Form 0920-0572 ATSDR-Message-Testing_Attachment-2_Screener-Consumers_Cl

Form Approved

OMB No. 0920-0572

Exp. Date: 2/28/2015

ATSDR Task Order 15 Message Testing

Attachment 2

Screener: Consumers¹

OVERVIEW

Our desired participants are consumers.

Participants should represent a mix of education levels, race/ethnicities, and income levels.

Gender: Mixed

Age: 18 and over

Race/Ethnicity: Mixed

Education level: Mixed (at least half of participants cite high school as the highest level of education completed.)

Income: Mixed

Geographic Location: Washington D.C. metro area

We will exclude from participation people who:

• Are under the age of 18

• Have participated in any research within the past 6 months

• Conduct market research or work in advertising or public relations

• Are unable to speak and read English well enough to complete the study

Public reporting burden of this collection of information varies from 5 to 10 minutes with an estimated average of 10 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 CDC/ATSDR Information Collection Review Office, 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (0920-0572).

SCRIPT

Hello,

This is NAME from COMPANY. We are doing a research study to help develop new messages on behalf of the Agency of Toxic Substances and Disease Registry (ATSDR), which is a federal agency of the Centers for Disease Control and Prevention (CDC). If you qualify to participate in the focus group, we will offer you $40 as a token of appreciation to participate in a 1-hour focus group in Rockville, Maryland.

This is a research study. We are not selling anything. Other people who have participated in similar studies have found it to be interesting and fun. Does it sound like something you would be interested in?

Great. Let's find out if you qualify. I have a few simple questions to ask. This should take about 5 minutes. At some point, I may end the questions if I discover you don't qualify. This has nothing to do with you. We simply are looking for people who meet certain criteria.

2a. In which of the following categories does your age fall:

______ under 18 years of age (TERMINATE)

______ 18-24 years of age (CONTINUE)

______ 25-34 years of age (CONTINUE)

______ 35-44 years of age (CONTINUE)

______ 45-54 years of age (CONTINUE)

______ 55-64 years of age (CONTINUE)

______ 65-74 years of age (CONTINUE)

______ 75 years of age or older (CONTINUE)

13a. Which of the following categories best describe your total, annual household income?

________ Under $20,000/year (CONTINUE)

________ $20,001 - $30,000/year (CONTINUE)

________ $30,001 - $40,000/year (CONTINUE)

________ $40,001 - $50,000/year (CONTINUE)

________ $50,001 - $60,000/year (TERMINATE)

________ $60,001 - $80,000/year (TERMINATE)

________ $80,001 - $100,000/year (TERMINATE)

________ Over $100,000/year (TERMINATE)

4a. What is the highest level of education you have completed? (Recruit at least half with high school as the highest level of education completed)

________ Grade school

________ Less than high school graduate/some high school

________ High school graduate or completed GED

________ Some college or technical school

________ Received four-year college degree

________ Some post graduate studies

________ Received advanced degree

________ Other: _____________________

1a. Gender:

_______ Male

_______ Female

5a. Are you Hispanic, Latino/a,or Spanish Origin?
(One or more categories may be selected)

Categories

1. ____No, not of Hispanic, Latino/a, or Spanish origin

2. ____Yes, Mexican, Mexican American, Chicano/a

3. ____ Yes, Puerto Rican

4. ____ Yes, Cuban

5. ____ Yes, Another Hispanic, Latino/a or Spanish origin

Categories

1. ____ White

2. ____ Black or African American

3. ____ American Indian or Alaska Native

4. ____ Asian Indian

5. ____ Chinese

6. ____ Filipino

7. ____ Japanese

8. ____ Korean

9. ____ Vietnamese

10. ____ Other Asian

11. ____ Native Hawaiian

12. ____ Guamanian or Chamorro

13. ____ Samoan

14. ____ Other Pacific Islander

1b. Do you, or does any member of your household or immediate family work for:

• a market research company

• an advertising agency or public relations firm

• the media (TV/radio/newspapers/magazines)

• as a healthcare professional (doctor, nurse, pharmacist, dietician, etc.)

_______ Yes (TERMINATE)

_______ No (CONTINUE)

2b. Have you participated in a focus group, intercept interview, telephone survey, and/or online survey in which you were asked your opinions regarding a product, a service, or advertising within the past six months?

_______ Yes (TERMINATE)

_______ No (CONTINUE)

1 This request is for a one-time data collection.