RTI International is working with the Centers for Disease Control and Prevention (CDC) to conduct focus groups examining women’s views on alcohol and reproductive health. They are inviting groups of women in to discuss their views with them and with each other. If you qualify for this project, and participate in our focus group, you will receive a $75 incentive for your participation. All information that you provide today and all information that you provide during the discussions will remain confidential. Right now I am going to ask you some personal questions, including questions about your alcohol use and/or sexual behavior, to see if you are qualified for the project. Some of the questions may make you feel uncomfortable. Your decision to answer the questions is completely voluntary and you can choose to stop answering questions at any time. Are you ready to begin?
1) How old are you?
18-35 ----> CONTINUE
Other ----> EXCLUDED
2) Are you comfortable participating in a discussion in English?
No ----> EXCLUDED
3) Have you drunk any alcohol in the past 3 years?
No ----> EXCLUDED
4) If yes, did you drink alcohol other than for religious reasons?
No ----> EXCLUDED
5) Are you currently pregnant?
Yes ----> EXCLUDED
6) Have you given birth in the past 12 months?
Yes ----> INCLUSION Group 3 – Women who have had a baby within the past year – GO ON TO DEMOGRAPHIC QUESTIONS
NO ----> CONTINUE
7) Are you currently trying to get pregnant, or planning on getting pregnant within the next 12 months?
Yes ----> INCLUSION Group 2 – Women who are currently trying to get pregnant or who plan to become pregnant in the next year – GO ON TO DEMOGRAPHIC QUESTIONS
NO ----> CONTINUE
8) Have you had a tubal ligation or other surgical sterilization or hysterectomy? Have you been told by a doctor or other medical provider that you can not get pregnant?
Yes ----> EXCLUDED
9) Have you had vaginal intercourse in the past 90 days?
No ----> EXCLUDED
10) Have you had at least one drink of alcohol in the past 90 days (other than for religious purposes)? (No – EXCLUSION)
No ----> EXCLUDED
11) In the past 90 days, what types of birth control did you use?
None
OR
Spermicidal foam/jelly without a condom AND/OR Withdrawal AND/OR Rhythm method ----> INCLUSION Group 1– Women not trying to get pregnant but who are at risk of having an AEP – GO ON TO DEMOGRAPHIC QUESTIONS
Condom AND/OR |
READ ONLY THE FOLLOW-UP QUESTIONS BELOW RELATED TO THE BIRTH CONTROL METHODS USED BY THE RESPONDENT
NOTE: If the respondent indicated that they used more than one of the effective methods listed to the left, then assess whether they used at least one method consistently and effectively as indicated below OR that they used an effective backup method when the first method was not used correctly/consistently.
NOTE: Use the italicized information below as probes to assess effective use. |
Birth Control Pill AND/OR |
|
Female Condom AND/OR |
|
Diaphragm AND/OR |
|
Cervical Cap AND/OR |
|
IUD AND/OR |
|
Depo-Provera/Hormone injection AND/OR |
|
The Patch AND/OR |
|
The Ring – NuvaRing AND/OR |
|
Emergency Contraception (Morning after pill) |
NOTE: Most women will be condom or contraceptive pill users.
Condom users: In the last 90 days did your partner put a new condom on before every time you had vaginal intercourse? Did you put the condom on before the penis approached the vagina? Did the condom stay on through when the penis withdrew (pulled out) every time? Did the condom stay intact every time (i.e. no rips or tears or leakage)?
Yes ----> EXCLUDED
No (AND did not use other effective methods) ----> INCLUSION Group 1– Women not trying to get pregnant but who are at risk of having an AEP – GO ON TO DEMOGRAPHIC QUESTIONS
Birth Control Pill users: In the past 90 days did you miss more than 2 pills in a row in a month when you had vaginal intercourse?
No ----> EXCLUDED
Yes (AND did not use other effective methods) ----> INCLUSION Group 1– Women not trying to get pregnant but who are at risk of having an AEP – GO ON TO DEMOGRAPHIC QUESTIONS
Female Condom users: In the last 90 days did you insert and use a new condom as indicated before every time you had vaginal intercourse? (Lubricate the closed end; squeeze together sides of inner ring at closed and insert it into the vagina like a tampon; push the inner ring into the vagina as far as it could go; let the outer ring hang about an inch outside the vagina; stop intercourse if penis slips between condom and walls of the vagina or if outer ring is pushed into the vagina; remove by squeezing and twisting outer ring to keep semen inside the pouch)
Yes ----> EXCLUDED
No (AND did not use other effective methods) ----> INCLUSION Group 1– Women not trying to get pregnant but who are at risk of having an AEP – GO ON TO DEMOGRAPHIC QUESTIONS
Diaphragm users: In the last 90 days did you use the diaphragm as indicated before every time you had vaginal intercourse? (use with one to two teaspoons of spermicidal jelly spread in the bowl and outer rim of the diaphragm; insert before vaginal intercourse; add an applicator of spermicide – leaving diaphragm in place – before each time you have intercourse; leave in place for 6 to 8 hours after having sex; store away from heat, cold and light; check periodically for cracks/holes; resize if you gained or lost 15 pounds)
Yes ----> EXCLUDED
No (AND did not use other effective methods) ----> INCLUSION Group 1– Women not trying to get pregnant but who are at risk of having an AEP – GO ON TO DEMOGRAPHIC QUESTIONS
Cervical cap users: In the last 90 days did you use the cervical cap as indicated before every time you had vaginal intercourse? (fill dome one-third with spermicide; insert before vaginal intercourse; check position before and after intercourse, and leave in place for 8 hours after having sex; check before use for damage – puckers and holes, avoid contact with heat, light, petroleum products, and newspaper; do not douche with cap in place; resize after pregnancy, abdominal surgery, or an abortion)
Yes ----> EXCLUDED
No (AND did not use other effective methods) ----> INCLUSION Group 1– Women not trying to get pregnant but who are at risk of having an AEP – GO ON TO DEMOGRAPHIC QUESTIONS
IUD users: In the last 90 days did you use an IUD that was properly in place (feel for the string regularly between periods) and not expired (10 years for copper T, 5 years for Mirena)?
Yes ----> EXCLUDED
No (AND did not use other effective methods) ----> INCLUSION Group 1– Women not trying to get pregnant but who are at risk of having an AEP – GO ON TO DEMOGRAPHIC QUESTIONS
Depo-Provera (hormone injection) users: In the past 90 days did you receive the shot at least once?
Yes ----> EXCLUDED
No (AND did not use other effective methods) ----> INCLUSION Group 1– Women not trying to get pregnant but who are at risk of having an AEP – GO ON TO DEMOGRAPHIC QUESTIONS
The Patch users: In the past 90 days did you wear the patch continuously for three out of four weeks and place a new patch each week? Did your patch stay in place each week? Did you wear the patch on the skin of the buttocks, lower abdomen, upper outer arm, or upper torso?
Yes ----> EXCLUDED
No (AND did not use other effective methods) ----> INCLUSION Group 1– Women not trying to get pregnant but who are at risk of having an AEP – GO ON TO DEMOGRAPHIC QUESTIONS
The Ring - NuvaRing users: In the past 90 days did you insert a new ring once per month, and keep it in place 3 weeks in a row? Did you then take it out and replace a new ring one week later? Did you replace it within 3 hours if it slipped out?
Yes ----> EXCLUDED
No (AND did not use other effective methods) ----> INCLUSION Group 1– Women not trying to get pregnant but who are at risk of having an AEP – GO ON TO DEMOGRAPHIC QUESTIONS
Emergency Contraception (Morning after pill) users: In the past 90 days did you use emergency contraception by taking the two does 12 hours apart? (for plan B 2 doses at same time)? Did you take the first pill within 3 days after unprotected vaginal intercourse?
Yes ----> EXCLUDED
No (AND did not use other effective methods) ----> INCLUSION Group 1– Women not trying to get pregnant but who are at risk of having an AEP – GO ON TO DEMOGRAPHIC QUESTIONS
_______________________________________________________________________
DEMOGRAPHIC QUESTIONS:
1) What is your date of birth? MONTH __ YEAR __
2) Are you Hispanic or Latina? YES -- INCLUDE IN RELEVANT HISPANIC GROUP
NO, REFUSE, OR DON’T KNOW - CONTINUE
3) Which of the following categories best describes your race?
American Indian or Alaska Native ---------- EXCLUDE
Asian --------------------------------------------- EXCLUDE
Black or African American INCLUDE IN RELEVANT BLACK GROUP
Native Hawaiian or Other Pacific Islander -EXCLUDE
White-------------------------- INCLUDE IN RELEVANT WHITE GROUP
IF THEY DON’T KNOW, REFUSE TO ANSWER, INDICATE OTHER, INDICATE MULTIPLE RACES, OR CAN NOT PICK THEN EXCLUDE
_______________________________________________________________________
WRAP-UP FOR EXCLUDED INDIVIDUALS:
_______________________________________________________________________
WRAP-UP FOR INCLUDED INDIVIDUALS:
| File Type | application/msword |
| File Title | Attachment 5—Screening Instrument |
| Author | Elvira Elek |
| Last Modified By | muw1 |
| File Modified | 2009-09-28 |
| File Created | 2009-08-04 |