U.S. Demographic Survey

U.S. Demographic Survey

Overview | Demographic Survey | Computer Familiarity Survey | Reading Patterns and Attitudes Survey

Below is the US Demographic Survey used in Phase 1 of our project. Some questions were from taken existing survey projects, and others were developed in-house. Surveys from which questions were sourced are listed at the bottom of our survey, along with a list of items that come from that survey. Click each question to view information about its source (if applicable) and any modifications made by CSAL.

Instructions to examiner: Before beginning, please remind the participant that all information is confidential and will not be shared with anyone. Also, remind the participant that they can skip any item they are not comfortable answering.

Read each question and choice slowly and clearly. If the person takes more than 5 seconds to answer, ask if he/she would like you to repeat the question and the choices.

1. Are you a: (ask only if uncertain)
o    Man
o    Woman

2. What is your date of birth? (day-month-year)

____________________________________________________

3. How old are you?____________________________________________________

4. Are you Hispanic or Latino?
o    Yes
o    No
o    Don’t Know
o    No Response

5. Which of the groups on this card best describes you? Choose one or more.
o    White
o    Black or African American
o    Asian
o    American Indian or Alaska Native
o    Native Hawaiian or other Pacific Islander
o    Don’t Know
o    No Response

6. You chose the following group(s) [indicate participant’s response]. Is there a different or another group you would select to describe yourself?  If yes, please tell me what that group is.
o    Yes - other group is _________________________________________
o    No
o    Don’t Know
o    No Response

7. Do you know how to speak any other language or languages in addition to English?
o    Yes                       
o    No
o    Don’t Know                    
o    No Response

If participant answers Yes, please proceed to question 8, otherwise go to question 9.

8. What other language or languages do you know how to speak?

________________________________________________________________

9. What was the first language you learned to speak?
o    English
o    Other ________________________________________________________________

If participant answers English, please proceed to question 11, otherwise go to question 10.

10. How well do you read and write in your first language?
o    Very well
o    Somewhat
o    Never learned to read and write
o    Don’t Know
o    No response

11. When you were growing up, what language or languages were usually spoken at home?
o    English
o    Other _____________________________________________________________
o    Don’t Know
o    No response

12. Do you speak a language other than English at home now?
o    Yes. Which language? __________________________________________________
o    No
o    Don’t Know
o    No response

13. What language do you now speak most often?
o    English
o    Other_____________________________________________________________
o    Don’t Know
o    No response

14. What language do you prefer to speak?__________________________________________

15. When you said that _________________ was the language you prefer to speak, where or what kind of situations were you thinking of?
(If necessary probe further and ask “were you thinking about home, work, with friends, etc.?”)

_____________________________________________________________________

________________________________________________________________________
o    Don’t Know
o    No Response

16. How old were you when you learned to speak English?
o    1-4 years old
o    5-10 years old
o    11-15 years old
o    16-20 years old
o    21 years or older
o    Does not speak English
o    Don’t Know
o    No Response

17a. What language do you speak most often at home? [Mark only one.]
o    English
o    Spanish
o    French
o    Italian
o    Chinese
o    German
o    Other language
o    Don’t Know
o    No Response

17b. If “other language”: What language was that?

____________________________________________________________________________________

18. Do you use English outside the home?
o    Yes
o    No
o    Don’t Know
o    No Response

19. With regard to English, how well do you…

19a. understand it when it is spoken to you? Would you say…
o    Very well
o    Well
o    Not well
o    Not at all
o    Don’t Know
o    No Response

19b. speak it? Would you say…
o    Very well
o    Well
o    Not well
o    Not at all
o    Don’t Know
o    No Response

19c. read it? Would you say…
o    Very well
o    Well
o    Not well
o    Not at all
o    Don’t Know
o    No Response

19d. write it? Would you say…
o    Very well
o    Well
o    Not well
o    Not at all
o    Don’t Know
o    No Response

20. As an adult, have you ever taken classes or had a tutor to learn English?
o    Yes
o    No
o    Don’t Know
o    No Response

If participant answers Yes, please proceed to question 21, otherwise go to question 23.

21. During the past 12 months, did you take any classes or have a tutor to learn English as a Second Language?
o    Yes
o    No
o    Don’t Know
o    No Response

22. When did your last English as a second language class end?

__________________________
o    Don’t Know
o    No Response

23. In what country were you born?
o    USA
o    Other (Specify)______________________________________________________
o    Don’t Know
o    No Response

If participant answers USA, please skip to question 28, otherwise go to question 24.

24. When did you first come to the United States?
a). Age ______________________
o    Don’t Know
o    No Response

b). Year ________________   
o    Don’t Know
o    No Response

25. Have you lived in other countries in addition to the country where you were born and the United States?
o    Yes (specify which countries and ages when lived in each country)_______________
o    No
o    Don’t Know
o    No Response

26. Before coming to the United States, which grade level did you finish in school?

     _____________________________________________________________________
o    Don’t Know
o    No Response

27. Before coming to the United States, did you attain any of the following?
o    High school diploma
o    Training certificates (specify)________________________________________
o    College/University degree (specify major) _______________________________________
o    Graduate degree (specify masters or PhD and in what area)________________
o    None of the above
o    Don’t Know
o    No Response

28. I would now like to ask you some questions about your education. Looking at this card, what is the highest level of education you have completed?
o    Pre-primary or no schooling
o    Grades 1-6
o    Grades 7-9
o    High school diploma
o    Pre-associate education. Attended trade school, college, or university, no certificate or degree received
o    A certificate from a college or trade school for completion of a program prior to the associate/bachelor degree
o    Associate degree
o    Bachelor’s degree (e.g. BA, AB, BS)
o    Master’s degree (e.g. MA, MS, MEng, MEd, MSW, MBA)
o    Professional degree (e.g. MD, DDS, DVN, LLB, JD)
o    Doctorate degree (e.g. PhD, EdD)
o    Foreign degree
o    Don’t Know
o    No Response

29. What is your education goal?
o    High school diploma or equivalency
o    Vocational, trade or business certification/license
o    One or two year college degree
o    University degree
o    Graduate school
o    Professional degree (e.g. MD, DDS, DVN, LLB, JD)
o    Doctorate degree (e.g. PhD, EdD)
o    None of the above   
o    Don’t Know
o    No Response

30. What is the highest grade or year of school you completed in the United States?

__________________
o    Don’t Know   
o    No Response

31. Did you graduate from high school in the United States?
o    Yes
o    No
o    Don’t Know
o    No Response

32. Do you have:

Yes No Don’t Know No Response
1.  A GED o o o o
2.  A High School Diploma o o o o
3. Special Education Diploma o o o o


33. What was the highest grade your mother completed in school?________________________
o    Don’t Know
o    No Response

34. What was the highest grade your father completed in school?_________________________
o    Don’t Know
o    No Response

35. How old were you when you left school? _________________________________________
o    Don’t Know
o    No Response

36. Why did you leave school?_____________________________________________________
o    Don’t Know
o    No Response

37. What was the main reason you left school? If there is more than one reason, please say.
o    Did not do well in school
o    Could not get along with teachers
o    I didn’t get along with other students
o    I was bored
o    I did not like school
o    Felt I did not belong in school
o    Failing School
o    Expelled
o    I/my partner was pregnant
o    I had to help support my family
o    Got a job
o    Illness or disability
o    My friends were dropping out
o    Personal/relationship problems
o    Graduated
o    Other
o    Don’t Know
o    No Response

38. Think about your overall experience of school from first grade to when you left. Would you say your experience was:
o    very negative
o    somewhat negative
o    neither negative nor positive
o    somewhat positive
o    very positive
o    Don’t Know
o    No Response

39. Did you ever repeat a grade in school?
o    Yes. Which grades?___________________________________________________
o    No
o    Don’t Know
o    No Response

40. While you attended school, did you ever have to miss school for a long time, such as a few weeks or a few months?
o    Yes Why?___________________________________________________________
o    No
o    Don’t Know
o    No Response

41. Have you attended any special education classes?
o    Yes. During which grade(s)? What type of special education class?_______________   
o    No
o    Don’t Know
o    No Response

42. Has anyone ever suggested to you that you have:

Yes No Don’t Know No Response
1. a learning disability o o o o
2. an educational problem o o o o
3. eye trouble (not corrected by glasses) o o o o
4. hearing problems o o o o
5. a physical disability o o o o
6. a long-term illness (6+ mo.) o o o o



43. Have you ever been tested for any of the following problems, as a child or as an adult:

Yes No Don’t Know No Response
1. a learning disability o o o o
2. an educational problem o o o o
3. eye trouble (not corrected by glasses) o o o o
4. hearing problems o o o o
5. a physical disability o o o o
6. a long-term illness (6+ mo.) o o o o

44. Have you ever had:

Yes No Don’t Know No Response
1.    A head injury
If yes, when__________________ 
o o o o
2.    A stroke o o o o

45. Have any family members had problems in learning to read?
o    Yes   
o    No
o    Don’t Know
o    No Response

If participant answers yes, please proceed to question 46, otherwise go to question 47.

46. If yes who:

Yes No Don't Know No Response
1. Your children? o o o o
2. Your parents? o o o o
3. Your brothers/sisters? o o o o
4. Other_____________________ o o o o

47. Have you ever taken any of the GED tests?
o    Yes
o    No
o    Don’t Know
o    No Response

If participant answers yes, please proceed to question 48, otherwise go to question 50.

48. If yes, which ones did you take?
o    English
o    Math
o    Science
o    Social Studies
o    Writing
o    Don’t Know
o    No Response

49. Which ones did you pass?
o    None
o    English
o    Math
o    Science
o    Social Studies
o    Writing
o    Don’t Know
o    No Response

Now I would like to ask you some questions about your finances.

50. What was your household income for the past year? ____________________   
o    Don’t Know
o    No Response

51. I would now like to ask some questions about your activities last week, that is, the 7 days ending last Sunday.

51a. In the last week, did you do any PAID work for at least one hour, either as an employee or as self-employed? (Try to probe for an answer.)
o    Yes
o    No
o    Don’t Know
o    No Response

51b. Last week, did you do any UNPAID work for at least one hour for a business that you own or a relative owns? (Try to probe for an answer.)
o    Yes   
o    No
o    Don’t Know
o    No Response

52. Which of the following describes your work history?
o       Held a paying job within the last three years
o       Held a paying job, but not within the last three years
o       Never had a job
o       Don’t Know
o       No response

53. Do you have a paying job right now?
o    Yes
o    No
o    Don’t Know
o    No Response

If participant answers Yes, please proceed to question 54, otherwise go to question 58.

54. What is your job? ___________________________________________________________
o    Don’t Know
o    No Response

55. Do you work full-time or part-time?
o        Full-time
o        Part-time
o        Don’t Know
o        No response
o        Not applicable

56. About how many hours or days did you work last week?

    Hours: _________________
    Days: __________________
o    Don’t Know
o    No response
o    Not applicable

57. What is the easiest way for you to tell us your usual gross wage or salary for your current job?

Would it be…(Read answer categories to participant and make sure it is expressed in time units. When people get paid per piece, ask them how long it takes on average to finish a piece of work and specify this in hours. The response option “I get no salary or wage at all” could refer to apprentices who only receive training.)

o    per hour (proceed to question 57b)
o    per day (proceed to question 57c)
o    per week (proceed to question 57d)
o    per two weeks (proceed to question 57e)
o    per month (proceed to question 57f)
o    per year (proceed to question 57g)
o    piece rate (proceed to question 57a)
o    I get no salary or wage at all (proceed to question 58)
o    Don’t Know
o    No Response

57a. (If paid piece-rate:) “Could you please specify how many hours on average it takes to produce one piece?” If finishing a piece takes less than 2 hours, you may enter decimals to specify the minutes as well. For easy reference: 0.5 is half hour; 0.25 is 15 minutes; 0.10 is approximately 5 minutes; and 0.02 is approximately one minute.
    ___________________________
o    Don’t Know
o    No Response

PROCEED TO QUESTION 58

57b. (If paid per hour:) How much would you estimate your usual gross pay per hour is? By gross, we mean before deductions for tax and national insurance (social security contributions). Please include any regular overtime pay, regular bonuses, tips and commissions. Don’t include annual bonuses or holiday pay. 
o    Up to $7.99
o    Between $8.00 and $8.99
o    Between $9.00 and $12.99
o    Between $13.00 and $17.99
o    Between $18.00 and $24.99
o    $25.00 and above
o    Don’t Know
o    No Response

PROCEED TO QUESTION 58

57c. (If paid per day:) How much would you estimate your usual gross pay per day is? By gross, we mean before deductions for tax and national insurance (social security contributions). Please include any regular overtime pay, regular bonuses, tips and commissions. Don’t include annual bonuses or holiday pay. 
o    Up to $19.99
o    Between $20.00 and $39.99
o    Between $40.00 and $79.99
o    Between $80.00 and $139.99
o    Between $140.00 and $219.99
o    $220.00 and above
o    Don’t Know
o    No Response

PROCEED TO QUESTION 58

57d. (If paid per week:) How much would you estimate your usual gross pay per week is? By gross, we mean before deductions for tax and national insurance (social security contributions). Please include any regular overtime pay, regular bonuses, tips and commissions. Don’t include annual bonuses or holiday pay. 
o    Up to $199
o    Between $200 and $399
o    Between $400 and $599
o    Between $600 and $999
o    Between $1,000 and $1,499
o    $1,500 and above
o    Don’t Know
o    No Response

PROCEED TO QUESTION 58

57e. (If paid per 2 wks:) How much would you estimate your usual gross pay per two weeks is? By gross, we mean before deductions for tax and national insurance (social security contributions). Please include any regular overtime pay, regular bonuses, tips and commissions. Don’t include annual bonuses or holiday pay. 
o    Up to $199
o    Between $200 and $599
o    Between $600 and $1,199
o    Between $1,200 and $1,899
o    Between $1,900 and $3,099
o    $3,100 and above
o    Don’t Know
o    No Response

PROCEED TO QUESTION 58

57f. (If paid per month:) How much would you estimate your usual gross pay per month is? By gross, we mean before deductions for tax and national insurance (social security contributions). Please include any regular overtime pay, regular bonuses, tips and commissions. Don’t include annual bonuses or holiday pay. 
o    Up to $499
o    Between $500 and $1,299
o    Between $1,300 and $2,499
o    Between $2,500 and $4,199
o    Between $4,200 and $6,699
o    $6,700 and above
o    Don’t Know
o    No Response

PROCEED TO QUESTION 58

57g. (If paid per year) How much would you estimate your usual gross pay per year is? By gross, we mean before deductions for tax and national insurance (social security contributions). Please include any regular overtime pay, regular bonuses, tips and commissions. Don’t include annual bonuses or holiday pay. 
o    Up to $5,999
o    Between $6,000 and $14,999
o    Between $15,000 and $29,999
o    Between $30,000 and $49,999
o    Between $50,000 and $79,999
o    $80,000 and above
o    Don’t Know
o    No Response

58. Have you ever received:

Yes No Don't Know No Response
1. Supplemental security income o o o o
2. Food Stamps o o o o
3. WIC Supplemental Nutrition Benefits o o o o
4. Temporary Aid to Needy Families (TANF),
Aid to Families with Dependent Children (AFDC), public assistance,
public welfare payments.
o o o o
5. Retirement or Disability Payments o o o o

59. Do you currently receive?

Yes No Don't Know No Response
1. Supplemental security income o o o o
2. Food Stamps o o o o
3. WIC Supplemental Nutrition Benefits o o o o
4. Temporary Aid to Needy Families (TANF),
Aid to Families with Dependent Children (AFDC), public assistance,
public welfare payments.
o o o o
5. Retirement or Disability Payments o o o o

60. Would you say that keeping a regular schedule in your life is important or not important?
o    Important
o    Not important
o    Don’t Know
o    No Response

61. I am going to read four different answers, please tell me which one is the best description of you:
o    I am usually able to keep the same schedule every week.
o    I try to keep the same schedule every week but unexpected things happen once in a while that interfere with my schedule.
o    I try to keep the same schedule every week but unexpected things happen often that interfere with my schedule.
o    It's not possible for me to keep the same schedule every week.
o    Don’t Know
o    No Response

62. In your day-to-day life, how often do you have to change or cancel an appointment because something unexpected comes up?
o    Every Day 
o    A few times a week
o    Once a week 
o    Less than once a week 
o    Rarely
o    Never 
o    Don’t Know
o    No Response

Now I would like to ask you some questions about how you deal with problems and tasks you encounter. To what extent do the following statements apply to you?

63. I like learning new things.
o    Not at all
o    Very little
o    To some extent
o    To a high extent
o    To a very high extent
o    Don’t Know
o    No Response

64. When I come across something new, I try to relate it to what I already know.
o    Not at all
o    Very little
o    To some extent
o    To a high extent
o    To a very high extent
o    Don’t Know
o    No Response

65.  I like to get to the bottom of difficult things. 
o    Not at all
o    Very little
o    To some extent
o    To a high extent
o    To a very high extent
o    Don’t Know
o    No Response

66. If I don’t understand something, I look for additional information to make it clearer.
o    Not at all
o    Very little
o    To some extent
o    To a high extent
o    To a very high extent
o    Don’t Know
o    No Response

67.  In the last 12 months, how often, if at all, did you do voluntary work, including unpaid work for a charity, political party, trade union or other non-profit organization?
o    Never
o    Less than once a month
o    Less than once a week but at least once a month
o    At least once a week but not every day
o    Every day
o    Don’t Know
o    No Response

68. Do you have a professional certification or a state or industry license that is valid in the United States? A professional certification or license shows you are qualified to perform a specific job and includes things like Licensed Realtor, Certified Medical Assistant, Certified Construction Manager, a Project Management Professional certification, or an IT certification.
o    Yes continue
o    No stop
o    Don’t Know
o    No Response

PROCEED ONLY IF PERSON ANSWERED YES TO THE ABOVE QUESTION. OTHERWISE END SURVEY.

69. Thinking of all the certifications and licenses you have, did you get any of them for work-related reasons, or were they all for personal interest?
o    I got at least one certification or license for work-related reasons continue
o    I did not get any certifications or licenses for work-related reasons stop
o    Don’t Know
o    No Response

PROCEED ONLY IF PERSON ANSWERED Number 1 TO THE ABOVE QUESTION. OTHERWISE END SURVEY.

70. These next questions ask about the most recent certification or license you earned for work-related reasons. First, who issued this certification or license?
o    Federal, state, or local government?
o    Professional or trade association (for example, Pediatric Nursing Certification Board, National Exercise and Sports Trainers Association, CompTIA)
o    Business or company (for example, Microsoft, 3M Company, Xerox)
o    Other group or organization, specify: ___________________
o    Don’t Know
o    No Response

71.  Still thinking about the most recent certification or license you earned for work-related reasons, did you have to pass a test or exam or demonstrate your skills in order to get it?
o    Yes
o    No
o    Don’t Know
o    No Response

72. And could you use this certification or license to get a job with any employer in the line of work that it applies to? If you have a state certification or license that can be used state-wide, please answer “yes”.
o    Yes
o    No
o    Don’t Know
o    No Response

Sources

PIAAC – Program for the International Assessment of Adult Competencies
Items: 4, 5, 16-21, 23, 24, 28, 51, 57, 63-67
The 2012 Program for the International Assessment of Adult Competencies (PIAAC). Developed by the Organization for Economic Co-operation and Development and adapted for the United States by the U.S Department of Education, Institute of Education Sciences, National Center for Education Statistics. Retrieved May 20, 2016 from
https://nces.ed.gov/surveys/piaac/final_en_bq.htm.

NATES – National Adult Training and Education Survey
Items: 68-72
United States Department of Education, Institute of Education Sciences, National Center for Education Statistics, National Adult Training and Education Survey (NATES), 2013. Retrieved May 20, 2016 from
https://nces.ed.gov/surveys/gemena/pdf/NATESInstrument.pdf.

Demographic Interview
Items: 11, 31-34, 40-46, 52, 54-56, 58, 59
Developed by Georgia State University researchers as part of the following grant: Greenberg, D., Morris, R., Fredrick, L., Rodrigo, V., & Laures, J. (2002-2009) Research on Reading Instruction for Low Literate Adults. National Institute of Child Health and Human Development, the National Institute for Literacy, and the U.S. Department of Education (grant #1 R01 HD43801-01)

LSAL Wave 1 – The Longitudinal Study of Adult Learning Wave 1 Questionnaire
Items: 9, 10, 22, 30, 35, 37, 38, 47-49
The Longitudinal Study of Adult Learning Wave 1 Questionnaire (1998). Developed under the National Center for the Study of Adult Learning and Literacy at Portland State University. Retrieved May 20, 2016 from
http://www.lsal.pdx.edu/docs/pdf/wave1.pdf.

LSAL Wave 6 – The Longitudinal Study of Adult Learning Wave 6 Questionnaire
Items: 29, 60-62
The Longitudinal Study of Adult Learning Wave 6 Questionnaire (2007). Developed under the National Center for the Study of Adult Learning and Literacy at Portland State University. Retrieved May 20, 2016 from
http://www.lsal.pdx.edu/docs/pdf/wave6.pdf.