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Appendix C. Long Screener to Collect Telephone Number C-1
What is the Survey of Community Attitudes? This is a survey of households that asks questions about your community. The survey covers different topics about what it is like living in your community. Who is the Conducting this Survey? Westat, a social science research firm, is collecting this information through a contract awarded by the National Academy of Sciences. Why are you asking for my phone number? We sampled your household by your address. Since the survey will be conducted by telephone, we need your number to call you to complete the survey. How long will it take to complete this survey? It will take 3 minutes to complete this mail survey. The follow-up telephone interview will take approximately 15 minutes to complete. Am I required to complete this survey? Participation is voluntary and there are no penalties for refusing to answer. However, your household was randomly selected for this scientific sample survey and you cannot be replaced with another household. Your cooperation is extremely important to help ensure the completeness and accuracy of the study. Who will use this information? Westat, a social science research firm, is collecting this information through a contract awarded by the National Academy of Sciences. The information will be used to measure residentsâ attitudes about their environment. Who can I call with questions? Westat, a private research firm is collecting the data. If you would like further information, you can contact Westat at 1-###-###-####. How was my household selected? Households were selected at random from all residential addresses in your community. By selecting households randomly, we will be able to create scientific estimates about households in your community. Itâs important to participate, so that we have an accurate picture of all communities. C-3
This survey should be filled out by an adult household member living at this address. Please use a blue or black pen if available. These first questions ask about your neighborhood. 1. Thinking about the last 12 months or so, when you are here at home, how much does each of the following bother, disturb or annoy you? Not at all ï± Slightly ï± Moderately ï± Very ï± Extremely ï± a. Noise from cars trucks or other road traffic b. Smells or dirt from road traffic c. Smoke, gas or bad smells from anything else d. Litter or poorly kept up housing e. Noise from aircraft f. Your neighborsâ noise or other activities g. Any other noises you hear when you are here at home If this bothers or annoys you, what is the noise? h. Undesirable business, institutional or industrial property i. A lack of parks or green spaces j. Inadequate public transportation k. The amount of neighborhood crime l. Poor city or county services m. Any other problems that you notice when you are here at home If this bothers or annoys you, what is the problem? C-4
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2. Now considering how you feel about everything in your neighborhood, how would you rate your neighborhood as a place to live on a scale from 0 to 10 where 0 is worst and 10 is best? Worst 0 ï± 1 ï± 2 ï± 3 ï± 4 ï± 5 ï± 6 ï± 7 ï± 8 ï± 9 ï± Best 10 ï± These last questions are about your household. 3. Including yourself, how many adults at least 18 years old live in this household? (Please include any persons who are temporarily away at this time, for example, anyone temporarily hospitalized or on a vacation or business trip.) |__|__| 4. What is the best phone number to use to contact you? (This phone number will only be used for the purpose of this research study.) |__|__|__| - |__|__|__| - |__|__|__|__| Thank you. Please return this form in the postage paid envelope provided or mail it to: Community Environmental Study Westat 1600 Research Blvd. Room Rockville, MD 20850 Toll-free number for questions: XXX-XXX-XXXX C-5