Telephone Interviews to Screen Potential Focus Group Participants for Exploratory Research and Message Pre-Testing Among Foreign-Born Asian Americans

Form Approved

OMB No. 0920-1027

Expiration Date 08/31/2017

2015 CDC Hep B Campaign Testing

Asian American Segment Recruiting Screener

Attachment 1

Public reporting burden of this collection of information is estimated to average 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 Reports Clearance Officer; 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; Attn: OMB-PRA (0920-1027)

2015 CDC Hep B Campaign Testing

Asian American Segment Recruiting Screener

(To be used to recruit Mandarin, Korean and Vietnamese and English speaking participants)

Hello, my name is ________ from GC GLOBAL Research, a multicultural marketing research firm. We are currently conducting a study among Asian consumers and would like to speak to you for a few minutes. This study is sponsored by the Centers for Disease Control and Prevention (CDC). Please be assured we are not trying to sell you anything, and are only interested in your opinions. I have a few questions to ask you. Your responses will be kept in the strictest of confidence. We will take only a few minutes of your time.

NOTE GENDER:

____ Male _____ Female

1. In this study, we would like to include Asian consumers from different cultural heritages. Which Asian heritage do you most identify yourself with? [READ]

Mainland Chinese ( ) CONTINUE FOR ALL GROUPS

Korean ( ) CONTINUE FOR ALL GROUPS

Vietnamese ( ) CONTINUE FOR ALL GROUPS

Taiwanese Chinese ( ) CONTINUE FOR ENGLISH-SPEAKING GPS ONLY

Hong Kong Chinese ( ) CONTINUE FOR ENGLISH-SPEAKING GPS ONLY

Thai ( ) CONTINUE FOR ENGLISH-SPEAKING GPS ONLY

Burmese ( ) CONTINUE FOR ENGLISH-SPEAKING GPS ONLY

Laotian ( ) CONTINUE FOR ENGLISH-SPEAKING GPS ONLY

Cambodian ( ) CONTINUE FOR ENGLISH-SPEAKING GPS ONLY

Other Asian heritage ( ) TERMINATE

2. Which of the following age group do you belong to?

Under 30 ( ) TERMINATE

30-34 ( ) CONTINUE

35-44 ( ) CONTINUE

45-50 ( ) CONTINUE

Over 50 ( ) TERMINATE

3. How long have you lived in the U.S.?

Less than 5 years ( ) TERMINATE

5-9 years ( ) CONTINUE

10-15 years ( ) CONTINUE

16-19 years ( ) CONTINUE

20-29 years ( ) CONTINUE

30 years or more ( ) CONTINUE

Since Birth ( ) TERMINATE

4. What language do you speak most often AT HOME, that is, more than 50% of the time, with your family? (READ)

Mandarin ( ) CONTINUE

Korean ( ) CONTINUE

Vietnamese ( ) CONTINUE

English ( ) CONTINUE FOR ENGLISH GP ONLY. TERMINATE FOR IN-LANGUAGE GROUPS

Other / None of the above ( ) TERMINATE

5. [IN-LANGUAGE GROUPS ONLY] How well do you speak and read [INSERT APPROPRIATE LANGUAGE: MANDARIN CHINESE/KOREAN/VIETNAMESE]?

Very well ( ) CONTINUE

Well ( ) CONTINUE

Average ( ) TERMINATE

Poorly ( ) TERMINATE

6. [IN-LANGUAGE GROUPS ONLY] On average, how many hours per week do you usually spend on (INSERT Chinese/Korean/Vietnamese) media? This includes newspaper, magazines, radio, Internet and TV.

RECORD ____________________ HOURS (TERMINATE IF LESS THAN 5 HOURS)

7. [ENGLISH-SPEAKING GROUPS ONLY] In general, how comfortable are you to speak English with people outside of your family, especially those who don’t know you well? Would you say you are…

Extremely comfortable ( ) CONTINUE

Very comfortable ( ) CONTINUE

Somewhat comfortable ( ) TERMINATE

Not very comfortable ( ) TERMINATE

Extremely uncomfortable ( ) TERMINATE

8. [ALL RESPONDENTS] Culturally, how would you describe yourself?  Would you say… (READ LIST AND RECORD BELOW)

             

Culturally, I am 100% Asian ( ) CONTINUE

Culturally, I am more Asian than American ( ) CONTINUE

  Culturally, I am equally Asian and American ( ) TERMINATE

Culturally, I am more American than Asian ( ) TERMINATE

Culturally, I am 100% American ( ) TERMINATE

9. Thank you. Next, I would like to ask you a few health related questions. Has a close family member ever been diagnosed with any of the following conditions? [READ]

YES NO

Diabetes ( ) ( )

High blood pressure or other heart condition ( ) ( )

Hepatitis, liver disease or liver cancer ( ) ( )

Osteoporosis ( ) ( )

[MUST SAY “NO” TO “HEPATITIS, LIVER DISEASE OR LIVER CANCER” TO CONTINUE. ]

10. Have you ever had a blood test for any of the following conditions? [READ]

Yes No

Diabetes ( ) ( )

Cholesterol ( ) ( )

Hepatitis ( ) ( )

[MUST SAY “NO” TO “HEPATITIS” TO CONTINUE. OTHERWISE TERMINATE]

11. Which of the following describes your highest education level? (READ LIST.)

Less than High School ( ) TERMINATE

Some high school ( ) CONTINUE

High school diploma ( ) CONTINUE

Some college ( ) CONTINUE

College graduate ( ) CONTINUE

Graduate school or above ( ) CONTINUE

12. Which of the following category best describes your annual household income before tax in 2013? (READ LIST. RECRUIT A MIX.)

Under $50K ( ) CONTINUE

$51K – $75K ( ) CONTINUE

$76K-$100K ( ) CONTINUE

$101K or more ( ) CONTINUE

13. What is your occupation? Record________________________

(TERMINATE IF RESPONDENT IS WORKING IN THE FOLLOWING INDUSTRIES)

• Public relations, advertising or news media (e.g. newspaper, tv, radio station, etc.)

• Market research company

• Health care facility, such as a hospital, HMO, doctor’s office, or clinic

• Medical association, pharmaceutical, or drug company

• State or local health department

• Other health-related organization such as a nursing school, or non-profits like the American Cancer Society, Heart Association etc.

14. Have you participated in a focus group discussion in the past 6 months?

No ( ) CONTINUE

Yes ( ) THANK AND TERMINATE

Thank you. We would like to invite you to participate in a group discussion about some health related advertising. The discussion will take place at a convenient office location, and will last for about 2 hours. Refreshments will be served. The discussion will be conducted in [INSERT APPROPRIATE LANGUAGE: MANDARIN/VIETNAMESE/KOREAN/ENGLISH] and will take place at [LOCATION, DATE AND TIME]. This discussion is strictly for research purposes and we are not trying to sell you anything, we are only interested in your opinions. Are you willing to participate?

If yes, we will mail you a confirmation, and call you the day before you are to come to remind you of your appointment. However, if you know in advance that you will have to cancel, please be sure to call us at _____.