:
1= describes my
situation; 0 =
does not
describe my
situation
(E) NO, only because I do
not have time to schedule
it because of my work
and other obligations:
1= describes my
situation; 0 = does not
describe my situation
(F), NO, because it is
not required at work
otherwise I will get
vaccinated:
1=
describes my
situation; 0 = does
not describe my
situation
nated? Why or why not? (choose all that apply)
Respondent
Number
8
9
10
11
12
(D) NO,
because I
choose not to:
1= describes my
situation; 0 =
does not
describe my
situation
(E) NO, only because I do
not have time to schedule
it because of my work
and other obligations:
1= describes my
situation; 0 = does not
describe my situation
(F), NO, because it is
not required at work
otherwise I will get
vaccinated:
1=
describes my
situation; 0 = does
not describe my
situation
nated? Why or why not? (choose all that apply)
Respondent
Number
13
14
15
16
17
(D) NO,
because I
choose not to:
1= describes my
situation; 0 =
does not
describe my
situation
(E) NO, only because I do
not have time to schedule
it because of my work
and other obligations:
1= describes my
situation; 0 = does not
describe my situation
(F), NO, because it is
not required at work
otherwise I will get
vaccinated:
1=
describes my
situation; 0 = does
not describe my
situation
nated? Why or why not? (choose all that apply)
Respondent
Number
18
19
20
21
22
(D) NO,
because I
choose not to:
1= describes my
situation; 0 =
does not
describe my
situation
(E) NO, only because I do
not have time to schedule
it because of my work
and other obligations:
1= describes my
situation; 0 = does not
describe my situation
(F), NO, because it is
not required at work
otherwise I will get
vaccinated:
1=
describes my
situation; 0 = does
not describe my
situation
nated? Why or why not? (choose all that apply)
Respondent
Number
23
24
25
26
27
(D) NO,
because I
choose not to:
1= describes my
situation; 0 =
does not
describe my
situation
(E) NO, only because I do
not have time to schedule
it because of my work
and other obligations:
1= describes my
situation; 0 = does not
describe my situation
(F), NO, because it is
not required at work
otherwise I will get
vaccinated:
1=
describes my
situation; 0 = does
not describe my
situation
nated? Why or why not? (choose all that apply)
Respondent
Number
28
29
30
(D) NO,
because I
choose not to:
1= describes my
situation; 0 =
does not
describe my
situation
(E) NO, only because I do
not have time to schedule
it because of my work
and other obligations:
1= describes my
situation; 0 = does not
describe my situation
(F), NO, because it is
not required at work
otherwise I will get
vaccinated:
1=
describes my
situation; 0 = does
not describe my
situation
nated? Why or why not? (choose all that apply)
Respondent
Number
(D) NO,
because I
choose not to:
1= describes my
situation; 0 =
does not
describe my
situation
(E) NO, only because I do
not have time to schedule
it because of my work
and other obligations:
1= describes my
situation; 0 = does not
describe my situation
(F), NO, because it is
not required at work
otherwise I will get
vaccinated:
1=
describes my
situation; 0 = does
not describe my
situation
nated? Why or why not? (choose all that apply)
Respondent
Number
(D) NO,
because I
choose not to:
1= describes my
situation; 0 =
does not
describe my
situation
(E) NO, only because I do
not have time to schedule
it because of my work
and other obligations:
1= describes my
situation; 0 = does not
describe my situation
(F), NO, because it is
not required at work
otherwise I will get
vaccinated:
1=
describes my
situation; 0 = does
not describe my
situation
nated? Why or why not? (choose all that apply)
Respondent
Number
(D) NO,
because I
choose not to:
1= describes my
situation; 0 =
does not
describe my
situation
(E) NO, only because I do
not have time to schedule
it because of my work
and other obligations:
1= describes my
situation; 0 = does not
describe my situation
(F), NO, because it is
not required at work
otherwise I will get
vaccinated:
1=
describes my
situation; 0 = does
not describe my
situation
nated? Why or why not? (choose all that apply)
Respondent
Number
(D) NO,
because I
choose not to:
1= describes my
situation; 0 =
does not
describe my
situation
(E) NO, only because I do
not have time to schedule
it because of my work
and other obligations:
1= describes my
situation; 0 = does not
describe my situation
(F), NO, because it is
not required at work
otherwise I will get
vaccinated:
1=
describes my
situation; 0 = does
not describe my
situation

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