Attachment D - Youth Recruitment Screener

BPA Formative Interviews
(Youth Group)

FACILITY TO DO THE SCREENING.
Ask to speak with an adult male or female over 18 years of age living in the
household:
I’m with
, a local opinion research company. We are working with
Hello, my name is
RTI International, a nonprofit research organization, on a project sponsored by the federal
health agency, the Food and Drug Administration (FDA). The research is on new types of
tobacco products. I want to assure you that we are not from a tobacco company and we are
not promoting these products. And we are not from a company that sells anything, including
quit-smoking aids. We will be holding interviews with teens ages 15 to 17. The purpose of
these interviews is to learn what teens know about these products and how they view them.
Are you the parent or guardian of a child between the ages of 15 and 17?
Yes – [Ask Gender_______; Age ______ of child and Go to “For Interview
Recruiting- Parent/Guardian” section below]
If Yes – [Ask to speak to him/her and Go to “For Interview RecruitingParent/Guardian” section below]
No – Does an adult parent or guardian of a child between the ages of 15 and 17 live in
this household?
If No – [Thank and end call.]
FOR INTERVIEW RECRUITING—PARENT/GUARDIAN:
As I mentioned, we will be interviewing about 12 youth between the ages of 15 and 17. The
purpose of the interviews is to learn what teens know about a new form of tobacco called a
dissolvable. [IF PARENT/GUARDIAN ASKS WHAT DISSOLVABLES ARE READ TEXT
BELOW]. We will only be talking with teens who have heard of these products before. The
discussion will be held at [INSERT DATE] and last about an hour. In appreciation for your
child’s participation, they will be reimbursed for their time, effort, and travel expenses. In
order to determine whether your child is eligible we need to speak to him/her to ask a few
questions to determine eligibility. We ask that we can speak to your child privately so they
will feel comfortable talking to us to insure the information that we get is accurate. Is that
OK?
IF ASKED WHAT DISSOLVABLES ARE: Dissolvables are smokeless tobacco products that
are used by inserting the product in your mouths. They come in different forms such as
sticks, strips, and tablets called orbs.
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Yes – [Continue]
No – [Thank and end call.]
[Note: If child not home, ask when to call back or provide a number where the child can
call the recruiter back.]

FOR INTERVIW RECRUITING—YOUTH:
I’m with
, a local opinion research company. We are working with
Hello, my name is
RTI International, a nonprofit research organization, on a project sponsored by a federal
health agency. The research is on teens and new types of tobacco products.
We will be interviewing 12 teens around your age. The discussion will be held at [INSERT
DATE] and last about 1 hour. As a thank you for being interviewed, you will be given $30 for
your time, effort, and travel expenses. Would you mind if I ask you a few questions now in
order to see if you are able to participate? I will need you to answer all of these questions
to see if you are able to attend. I will not share your answers with your parent or guardian.
Also, if you are able and decide to participate, nothing that you say during the interview will
be shared with your parent or guardian and they will not be in the room at the time of the
interview.
Yes – [Continue]
No – [Thank and end call.]
1. Confirm respondent gender:
[ASK respondent’s gender if you are unsure]
•
•

Male
Female

2. Confirm respondent’s age: _____________ [If not 15-17, Terminate]
3. What types of tobacco products have you heard of? [DO NOT READ LIST; Check all
that are freely mentioned; see attached for descriptions of products]
Cigarettes
Cigars
Cigarillos
Pipes
Hookahs or water pipes
Snus
Chewing tobacco/dip/snuff
Dissolvable tobacco products
Other: ________________________

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4. Have you ever heard of dissolvable tobacco products?
•

Yes
o

•

If yes, what have you heard? [see attached for description of
acceptable responses]
________________________________________________________
________________________________________________________
________________________________________________________

No – HOLD (Continue asking questions, but place hold)

The next few questions are about tobacco use. As a reminder, your responses will not be
shared with your parent or guardian.
5. Have you ever tried smoking, even one or two puffs of a cigarette?
• Yes
• No
6. In the past 30 days, have you smoked a cigarette?
•
•

Yes
No

7. Have you ever used another type of tobacco product?
• Yes
o

•

If yes, which one(s)?
________________________________________________________
________________________________________________________

No

Recruiter:
• IF participants answers “no” to question 5, 6 AND 7, then TERMINATE.
• OTHERWISE, CONTINUE.

9. Approximately how many people that you live with (either all of the time or part of the
time) use tobacco products? Would you say…
•
•
•
•

All, of them
Most of them
A Few of them
None of them

10. Approximately how many of your friends use tobacco products? Would you say…
•

All, of them
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•
•
•

Most of them
A Few of them
None of them

11. How would you describe your race?
[DO NOT READ OPTIONS. Circle all options given by respondent. ]
(1) Hispanic
Non-Hispanic
(2) White
(3) Black or African American
(4) American Indian or Alaska Native
(5) Asian
(6) Native Hawaiian or Other Pacific Islander
(7) Multiple races mentioned
(8) Other: __________________
12. Have you attended a focus group discussion or interview about smoking or other
tobacco products in the past 3 months? By focus group, we mean an informal, roundtable
discussion, conducted by a facilitator, in which you were asked your opinions about
something related to smoking?
•
•

Yes ÆTerminate (However, let RTI know for a possible hold)
No

Thank you. That is all of the questions that I have for you.
[IF INELIGIBLE: I’m sorry, but we have enough people that fit into your category.]
IF Eligible
INTERVIEW INVITATION: Child
I’d like to invite you to participate in an interview being held [PROVIDE DATE/TIME]. The
discussion will last no more than 1 hour, and will be video-taped, and observed by the focus
group staff. The interview will be at a facility that is easy to get to. You will receive $30 for
your participation. A [LIGHT MEAL/REFRESHMENTS] will be served. As a reminder, if you
decide to participate, nothing that you say will be shared with your parent or guardian.
They will not be in the room with you during the discussion.
Are you interested in participating?
(1)
(2)

Yes Æ Ask to speak to parent/guardian again
No [Thank and end call.]

INTERVIEW INVITATION: Parent

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I’d like to invite your child to participate in an interview being held [PROVIDE DATE/TIME].
The discussion will last no more than 1 hour, and will be video-taped, and observed by the
focus group staff. The discussion will be at a facility that is easy to get to. Your child will
receive $30 for their participation. A [LIGHT MEAL/REFRESHMENTS] will be served. We ask
that you do not discuss the topic of dissolvable tobacco with your child until after the groups
are over.
Confirm child is interested in participating?
(1)
(2)

Yes
No [Thank and end call.]

We prefer that you accompany your child to the facility. If you’d like to stay, we will provide
some refreshments and a room where you can wait. You will not be able to observe the
interview and we won’t be able to share any information from the discussion with you. You
will be provided $25 to compensate for travel expenses in addition to the $30 your child
receives. Will you be able to accompany your child?
(1)
(2)

Yes Æ Go to “Ask all Participants”
No [Go to Consent]

Consent for Non-Accompanied Minors
Since you will not be accompanying your child to the facility, I’d like to confirm that you are
giving permission for your child to participate in the interview. In addition to your verbal
permission, I will also need you to sign an informed consent document. Since you will not
be accompanying your child, we will mail this to your house. Your child MUST bring this
signed permission form with them to the interview in order to participate.
(1)
(2)

Yes
No [Thank and end call.]

ASK ALL PARTICIPANTS:
We are asking for your contact information only for the purpose of sending you a reminder
letter and giving you a call to remind you and your child of the interview. We will destroy all
contact information the interviews are completed.
PARENT’S NAME: _______________________________________________________
CHILD’S NAME: _________________________________________________________
ADDRESS: ____________________________________________________
CITY: ________________________________________________________
ZIP CODE: ____________________________________________________
E-MAIL: _______________________________________________________
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What is the best time to reach you? What is the best telephone number to reach you at
that time?
BEST TIME TO BE REACHED: ________________________________________
BEST PHONE NUMBER:

__________________

Is there another time and number we can try if we miss you?
ALTERNATE TIME TO BE REACHED:
ALTERNATE PHONE NUMBER:
Your child’s participation in this study is very important. If for some reason he/she will not
be able to attend the interview, please let us know right away.
You can call us anytime at [INSERT PHONE NUMBER]. If we are not here, please leave a
message. Thank you.
Interviewer: _________________________________
Supervisor Confirm: ___________________________

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