Att M_--_Focus_Group_Screening_Instrument_for_Parents_and_Youth REV 6 17 09

Attachment M: Focus Group Screening Instrument for Parents and Youth

Form Approved

OMB No. __0920-XXXX__

Exp. Date _xx/xx/20xx_

Public Reporting burden of this collection of information is estimated at 5 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency many not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Reports Clearance Officer, 1600 Clifton Road NE, MS D-74, Atlanta, GA 30333; Attn: PRA (0920-XXXX).

Focus Group Screening Instrument for Parents and Youth

Choose Respect Study: Screener

RESPONDENT CONTACT INFO (for facility use only)

Respondent’s Name: ______________________________________ Address: __________________________________________________ Phone Numbers: Home: ___________________________________________ Office: ___________________________________________ Cell: _____________________________________________

TWeen/teen Study: Screener

QUESTIONNAIRE

THIS SCREENER IS DESIGNED TO RECRUIT BOYS AND GIRLS, AGES 11-14, WHO ARE IN GRADES 6, 7, AND 8.

INITIAL SCREENING FOR A TEEN MUST GO THROUGH PARENT/GUARDIAN. ESTABLISH CONTACT WITH ADULT WHO IS THE PARENT/GUARDIAN OF CHILDREN LIVING IN THE HOME (EITHER M OR F), THEN BEGIN HERE: Hello. My name is ________ from ________, a consumer research company located here in (LOCATION). We are currently involved in a study to understand the ways adolescents today spend their time, access information, and interpret messages. We would like to ask your permission for your child to participate in these discussions, which will help us to better understand how best to communicate with youth on the topic of healthy relationships.

As part of our research study, we’d like to conduct focus groups with boys and girls ages 11-14, who are in 6^th, 7^th, or 8^th grade. Do you have a child in one of these grades? Are they at home?

IF “YES, CONTINUE.

IF “NO,” THANK AND END INTERVIEW

IF PARENT WANTS TO KNOW THE NATURE OF THE QUESTIONS YOU’D BE ASKING THE CHILD, SAY: Our research study will focus on the issue of “relationships in the lives of youth.” Some potential discussion areas are: feedback on specific events where materials should be displayed (e.g., music concerts for particular bands or musicians); potential business/organization partners that are highly used/respected/recognized by youth ages 11 to 14; where information should be distributed (e.g., Boys & Girls Clubs, specific social networking sites); and draft content and designs developed for campaign materials. However, the survey questions that I will ask your child in this conversation will be rather general in nature and geared more toward determining if he or she feels comfortable chatting both with same age peers, and an adult research analyst.

Would you permit me to interview your child for research purposes? I’d like to assure you that this is NOT a telephone sales solicitation. I am not trying to sell you or your child any new products or services. This is a survey that is being conducted for information-gathering and analytic purposes only. In fact – at the end of my survey – I may want to invite your child to attend a panel discussion. Would you permit me to interview your child and perhaps invite (him/her) to attend a panel discussion? He/she will be compensated $50 for his/her participation in the focus group.

IF “YES, CONTINUE AT Q1a. IF “NO,” THANK AND END INTERVIEW.

1a.	Thanks very much. Now is your child a boy or a girl?
		BOY		GIRL	 SEE QUOTAS.
1b.	I’d like to ask you a few brief household classification questions, then speak directly with your child. Now, I know that your child is in 6th, 7th, or 8th grade. Which grade is your child in specifically? 6th grade  7th grade  8th grade  SEE QUOTAS.
1c.	And how old is your child? 11-12 (for 6th grade)  12-13 (for 7th grade)  13-14 (for 8th grade)  MAKE SURE AGE MATCHES GRADE IN PARENTHESIS ( ). IF NOT, THANK AND END.

2a. Does your child attend a middle school, junior high, or high school?

Middle  CONTINUE

Junior high  CONTINUE

High  THANK AND END

2b. Does your child attend a public school, private school, or his he/she home schooled?

Public school  CONTINUE

Private school  CONTINUE

Home schooled  CONTINUE

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3.	We want to be certain that our research reflects the country’s diversity. Which of the following comes the closest to describing your child’s racial background? READ LIST.
	American Indian or Alaska Native	
	Asian	
	Black or African American	
	Native Hawaiian or Other Pacific Islander	
	White	
RECRUIT 4-6 NON-CAUCASIAN RESPONDENTS IN EACH MARKET.
3a.	Which of the following comes the closest to describing your child’s ethnic background? READ LIST.
	Hispanic or Latino		
	Not Hispanic or Latino		
			
RECRUIT 8-10 HISPANIC OR LATINO RESPONDENTS IN EACH MARKET.
3b.	We’d like to collect a diverse set of opinions, so can you please tell me your family’s approximate annual household income?
	Less than $20,000  CONTINUE
	$20-$30,000  CONTINUE
	$30-$50,000  CONTINUE
	$50-$75,000  CONTINUE
	$75-$100,000  CONTINUE
	More than $100,000  CONTINUE

4a.	When – if ever – did your child last participate in an in-person consumer research panel discussion or individual interview? Was it ... READ LIST
	Within the past 6 months		THANK AND END
	More than 6 months ago		CONTINUE AT Q4b.
	Never participated		CONTINUE AT Q4b.

4b.	Is he/she currently participating in or scheduled to participate in any other consumer research panels, interviews or projects with our agency or with any other consumer research company?
	Yes		THANK AND END
	No		CONTINUE

5.	Which of the following would you say describes your (son/daughter)? If more than one describes your (son/daughter), please feel to indicate that. READ LIST AND RECORD.
	Very talkative	*	Very imaginative	*
	Tends to be quiet		Prefers to spend time alone	
	Friendly	*	Gets along with other kids
	Intelligent	*	even if (he/she) doesn’t know them	*
	Has a pretty good
	attention span	*
	Shy with strangers	
	PREFERENCE SHOULD GO TO * DESCRIPTIONS FOR MAXIMIUM GROUP PARTICPATION

6. Would you say the neighborhood that you live in is urban, suburban or rural?

Urban 

Suburban 

Rural 

AT THIS POINT, EXPLAIN TO PARENT THAT YOU WOULD LIKE TO SPEAK DIRECTLY TO THE CHILD UNDER DISCUSSION TO ASK (HIM/HER) A FEW BRIEF QUESTIONS. TELL PARENT THAT YOU USE THE QUESTIONS YOU ASK THE CHILD TO DETERMINE IF HE/SHE IS APPROPRIATE FOR ONE OF THE SESSIONS. FINALLY, TELL PARENT THAT YOU WILL ASK TO SPEAK TO HIM/HER (THE PARENT) ONCE AGAIN AFTER SPEAKING WITH THE CHILD TO CONFIRM LOCATION OF FACILITY, DATE AND TIME OF SESSION, ETC.

7.

	I’ve been asking your (mom/dad) some survey questions, and now would like to ask you a few questions too if that’s okay.
		7a.		First, could you tell me what grade are you in:	____		MUST MATCH PARENT’S RESPONSE
		7b.		And, how old are you:		____	MUST MATCH PARENT’S RESPONSE
		7c.		I’m going to read a few sentences to you. After I read each sentence to you, please tell me if that sentence describes you.			YES NO
				I enjoy meeting and talking to new people.  *  I enjoy spending time with other kids my age.  * 										
														
				When I meet new people for the first time, I
				am quiet and don’t talk much.					
				ALL * DESCRIPTIONS MUST BE CHECKED.
				ALL DESCRIPTIONS NOT DESIGNATED * MUST NOT BE CHECKED.
8. Which of the following statements do you agree with the most? (MUST PICK ONLY ONE) Friends are the most important thing in my life.  CONTINUE Friends are pretty important, but not the most important thing to me.  CONTINUE Friends are not that important in my life.  THANK AND END
9. ASK ALL: How do you like to spend your free time? READ LIST. Intellectual activities such as: reading, writing, doing homework, etc.  Creative activities such as: doing crafts, sewing Painting, etc.  Social activities such as: “hanging out with friends, talking on the phone, dating, etc.  Physical activities such as: playing sports, working out at the gym, etc.  Community activities such as: going to religious functions, volunteer work, etc.  RECRUIT A MIX OF RESPONDENTS WHO SPEND THEIR TIME IN DIFFERENT WAYS.

10. ASK ALL: If Nike were to decide to go into the music business, what type of music would they make? What would the style be called? How would it be different from other types of music?

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USE THIS QUESTION TO DETERMINE WHETHER OR NOT RESPONDENT CAN CLEARLY ARTICULATE HIS/HER THOUGHTS AND FEELINGS. IF RESPONDENT SAYS “I DON’T KNOW,” “I DON’T REMEMBER,” SEEMS UNWILLING TO SHARE HIS/HER IDEAS WITH THE RECRUITER, OR SEEMS TO EXHIBIT ANY SPEECH OR HEARING DIFFICULTIES, DO NOT INVITE. LOOK FOR RESPONDENTS WHO ARE VERY ARTICULATE FOR THEIR AGES.

IF RESPONDENT HAS QUALIFIED TO THIS POINT, ASK HIM/HER ABOUT PARTICIPATING IN A GROUP DISCUSSION WITH OTHER SAME GRADE/SAME GENDER KIDS. IF HE/SHE INDICATES THAT HE/SHE WOULD LIKE TO PARTICIPATE, ASK ONCE AGAIN TO SPEAK TO PARENT. INFORM PARENT THAT CHILD IS QUALIFIED AND OBTAIN FINAL PARENTAL PERMISSION.

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