Research Methods for Understanding Aircraft Noise Annoyances and Sleep Disturbance (2014)

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Appendix D. Mail Survey Instrument D-1

D-2

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 Conducting this Survey? Westat, a social science research firm, is collecting this information through a contract awarded by the National Academy of Sciences. How long will it take to complete this survey? It will take 10 minutes to complete this survey. 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 residents’ 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. It’s important to participate, so that we have an accurate picture of all communities. D-3

Starting with yourself, please mark the sex, and write in the age and month of birth for each adult 18 years of age or older living at this address. Sex Age Month Born (01-12) SELF Male Female Adult 2 Male Female Adult 3 Male Female Adult 4 Male Female Adult 5 Male Female Thank you. Please return this form in the postage paid envelope provided or mail it to: [Survey Name] Westat 1600 Research Blvd. Room ## ### Rockville, MD 20850 Toll-free number for questions: ###-###-#### D-4

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 household. 1. Is there more than one person age 18 or older living in this household? Yes No GO TO number 5 on the next page 2. Including yourself, how many people age 18 or older live in this household? 3. The adult with the next birthday should complete this questionnaire. This way, across all households, this survey will include responses from adults of all ages. 4. Please write the first name, nickname or initials of the adult with the next birthday. This is the person who should complete the questionnaire. D-5

5. 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  Slightly  Moderately  Very  Extremely  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 neighbors’ 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? D-6

6. 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  1  2  3  4  5  6  7  8  9  Best 10  These last questions are about you and your household. 7. In what year were you born? Y Y Y Y 8. Are you male or female? Male Female 9. Are you Spanish, Hispanic, or Latino/a? Yes No 10. What is your race? One or more categories may be selected. Mark one or more. White Black or African American American Indian or Alaska Native Asian Native Hawaiian or Other Pacific Islander Other (Specify): X D-7