Pretest invitation, Pretest, Survey invitation, Survey (Study 1)

Experimental Studies of Nutrition Symbols on Food Packages

Appendix M

Studies 1 and 2

(DRAFT, November 2009)

COGNITIVE INTERVIEW SCREENER

Form Approved: OMB No. 0910-XXXX

Expiration Date ____/__/_____

PUBLIC Disclosure Burden Statement

Public reporting burden for this collection of information is estimated to average 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 may 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:

Department of Health and Human Services
Food and Drug Administration
CFSAN/PRB Comments/HFS-24
5100 Paint Branch Parkway
College Park, MD 20740-3835.

An agency may 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.

Hello, my name is xxx and I work for (name of contractor), a local research firm. We're doing research for the Food and Drug Administration about food labels and nutrition. If you are eligible and you agree to participate, we will give you $75 to complete an in-person interview that should last about an hour. In order to find out if you are eligible to be interviewed, I’d like to get some background information.

Before I proceed, I must make sure that you are at least 18 years old.

UNDER 18 :___: [THANK AND END]

18 OR OLDER :___:

1. Do you work either full- or part-time in health services research, or for a food or nutrition company?

YES :___: [THANK AND END]

NO :___:

2. How long have you been using the Internet?

NEVER USED IT :___: [THANK AND END]

LESS THAN 6 MONTHS :___: [THANK AND END]

6 MONTHS OR MORE :___:

DON’T KNOW :___: [THANK AND END]

3. [RECORD GENDER. IF NOT OBVIOUS, ASK]

Are you male or female?

FEMALE :___:

[RECRUIT 4-5 OF EACH]

MALE :___:

4. What is your age? [CODE INTO ONE OF THE FOLLOWING CATEGORIES].

18-24 :___:

25-39 :___:

40-54 :___:

55-64 :___:

65 OR OLDER :___:

:___: [RECRUIT A MIX]

5. What is the highest level of education that you have completed? [CODE INTO ONE OF THE FOLLOWING CATEGORIES].

LESS THAN A HIGH SCHOOL DIPLOMA :___:

HIGH SCHOOL GRADUATE OR GED :___:

SOME COLLEGE, ASSOCIATES DEGREE :___:

COLLEGE GRADUATE :___:

ADVANCED DEGREE :___:

[RECRUIT 2 WITH HIGH SCHOOL DIPLOMA OR LESS]

6. Do you consider yourself to be…..

White :___:

Black/African American :___:

Hispanic or Latino :___:

Asian, or :___:

Something else? :___:

(specify)_______________________________________

[RECRUIT 3-4 WHO ARE NOT WHITE]

7. What is your occupation?

______________________________________________________________________

INVITATION

Thank you for answering all my questions. I’d like to invite you to participate in an in-person that will take about an hour to complete. We’ll pay you $75 for your time with us. Let me give you some available times and you tell me what would be best for you.

INTERVIEW DATE AND TIME:

The interview will be held at (location). I would like to send you directions. Where can I send them? Also, may I please have your phone number in case we need to get hold of you for any reason?

COLLECT RESPONDENT NAME, ADDRESS (IF APPLICABLE) AND PHONE

Name: _____________________________________________________________

Address: _____________________________________________________________

City: _________________________________ State: ______ Zip Code: __________

Phone: ________________________________________

In case you need to contact me for any reason, you can reach me at 1-800-xxx-xxxx.