Communities Putting Prevention to Work (CPPW) National Prevention Media Initiative Focus Group with Parents/Caregivers

Form Approved

OMB No. 0920-0572

Expiration Date: 2/28/2015

Attachment 2: Eligibility Screener

Communities Putting Prevention to Work

National Prevention Media Initiative Focus Groups with Parents/Caregivers

Summary Table

Group	Location	Date/Time	Audience
#1	Philadelphia, PA	TBD ~5:30	Busy parents/caregivers of younger children
#2	Philadelphia, PA	TBD ~7:30	Busy parents/caregivers of older children
#3	Philadelphia, PA	TBD ~5:30	Busy parents/caregivers of younger children
#4	Philadelphia, PA	TBD ~5:30	Busy parents/caregivers of older children

Group	Location	Date/Time	Audience
#5	Jefferson County, AL	TBD ~5:30	Busy parents/caregivers of younger children
#6	Jefferson County, AL	TBD ~7:30	Busy parents/caregivers of older children
#7	Jefferson County, AL	TBD ~5:30	Busy parents/caregivers of younger children
#8	Jefferson County, AL	TBD ~7:30	Busy parents/caregivers of older children

Group	Location	Date/Time	Audience
#9	Minneapolis, MN	TBD ~5:30	Busy parents/caregivers of younger children
#10	Minneapolis, MN	TBD ~7:30	Busy parents/caregivers of older children
#11	Minneapolis, MN	TBD ~5:30	Busy parents/caregivers of younger children
#12	Minneapolis, MN	TBD ~7:30	Busy parents/caregivers of older children

Public Reporting Burden Statement

Public reporting burden of 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 CDC/ATSDR Information Collection Review Office, 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (0920-0572).

Parents/Caregivers

• Recruitment: Recruit 10 parents/caregivers for 8 participants to show for each group (total = 40 participants per market)

• Incentive: $50 for each parent/caregiver, who participate in focus group

• Duration: 90 minutes for each session

Introduction

Hello, my name is ________ and I am calling on behalf of the U.S. Centers for Disease Control and Prevention (known also as CDC). I am a representative from __________________, a marketing research firm in the ________________ area. I know you receive a lot of telephone calls from telemarketers, but I assure you, this is not a sales call. I am calling today to see if you might qualify to participate in a discussion group that is sponsored by the CDC. Everyone who is eligible and participates will receive $50 as a token of appreciation. These groups are sponsored by the U.S. Centers for Disease Control and Prevention (the CDC). We are interested in hearing the opinions of people in our community on several topics.

May I please ask you a few questions about yourself and your interest in several health topics? Thank you.

Screens

1. In the past 6 months have you participated in a market research study, discussion, focus group or interview, not including online surveys, where you were paid for your time and/or for providing your opinions?

( ) Yes ……Terminate

( ) No Continue

2. Not including email, how often over the past 6 months have you personally used the Internet on your computer or on your cell phone, to find more information on a topic of interest to you?

( ) Frequently/Often Continue

( ) Occasionally/Sometimes Continue

( ) Not at all Terminate

( ) Refuse/Don’t know Terminate

3. Are you or anyone in your household…? [Read each statement below]

( ) Employed in advertising, marketing, market research, or public relations? Terminate

( ) Employed in the medical, healthcare, or health promotion fields? Terminate

( ) Employed by a company that makes tobacco products such as cigarettes? Terminate

( ) An employee of the Federal government? Terminate

[Continue only if none of the above employment situations are marked]

4. Which of the following categories best describes your employment status?

( ) Employed full-time Continue

( ) Employed part-time Continue

( ) Unemployed or laid off and looking for work Continue

( ) Stay-at-home caregiver or homemaker Continue

( ) Retired from work Terminate

( ) Other (specify_________________________________) Continue

( ) Refuse/Don’t know Terminate

[Recruit a mix of employment types. Do not recruit any more than 3 participants in the “stay-at-home caregiver or homemaker” category]

5. Are you the parent, step-parent, or primary caregiver of any children who are 19 years old or older?

( ) Yes Terminate

( ) No Continue

6. Are you the parent or primary caregiver of any children who are 18 years old or younger living in your household?

( ) Yes Continue

( ) No Terminate

7. So that we achieve a good mix, please tell me the ages of the children who live at home with you.

Child 1: ___________

Child 2: ___________

Child 3: ___________

Child 4: ___________

Child 5: ___________

Child 6: ___________

Child 7: ___________

Child 8: ___________

[Recruit a mix]

8. [DO NOT ASK – RECORD PARENT CATEGORY.]

( ) Has young children but none 11 to 18 Eligible for groups 1 and 3 - YOUNGER

( ) Has children 11 to 18 Eligible for groups 2 and 4 - OLDER

Note: For “younger” groups - must have at least one child 10 years old or younger and none who are 11 or older.

For “older” groups – must have at least one child 11-18 years old (okay if have younger children as well)

[Recruit a mix]

9. Thinking about these children, to what extent are you interested in the topic of…? [Repeat for 9A through 9C]

9A. Eating healthy foods?

( ) Very interested Continue

( ) Somewhat interested Continue

( ) Not at all interested [Check quota]

( ) Refuse/Don’t know Terminate

9B. Physical activity?

( ) Very interested Continue

( ) Somewhat interested Continue

( ) Not at all interested [Check quota]

( ) Refuse/Don’t know Terminate

9C. Preventing smoking and tobacco exposure?

( ) Very interested Continue

( ) Somewhat interested Continue

( ) Not at all interested [Check quota]

( ) Refuse/Don’t know Terminate

MUST BE “SOMEWHAT” OR “VERY” INTERESTED IN AT LEAST 2 ISSUES IN Q.9A-9C

TO CONTINUE

10. As a parent, how often do you feel that you do not have enough time in a day to tend to all of your commitments and obligations?

( ) Always Continue

( ) Very often Continue

( ) Sometimes Continue
( ) Rarely Terminate
( ) Never Terminate

( ) Refuse/Don’t know Terminate

11. Would you be comfortable reading brief handouts in English on health topics related to physical activity, nutrition, and tobacco use and then talking about your opinions in a small group setting?

( ) Yes Continue

( ) No Terminate

( ) Refuse/Don’t know, or any other answer Terminate

12. Please tell me your race or ethnic background. Do you consider yourself?

( ) Hispanic or Latino Continue

( ) Not Hispanic or Latino Continue

[Recruit a mix]

Please tell me your race or ethnic background. Please select one or more of the following choices…..Do you consider yourself?

( ) American Indian or Alaska Native Continue

( ) Asian Continue

( ) Black or African American Continue

( ) Native Hawaiian or Other Pacific Islander Continue

( ) White Continue

[Recruit at least 4 participants in each group who are Hispanic/Latino and/or non-white]

13. What is your age?

|___|___|

[Record age; Terminate if less than 25 or older than 64]

[Only recruit participants who are 25 to 64 years of age]

14. What is the highest level of education you have completed?

( ) Less than high school Continue

( ) High school diploma/GED Continue

( ) Some college Continue

( ) College degree Continue

( ) Master’s level graduate degree Continue

( ) Doctoral level graduate degree (MD, JD, PhD) Continue

( ) Refuse Continue

[Recruit a mix of education levels]

15. Last year, in 2012, was your total household income greater than $27,000 or was it $27,000 or less?

( ) $27,000 or less Go to Q 16

( ) More than $27,000 Go to Q 15A

( ) Refused/Don’t know Go to Q 16

[Recruit at least 2 participants per group who earn less than $27,000 per year]

15A.Now just stop me when I get to the right category. Was your income…?

( ) More than $27,000 to under $50,000 Continue

( ) $50,000 to under $75,000 Continue

( ) $75,000 to under $100,000 Continue

( ) $100,000 or more Continue

( ) Refused/Don’t know Continue

[Recruit a good mix of incomes]

16. Are you married, living with a partner, widowed, divorced, separated or have you never been married?

( ) Married Continue

( ) Living with a partner Continue

( ) Divorced Continue

( ) Separated Continue

( ) Widowed Continue

( ) Never been married Continue

( ) Refused/Don’t know Continue

[Recruit a mix]

17. Which of the following statements best describes how you think the problem of obesity should be solved in your community? SINGLE RESPONSE, RANDOMIZE LIST.

( ) Obesity is an individual problem that is best solved by people taking personal

responsibility for what they eat and how physically active they are…..Continue

( ) Obesity is a community problem that is best solved by people working together to

make it easier for everyone to eat healthy foods and be physically active …………………………………………………………………………………………………………..Continue

( ) Obesity is both an individual and community problem that is best solved by people

taking personal responsibility for what they eat and how physically active they are, and the community working together to make these behaviors easier to do…………………………………………………………………………………………………..….Continue

[Recruit a mix]

18. [DO NOT ASK - RECORD SEX]

( ) Female Continue

( ) Male Continue

[Recruit a mix]

INVITATION

Thank you for answering my questions. I would like to tell you a little more about the discussion group. The group will meet on [Date] at [Time] at our facility in [Location]. [Give address]. You will join up to 7 other people and a moderator. The group will meet for about two hours. As a thank you for your participation in the discussion you will get $50.

Schedule:

[Day 1 – XXXXXXXX]

5:30 PM [ ] Parents/caregivers of younger children

7:30 PM [ ] Parents/caregivers of older children

[Day 2 – XXXXXXXX]

5:30 PM [ ] Parents/caregivers of younger children

7:30 PM [ ] Parents/caregivers of older children

If you wear reading glasses or use a hearing aid, please remember to bring them with you to the discussion.

Before we hang up, let me get the correct spelling of your name, and your address and phone numbers so we can send you a confirmation letter with directions and give you a reminder call a day or two before the day the group meets.

FULL NAME ____________________________________________

ADDRESS ____________________________________________

____________________________________________

E-MAIL ____________________________________________

CELL PHONE ____________________________________________

HOME PHONE____________________________________________

WORK PHONE____________________________________________

Thank you for agreeing to participate. We expect to see you on [Date] at [Time] at our facility in [Location]. [Give address]. We are under obligation to our client to seat the correct number of participants in each group, so if you discover that you must cancel, please inform us at once so that we can replace you.

Please bring the confirmation letter with you to the session, as well as your photo ID.

We will call/email you a day or two before your session just to confirm everything. Thank you again for your time and we will see you at the group discussion.

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