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Community Health Media Center – Testing Educational Campaign Materials with African
American and Hispanic Audiences
Attachment 2 – Materials for African American Audiences
Contents
Attachment 2a: CHMC Ads for African American Audiences………………………………………………………………………………………….1
Attachment 2b: Online Eligibility Screener for African American Audiences………………………………………………………………….9
Attachment 2c: Screen Captures of Online Eligibility Screener for African American Audiences………………………………… 15
Attachment 2d: Online Survey for Healthy Drinks for African American Audiences…………….………………………………………36
Attachment 2e: Screen Captures of Online Survey for Healthy Drinks for African American Audiences…………….………..54
Attachment 2f: Online Survey for Physical Activity for African American Audiences………………………………………………….106
Attachment 2g: Screen Captures of Online Survey for Physical Activity for African American Audiences…………….…….124
Attachment 2h: Online Survey for Healthy Food for African American Audiences…………….……………………………………….174
Attachment 2i: Screen Captures of Online Survey for Healthy Food for African American Audiences.……………………….191
Attachment 2j: Online Survey for Healthy Living for African American Audiences…………………………….……………………….243
Attachment 2k: Screen Captures of Online Survey for Healthy Living for African American Audiences………………………264
1
ID
Campaign
Shaded
Community
State
Ad Title
Medium
Link
Language
Image/Script
Target
Audience:
African
American
(from CHMC)
Target
Audience:
Hispanic
(from CHMC)
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Community Health Media Center – Testing Educational Campaign Materials with African American and Hispanic Audiences
Attachment 2a: CHMC Ads for African American Audiences
Healthy Drinks: 13
Print: 7, TV: 5, Radio: 1
AA‐2
Boston Public
Health
Commission MA
Protection
Campaign:
Rollerboy
Unhealthy Drink Print
http://nccd.cdc.gov/chmc
/Apps/searchdetails.aspx?
CatalogID=2051
English
AA‐3
Boston Public
Health
Commission MA
Protection
Television
http://nccd.cdc.gov/CHM
C/Apps/searchdetails.aspx
?CatalogID=2055
English
TV 30s
AA‐4
Boston Public
Health
Commission MA
Protection
Radio
AA‐5
Los Angeles
County
Department of
Public Health CA
Choose Health
LA: Unhealthy
Drink
Print
Radio 30s
http://nccd.cdc.gov/CHM
C/Apps/searchdetails.aspx
?CatalogID=2048
English
http://nccd.cdc.gov/CHM
C/Apps/searchdetails.aspx
?CatalogID=2200
English
VO: YOU DO SO MANY THINGS TO
PROTECT YOUR KIDS.
VO: BUT YOU MAY NEVER HAVE
REALIZED ONE OF THE THINGS THAT
CAN HURT THEM.
VO: 16‐OUNCE SUGARY DRINKS LIKE
SODAS AND SPORTS DRINKS
CONTAIN 13 PACKETS OF SUGAR
1
ID
Campaign
Shaded
Community
State
Ad Title
Medium
Link
Language
Image/Script
Target
Audience:
African
American
(from CHMC)
Target
Audience:
Hispanic
(from CHMC)
AA‐6
Los Angeles
County
Department of
Public Health CA
Choose Health
LA: Unhealthy
Drink
TV 30s
http://nccd.cdc.gov/CHM
C/Apps/searchdetails.aspx
?CatalogID=2196
English
Yes
Yes
AA‐13
Santa Clara
County Public
Health
Department CA
ReThinkYourDri
nk: Drowning
English
Print
http://nccd.cdc.gov/CHM
C/Apps/searchdetails.aspx
?CatalogID=2427
English
Yes
Yes
AA‐1
New York City
Department of
Health and
Mental
Hygiene
NY
Drinking
Yourself Sick:
African
American
Woman_BrainSt
roke
Print
http://nccd.cdc.gov/CHM
C/Apps/searchdetails.aspx
?CatalogID=2556
English
Includes an
African
American actor
General
audiences and
adults
AA‐7
New York City
Department of
Health and
Mental
Hygiene
NY
Day :30 English TV 30s
http://nccd.cdc.gov/CHM
C/Apps/searchdetails.aspx
?CatalogID=2097
English
Yes
Yes
AA‐8
New York City
Department of
Health and
Mental
Hygiene
NY
Pouring on the
Pounds: Are You
Drinking
Calories?
English :30
TV 30s
http://nccd.cdc.gov/CHM
C/Apps/searchdetails.aspx
?CatalogID=2420
English
Yes
Yes
2
ID
Campaign
Shaded
Community
State
Ad Title
Medium
Link
Print
http://nccd.cdc.gov/CHM
C/Apps/searchdetails.aspx
?CatalogID=2564
Language
Image/Script
Target
Audience:
African
American
(from CHMC)
Target
Audience:
Hispanic
(from CHMC)
AA‐9
New York City
Department of
Health and
Mental
Hygiene
NY
Drinking
Yourself Sick:
Sip In The Right
Direction
AA‐10
New York City
Department of
Health and
Mental
Hygiene
NY
Portion
Control_Amput
ee_Drinks
Print
http://nccd.cdc.gov/CHM
C/Apps/searchdetails.aspx
?CatalogID=2081
English
Yes
Yes
AA‐11
San Antonio
Metropolitan
Health District TX
Find Your
Balance‐Water
Bottle‐Healthy
Drink
Print
http://nccd.cdc.gov/CHM
C/Apps/searchdetails.aspx
?CatalogID=2246
English
Yes
Yes
San Antonio
Metropolitan
Health
TX
Find Your
Balance ‐ Dose
of Reality:
Diabetes ‐
Television
TV 30 Sec
http://nccd.cdc.gov/CHM
C/Apps/searchdetails.aspx
?CatalogID=2259
English
Yes
Yes
AA‐12
English
General
General
audiences and audiences and
adults
adults
3
ID
Campaign
Shaded
Community
State
Ad Title
Medium
Link
Language
Image/Script
Target
Audience:
African
American
(from CHMC)
Target
Audience:
Hispanic
(from CHMC)
Physical Activity: 6
Print: 5, TV: 0, Radio: 1
AA‐18
Centers for
Disease
Control and
Prevention
(CDC)
AA‐19
Centers for
Disease
Control and
Prevention
(CDC)
AA‐20
Centers for
Disease
Control and
Prevention
(CDC)
AA‐34
Centers for
Disease
Control and
Prevention
(CDC)
N/A
Our Community
Deserves: Safer
Streets
Print
http://nccd.cdc.gov/chmc
/Apps/searchdetails.aspx?
CatalogID=2467#text
English
Yes
Yes
N/A
Our Community
Deserves: Jump
Rope Girl
Print
http://nccd.cdc.gov/CHM
C/Apps/searchdetails.aspx
?CatalogID=2461
English
Yes
Yes
N/A
CDC Obesity
Infographic:
Screen Time vs.
Lean Time ages
11‐14
Print
http://nccd.cdc.gov/CHM
C/Apps/searchdetails.aspx
?CatalogID=2243
English
Yes
No
N/A
CDC Obesity
Infographic: The
More They
Burn, The Better
They Learn
Print
http://nccd.cdc.gov/CHM
C/Apps/searchdetails.aspx
?CatalogID=2240
English
General
General
audiences and audiences and
adults
adults
4
ID
Campaign
Shaded
Community
State
Ad Title
Medium
Link
Language
AA‐21
City of
Chicago/Childr
en's Memorial
Hospital
IL
Chicago
Deserves‐
Healthy Places‐
Active Kids
Radio 30s
http://nccd.cdc.gov/CHM
C/Apps/searchdetails.aspx
?CatalogID=2204
English
AA‐22
Miami‐Dade
County Health
Department FL
Make Healthy
Happen Miami:
Safe Walkways
and Bike Paths Print
http://nccd.cdc.gov/CHM
C/Apps/searchdetails.aspx
?CatalogID=2326
English
Image/Script
Active Kids (30‐second PSA)
(Music plays throughout)
Narrator: Chicagoans deserve to
live, work, learn and play in healthy
environments. Our children deserve
more ways to be physically active
and to exercise their bodies as well
as their minds So the City of
Target
Audience:
African
American
(from CHMC)
Target
Audience:
Hispanic
(from CHMC)
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Healthy Food: 6
Print: 3, TV: 1, Radio: 2
AA‐15
AA‐16
City of North
Little Rock
AR
City of North
Little Rock AR
Fit 2 Live
Campaign:
We're Supposed
to Eat Healthy
Flyer
Print
Fit 2 Live Kids
Radio
Radio 30s
http://nccd.cdc.gov/CHM
C/Apps/searchdetails.aspx
?CatalogID=2127
English
http://nccd.cdc.gov/CHM
C/Apps/searchdetails.aspx
?CatalogID=2126
English
Teen My Mom and Dad are always
trying to get us to eat healthier. I
bet they think I only eat junk food
when Im not with themlike when Im
at school. I actually LIKE eating fresh
fruits and veggies, but its hard to
find that at school. And when youre
hungry sometimes youll se le for
5
ID
Campaign
Shaded
Community
State
Ad Title
Medium
Link
Language
Image/Script
Mom 1 Moms talk to our kids all the
time about eating healthy.
Target
Audience:
African
American
(from CHMC)
Target
Audience:
Hispanic
(from CHMC)
Yes
Yes
Yes
Yes
Yes
Yes
SFX school bell and hall buzz
AA‐17
City of North
Little Rock AR
Fit to Live
Parents Radio
Radio 30s
http://nccd.cdc.gov/CHM
C/Apps/searchdetails.aspx
?CatalogID=2125
English
AA‐14
Centers for
Disease
Control and
Prevention
(CDC)
AA‐17
Miami‐Dade
County Health
Department FL
Make Healthy
Happen Miami:
Healthy Vending
Options
TV 30s
http://nccd.cdc.gov/CHM
C/Apps/searchdetails.aspx
?CatalogID=2364
English
AA‐35
Centers for
Disease
Control and
Prevention
(CDC)
CDC Obesity
Infographic: Go
Light When You
Grab A Bite
Print
http://nccd.cdc.gov/chmc
/Apps/searchdetails.aspx?
CatalogID=2315
English
N/A
N/A
Our Community
Deserves:
Mother/Daught
er Market
Print
http://nccd.cdc.gov/chmc
/Apps/searchdetails.aspx?
CatalogID=2463
English
Mom 2 One day, we all went to help
out at school. (a little attitude) We
walked by the cafeteria and a la
General
General
audiences and audiences and
adults
adults
6
ID
Campaign
Shaded
Community
State
Ad Title
Medium
Link
Language
Image/Script
Target
Audience:
African
American
(from CHMC)
Target
Audience:
Hispanic
(from CHMC)
Yes
Yes
Yes
Yes
Yes
No
Yes
Yes
Healthy Living: 7
Print: 3, TV: 2, Radio: 2
AA‐25
Miami‐Dade
County Health
Department FL
Make Healthy
Happen Miami:
Imagine
Miami_Daycare
Center
Print
http://nccd.cdc.gov/CHM
C/Apps/searchdetails.aspx
?CatalogID=2328
English
AA‐26
Miami‐Dade
County Health
Department FL
Make Healthy
Happen Miami:
Parks
TV 30s
http://nccd.cdc.gov/CHM
C/Apps/searchdetails.aspx
?CatalogID=2363
English
AA‐28
Southern
Nevada Health
District
NV
SNHD_Healthy
Choices
Radio 60s
http://.nccd.cdc.gov/CHM
C/Apps/searchdetails.aspx
?CatalogID=2356
English
AA‐29
San Antonio
Metropolitan
Health District TX
Find Your
Balance ‐
Walking ‐
Physical Activity Print
http://nccd.cdc.gov/CHM
C/Apps/searchdetails.aspx
?CatalogID=2245
English
Narrator: From the sunny skies of
excitement to shopping and
entertainment, there are a lot of
great things about living in Clark
County. But in Clark County only one
in five of us are eating the
recommended number of fruits and
vegetables And only half of us are
7
ID
AA‐31
Campaign
Shaded
Community
State
Texas
Department of
State Health
Services
TX
AA‐32
Centers for
Disease
Control and
Prevention
(CDC)
AA‐33
Centers for
Disease
Control and
Prevention
(CDC)
Ad Title
Blazing Trails
Across
Communities:
Long Live
Texans
Medium
TV 30s
Link
Language
Image/Script
http://nccd.cdc.gov/CHM
C/Apps/searchdetails.aspx
?CatalogID=2439
English
N/A
Our Community
Deserves:
Michelle
Radio 30s
http://nccd.cdc.gov/CHM
C/Apps/searchdetails.aspx
?CatalogID=2482
English
N/A
CDC Obesity
Infographic: The
New (Ab)
Normal
Infographic
Print
http://nccd.cdc.gov/CHM
C/Apps/searchdetails.aspx
?CatalogID=2239
English
Narrator: Michelle always wanted to
be a mother. And when that day
came, she did everything she could
to protect her son.
Michelle: No trading lunches at
school today A.J.
Narrator: She volunteered as a room
parent at school and people
Target
Audience:
African
American
(from CHMC)
Target
Audience:
Hispanic
(from CHMC)
Yes
Yes
Yes
Yes
General
General
audiences and audiences and
adults
adults
8
Form Approved
OMB No. 0920-0572
Expiration Date: 2/28/2015
Attachment 2b: Online Eligibility Screener for African American Audiences
Community Health Media Center – Testing Educational Campaign
Materials with African American and Hispanic Audiences
Introduction
SHOW: About this screener: Thank you for your interest in participating in this survey about health
information. Your participation in this survey is completely voluntary. The screener will take approximately
3 minutes to complete. If you qualify to participate, the online survey will take approximately 22 minutes of
your time. In this online survey, you are going to be shown sample advertisements and asked to share your
honest opinions about them.
Your responses will be entered into a database and will only be seen by researchers associated with this
online survey. Your answers will be kept secure to the extent permitted by law. There will be no risk to you.
You may stop at any time. You will receive your gift, as it is explained in your online survey invitation, after
completing the online survey.
If you have any questions about this online survey or about your rights as an online survey participant,
please email them to StudyInfo@fhi360.org.
By clicking ‘Continue,' I am agreeing to the above project description.
Public Reporting Burden Statement
Public reporting burden of this collection of information is estimated to be approximately 3 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).
9
GENERAL SCREEN OUT MESSAGE UNLESS OTHERWISE NOTED: Thank you for answering these
questions. Unfortunately, your responses indicate that you did not qualify for this particular online survey,
or that we have already reached our required quota of responses from participants similar to you. We
appreciate your enthusiasm for our online survey and hope you will join us on future online surveys!
Screening Criteria
S1.
What is your gender?
1
2
S2.
Male …………………………………………………………………………………..
Female…………….…………………………………………………………………..
[Recruit Approximately 50% Male and 50% Female]
Continue
Continue
In what year were you born?
1
2
3
S3.
Record year of birth: [4-DIGIT NUMERIC RESPONSE]…………………….
Continue
[Terminate if not age 25 to 64]
Don’t know/Not sure…………………………………….…………………….….
Terminate
Prefer not to answer…………………….………………………………..…….. Terminate
What is the highest level of education you have completed?
1
2
3
4
5
6
7
8
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: _____________________ …………………………………………………
Continue
Continue
Continue
Continue
Continue
Continue
Continue
Continue
10
S4.
Please indicate your race or ethnic background. Are you….?
Ethnicity
1
2
SELECT ONE
Hispanic or Latino……………………………………………………….…………….
Not Hispanic or Latino……………………………………………………….………..
SELECT ONE OR MORE
Race:
White_............. ………………………………..……….……………………………..
Black or African American………………………………….…………………………
American Indian or Alaska Native…………………………….……………………..
Native Hawaiian or Other Pacific Islander………………………………………..…
Asian…………………………………….…………………………………………….…
1
2
3
4
5
Continue
Continue
Continue
Continue
Continue
Continue
Continue
[IF S4/ethnicity = 1 (Hispanic or Latino), CONTINUE TO S4-1. OTHERS SKIP TO S5.
S4_1. Please indicate below if you would prefer to take the survey in English or in Spanish.
1 English…………………………………………………………………….……………. Continue
2
Spanish (español)…………………………………………………………….………..
Continue
[BASED ON RESPONSE TO S4_1, MOVE THEM TO QUESTION S4_A ON CORRESPONDING
ENGLIGH OR SPANISH SCREENER FOR HISPANIC AUDIENCES]
S5.
In what state, city, and zip code do you currently live?
1
2
3
State: DROPDOWN LIST OF STATE CODES, ALPHABETIC CODED 1-50….
City: OPEN ENDED……………………………………………………………………
Zip code: NUMERIC FIELD WITH FIVE DIGIT ZIP ENTRY. …………………
Continue
Continue
Continue
S6. Do you, or does any member of your household or immediate family work:
1
2
3
4
5
For a market research company ………………………………………………….
For an advertising agency or public relations firm …………………………………
For the media (TV/radio/newspapers/magazines) ………………………………..
As a healthcare professional (doctor, nurse, pharmacist, dietician, etc.) ……..
None of the above………………………………………………………………….
Terminate
Terminate
Continue
Continue
Continue
S6_1. As a part of your job, are you physically active for a total of at least 30 minutes per work day?
(Add up all the time you spend in any kind of physical activity that increases your heart rate and
makes you breathe hard.)
1
2
Yes……………………………………………………………………………………...
No……………………………………………………………………………………...
Continue
Continue
11
THERE IS NO S7.
S8.
About how often do you use the Internet?
1
2
3
4
5
6
7
8
S9.
Several times a day…………………………………………………………………
About once a day……………………………………………………………………
3-5 days a week…………………………………………………………………….
1-2 days a week…………………………………………………………………….
Every few weeks…………………………………………………………………….
Less often …………………………………………………………………………..
Never…………………………………………………………………………………
Don’t know
………………………………………………………………...
About how much do you weigh without shoes?
_____ pounds ……………………………………… ………………………………………
8 Don‘t know / Not sure………………………………………………………………….
9 Prefer not to answer
…………………………………………………………….
S10.
Continue
Continue
Continue
Continue
Continue
Continue
Terminate
Continue
Continue
Terminate
Terminate
About how tall are you without shoes?
_____ feet and _____ inches………………………………………………………………
8 Don‘t know / Not sure………………………………………………………………….
9 Prefer not to answer
…………………………………………………………….
Continue
Terminate
Terminate
S10_1. CODING, DO NOT DISPLAY – CALCULATE BMI BASED ON S9/S10
CALCULATING BMI (FROM CDC WEBSITE)
FORMULA: [WEIGHT (LB) / [HEIGHT (IN)]2 X 703
Calculate BMI by dividing weight in pounds (lbs) by height in inches (in) squared and multiplying by
a conversion factor of 703.
Example: Weight = 150 lbs, Height = 5'5" (65")
Calculation: [150 ÷ (65)2] x 703 = 24.96
IF BMI IS LESS THAN 18.5, CODE S10_1 AS 1 (UNDERWEIGHT). IF BMI IS AT LEAST 18.5
BUT LESS THAN 25, CODE 10_1 AS 2 (NORMAL). IF BMI IS AT LEAST 25 BUT LESS THAN 30,
CODE 10_1 AS 3 (OVERWEIGHT). IF BMI IS 30 OR ABOVE, CODE 10_1 AS 4 (OBESE).
1
2
3
4
UNDERWEIGHT
NORMAL
OVERWEIGHT
OBESE
12
S11.
1
2
During the past 7 days, did you drink any regular soft drinks (non-diet) or other sugary drinks – for
example, regular pop or soda (non-diet), sugary sports drinks and energy drinks, and fruit flavored
drinks (not counting 100% fruit juice)?
Yes ……………………………………………...………………………………………… Continue
No……………………………………………...………………………………………… Continue
[IF S11 = 2 (NO), SKIP TO S12. OTHERS CONTINUE TO S11_1]
S11_1. During the past 7 days, on how many days would you say you drank any regular soft drinks (nondiet) or other sugary drinks?
1
Enter number of days: [Numeric Response: 1-7] …………………………………... Continue
S11_2. On [IF S11_1=1, INSERT “that day” IF S11_1>1, INSERT “those ___[INSERT S11_1
RESPONSE]_ days”] when you drank at least one regular soft drink (non-diet) or other sugary
drink, about how many did you drink [IF S11_1>1, INSERT “ on average”]?
1
S12.
1
2
Enter number of drinks: [Numeric Response: 1-100]……..………………………… Continue
During the past 7 days did you spend time doing any kind of physical activity that increased your
heart rate and made you breathe hard some of the time?
Yes ……………………………………………...………………………………………… Continue
No……………………………………………...………………………………………… Continue
[IF S12 = 2 (NO), SKIP TO S13. OTHERS CONTINUE TO S12_1]
S12_1. During the past 7 days, on how many days would you say you spent time doing any kind of
physical activity that increased your heart rate and made you breathe hard some of the time?
NUMERIC RESPONSE 1-7.
1
Enter number of days: [Numeric Response: 1-7] …………………………………... Continue
S12_2. On [IF S12_1=1, INSERT “that day” IF S12_1>1, INSERT “those ___[INSERT S12_1
RESPONSE]_ days”] when you spent time doing any kind of physical activity that increased your
heart rate and made you breathe hard some of the time, about how many minutes were you
physically active [IF S12_1>1, INSERT “on average”]?
1
S13.
1
2
Enter number of minutes: [Numeric Response: 0-1000]…………………………... Continue
On average, about how many meals and snacks do you eat in a typical day?
_____ number of meals [Numeric Response: 0-10]………………………………… Continue
_____ number of snacks [Numeric Response: 0-10]…………………………………Continue
13
S13_1. During the past 7 days, on how many days would you say you ate healthy meals or snacks?
NUMERIC RESPONSE 0-7.
1
Enter number of days: [Numeric Response: 0-7] ………………………………...
Continue
[IF S13_1 = 0, SKIP TO INSTRUCTIONS BEFORE Q1. OTHERS CONTINUE TO S13_2]
S13_2. On [IF S13_1=1, INSERT “that day” IF S13_1>1, INSERT “those ___[INSERT S13_1
RESPONSE]_ days”] when you ate healthy meals or snacks, about how many healthy meals
and snacks did you eat [IF S13_1>1, INSERT “ on average”]?
1
2
_____ number of meals [Numeric Response: 1-10]………………………………… Continue
_____ number of snacks [Numeric Response: 1-10]…………………………………Continue
14
Attachment 2c: Screen Captures of Online Eligibility Screener for African American Audiences
Community Health Media Center – Testing Educational Campaign
Materials with African American and Hispanic Audiences
Screenshot – Online Screener Home Page
15
{Note to reviewers: Respondents who wish to participate and click “Continue” will be shown the
following screens.}
Screenshot – Online Screener Question S1
16
Screenshot – Online Screener Question S2
17
{Note to reviewers: Respondents who refuse to respond or who respond “Don’t know/Not sure” to the
question “In what year were you born?,” or who indicate they are not between the ages of 25 and 64, will
be shown the general screen out message below and terminated.* All others will continue to the
questions that follow.}
Screenshot – General Screen Out Message
* This general screen out message will be the same that is shown at any point in the survey in which a respondent’s response does not
meet the screening criteria and they are being terminated.
18
Screenshot – Online Screener Question S3
19
Screenshot – Online Screener Question S4
{Note to reviewers: Only respondents who indicated in question S4 that they are “Not Hispanic or Latino” in
combination with “Black or African American” will advance to the next question. Those indicating they are
Hispanic in combination with any race will be redirected to the Hispanic screener; all others will be shown the
screen out message and terminated.}
20
Screenshot – Online Screener Question S5
21
Screenshot – Online Screener Question S6
22
{Note to reviewers: Respondents who indicated in question S6 that they or someone in their
household or immediate family works “for a market research company” or “for an advertising
agency or public relations firm” will be shown the general screen out message and terminated. All
others will continue to the questions that follow.}
Screenshot – Online Screener Question S6_1
23
{Note to reviewers: There is no question S7.}
Screenshot – Online Screener Question S8
24
{Note to reviewers: Respondents who indicated in question S8 that they “never” use the Internet,
will be shown the general screen out message and terminated. All others will continue to the
questions that follow.}
Screenshot – Online Screener Question S9
25
{Note to reviewers: Respondents who prefer not to answer, or who respond “Don’t know/Not
sure,” to the question “About how much do you weigh without shoes?,” will be shown the general
screen out message and terminated. All others will continue to the questions that follow.}
Screenshot – Online Screener Question S10
26
{Note to reviewers: Respondents who prefer not to answer, or who respond “Don’t know/Not
sure,” to the question “About how tall are you without shoes?,” will be shown the general screen
out message and terminated. All others will continue to the questions that follow.}
Screenshot – Online Screener Question S11
27
{Note to reviewers: Respondents who indicated “yes” on question S11 will be shown the following
screen (S11_1). Others will skip to Q12.}
Screenshot – Online Screener Question S11_1
28
Screenshot – Online Screener Question S11_2
29
Screenshot – Online Screener Question S12
30
{Note to reviewers: Respondents who indicated “yes” on question S12 will be shown the following
screen (S12_1). Others will skip to Q13.}
Screenshot – Online Screener Question S12_1
31
Screenshot – Online Screener Question S12_2
32
Screenshot – Online Screener Question S13
33
Screenshot – Online Screener Question S13_1
34
{Note to reviewers: Only respondents who indicate a number above “0” on S13_1 will be shown
the question below (S13_2), the last question of the screener.}
Screenshot – Online Screener Question S13_2
35
Form Approved
OMB No. 0920-0572
Expiration Date: 2/28/2015
Attachment 2d: Online Survey for Healthy Drinks
for African American Audiences
Community Health Media Center – Testing Educational Campaign
Materials with African American and Hispanic Audiences
Introduction
SHOW: About this online survey: Thank you for answering these questions. You are qualified to
participate in this online survey, which is being conducted on behalf of the Centers for Disease
Control and Prevention, sometimes referred to as CDC, in Atlanta. The online survey will take
about 22 minutes to complete. In this online survey, you are going to be shown sample
advertisements and asked to share your honest opinions about them.
Your responses will be entered into a database and will only be seen by researchers associated
with this online survey. Your answers will be kept secure to the extent permitted by law. There will
be no risk to you. You may stop at any time. You will receive your gift, as it is explained in your
online survey invitation, after completing the online survey.
If you have any questions about this online survey or about your rights as an online survey
participant, please email them to StudyInfo@fhi360.org.
By clicking 'Next,' I am agreeing to the above project description.
Public Reporting Burden Statement
Public reporting burden of this collection of information is estimated to average 22 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).
36
[BACKGROUND HEALTH BEHAVIORS AND ATTITUDES]
[Contemplation and Behavioral Intentions]
Pre-Post Questions
[CHECK S11. IF S11=1 (YES), ASK Q1. OTHERS SKIP TO Q1_2]
Q1.
Are you planning to stop drinking regular soft drinks (non-diet) or other sugary drinks within
the next 30 days? SINGLE RESPONSE, DO NOT ROTATE
1
2
Yes………………………………………………………….. Continue
No……………………………………………………………. Continue
[IF Q1=1 SKIP TO Q1_2. IF Q1=2 CONTINUE TO Q1_1]
Q1_1. Are you planning to cut back on regular soft drinks (non-diet) or other sugary drinks within
the next 30 days? SINGLE RESPONSE, DO NOT ROTATE
1
2
Yes………………………………………………………….. Continue
No……………………………………………………………. Continue
Q1_2. Are you planning to be more physically active within the next 30 days? SINGLE
RESPONSE, DO NOT ROTATE
1
2
Yes………………………………………………………..…. Continue
No……………………………………………………………. Continue
Q1_3. Are you planning to eat healthier meals and snacks within the next 30 days? SINGLE
RESPONSE, DO NOT ROTATE
1
2
Q2.
Yes……………………………………………………….…. Continue
No………………………………………………………...…. Continue
Are you planning to do something about your weight within the next 30 days? SINGLE
RESPONSE, ROTATE 1-3.
1
2
3
4
Yes, I plan to try to lose weight……………………….….
Yes, I plan to try to gain weight……………………….….
Yes, I plan to try to maintain my current weight…….….
No, I have no plans to do anything about my weight.….
Continue
Continue
Continue
Continue
37
Q3.
During the past 12 months, did you try to cut back on regular soft drinks (non-diet) or
other sugary drinks? SINGLE RESPONSE, DO NOT ROTATE
1
2
Yes………………………………………………………….. Continue
No………………………………………………………...…. Continue
Q3_1. During the past 12 months, did you try to be more physically active? SINGLE
RESPONSE, DO NOT ROTATE
1
2
Yes………………………………………………………….. Continue
No………………………………………………………...…. Continue
Q3_2. During the past 12 months, did you try to eat healthier meals and snacks? SINGLE
RESPONSE, DO NOT ROTATE
1
2
Q4.
Yes………………………………………………………….. Continue
No……………………………………………………………. Continue
In the past year, have you tried to do any of the following? MULTIPLE RESPONSE, DO
NOT ROTATE.
1
2
3
Lose weight……………………………………………...…. Continue
Gain weight…………………………………………………. Continue
Maintain your current weight……………………………... Continue
Q4_1. Compared to a year ago, do you weigh…? SINGLE RESPONSE, DO NOT ROTATE.
1
2
3
Less……………………………………….….……………..
More…………………………………………………………
About the same…………………………….………………
Continue
Continue
Continue
Q4_2. And compared to a year ago, would you say that you are…? SINGLE RESPONSE, DO
NOT ROTATE.
1
2
3
More healthy……………………………………………….
Less healthy………………………………….…………….
About the same ……………………………..…………….
Continue
Continue
Continue
[CHECK S11. IF S11=1 (YES) ASK Q5. OTHERS SKIP TO Q7]
38
Q5.
Overall, on a scale from 1 to 5, where 1 is not at all interested and 5 is extremely
interested, how interested are you in…? SINGLE RESPONSE GRID FORMAT,
RANDOMIZE LIST.
[CHECK S11. IF S11=1 (YES), INSERT A. INSERT B AND C FOR ALL PERSONS]
1
2
3
4
5
A
B
C
Not at all interested………………………………………
A little interested.…………………………………………
Somewhat interested……….……………………………
Very interested……………………………………………
Extremely interested ………………………………….…
Continue
Continue
Continue
Continue
Continue
Cutting back on regular soft drinks (non-diet) or other sugary drinks
Being more physically active
Eating healthier meals and snacks
[THERE IS NO Q6.]
Q7.
Thinking about the next six months, how likely are you to…? Please use a scale from 1 to
5, where 1 is not at all likely and 5 is extremely likely. SINGLE RESPONSE GRID
FORMAT, ROTATE LIST.
1
2
3
4
5
A
B
C
Not at all likely…………………………………………..…
Somewhat unlikely..………………………………………
Neither likely nor unlikely..…………………………….…
Somewhat likely..……………………………………….…
Extremely likely …………………………………………...
Continue
Continue
Continue
Continue
Continue
Look for more information on the health benefits of cutting back on regular soft
drinks (non-diet) or other sugary drinks
Talk to a friend about the health benefits of cutting back on regular soft drinks
(non-diet) or other sugary drinks
Participate in community efforts to reduce obesity
[Self-Efficacy Questions]
Q8.
On a scale from 1 to 5, where 1 indicates that you strongly disagree and 5 indicates that
you strongly agree, please indicate how much you agree or disagree with each of these
statements. SINGLE RESPONSE GRID FORMAT, ROTATE LIST.
1
2
3
4
5
Strongly disagree…………………………………………..
Somewhat disagree…………………………………….....
Neither agree nor disagree……………………………….
Somewhat agree…………………………………………..
Strongly agree……………………………………………..
Continue
Continue
Continue
Continue
Continue
39
A I feel as though I can make a difference regarding my risk for being overweight or
obese
B I am confident that I can protect myself from being overweight or obese
C There are many things I can do to protect myself from being overweight or obese
D Generally speaking, it is possible to reduce one’s risk for being overweight or obese
[Behavioral Beliefs]
Q9.
On a scale from 1 to 5, where 1 indicates that you strongly disagree and 5 indicates that
you strongly agree, please indicate how much you agree or disagree with each of these
statements. SINGLE RESPONSE GRID FORMAT, RANDOMIZE LIST.
1
2
3
4
5
Strongly disagree……………………………………….….
Somewhat disagree………………………………………..
Neither agree nor disagree…………………………….….
Somewhat agree……………………………………………
Strongly agree………………………………………………
Continue
Continue
Continue
Continue
Continue
Eliminating regular soft drinks (non-diet) and other sugary drinks during meals every day
would…
A
…make me feel that I was doing something good for my health
B
…make eating meals less enjoyable for me
C
…help me prevent weight gain
D
…make life more stressful for me
E
…help me save money
F
…make it easier for me to drink milk or water at mealtimes
G
…help me lose weight
H
…help me maintain a healthy weight
[Community Attitudes]
Q10.
1
2
3
Which of the following statements best describes how you think the problem of obesity
should be solved in your community? SINGLE RESPONSE, ROTATE 1-2.
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
40
CAMPAIGN EVALUATIONS
MOST RESPONDENTS WILL FIRST SEE A SET OF ADS THAT CORRESPOND TO A
DISCRETE CAMPAIGN (RANDOMLY CHOSEN). AFTER EACH AD SHOWN, ASK Q12-Q19.
AFTER THE ENTIRE CAMPAIGN IS SHOWN, ASK Q20.
Q11.
CAMPAIGN SHOWN – CODE, DO NOT DISPLAY
SHOW: Now we would like to show you a few different health-related ads, including a television,
print, and/or radio ad, and then ask you to evaluate each ad. Even if an ad is from another
community or city, please rate it as if it were an ad from your local community. Also, please note
that the video quality of these ads may vary – please rate them based on the content of the ads,
not on the quality of the video.
Please make sure the volume on your computer is turned up, so that you may both see and/or hear
the TV and radio ads.
Please click “Next” to continue.
NOTE: WHEN THE TV ADS ARE PRESENTED, PLEASE SHOW THE FOLLOWING MESSAGE
ABOVE THE SCREEN: This ad is a TV ad. Please be patient while the video loads; also note that
the video may stop to buffer from time to time. We do not expect buffering to continue for more
than 30 seconds. If you find that it is buffering too long, you can suspend the survey at any time
and return to this point in the survey simply by clicking on the original survey link.
And remember: even if an ad is from another community or city, please rate it as if it were an ad
from your local community.
NOTE: WHEN THE RADIO ADS ARE PRESENTED, PLEASE SHOW THE FOLLOWING
MESSAGE ABOVE THE SCREEN: This ad is a radio ad. Please be patient while the audio
loads; also note that the audio may stop to buffer from time to time. We do not expect buffering to
continue for more than 30 seconds. If you find that it is buffering too long, you can suspend the
survey at any time and return to this point in the survey simply by clicking on the original survey
link.
And remember: even if an ad is from another community or city, please rate it as if it were an ad
from your local community.
41
Questions for Each Ad
SHOW: Please answer the following questions about the ad you just viewed.
Q12.
If you saw or heard this message, would it get your attention? SINGLE RESPONSE, DO
NOT ROTATE
1
2
Yes………………………………………………………….. Continue
No……………………………………………………...……. Continue
Q13.
Why or why not? OPEN ENDED…………………………………………….
Q14.
Is this message believable? SINGLE RESPONSE, DO NOT ROTATE
1
2
Continue
Yes………………………………………………………….. Continue
No……………………………………………………...……. Continue
Q15.
Why or why not? OPEN ENDED…………………………………………….
Q16.
Did you think this ad would be effective to motivate you or someone else to cut back on
regular soft drinks or other sugary beverages – for example, regular pop or soda (nondiet), sugary sports drinks and energy drinks, fruit flavored drinks (not counting 100% fruit
juice), or other sugary drinks?
Please use a scale from 1 to 5, where 1 is not at all effective and 5 is extremely effective.
SINGLE RESPONSE, DO NOT ROTATE
Q17.
1
Not at all effective…………………………………………
2
Somewhat ineffective.………………………………….…
3
Neither effective nor ineffective……………………….…
4
Somewhat effective…………………………………….…
5
Extremely effective ……………………………………….
Who would you say this ad is trying to reach? Please check all that apply.
RESPONSE, DO NOT ROTATE
1
2
3
You…………………………………………………………..
People like you……………………………………….…….
Someone else………………………………………..…….
Continue
Continue
Continue
Continue
Continue
Continue
MULTIPLE
Continue
Continue
Continue
42
Q18.
On a scale from 1 to 5, where 1 indicates that you strongly disagree, and 5 indicates that
you strongly agree, please indicate how much you agree or disagree with each of the
following statements about this advertisement. SINGLE RESPONSE GRID FORMAT.
RANDOMIZE LIST.
1
2
3
4
5
A
B
C
D
E
F
G
H
I
J
K
Strongly disagree…………………………………………..
Somewhat disagree………………………………………..
Neither agree nor disagree………………………….…….
Somewhat agree……………………………………………
Strongly agree………………………………………………
Continue
Continue
Continue
Continue
Continue
Overall, I liked this ad
I am interested in this ad’s topic
I trust the information in this ad
This ad was confusing
This ad was convincing
This ad said something important to me
This ad grabbed my attention
I learned something new from this ad
I can do what this ad suggests
This ad was easy to understand
I would notice this ad if I saw/heard it
IF RESPONSE 4 OR 5 TO Q18G, ASK Q19. OTHERS SKIP TO INSTRUCTIONS
BEFORE Q20.
Q19.
You mentioned that this ad grabbed your attention. What makes it stand out? OPEN
ENDED…………………………………………………………………………… Continue
BEFORE THE NEXT AD IS EVALUATED, UNTIL THE LAST AD, SHOW: Now you will see
another ad to evaluate. Once again, even if an ad is from another community or city, please rate it
as if it were an ad from your local community. Please note that we would like your reaction to each
ad individually – we will not ask you to compare one ad to any other.
[ONLY ASK Q20 ONCE A WHOLE “CAMPAIGN” IS EVALUATED]
43
Campaign Summary Evaluation
Q20.
Considering the impact of these ads together, please indicate how much you agree or
disagree with each statement. SINGLE RESPONSE GRID FORMAT, RANDOMIZE LIST.
1
2
3
4
5
A
B
C
D
E
F
G
Strongly disagree…………………….…………………….
Somewhat disagree………………………………………..
Neither agree nor disagree…………….………………….
Somewhat agree……………………………………………
Strongly agree………………………………………………
Continue
Continue
Continue
Continue
Continue
I trust the information in this set of ads.
This set of ads was convincing.
This set of ads grabbed my attention.
This set of ads told me something I didn’t already know.
The message about regular soft drinks (non-diet) or other sugary drinks in this set
of ads was persuasive.
This set of ads gave me good reasons to cut back on regular soft drinks (non-diet)
or other sugary drinks.
This set of ads gave me good reasons to stop drinking regular soft drinks (nondiet) or other sugary drinks.
BEFORE THE SECOND CAMPAIGN SEQUENCE IS EVALUATED, SHOW: Now you will see
another series of ads to evaluate. Once again, even if an ad is from another community or city,
please rate it as if it were an ad from your local community.
44
INDIVIDUAL SPOT EVALUATIONS
EACH RESPONDENT WILL SEE A SET OF RANDOMLY CHOSEN INDIVIDUAL ADS. AFTER
EACH AD SHOWN, ASK Q22-Q29.
Q21.
ADS SHOWN – CODE, DO NOT DISPLAY, ADS SHOWN
SHOW: We would now like to show you a few more ads and then gather your reactions to them. If
you are watching a television or radio ad, please make sure the volume on your computer is turned
up, so that you may both see and hear the video or audio.
Once again, even if an ad is from another community or city, please rate it as if it were an ad from
your local community, and please rate the ads based on their content, not on the quality of the
video. Please note that we would like your reaction to each ad individually – we are not interested
in comparing any of the ads to one another.
Please click “Next” to continue.
NOTE: WHEN THE TV ADS ARE PRESENTED, PLEASE SHOW THE FOLLOWING MESSAGE
ABOVE THE SCREEN: This ad is a TV ad. Please be patient while the video loads; also note that
the video may stop to buffer from time to time. We do not expect buffering to continue for more
than 30 seconds. If you find that it is buffering too long, you can suspend the survey at any time
and return to this point in the survey simply by clicking on the original survey link.
And remember: even if an ad is from another community or city, please rate it as if it were an ad
from your local community.
NOTE: WHEN THE RADIO ADS ARE PRESENTED, PLEASE SHOW THE FOLLOWING
MESSAGE ABOVE THE SCREEN: This ad is a radio ad. Please be patient while the audio
loads; also note that the audio may stop to buffer from time to time. We do not expect buffering to
continue for more than 30 seconds. If you find that it is buffering too long, you can suspend the
survey at any time and return to this point in the survey simply by clicking on the original survey
link.
And remember: even if an ad is from another community or city, please rate it as if it were an ad
from your local community.
45
Questions for Each Ad
SHOW: Please answer the following questions about the ad you just viewed.
Q22.
If you saw or heard this message, would it get your attention? SINGLE RESPONSE, DO
NOT ROTATE
1
2
Yes…………………………………………….……………. Continue
No……………………………………………..…………….. Continue
Q23.
Why or why not? OPEN ENDED…………………………………………….. Continue
Q24.
Is this message believable? SINGLE RESPONSE, DO NOT ROTATE
1
2
Yes………………………………………….………………. Continue
No………………………………………….………………... Continue
Q25.
Why or why not? OPEN ENDED…………………………..………………… Continue
Q26.
Did you think this ad would be effective to motivate you or someone else to cut back on
regular soft drinks or other sugary drinks – for example, regular pop or soda (non-diet),
sugary sports drinks and energy drinks, fruit flavored drinks (not counting 100% fruit juice),
or other sugary drinks?
Please use a scale from 1 to 5, where 1 is not at all effective and 5 is extremely effective.
SINGLE RESPONSE, DO NOT ROTATE
1
2
3
4
5
Q27.
Not at all effective…………………………………….……
Somewhat ineffective.………………………………….…
Neither effective nor ineffective………………………..…
Somewhat effective……………………………………..…
Extremely effective ………………………………………..
Continue
Continue
Continue
Continue
Continue
Who would you say this ad is trying to reach? Please check all that apply. MULTIPLE
RESPONSE, DO NOT ROTATE.
1
2
3
You………………………………………………………….. Continue
People like you…………………………………………….. Continue
Someone else……………………………………..……….. Continue
46
Q28.
On a scale from 1 to 5, where 1 indicates that you strongly disagree, and 5 indicates that
you strongly agree, please indicate how much you agree or disagree with each of the
following statements about this advertisement. SINGLE RESPONSE GRID FORMAT,
RANDOMIZE LIST.
1
2
3
4
5
A
B
C
D
E
F
G
H
I
J
K
Strongly disagree…………………………………….…….
Somewhat disagree………………………………………..
Neither agree nor disagree………………………….…….
Somewhat agree……………………………………………
Strongly agree………………………………………………
Continue
Continue
Continue
Continue
Continue
Overall, I liked this ad
I am interested in this ad’s topic
I trust the information in this ad
This ad was confusing
This ad was convincing
This ad said something important to me
This ad grabbed my attention
I learned something new from this ad
I can do what this ad suggests
This ad was easy to understand
I would notice this ad if I saw/heard it
IF RESPONSE 4 OR 5 TO Q28G, ASK Q29. OTHERS SKIP TO INSTRUCTIONS AFTER
Q29.
Q29.
You mentioned that this ad grabbed your attention. What makes it stand out? OPEN
ENDED………………………………………………………………………..… Continue
BEFORE THE NEXT AD IS EVALUATED, UNTIL THE LAST AD, SHOW: Now you will see
another ad to evaluate. Once again, even if an ad is from another community or city, please rate it
as if it were an ad from your local community. Please note that we would like your reaction to each
ad individually – we are not interested in comparing any of the ads to one another.
47
Pre-Post Questions
[Behavioral Intentions]
[CHECK S11. IF S11=1 (YES), ASK Q30. OTHERS SKIP TO Q30_2]
Q30.
Are you planning to stop drinking regular soft drinks (non-diet) or other sugary drinks within
the next 30 days? SINGLE RESPONSE, DO NOT ROTATE.
1
2
Yes……………………………………….………………….. Continue
No……………………………………………………………. Continue
[IF Q30=1 SKIP TO Q30_2. IF Q30=2 CONTINUE TO Q30_1]
Q30_1. Are you planning to cut back on regular soft drinks (non-diet) or other sugary drinks within
the next 30 days? SINGLE RESPONSE, DO NOT ROTATE.
1
2
Yes………………………………………………………….. Continue
No……………………………………………………………. Continue
Q30_2. Are you planning to be more physically active within the next 30 days? SINGLE
RESPONSE, DO NOT ROTATE.
1
2
Yes……………………………………..……………………. Continue
No……………………………………………………………. Continue
Q30_3. Are you planning to eat healthier meals and snacks within the next 30 days? SINGLE
RESPONSE, DO NOT ROTATE.
1
2
Q31.
Yes……………………………………..……………………. Continue
No……………………………………………………………. Continue
Are you planning to do something about your weight within the next 30 days? SINGLE
RESPONSE, ROTATE 1-3.
1
2
3
4
Yes, I plan to try to lose weight……………………..…….
Yes, I plan to try to gain weight……………………..…….
Yes, I plan to try to maintain my current weight……..….
No, I have no plans to do anything about my weight..….
Continue
Continue
Continue
Continue
[CHECK S11. IF S11=1 (YES), ASK Q32. OTHERS SKIP TO Q32_1]
48
Q32.
Overall, on a scale from 1 to 5, where 1 is not at all interested and 5 is extremely
interested, how interested are you in cutting back on regular soft drinks (non-diet) or other
sugary drinks? SINGLE RESPONSE, DO NOT ROTATE.
1
2
3
4
5
Not at all interested………………………………..………
A little interested.……………………………………..……
Somewhat interested……….…………………………..…
Very interested……………………………………………..
Extremely interested ………………………………………
Continue
Continue
Continue
Continue
Continue
Q32_1. Overall, on a scale from 1 to 5, where 1 is not at all interested and 5 is extremely
interested, how interested are you in trying to be more physically active? SINGLE
RESPONSE, DO NOT ROTATE.
1
2
3
4
5
Not at all interested…………………………………..……
A little interested.………………………………………..…
Somewhat interested……….…………………………..…
Very interested…………………………………………..…
Extremely interested ………………………………………
Continue
Continue
Continue
Continue
Continue
Q32_2. Overall, on a scale from 1 to 5, where 1 is not at all interested and 5 is extremely
interested, how interested are you in trying to eat healthier meals and snacks? SINGLE
RESPONSE, DO NOT ROTATE.
1
2
3
4
5
Not at all interested…………………………………..……
A little interested.………………………………………..…
Somewhat interested……….…………………………..…
Very interested…………………………………………..…
Extremely interested ………………………………………
Continue
Continue
Continue
Continue
Continue
[THERE IS NO Q33]
Q34.
Thinking about the next six months, how likely are you to…? Please use a scale from 1 to
5, where 1 is not at all likely and 5 is extremely likely. SINGLE RESPONSE GRID
FORMAT, RANDOMIZE LIST
1
2
3
4
5
A
B
C
Not at all likely……………………………………...………
Somewhat unlikely..………………………………….……
Neither likely nor unlikely..……………………………..…
Somewhat likely..………………………………………..…
Extremely likely …………………………………………....
Continue
Continue
Continue
Continue
Continue
Look for more information on the health benefits of cutting back on regular soft
drinks (non-diet) or other sugary drinks
Talk to a friend about the health benefits of cutting back on regular soft drinks
(non-diet) or other sugary drinks
Participate in community efforts to reduce obesity
49
[Self-Efficacy Questions]
Q35.
On a scale from 1 to 5, where 1 indicates that you strongly disagree and 5 indicates that
you strongly agree, please indicate how much you agree or disagree with each of these
statements. SINGLE RESPONSE GRID FORMAT, RANDOMIZE LIST
1
2
3
4
5
Strongly disagree………………………………………….
Somewhat disagree…………………………………...…..
Neither agree nor disagree……………………………….
Somewhat agree……………………………………...……
Strongly agree………………………………………………
Continue
Continue
Continue
Continue
Continue
A I feel as though I can make a difference regarding my risk for being overweight or
obese
B I am confident that I can protect myself from being overweight or obese
C There are many things I can do to protect myself from being overweight or obese
D Generally speaking, it is possible to reduce one’s risk for being overweight or obese
Q36.
On a scale from 1 to 5, where 1 indicates that you strongly disagree and 5 indicates that
you strongly agree, please indicate how much you agree or disagree with each of these
statements. SINGLE RESPONSE GRID FORMAT, RANDOMIZE LIST.
1
2
3
4
5
Strongly disagree……………………………………….….
Somewhat disagree………………………………………..
Neither agree nor disagree…………………………….….
Somewhat agree……………………………………………
Strongly agree………………………………………………
Continue
Continue
Continue
Continue
Continue
Eliminating regular soft drinks (non-diet) and other sugary drinks during meals every day
would…
A
…make me feel that I was doing something good for my health
B
…make eating meals less enjoyable for me
C
…help me prevent weight gain
D
…make life more stressful for me
E
…help me save money
F
…make it easier for me to drink milk or water at mealtimes
G
…help me lose weight
H
…help me maintain a healthy weight
50
[Community Attitudes]
Q37.
1
2
3
Which of the following statements best describes how you think the problem of obesity
should be solved in your community? SINGLE RESPONSE, ROTATE 1-2.
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
51
CLASSIFICATION
SHOW: You’re almost done! These last few questions are for classification purposes only and will
be used for analyzing the results of the survey in total. They will not be identified with you
personally.
C1.
Has a healthcare professional ever told you that you are overweight or at risk for being
overweight? SINGLE RESPONSE, DO NOT ROTATE
1
2
3
C2.
Yes………………………………………………………….. Continue
No………………………………………………………...…. Continue
Don’t know / not sure …………………………………..…. Continue
What is your current occupational status? Are you…? Please select the option that best
applies to you. SINGLE RESPONSE, DO NOT ROTATE.
1
2
3
4
5
6
7
8
10
C4.
Continue
Continue
Continue
Has anyone else in your household been identified by a health care professional as being
overweight or at risk for being overweight? SINGLE RESPONSE DO NOT ROTATE
1
2
3
C3.
Yes……………………………………………….……...….
No……………………………………………………..…….
Don’t know / not sure ………………………………….….
Employed full time………………………………………...
Employed part time………………………………………..
Unemployed………………………………………………..
Homemaker………………………………………………..
Student ………………………………………………..…...
Retired ………………………………………………..…....
Disabled …………………………………………………...
Other (Please specify: _________)………………..…....
Prefer not to answer……..………………………………...
Continue
Continue
Continue
Continue
Continue
Continue
Continue
Continue
Continue
What is your marital status? SINGLE RESPONSE, ROTATE 1-6.
1
2
3
4
5
6
8
Married ……………………………………………….……
Unmarried living with a partner……………………….…
Divorced ………………………………………………..…
Widowed ………………………………………………..…
Separated……………………………………………….…
Single, never been married ……………………………..
Prefer not to answer……..…………………………….….
Continue
Continue
Continue
Continue
Continue
Continue
Continue
52
C5.
How many children (under age 18) live in your household?
1
2
C6.
Continue
Continue
What is your household’s total income from all sources before taxes? SINGLE
RESPONSE, DO NOT ROTATE
1
2
3
4
5
6
7
8
9
C7.
Enter number: [Numeric Response] …………….………………
Prefer not to answer [Check Box]……..………………………….
Under $20,000……..………………………………....…………….
$20,000 to $29,999 .…………………………….………………….
$30,000 to $39,999 .…………………………….………………….
$40,000 to $49,999 .…………………………….………………….
$50,000 to $74,999 .…………………………….………………….
$75,000 to $99,999 .…………………………….………………….
$100,000 to $199,999 .…………………………….…………….…
$200,000 or more.……………………..………….………………...
Prefer not to answer.…………………………….………………….
Continue
Continue
Continue
Continue
Continue
Continue
Continue
Continue
Continue
In the following list of items, please indicate which devices you currently use or own.
MULTIPLE RESPONSE, ROTATE LIST.
1
2
3
4
5
6
A desktop computer………………………………………………… Continue
A laptop computer…………………………………………………… Continue
A smartphone, such as an iPhone, BlackBerry, Android, Windows phone, etc.
………………………………………………………….……………… Continue
A tablet, such as an iPad, Kindle Fire, Nook Color, Motorola Xoom, etc.
……………………………………………………………………….… Continue
An iPod or other mp3 player ……………………………………..… Continue
None of these – EXCLUSIVE - ANCHOR
SHOW: That is the last question. Thank you for your time. Please click “OK” to confirm
your participation.
53
Attachment 2e: Screen Captures of Online Survey for Healthy Drinks for African American Audiences
Community Health Media Center – Testing Educational Campaign
Materials with African American and Hispanic Audiences
Screenshot – Online Survey Start Screen
54
{Note to reviewers: Only respondents who selected “yes” for screener QS11,“did you drink any regular soft drinks
(non-diet) or other sugary drinks,?” will be shown the following screen (Q1). Others will skip to Q1_2.}
Screenshot – Online Survey Question Q1
55
{Note to reviewers: Only respondents who selected “no” for Q1,“are you planning to stop drinking regular soft
drinks (non-diet) or other sugary drinks?,” will be shown the following screen (Q1_1). Others will skip to Q1_2.}
Screenshot - Online Survey Question Q1_1
56
Screenshot – Online Survey Question Q1_2
57
Screenshot - Online Survey Question Q1_3
58
Screenshot – Online Survey Question Q2
59
Screenshot – Online Survey Question Q3
60
Screenshot – Online Survey Question Q3_1
61
Screenshot – Online Survey Question Q3_2
62
Screenshot – Online Survey Question Q4
63
Screenshot – Online Survey Question 4_1
64
Screenshot – Online Survey Question Q4_2
65
{Note to reviewers: All respondents will be asked Q5. However, respondents who had selected “no” for screener
QS11, “did you drink any regular soft drinks (non-diet) or other sugary drinks?,” will not be shown the item in Q5
that asks “how interested are you in cutting back on regular soft drinks (non-diet) or other sugary drinks.”}
Screenshot – Online Survey Question Q5
66
{Note to reviewers: There is no Q6}
Screenshot – Online Survey Question Q7
67
Screenshot – Online Survey Question Q8
68
Screenshot – Online Survey Question Q9
69
Screenshot – Online Survey Question Q10
70
{Note to reviewers: At this point, some respondents will be shown a set of ads (TV, radio and/or print) that
correspond to a discrete campaign (randomly chosen). Others will be shown randomly chosen individual ads that
do not correspond to a discrete campaign. After each ad is shown, they will be asked Q12-Q19.}
Screenshot: Initial Screen for Ad Evaluations
71
{Note to reviewers: The screen below is a sample of the screen respondents will see when viewing each ad. The
questions they will be asked for each ad will be the same, regardless of the ad they see.}
Screenshot: Sample Screen of Ad Presentation
72
Screenshot: Ad Survey Question Introduction Page
73
Screenshot – Online Survey Question Q12
74
Screenshot – Online Survey Question Q13
75
Screenshot – Online Survey Question Q14
76
Screenshot – Online Survey Question Q15
77
Screenshot – Online Survey Question Q16
78
Screenshot – Online Survey Question Q17
79
Screenshot – Online Survey Question Q18
80
{Note to reviewers: Only respondents who selected “somewhat agree” or “strongly agree” on Q18 for the item
“This ad grabbed my attention,” will be shown the question below (Q19). Others will skip to next ad or, if
appropriate, will be shown Q20.}
Screenshot – Online Survey Question Q19
81
Screenshot: Transition Page before Each Ad
82
{Note to reviewers: Q20 below will only be shown if respondents have evaluated individual ads that together
comprise a campaign.}
Screenshot – Online Survey Question Q20
83
{Note to reviewers: At this point, respondents who were being shown individual
ads corresponding to a discrete campaign, will begin seeing a set of randomly
chosen individual ads (TV, radio, and/or print) that do not correspond to a
campaign. Those who were already being shown individual ads not
corresponding to a campaign, will continue to be shown individual spots. After
each ad is shown, they will be asked Q22-29 (which are the same as Q12-Q19,
presented above). Respondents will then see the questions that follow.}
84
{Note to reviewers: Only respondents who selected “yes” for screener QS11, “did you drink any regular soft drinks
(non-diet) or other sugary drinks?,” will be shown the following screen (Q30). Others will skip to Q30_2.}
Screenshot – Online Survey Question Q30
85
{Note to reviewers: Only respondents who selected “no” for Q30, “are you planning to stop drinking regular soft
drinks (non-diet) or other sugary drinks?,” will be shown the following screen (Q30_1). Others will skip to Q30_2.}
Screenshot – Online Survey Question Q30_1
86
Screenshot – Online Survey Question Q30_2
87
Screenshot – Online Survey Question Q30_3
88
Screenshot – Online Survey Question Q31
89
{Note to reviewers: Only respondents who selected “yes” for screener QS11, “did you drink any regular soft drinks
(non-diet) or other sugary drinks?,” will be shown the following screen (Q32). Those who responded “no” to QS11
on the screener will skip to Q32_1.}
Screenshot – Online Survey Question Q32
90
Screenshot – Online Survey Question Q32_1
91
Screenshot – Online Survey Question Q32_2
92
{Note to reviewers: There is no Q33}
Screenshot – Online Survey Question Q34
93
Screenshot – Online Survey Question Q35
94
Screenshot – Online Survey Question Q36
95
Screenshot – Online Survey Question Q37
96
Screenshot: Initial Screen for Classification Questions
97
Screenshot – Online Survey Question C1
98
Screenshot – Online Survey Question C2
99
Screenshot – Online Survey Question C3
100
Screenshot – Online Survey Question C4
101
Screenshot – Online Survey Question C5
102
Screenshot – Online Survey Question C6
103
Screenshot – Online Survey Question C7
104
Screenshot – Survey End Page
105
Form Approved
OMB No. 0920-0572
Expiration Date: 2/28/2015
Attachment 2f: Online Survey for Physical Activity
for African American Audiences
Community Health Media Center – Testing Educational Campaign
Materials with African American and Hispanic Audiences
Introduction
SHOW: About this online survey: Thank you for answering these questions. You are qualified to participate
in this online survey, which is being conducted on behalf of the Centers for Disease Control and
Prevention, sometimes referred to as CDC, in Atlanta. The online survey will take about 22 minutes to
complete. In this online survey, you are going to be shown sample advertisements and asked to share your
honest opinions about them.
Your responses will be entered into a database and will only be seen by researchers associated with this
online survey. Your answers will be kept secure to the extent permitted by law. There will be no risk to you.
You may stop at any time. You will receive your gift, as it is explained in your online survey invitation, after
completing the online survey.
If you have any questions about this online survey or about your rights as an online survey participant,
please email them to StudyInfo@fhi360.org.
By clicking 'Next,' I am agreeing to the above project description.
Public Reporting Burden Statement
Public reporting burden of this collection of information is estimated to average 22 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 (09200572).
106
[BACKGROUND HEALTH BEHAVIORS AND ATTITUDES]
[Contemplation and Behavioral Intentions]
Pre-Post Questions
[CHECK S11. IF S11=1 (YES), ASK Q1. OTHERS SKIP TO Q1_2]
Q1.
Are you planning to stop drinking regular soft drinks (non-diet) or other sugary drinks within the
next 30 days? SINGLE RESPONSE, DO NOT ROTATE
1
2
Yes………………………………….……………………….. Continue
No……………………………………………………………. Continue
[IF Q1=1 SKIP TO Q1_2. IF Q1=2 CONTINUE TO Q1_1]
Q1_1. Are you planning to cut back on regular soft drinks (non-diet) or other sugary drinks within the next
30 days? SINGLE RESPONSE, DO NOT ROTATE
1
2
Yes………………………………….……………………….. Continue
No……………………………………………………………. Continue
Q1_2. Are you planning to be more physically active within the next 30 days? SINGLE RESPONSE, DO
NOT ROTATE
1
2
Yes…………………………………………………..………. Continue
No……………………………………………………………. Continue
Q1_3. Are you planning to eat healthier meals and snacks within the next 30 days? SINGLE
RESPONSE, DO NOT ROTATE
1
2
Q2.
Yes…………………………………………………..………. Continue
No……………………………………………………………. Continue
Are you planning to do something about your weight within the next 30 days? SINGLE
RESPONSE, ROTATE 1-3.
1
2
3
4
Yes, I plan to try to lose weight…………………….…….
Yes, I plan to try to gain weight…………………….…….
Yes, I plan to try to maintain my current weight….…….
No, I have no plans to do anything about my weight.….
Continue
Continue
Continue
Continue
107
Q3.
During the past 12 months, did you try to cut back on regular soft drinks (non-diet) or other sugary
drinks? SINGLE RESPONSE, DO NOT ROTATE
1
2
Yes………………………………………………………….. Continue
No……………………………………………………...……. Continue
Q3_1. During the past 12 months, did you try to be more physically active? SINGLE RESPONSE, DO
NOT ROTATE
1
2
Yes………………………………………………………….. Continue
No……………………………………………………………. Continue
Q3_2. During the past 12 months, did you try to eat healthier meals and snacks? SINGLE RESPONSE,
DO NOT ROTATE
1
2
Q4.
Yes………………………………………………………….. Continue
No……………………………………………………...……. Continue
In the past year, have you tried to do any of the following? MULTIPLE RESPONSE, DO NOT
ROTATE.
1
Lose weight…………………………………………………. Continue
2
Gain weight…………………………………………………. Continue
3
Maintain your current weight…………………………….... Continue
Q4_1. Compared to a year ago, do you weigh…? SINGLE RESPONSE, DO NOT ROTATE.
1
2
3
Less……………………………………….………………...
More…………………………………………………………
About the same………………………………………….…
Continue
Continue
Continue
Q4_2. And compared to a year ago, would you say that you are…? SINGLE RESPONSE, DO NOT
ROTATE.
1
2
3
Q5.
More healthy……………………………………………….. Continue
Less healthy………………………………………………... Continue
About the same ……………………………………………. Continue
Overall, on a scale from 1 to 5, where 1 is not at all interested and 5 is extremely interested, how
interested are you in…? SINGLE RESPONSE GRID FORMAT, RANDOMIZE LIST.
[CHECK S11. IF S11=1 (YES), INSERT A. INSERT B AND C FOR ALL PERSONS]
1
2
3
Not at all interested………………………………………
A little interested.…………………………………………
Somewhat interested……….……………………………
Continue
Continue
Continue
108
4
5
A
B
C
Very interested……………………………………………
Extremely interested ………………………………….…
Continue
Continue
Cutting back on regular soft drinks (non-diet) or other sugary drinks
Being more physically active
Eating healthier meals and snacks
[THERE IS NO Q6.]
Q7.
Thinking about the next six months, how likely are you to…? Please use a scale from 1 to 5, where
1 is not at all likely and 5 is extremely likely. SINGLE RESPONSE GRID FORMAT, ROTATE LIST.
1
2
3
4
5
A
B
C
Not at all likely…………………………………………..…
Somewhat unlikely..………………………………………
Neither likely nor unlikely..…………………………….…
Somewhat likely..…………………………………………
Extremely likely …………………………………………..
Continue
Continue
Continue
Continue
Continue
Look for more information on the health benefits of being more physically active
Talk to a friend about the health benefits of being more physically active
Participate in community efforts to reduce obesity
[Self-Efficacy Questions]
Q8.
On a scale from 1 to 5, where 1 indicates that you strongly disagree and 5 indicates that you
strongly agree, please indicate how much you agree or disagree with each of these statements.
SINGLE RESPONSE GRID FORMAT, ROTATE LIST.
1
2
3
4
5
A
B
C
D
Strongly disagree…………………………………………..
Somewhat disagree………………………………………..
Neither agree nor disagree………………………………..
Somewhat agree……………………………………………
Strongly agree………………………………………………
Continue
Continue
Continue
Continue
Continue
I feel as though I can make a difference regarding my risk for being overweight or obese
I am confident that I can protect myself from being overweight or obese
There are many things I can do to protect myself from being overweight or obese
Generally speaking, it is possible to reduce one’s risk for being overweight or obese
109
[Behavioral Beliefs]
Q9.
On a scale from 1 to 5, where 1 indicates that you strongly disagree and 5 indicates that you
strongly agree, please indicate how much you agree or disagree with each of these statements.
SINGLE RESPONSE GRID FORMAT, RANDOMIZE LIST.
1
2
3
4
5
Strongly disagree…………………………………………. Continue
Somewhat disagree………………………………………. Continue
Neither agree nor disagree………………………………. Continue
Somewhat agree………………………………………...… Continue
Strongly agree…………………………………………...… Continue
Being more physically active several times per week would…
A
…make me feel that I was doing something good for my health
B
…give me more energy and stamina
C
…help me prevent weight gain
D
…make life more stressful for me
E
…help me save money
F
…make me feel more comfortable with the way I look
G
…help me lose weight
H
…help me maintain a healthy weight
[Community Attitudes]
Q10.
1
2
3
Which of the following statements best describes how you think the problem of obesity should be
solved in your community? SINGLE RESPONSE, ROTATE 1-2.
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
110
CAMPAIGN EVALUATIONS
MOST RESPONDENTS WILL FIRST SEE A SET OF ADS THAT CORRESPOND TO A DISCRETE
CAMPAIGN (RANDOMLY CHOSEN). AFTER EACH AD SHOWN, ASK Q12-Q19. AFTER THE ENTIRE
CAMPAIGN IS SHOWN, ASK Q20.
Q11.
CAMPAIGNS SHOWN – CODE, DO NOT DISPLAY
SHOW: Now we would like to show you a few different health-related ads, including a television, print,
and/or radio ad, and then ask you to evaluate each ad. Even if an ad is from another community or city,
please rate it as if it were an ad from your local community. Also, please note that the video quality of these
ads may vary – please rate them based on the content of the ads, not on the quality of the video.
Please make sure the volume on your computer is turned up, so that you may both see and/or hear the TV
and radio ads.
Please click “Next” to continue.
NOTE: WHEN THE TV ADS ARE PRESENTED, PLEASE SHOW THE FOLLOWING MESSAGE ABOVE
THE SCREEN: This ad is a TV ad. Please be patient while the video loads; also note that the video may
stop to buffer from time to time. We do not expect buffering to continue for more than 30 seconds. If you
find that it is buffering too long, you can suspend the survey at any time and return to this point in the
survey simply by clicking on the original survey link.
And remember: even if an ad is from another community or city, please rate it as if it were an ad from your
local community.
NOTE: WHEN THE RADIO ADS ARE PRESENTED, PLEASE SHOW THE FOLLOWING MESSAGE
ABOVE THE SCREEN: This ad is a radio ad. Please be patient while the audio loads; also note that the
audio may stop to buffer from time to time. We do not expect buffering to continue for more than 30
seconds. If you find that it is buffering too long, you can suspend the survey at any time and return to this
point in the survey simply by clicking on the original survey link.
And remember: even if an ad is from another community or city, please rate it as if it were an ad from your
local community.
Questions for Each Ad
SHOW: Please answer the following questions about the ad you just viewed.
Q12.
If you saw or heard this message, would it get your attention? SINGLE RESPONSE, DO NOT
ROTATE
1
2
Yes……………………………………………….………….. Continue
No……………………………………………………………. Continue
111
Q13.
Why or why not? OPEN ENDED…………………………………………….
Q14.
Is this message believable? SINGLE RESPONSE, DO NOT ROTATE
1
2
Continue
Yes…………………………………………………………..
No………………………………………………………..….
Continue
Continue
Q15.
Why or why not? OPEN ENDED…………………………………………….
Continue
Q16.
Did you think this ad would be effective to motivate you or someone else to be more physically
active to lose weight or be healthier?
Please use a scale from 1 to 5, where 1 is not at all effective and 5 is extremely effective. SINGLE
RESPONSE, DO NOT ROTATE
1
2
3
4
5
Q17.
Not at all effective…………………………………………
Somewhat ineffective.…………………………….………
Neither effective nor ineffective………………….………
Somewhat effective……………………………….………
Extremely effective ……………………………….……….
Continue
Continue
Continue
Continue
Continue
Who would you say this ad is trying to reach? Please check all that apply. MULTIPLE
RESPONSE, DO NOT ROTATE
1
2
3
You……………………………………………………..…..
People like you…………………………………………….
Someone else……………………………………………..
Continue
Continue
Continue
112
Q18.
On a scale from 1 to 5, where 1 indicates that you strongly disagree, and 5 indicates that you
strongly agree, please indicate how much you agree or disagree with each of the following
statements about this advertisement. SINGLE RESPONSE GRID FORMAT. RANDOMIZE LIST.
1
2
3
4
5
A
B
C
D
E
F
G
H
I
J
K
Strongly disagree………………………….……………….
Somewhat disagree………………………………………..
Neither agree nor disagree………………….…………….
Somewhat agree……………………………………………
Strongly agree………………………………………………
Continue
Continue
Continue
Continue
Continue
Overall, I liked this ad
I am interested in this ad’s topic
I trust the information in this ad
This ad was confusing
This ad was convincing
This ad said something important to me
This ad grabbed my attention
I learned something new from this ad
I can do what this ad suggests
This ad was easy to understand
I would notice this ad if I saw/heard it
IF RESPONSE 4 OR 5 TO Q18G, ASK Q19. OTHERS SKIP TO INSTRUCTIONS BEFORE Q20.
Q19.
You mentioned that this ad grabbed your attention. What makes it stand out? OPEN
ENDED……………………………………………………………………………….…… Continue
BEFORE THE NEXT AD IS EVALUATED, UNTIL THE LAST AD, SHOW: Now you will see another ad to
evaluate. Once again, even if an ad is from another community or city, please rate it as if it were an ad from
your local community. Please note that we would like your reaction to each ad individually – we will not ask
you to compare one ad to any other.
[ONLY ASK Q20 ONCE A WHOLE “CAMPAIGN” IS EVALUATED]
113
Campaign Summary Evaluation
Q20.
Considering the impact of these ads together, please indicate how much you agree or disagree
with each statement. SINGLE RESPONSE GRID FORMAT, RANDOMIZE LIST.
1
2
3
4
5
Strongly disagree………………………………………….
Somewhat disagree……………………………………….
Neither agree nor disagree……………………………….
Somewhat agree………………………………………..…
Strongly agree…………………………………………...…
Continue
Continue
Continue
Continue
Continue
I trust the information in this set of ads.
A
This set of ads was convincing.
B
This set of ads grabbed my attention.
C
This set of ads told me something I didn’t already know.
D
The message about the health benefits of being more physically active in this set of ads
was persuasive.
E
This set of ads gave me good reasons to be more physically active.
F
This set of ads gave me good reasons to try to lose weight.
BEFORE THE SECOND CAMPAIGN SEQUENCE IS EVALUATED, SHOW: Now you will see another
series of ads to evaluate. Once again, even if an ad is from another community or city, please rate it as if it
were an ad from your local community.
114
INDIVIDUAL SPOT EVALUATIONS
EACH RESPONDENT WILL SEE A SET OF RANDOMLY CHOSEN INDIVIDUAL ADS. AFTER EACH AD
SHOWN, ASK Q22-Q29.
Q21.
ADS SHOWN – CODE, DO NOT DISPLAY, ADS SHOWN
SHOW: We would now like to show you a few more ads and then gather your reactions to them. If you are
watching a television or radio ad, please make sure the volume on your computer is turned up, so that you
may both see and hear the video or audio.
Once again, even if an ad is from another community or city, please rate it as if it were an ad from your
local community, and please rate the ads based on their content, not on the quality of the video. Please
note that we would like your reaction to each ad individually – we are not interested in comparing any of the
ads to one another.
Please click “Next” to continue.
NOTE: WHEN THE TV ADS ARE PRESENTED, PLEASE SHOW THE FOLLOWING MESSAGE ABOVE
THE SCREEN: This ad is a TV ad. Please be patient while the video loads; also note that the video may
stop to buffer from time to time. We do not expect buffering to continue for more than 30 seconds. If you
find that it is buffering too long, you can suspend the survey at any time and return to this point in the
survey simply by clicking on the original survey link.
And remember: even if an ad is from another community or city, please rate it as if it were an ad from your
local community.
NOTE: WHEN THE RADIO ADS ARE PRESENTED, PLEASE SHOW THE FOLLOWING MESSAGE
ABOVE THE SCREEN: This ad is a radio ad. Please be patient while the audio loads; also note that the
audio may stop to buffer from time to time. We do not expect buffering to continue for more than 30
seconds. If you find that it is buffering too long, you can suspend the survey at any time and return to this
point in the survey simply by clicking on the original survey link.
And remember: even if an ad is from another community or city, please rate it as if it were an ad from your
local community.
Questions for Each Ad
SHOW: Please answer the following questions about the ad you just viewed.
Q22.
If you saw or heard this message, would it get your attention? SINGLE RESPONSE, DO NOT
ROTATE
1
2
Yes……………………………………………….…………. Continue
No………………………………………………..………….. Continue
115
Q23.
Why or why not? OPEN ENDED………………………………..…………..
Q24.
Is this message believable? SINGLE RESPONSE, DO NOT ROTATE
1
2
Continue
Yes………………………………………………………….
No…………………………………………………………...
Continue
Continue
Q25.
Why or why not? OPEN ENDED……………………….……………………
Continue
Q26.
Did you think this ad would be effective to motivate you or someone else to be more physically
active to be healthier or lose weight?
Please use a scale from 1 to 5, where 1 is not at all effective and 5 is extremely effective. SINGLE
RESPONSE, DO NOT ROTATE
1
2
3
4
5
Q27.
Not at all effective…………………………………………
Somewhat ineffective.…………………….………………
Neither effective nor ineffective………….………………
Somewhat effective……………………….………………
Extremely effective ……………………………………….
Continue
Continue
Continue
Continue
Continue
Who would you say this ad is trying to reach? Please check all that apply. MULTIPLE RESPONSE,
DO NOT ROTATE.
1
2
3
You………………………………………………...………..
People like you…………………………………………….
Someone else……………………………………………...
Continue
Continue
Continue
116
Q28.
On a scale from 1 to 5, where 1 indicates that you strongly disagree, and 5 indicates that you
strongly agree, please indicate how much you agree or disagree with each of the following
statements about this advertisement.
1
2
3
4
5
A
B
C
D
E
F
G
H
I
J
K
Strongly disagree………………………………………….
Somewhat disagree…………………………………...…..
Neither agree nor disagree……………………………….
Somewhat agree……………………………………...……
Strongly agree………………………………………...……
Continue
Continue
Continue
Continue
Continue
Overall, I liked this ad
I am interested in this ad’s topic
I trust the information in this ad
This ad was confusing
This ad was convincing
This ad said something important to me
This ad grabbed my attention
I learned something new from this ad
I can do what this ad suggests
This ad was easy to understand
I would notice this ad if I saw/heard it
IF RESPONSE 4 OR 5 TO Q28G, ASK Q29. OTHERS SKIP TO INSTRUCTIONS AFTER Q29.
Q29.
You mentioned that this ad grabbed your attention. What makes it stand out? OPEN
ENDED………………………………………………………………………………..….………. Continue
BEFORE THE NEXT AD IS EVALUATED, UNTIL THE LAST AD, SHOW: Now you will see another ad to
evaluate. Once again, even if an ad is from another community or city, please rate it as if it were an ad from
your local community. Please note that we would like your reaction to each ad individually – we are not
interested in comparing any of the ads to one another.
Pre-Post Questions
[Behavioral Intentions]
[CHECK S11. IF S11=1 (YES), ASK Q30. OTHERS SKIP TO Q30_2]
Q30.
Are you planning to stop drinking regular soft drinks (non-diet) or other sugary drinks within the
next 30 days? SINGLE RESPONSE, DO NOT ROTATE.
1
2
Yes……………………………………………………….….. Continue
No……………………………………………………………. Continue
[IF Q30=1 SKIP TO Q30_2. IF Q30=2 CONTINUE TO Q30_1]
117
Q30_1. Are you planning to cut back on regular soft drinks (non-diet) or other sugary drinks within the next
30 days? SINGLE RESPONSE, DO NOT ROTATE.
1
2
Yes………………………………………………….……….. Continue
No……………………………………………………………. Continue
Q30_2. Are you planning to be more physically active within the next 30 days? SINGLE RESPONSE, DO
NOT ROTATE.
1
2
Yes……………………………………………….…………. Continue
No……………………………………………………………. Continue
Q30_3. Are you planning to eat healthier meals and snacks within the next 30 days? SINGLE
RESPONSE, DO NOT ROTATE.
1
2
Q31.
Yes………………………………………………..…………. Continue
No……………………………………………………………. Continue
Are you planning to do something about your weight within the next 30 days? SINGLE
RESPONSE, ROTATE 1-3.
1
2
3
4
Yes, I plan to try to lose weight………………….……….
Yes, I plan to try to gain weight………………….……….
Yes, I plan to try to maintain my current weight..……….
No, I have no plans to do anything about my weight…..
Continue
Continue
Continue
Continue
[CHECK S11. IF S11=1 (YES), ASK Q32. OTHERS SKIP TO Q32_1]
Q32.
Overall, on a scale from 1 to 5, where 1 is not at all interested and 5 is extremely interested, how
interested are you in cutting back on regular soft drinks (non-diet) or other sugary drinks? SINGLE
RESPONSE, DO NOT ROTATE.
1
2
3
4
5
Not at all interested…………………………………….…
A little interested.……………………………………….…
Somewhat interested……….………………………….…
Very interested………………………………………….…
Extremely interested …………………………………..…
Continue
Continue
Continue
Continue
Continue
118
Q32_1. Overall, on a scale from 1 to 5, where 1 is not at all interested and 5 is extremely interested, how
interested are you in trying to be more physically active? SINGLE RESPONSE, DO NOT ROTATE.
1
2
3
4
5
Not at all interested…………………………………..……
A little interested.………………………………………..…
Somewhat interested……….…………………………..…
Very interested…………………………………………..…
Extremely interested ………………………………………
Continue
Continue
Continue
Continue
Continue
Q32_2. Overall, on a scale from 1 to 5, where 1 is not at all interested and 5 is extremely interested, how
interested are you in trying to eat healthier meals and snacks? SINGLE RESPONSE, DO NOT
ROTATE.
1
2
3
4
5
Not at all interested……………………………………..…
A little interested.………………………………………..…
Somewhat interested……….……………………………..
Very interested……………………………………………..
Extremely interested …………………………………...…
Continue
Continue
Continue
Continue
Continue
[THERE IS NO Q33]
Q34.
Thinking about the next six months, how likely are you to…? Please use a scale from 1 to 5, where
1 is not at all likely and 5 is extremely likely. SINGLE RESPONSE GRID FORMAT, RANDOMIZE
LIST
1
2
3
4
5
A
B
C
Not at all likely……………………………………………..
Somewhat unlikely..………………………………………
Neither likely nor unlikely..…………………………….…
Somewhat likely..…………………………………………
Extremely likely …………………………………………..
Continue
Continue
Continue
Continue
Continue
Look for more information on the health benefits of being more physically active
Talk to a friend about the health benefits of being more physically active
Participate in community efforts to reduce obesity
119
[Self-Efficacy Questions]
Q35.
On a scale from 1 to 5, where 1 indicates that you strongly disagree and 5 indicates that you
strongly agree, please indicate how much you agree or disagree with each of these statements.
SINGLE RESPONSE GRID FORMAT, RANDOMIZE LIST.
1
2
3
4
5
A
B
C
D
Q36.
Strongly disagree…………………………………………..
Somewhat disagree………………………………………..
Neither agree nor disagree………………………………..
Somewhat agree……………………………………………
Strongly agree………………………………………………
Continue
Continue
Continue
Continue
Continue
I feel as though I can make a difference regarding my risk for being overweight or obese
I am confident that I can protect myself from being overweight or obese
There are many things I can do to protect myself from being overweight or obese
Generally speaking, it is possible to reduce one’s risk for being overweight or obese
On a scale from 1 to 5, where 1 indicates that you strongly disagree and 5 indicates that you
strongly agree, please indicate how much you agree or disagree with each of these statements.
SINGLE RESPONSE GRID FORMAT, RANDOMIZE LIST.
1
2
3
4
5
Strongly disagree…………………………………………..
Somewhat disagree………………………………………..
Neither agree nor disagree………………………………..
Somewhat agree……………………………………………
Strongly agree………………………………………………
Continue
Continue
Continue
Continue
Continue
Being more physically active several times per week would…
A
…make me feel that I was doing something good for my health
B
…give me more energy and stamina
C
…help me prevent weight gain
D
…make life more stressful for me
E
…help me save money
F
…make me feel more comfortable with the way I look
G
…help me lose weight
H
…help me maintain a healthy weight
120
[Community Attitudes]
Q37.
1
2
3
Which of the following statements best describes how you think the problem of obesity should be
solved in your community? SINGLE RESPONSE, ROTATE 1-2.
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
121
CLASSIFICATION
SHOW: You’re almost done! These last few questions are for classification purposes only and will be used
for analyzing the results of the survey in total. They will not be identified with you personally.
C1.
Has a healthcare professional ever told you that you are overweight or at risk for being
overweight? SINGLE RESPONSE, DO NOT ROTATE
1
2
3
C2.
Yes……………………………………………………………….. Continue
No……………………………………………………………...…. Continue
Don’t know / not sure ………………………………………..…. Continue
What is your current occupational status? Are you…? Please select the option that best applies to
you. SINGLE RESPONSE, DO NOT ROTATE.
1
2
3
4
5
6
7
8
10
C4.
Continue
Continue
Continue
Has anyone else in your household been identified by a health care professional as being
overweight or at risk for being overweight? SINGLE RESPONSE DO NOT ROTATE
1
2
3
C3.
Yes……………………………………………………………….
No………………………………………………………………...
Don’t know / not sure ………………………………….….
Employed full time…………………………………………..….
Employed part time…………………………………………….
Unemployed…………………………………………………….
Homemaker……………………………………………………..
Student ………………………………………………..……......
Retired ………………………………………………..……...….
Disabled ………………………………………………..…...…..
Other (Please specify: _________)………………..……...….
Prefer not to answer……..…………………………………..….
Continue
Continue
Continue
Continue
Continue
Continue
Continue
Continue
Continue
What is your marital status? SINGLE RESPONSE, ROTATE 1-6.
1
2
3
4
5
6
8
Married ……………………………………………………..……
Unmarried living with a partner…………………………..……
Divorced ………………………………………………………...
Widowed ……………………………………………………..….
Separated…………………………………………………….….
Single, never been married …………………………………....
Prefer not to answer……..……………………………………...
Continue
Continue
Continue
Continue
Continue
Continue
Continue
122
C5.
How many children (under age 18) live in your household?
1
2
C6.
What is your household’s total income from all sources before taxes? SINGLE RESPONSE, DO
NOT ROTATE
1
2
3
4
5
6
7
8
9
C7.
Enter number: [Numeric Response] …………………………..… Continue
Prefer not to answer [Check Box]……..………………………….. Continue
Under $20,000……..…………………………….…………..……...
$20,000 to $29,999 .…………………………….………..………...
$30,000 to $39,999 .…………………………….……..…………...
$40,000 to $49,999 .…………………………….…..……………...
$50,000 to $74,999 .…………………………….…..……………...
$75,000 to $99,999 .………………………………....………...…...
$100,000 to $199,999 .…………………………………………..…
$200,000 or more.……………………..………………………...….
Prefer not to answer.…………………………….………………….
Continue
Continue
Continue
Continue
Continue
Continue
Continue
Continue
Continue
In the following list of items, please indicate which devices you currently use or own. MULTIPLE
RESPONSE, ROTATE LIST.
1
2
3
4
5
6
A desktop computer…………………………………………….…… Continue
A laptop computer…………………………………………………… Continue
A smartphone, such as an iPhone, BlackBerry, Android, Windows phone, etc.
………………………………………………………………….……… Continue
A tablet, such as an iPad, Kindle Fire, Nook Color, Motorola Xoom, etc.
………………………………………………………………….……… Continue
An iPod or other mp3 player ……………………………………...… Continue
None of these – EXCLUSIVE - ANCHOR
SHOW: That is the last question. Thank you for your time. Please click “OK” to confirm your
participation.
123
Attachment 2g: Screen Captures of Online Survey for Physical Activity for African American Audiences
Community Health Media Center – Testing Educational Campaign
Materials with African American and Hispanic Audiences
Screenshot – Online Survey Start Screen
124
{Note to reviewers: Only respondents who selected “yes” for screener QS11,“did you drink any regular soft drinks
(non-diet) or other sugary drinks,?” will be shown the following screen (Q1). Others will skip to Q1_2.}
Screenshot – Online Survey Question Q1
125
{Note to reviewers: Only respondents who selected “no” for Q1,“are you planning to stop drinking regular soft
drinks (non-diet) or other sugary drinks?,” will be shown the following screen (Q1_1). Others will skip to Q1_2.}
Screenshot - Online Survey Question Q1_1
126
Screenshot – Online Survey Question Q1_2
127
Screenshot - Online Survey Question Q1_3
128
Screenshot – Online Survey Question Q2
129
Screenshot – Online Survey Question Q3
130
Screenshot – Online Survey Question Q3_1
131
Screenshot – Online Survey Question Q3_2
132
Screenshot – Online Survey Question Q4
133
Screenshot – Online Survey Question 4_1
134
Screenshot – Online Survey Question Q4_2
135
{Note to reviewers: All respondents will be asked Q5. However, respondents who had selected “no” for screener
QS11, “did you drink any regular soft drinks (non-diet) or other sugary drinks?,” will not be shown the item in Q5
that asks “how interested are you in cutting back on regular soft drinks (non-diet) or other sugary drinks.”}
Screenshot – Online Survey Question Q5
136
{Note to reviewers: There is no Q6}
Screenshot – Online Survey Question Q7
137
Screenshot – Online Survey Question Q8
138
Screenshot – Online Survey Question Q9
139
Screenshot – Online Survey Question Q10
140
{Note to reviewers: At this point, respondents will begin to be shown ads for their evaluation.}
Screenshot: Initial Screen for Ad Evaluations
141
{Note to reviewers: The screen below is a sample of the screen respondents will see when viewing each ad. The
questions they will be asked for each ad will be the same, regardless of the ad they see.}
Screenshot: Sample Screen of Ad Presentation
142
Screenshot: Ad Survey Question Introduction Page
143
{Note to reviewers: Q11-Q21 have been intentionally removed from this physical activity survey as they correspond
to campaign evaluations. There will be no campaign evaluations in the African American physical activity wave; only
individual ads not corresponding to a discrete campaign will be evaluated. After each ad is shown, they will be asked
Q22-Q29.}
Screenshot – Online Survey Question Q22
144
Screenshot – Online Survey Question Q23
145
Screenshot – Online Survey Question Q24
146
Screenshot – Online Survey Question Q25
147
Screenshot – Online Survey Question Q26
148
Screenshot – Online Survey Question Q27
149
Screenshot – Online Survey Question Q28
150
{Note to reviewers: Only respondents who selected “somewhat agree” or “strongly agree” on Q28 for the item
“This ad grabbed my attention,” will be shown the question below (Q29). Others will skip to next ad.}
Screenshot – Online Survey Question Q29
151
Screenshot: Transition Page before Each Ad
{Note to reviewers: After the last ad is shown, respondents will see the questions that follow.}
152
{Note to reviewers: Only respondents who selected “yes” for screener QS11, “did you drink any regular soft drinks
(non-diet) or other sugary drinks?,” will be shown the following screen (Q30). Others will skip to Q30_2.}
Screenshot – Online Survey Question Q30
153
{Note to reviewers: Only respondents who selected “no” for Q30, “are you planning to stop drinking regular soft
drinks (non-diet) or other sugary drinks?,” will be shown the following screen (Q30_1). Others will skip to Q30_2.}
Screenshot – Online Survey Question Q30_1
154
Screenshot – Online Survey Question Q30_2
155
Screenshot – Online Survey Question Q30_3
156
Screenshot – Online Survey Question Q31
157
{Note to reviewers: Only respondents who selected “yes” for screener QS11, “did you drink any regular soft drinks
(non-diet) or other sugary drinks?,” will be shown the following screen (Q32). Those who responded “no” to QS11
on the screener will skip to Q32_1.}
Screenshot – Online Survey Question Q32
158
Screenshot – Online Survey Question Q32_1
159
Screenshot – Online Survey Question Q32_2
160
{Note to reviewers: There is no Q33}
Screenshot – Online Survey Question Q34
161
Screenshot – Online Survey Question Q35
162
Screenshot – Online Survey Question Q36
163
Screenshot – Online Survey Question Q37
164
Screenshot: Initial Screen for Classification Questions
165
Screenshot – Online Survey Question C1
166
Screenshot – Online Survey Question C2
167
Screenshot – Online Survey Question C3
168
Screenshot – Online Survey Question C4
169
Screenshot – Online Survey Question C5
170
Screenshot – Online Survey Question C6
171
Screenshot – Online Survey Question C7
172
Screenshot – Survey End Page
173
Form Approved
OMB No. 0920-0572
Expiration Date: 2/28/2015
Attachment 2h: Online Survey for Healthy Foods
for African American Audiences
Community Health Media Center – Testing Educational Campaign
Materials with African American and Hispanic Audiences
Introduction
SHOW: About this online survey: Thank you for answering these questions. You are qualified to
participate in this online survey, which is being conducted on behalf of the Centers for Disease
Control and Prevention, sometimes referred to as CDC, in Atlanta. The online survey will take
about 22 minutes to complete. In this online survey, you are going to be shown sample
advertisements and asked to share your honest opinions about them.
Your responses will be entered into a database and will only be seen by researchers associated
with this online survey. Your answers will be kept secure to the extent permitted by law. There will
be no risk to you. You may stop at any time. You will receive your gift, as it is explained in your
online survey invitation, after completing the online survey.
If you have any questions about this online survey or about your rights as an online survey
participant, please email them to StudyInfo@fhi360.org.
By clicking 'Next,' I am agreeing to the above project description.
Public Reporting Burden Statement
Public reporting burden of this collection of information is estimated to average 22 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).
174
[BACKGROUND HEALTH BEHAVIORS AND ATTITUDES]
[Contemplation and Behavioral Intentions]
Pre-Post Questions
[CHECK S11. IF S11=1 (YES), ASK Q1. OTHERS SKIP TO Q1_2]
Q1.
Are you planning to stop drinking regular soft drinks (non-diet) or other sugary drinks within
the next 30 days? SINGLE RESPONSE, DO NOT ROTATE
1
2
Yes………………………………………………………….. Continue
No……………………………………………………………. Continue
[IF Q1=1 SKIP TO Q1_2. IF Q1=2 CONTINUE TO Q1_1]
Q1_1. Are you planning to cut back on regular soft drinks (non-diet) or other sugary drinks within
the next 30 days? SINGLE RESPONSE, DO NOT ROTATE
1
2
Yes………………………………………………………….. Continue
No……………………………………………………………. Continue
Q1_2. Are you planning to be more physically active within the next 30 days? SINGLE
RESPONSE, DO NOT ROTATE
1
2
Yes………………………………………………………….. Continue
No……………………………………………………………. Continue
Q1_3. Are you planning to eat healthier meals and snacks within the next 30 days? SINGLE
RESPONSE, DO NOT ROTATE
1
2
Q2.
Yes…………………………………………………………... Continue
No……………………………………………………………. Continue
Are you planning to do something about your weight within the next 30 days? SINGLE
RESPONSE, ROTATE 1-3.
1
2
3
4
Yes, I plan to try to lose weight………………………….
Yes, I plan to try to gain weight………………………….
Yes, I plan to try to maintain my current weight……….
No, I have no plans to do anything about my weight….
Continue
Continue
Continue
Continue
175
Q3.
During the past 12 months, did you try to cut back on regular soft drinks (non-diet) or
other sugary drinks? SINGLE RESPONSE, DO NOT ROTATE
1
2
Yes………………………………………………………….. Continue
No……………………………………………………………. Continue
Q3_1. During the past 12 months, did you try to be more physically active? SINGLE
RESPONSE, DO NOT ROTATE
1
2
Yes………………………………………………………….. Continue
No……………………………………………………………. Continue
Q3_2. During the past 12 months, did you try to eat healthier meals and snacks? SINGLE
RESPONSE, DO NOT ROTATE
1
2
Q4.
Yes………………………………………………………….. Continue
No……………………………………………………………. Continue
In the past year, have you tried to do any of the following? MULTIPLE RESPONSE, DO
NOT ROTATE.
1
2
3
Lose weight……………………………………………….... Continue
Gain weight……………………………………………….... Continue
Maintain your current weight……………………………... Continue
Q4_1. Compared to a year ago, do you weigh…? SINGLE RESPONSE, DO NOT ROTATE.
1
Less……………………………………….………………... Continue
2
More………………………………………………………… Continue
3
About the same……………………………………………. Continue
Q4_2. And compared to a year ago, would you say that you are…? SINGLE RESPONSE, DO
NOT ROTATE.
1
More healthy………………………………………………. Continue
2
Less healthy……………………………………………….. Continue
3
About the same …………………………………………... Continue
Q5.
Overall, on a scale from 1 to 5, where 1 is not at all interested and 5 is extremely
interested, how interested are you in…? SINGLE RESPONSE GRID FORMAT,
RANDOMIZE LIST.
[CHECK S11. IF S11=1 (YES), INSERT A. INSERT B AND C FOR ALL PERSONS]
1
2
3
4
5
Not at all interested………………………………………
A little interested.…………………………………………
Somewhat interested……….……………………………
Very interested……………………………………………
Extremely interested ………………………………….…
Continue
Continue
Continue
Continue
Continue
176
A
B
C
Cutting back on regular soft drinks (non-diet) or other sugary drinks
Being more physically active
Eating healthier meals and snacks
[THERE IS NO Q6.]
Q7.
Thinking about the next six months, how likely are you to…? Please use a scale from 1 to
5, where 1 is not at all likely and 5 is extremely likely. SINGLE RESPONSE GRID
FORMAT, ROTATE LIST.
1
2
3
4
5
A
B
C
Not at all likely…………………………………………..…
Somewhat unlikely..…………………………………….…
Neither likely nor unlikely..……………………………..…
Somewhat likely..……………………………………….…
Extremely likely …………………………………………...
Continue
Continue
Continue
Continue
Continue
Look for more information on the health benefits of eating healthier meals and
snacks
Talk to a friend about the health benefits of eating healthier meals and snacks
Participate in community efforts to reduce obesity
[Self-Efficacy Questions]
Q8.
On a scale from 1 to 5, where 1 indicates that you strongly disagree and 5 indicates that
you strongly agree, please indicate how much you agree or disagree with each of these
statements. SINGLE RESPONSE GRID FORMAT, ROTATE LIST.
1
2
3
4
5
Strongly disagree………………………………………….
Somewhat disagree…………………………………..…..
Neither agree nor disagree……………………………….
Somewhat agree……………………………………..……
Strongly agree………………………………………...……
Continue
Continue
Continue
Continue
Continue
A I feel as though I can make a difference regarding my risk for being overweight or
obese
B I am confident that I can protect myself from being overweight or obese
C There are many things I can do to protect myself from being overweight or obese
D Generally speaking, it is possible to reduce one’s risk for being overweight or obese
177
[Behavioral Beliefs]
Q9.
On a scale from 1 to 5, where 1 indicates that you strongly disagree and 5 indicates that
you strongly agree, please indicate how much you agree or disagree with each of these
statements. SINGLE RESPONSE GRID FORMAT, RANDOMIZE LIST.
1
2
3
4
5
Strongly disagree………………………………………….
Somewhat disagree…………………………………...…..
Neither agree nor disagree………………………..….….
Somewhat agree……………………………………..……
Strongly agree………………………………………..……
Continue
Continue
Continue
Continue
Continue
Eating healthier meals and snacks several times per week would…
A
…make me feel that I was doing something good for my health
B
…give me more energy and stamina
C
…help me prevent weight gain
D
…make life more stressful for me
E
…help me save money
F
…make me feel more comfortable with the way I look
G
…help me lose weight
H
…help me maintain a healthy weight
[Community Attitudes]
Q10.
1
2
3
Which of the following statements best describes how you think the problem of obesity
should be solved in your community? SINGLE RESPONSE, ROTATE 1-2.
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
178
CAMPAIGN EVALUATIONS
MOST RESPONDENTS WILL FIRST SEE A SET OF ADS THAT CORRESPOND TO A
DISCRETE CAMPAIGN (RANDOMLY CHOSEN). AFTER EACH AD SHOWN, ASK Q12-Q19.
AFTER THE ENTIRE CAMPAIGN IS SHOWN, ASK Q20
Q11.
CAMPAIGNS SHOWN – CODE, DO NOT DISPLAY
SHOW: Now we would like to show you a few different health-related ads, including a television,
print, and/or radio ad, and then ask you to evaluate each ad. Even if an ad is from another
community or city, please rate it as if it were an ad from your local community. Also, please note
that the video quality of these ads may vary – please rate them based on the content of the ads,
not on the quality of the video.
Please make sure the volume on your computer is turned up, so that you may both see and/or hear
the TV and radio ads.
Please click “Next” to continue.
NOTE: WHEN THE TV ADS ARE PRESENTED, PLEASE SHOW THE FOLLOWING MESSAGE
ABOVE THE SCREEN: This ad is a TV ad. Please be patient while the video loads; also note that
the video may stop to buffer from time to time. We do not expect buffering to continue for more
than 30 seconds. If you find that it is buffering too long, you can suspend the survey at any time
and return to this point in the survey simply by clicking on the original survey link.
And remember: even if an ad is from another community or city, please rate it as if it were an ad
from your local community.
NOTE: WHEN THE RADIO ADS ARE PRESENTED, PLEASE SHOW THE FOLLOWING
MESSAGE ABOVE THE SCREEN: This ad is a radio ad. Please be patient while the audio
loads; also note that the audio may stop to buffer from time to time. We do not expect buffering to
continue for more than 30 seconds. If you find that it is buffering too long, you can suspend the
survey at any time and return to this point in the survey simply by clicking on the original survey
link.
And remember: even if an ad is from another community or city, please rate it as if it were an ad
from your local community.
179
Questions for Each Ad
SHOW: Please answer the following questions about the ad you just viewed.
Q12.
If you saw or heard this message, would it get your attention? SINGLE RESPONSE, DO
NOT ROTATE
1
2
Yes………………………………………………………….. Continue
No……………………………………………………………. Continue
Q13.
Why or why not? OPEN ENDED…………………………………………….
Q14.
Is this message believable? SINGLE RESPONSE, DO NOT ROTATE
1
2
Continue
Yes………………………………………………………….. Continue
No……………………………………………………………. Continue
Q15.
Why or why not? OPEN ENDED…………………………………………….
Q16.
Did you think this ad would be effective to motivate you or someone else to eat healthier
meals and snacks to lose weight or be healthier?
Please use a scale from 1 to 5, where 1 is not at all effective and 5 is extremely effective.
SINGLE RESPONSE, DO NOT ROTATE
1
2
3
4
5
Q17.
Not at all effective…………………………………………
Somewhat ineffective.………………………………….…
Neither effective nor ineffective……………………….…
Somewhat effective…………………………………….…
Extremely effective ……………………………………….
Continue
Continue
Continue
Continue
Continue
Continue
Who would you say this ad is trying to reach? Please check all that apply. MULTIPLE
RESPONSE, DO NOT ROTATE.
1
2
3
You…………………………………………………….…....
People like you…………………………………………….
Someone else……………………………………………...
Continue
Continue
Continue
180
Q18.
On a scale from 1 to 5, where 1 indicates that you strongly disagree, and 5 indicates that
you strongly agree, please indicate how much you agree or disagree with each of the
following statements about this advertisement. SINGLE RESPONSE GRID FORMAT.
RANDOMIZE LIST.
1
2
3
4
5
A
B
C
D
E
F
G
H
I
J
K
Strongly disagree………………………………………….
Somewhat disagree……………………………………….
Neither agree nor disagree……………………………….
Somewhat agree…………………………………………..
Strongly agree……………………………………………...
Continue
Continue
Continue
Continue
Continue
Overall, I liked this ad
I am interested in this ad’s topic
I trust the information in this ad
This ad was confusing
This ad was convincing
This ad said something important to me
This ad grabbed my attention
I learned something new from this ad
I can do what this ad suggests
This ad was easy to understand
I would notice this ad if I saw/heard it
IF RESPONSE 4 OR 5 TO Q18G, ASK Q19. OTHERS SKIP TO INSTRUCTIONS
BEFORE Q20.
Q19.
You mentioned that this ad grabbed your attention. What makes it stand out? OPEN
ENDED……………… Continue
BEFORE THE NEXT AD IS EVALUATED, UNTIL THE LAST AD, SHOW: Now you will see
another ad to evaluate. Once again, even if an ad is from another community or city, please rate it
as if it were an ad from your local community. Please note that we would like your reaction to each
ad individually – we will not ask you to compare one ad to any other.
[ONLY ASK Q20 ONCE A WHOLE “CAMPAIGN” IS EVALUATED]
181
Campaign Summary Evaluation
Q20.
Considering the impact of these ads together, please indicate how much you agree or
disagree with each statement. SINGLE RESPONSE GRID FORMAT, RANDOMIZE LIST.
1
2
3
4
5
A
B
C
D
E
F
G
Strongly disagree…………………………………….…….
Somewhat disagree………………………………………..
Neither agree nor disagree……………………………….
Somewhat agree……………………………………………
Strongly agree………………………………………………
Continue
Continue
Continue
Continue
Continue
I trust the information in this set of ads.
This set of ads was convincing.
This set of ads grabbed my attention.
This set of ads told me something I didn’t already know.
The message about the health benefits of eating healthier meals and snacks in
this set of ads was persuasive.
This set of ads gave me good reasons to eat healthier meals and snacks.
This set of ads gave me good reasons to try to lose weight.
BEFORE THE SECOND CAMPAIGN SEQUENCE IS EVALUATED, SHOW: Now you will see
another series of ads to evaluate. Once again, even if an ad is from another community or city,
please rate it as if it were an ad from your local community.
182
INDIVIDUAL SPOT EVALUATIONS
EACH RESPONDENT WILL SEE A SET OF RANDOMLY CHOSEN INDIVIDUAL ADS. AFTER
EACH AD SHOWN, ASK Q22-Q29.
Q21.
ADS SHOWN – CODE, DO NOT DISPLAY, ADS SHOWN
SHOW: We would now like to show you a few more ads and then gather your reactions to them. If
you are watching a television or radio ad, please make sure the volume on your computer is turned
up, so that you may both see and hear the video or audio.
Once again, even if an ad is from another community or city, please rate it as if it were an ad from
your local community, and please rate the ads based on their content, not on the quality of the
video. Please note that we would like your reaction to each ad individually – we are not interested
in comparing any of the ads to one another.
Please click “Next” to continue.
NOTE: WHEN THE TV ADS ARE PRESENTED, PLEASE SHOW THE FOLLOWING MESSAGE
ABOVE THE SCREEN: This ad is a TV ad. Please be patient while the video loads; also note that
the video may stop to buffer from time to time. We do not expect buffering to continue for more
than 30 seconds. If you find that it is buffering too long, you can suspend the survey at any time
and return to this point in the survey simply by clicking on the original survey link.
And remember: even if an ad is from another community or city, please rate it as if it were an ad
from your local community.
NOTE: WHEN THE RADIO ADS ARE PRESENTED, PLEASE SHOW THE FOLLOWING
MESSAGE ABOVE THE SCREEN: This ad is a radio ad. Please be patient while the audio
loads; also note that the audio may stop to buffer from time to time. We do not expect buffering to
continue for more than 30 seconds. If you find that it is buffering too long, you can suspend the
survey at any time and return to this point in the survey simply by clicking on the original survey
link.
And remember: even if an ad is from another community or city, please rate it as if it were an ad
from your local community.
183
Questions for Each Ad
SHOW: Please answer the following questions about the ad you just viewed.
Q22.
If you saw or heard this message, would it get your attention? SINGLE RESPONSE, DO
NOT ROTATE
1
2
Yes………………………………………………………….
No…………………………………………………………..
Continue
Continue
Q23.
Why or why not? OPEN ENDED………………………………….………..
Continue
Q24.
Is this message believable? SINGLE RESPONSE, DO NOT ROTATE
1
2
Yes………………………………………………………….
No…………………………………………………………...
Continue
Continue
Q25.
Why or why not? OPEN ENDED………………………….…………………
Continue
Q26.
Did you think this ad would be effective to motivate you or someone else to eat healthier
meals and snacks to be healthier or lose weight?
Please use a scale from 1 to 5, where 1 is not at all effective and 5 is extremely effective.
SINGLE RESPONSE, DO NOT ROTATE
1
2
3
4
5
Q27.
Not at all effective…………………………………………
Somewhat ineffective.……………………….……………
Neither effective nor ineffective…………….……………
Somewhat effective………………………….……………
Extremely effective ……………………………………….
Continue
Continue
Continue
Continue
Continue
Who would you say this ad is trying to reach? Please check all that apply. MULTIPLE
RESPONSE, DO NOT ROTATE
1
2
3
You………………………………………………...………..
People like you…………………………………………….
Someone else……………………………………………...
Continue
Continue
Continue
184
Q28.
On a scale from 1 to 5, where 1 indicates that you strongly disagree, and 5 indicates that
you strongly agree, please indicate how much you agree or disagree with each of the
following statements about this advertisement. SINGLE RESPONSE GRID FORMAT,
RANDOMIZE LIST.
1
2
3
4
5
A
B
C
D
E
F
G
H
I
J
K
Strongly disagree………………………………………….
Somewhat disagree………………………………..……..
Neither agree nor disagree……………………………….
Somewhat agree…………………………………..………
Strongly agree……………………………………..………
Continue
Continue
Continue
Continue
Continue
Overall, I liked this ad
I am interested in this ad’s topic
I trust the information in this ad
This ad was confusing
This ad was convincing
This ad said something important to me
This ad grabbed my attention
I learned something new from this ad
I can do what this ad suggests
This ad was easy to understand
I would notice this ad if I saw/heard it
IF RESPONSE 4 OR 5 TO Q28G, ASK Q29. OTHERS SKIP TO INSTRUCTIONS AFTER
Q29.
Q29.
You mentioned that this ad grabbed your attention. What makes it stand out? OPEN
ENDED………………………………………………………………………… Continue
BEFORE THE NEXT AD IS EVALUATED, UNTIL THE LAST AD, SHOW: Now you will see
another ad to evaluate. Once again, even if an ad is from another community or city, please rate it
as if it were an ad from your local community. Please note that we would like your reaction to each
ad individually – we are not interested in comparing any of the ads to one another.
Pre-Post Questions
[Behavioral Intentions]
[CHECK S11. IF S11=1 (YES), ASK Q30. OTHERS SKIP TO Q30_2]
Q30.
Are you planning to stop drinking regular soft drinks (non-diet) or other sugary drinks within
the next 30 days? SINGLE RESPONSE, DO NOT ROTATE.
1
2
Yes………………………………………………………….. Continue
No……………………………………………………………. Continue
[IF Q30=1 SKIP TO Q30_2. IF Q30=2 CONTINUE TO Q30_1]
185
Q30_1. Are you planning to cut back on regular soft drinks (non-diet) or other sugary drinks within
the next 30 days? SINGLE RESPONSE, DO NOT ROTATE.
1
2
Yes………………………………………………………….. Continue
No……………………………………………………………. Continue
Q30_2. Are you planning to be more physically active within the next 30 days? SINGLE
RESPONSE, DO NOT ROTATE.
1
2
Yes………………………………………………………….
No………………………………………………..………….
Continue
Continue
Q30_3. Are you planning to eat healthier meals and snacks within the next 30 days? SINGLE
RESPONSE, DO NOT ROTATE.
1
2
Q31.
Yes……………………………………………….…………. Continue
No……………………………………………………………. Continue
Are you planning to do something about your weight within the next 30 days? SINGLE
RESPONSE, ROTATE 1-3.
1
2
3
4
Yes, I plan to try to lose weight…………………..……….
Yes, I plan to try to gain weight………………….……….
Yes, I plan to try to maintain my current weight..……….
No, I have no plans to do anything about my weight…...
Continue
Continue
Continue
Continue
[CHECK S11. IF S11=1 (YES), ASK Q32. OTHERS SKIP TO Q32_1]
Q32.
Overall, on a scale from 1 to 5, where 1 is not at all interested and 5 is extremely
interested, how interested are you in cutting back on regular soft drinks (non-diet) or other
sugary drinks? SINGLE RESPONSE, DO NOT ROTATE.
1
2
3
4
5
Not at all interested………………………………………
A little interested.…………………………………………
Somewhat interested……….……………………………
Very interested……………………………………………
Extremely interested ………………………………….…
Continue
Continue
Continue
Continue
Continue
Q32_1. Overall, on a scale from 1 to 5, where 1 is not at all interested and 5 is extremely
interested, how interested are you in trying to be more physically active? SINGLE
RESPONSE, DO NOT ROTATE.
1
2
3
4
5
Not at all interested………………………………………
A little interested.…………………………………………
Somewhat interested……….……………………………
Very interested……………………………………………
Extremely interested ………………………………….…
Continue
Continue
Continue
Continue
Continue
186
Q32_2. Overall, on a scale from 1 to 5, where 1 is not at all interested and 5 is extremely
interested, how interested are you in trying to eat healthier meals and snacks? SINGLE
RESPONSE, DO NOT ROTATE.
1
2
3
4
5
Not at all interested………………………………………
A little interested.…………………………………………
Somewhat interested……….……………………………
Very interested……………………………………………
Extremely interested ………………………………….…
Continue
Continue
Continue
Continue
Continue
[THERE IS NO Q33]
Q34.
Thinking about the next six months, how likely are you to…? Please use a scale from 1 to
5, where 1 is not at all likely and 5 is extremely likely. SINGLE RESPONSE GRID
FORMAT, RANDOMIZE LIST
1
2
3
4
5
A
B
C
Not at all likely………………………………….…………
Somewhat unlikely..…………………………...…………
Neither likely nor unlikely..………………………………
Somewhat likely..…………………………………………
Extremely likely ………………………………….……….
Continue
Continue
Continue
Continue
Continue
Look for more information on the health benefits of eating healthier meals and
snacks
Talk to a friend about the health benefits of eating healthier meals and snacks
Participate in community efforts to reduce obesity
[Self-Efficacy Questions]
Q35.
On a scale from 1 to 5, where 1 indicates that you strongly disagree and 5 indicates that
you strongly agree, please indicate how much you agree or disagree with each of these
statements. SINGLE RESPONSE GRID FORMAT, RANDOMIZE LIST
1
2
3
4
5
Strongly disagree………………………………………….
Somewhat disagree…………………………………...…..
Neither agree nor disagree……………………………….
Somewhat agree……………………………………...……
Strongly agree………………………………………………
Continue
Continue
Continue
Continue
Continue
A I feel as though I can make a difference regarding my risk for being overweight or
obese
B I am confident that I can protect myself from being overweight or obese
C There are many things I can do to protect myself from being overweight or obese
D Generally speaking, it is possible to reduce one’s risk for being overweight or obese
187
Q36.
On a scale from 1 to 5, where 1 indicates that you strongly disagree and 5 indicates that
you strongly agree, please indicate how much you agree or disagree with each of these
statements. SINGLE RESPONSE GRID FORMAT, RANDOMIZE LIST.
1
2
3
4
5
Strongly disagree……………………………………….….
Somewhat disagree………………………………………..
Neither agree nor disagree…………………………….….
Somewhat agree……………………………………………
Strongly agree………………………………………………
Continue
Continue
Continue
Continue
Continue
Eating healthier meals and snacks several times per week would…
A
…make me feel that I was doing something good for my health
B
…give me more energy and stamina
C
…help me prevent weight gain
D
…make life more stressful for me
E
…help me save money
F
… make me feel more comfortable with the way I look
G
…help me lose weight
H
…help me maintain a healthy weight
[Community Attitudes]
Q37.
1
2
3
Which of the following statements best describes how you think the problem of obesity
should be solved in your community? SINGLE RESPONSE, ROTATE 1-2.
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
188
CLASSIFICATION
SHOW: You’re almost done! These last few questions are for classification purposes only and will
be used for analyzing the results of the survey in total. They will not be identified with you
personally.
C1.
Has a healthcare professional ever told you that you are overweight or at risk for being
overweight? SINGLE RESPONSE, DO NOT ROTATE
1
2
3
C2.
Yes………………………………………………………….
No…………………………………………………………...
Don’t know / not sure ……………………………….…….
Continue
Continue
Continue
What is your current occupational status? Are you…? Please select the option that best
applies to you. SINGLE RESPONSE, DO NOT ROTATE.
1
2
3
4
5
6
7
8
10
C4.
Continue
Continue
Continue
Has anyone else in your household been identified by a health care professional as being
overweight or at risk for being overweight? SINGLE RESPONSE DO NOT ROTATE
1
2
3
C3.
Yes………………………………………………………….
No………………………………………………..………….
Don’t know / not sure ……………………….…………….
Employed full time……………...…………………..…….
Employed part time…………….…………………..…….
Unemployed…………………….………………..……….
Homemaker……………………..……………..………….
Student …………………………...…………..………..….
Retired ……………………………………..…………..….
Disabled …………………………….……..…………..….
Other (Please specify: ________)…....……………..….
Prefer not to answer……..………………..……..……….
Continue
Continue
Continue
Continue
Continue
Continue
Continue
Continue
Continue
What is your marital status? SINGLE RESPONSE, ROTATE 1-6.
1
2
3
4
5
6
8
Married ……………………………………….……………
Unmarried living with a partner……………….…………
Divorced …………………………………………..………
Widowed …………………………………………..………
Separated………………………………………….………
Single, never been married ………………………..……
Prefer not to answer……..………………………….…….
Continue
Continue
Continue
Continue
Continue
Continue
Continue
189
C5.
How many children (under age 18) live in your household?
1
2
C6.
Continue
Continue
What is your household’s total income from all sources before taxes? SINGLE
RESPONSE, DO NOT ROTATE
1
2
3
4
5
6
7
8
9
C7.
Enter number: [Numeric Response] …………………………….
Prefer not to answer [Check Box]……..………………………….
Under $20,000……..…………………………….………………….
$20,000 to $29,999 .…………………………….………………….
$30,000 to $39,999 .…………………………….………………….
$40,000 to $49,999 .…………………………….………………….
$50,000 to $74,999 .…………………………….………………….
$75,000 to $99,999 .…………………………….………………….
$100,000 to $199,999 .…………………………….………………
$200,000 or more.……………………..………….………………..
Prefer not to answer.…………………………….………………….
Continue
Continue
Continue
Continue
Continue
Continue
Continue
Continue
Continue
In the following list of items, please indicate which devices you currently use or own.
MULTIPLE RESPONSE, ROTATE LIST.
1
2
3
4
5
6
A desktop computer………………………………………………… Continue
A laptop computer………………………………………………...… Continue
A smartphone, such as an iPhone, BlackBerry, Android, Windows phone, etc.
………………………………………………………………………… Continue
A tablet, such as an iPad, Kindle Fire, Nook Color, Motorola Xoom, etc.
………………………………………………………………………… Continue
An iPod or other mp3 player ……………………………………..… Continue
None of these – EXCLUSIVE - ANCHOR
SHOW: That is the last question. Thank you for your time. Please click “OK” to confirm
your participation.
190
Attachment 2i: Screen Captures of Online Survey for Healthy Food for African American Audiences
Community Health Media Center – Testing Educational Campaign
Materials with African American and Hispanic Audiences
Screenshot – Online Survey Start Screen
191
{Note to reviewers: Only respondents who selected “yes” for screener QS11,“did you drink any regular soft drinks
(non-diet) or other sugary drinks,?” will be shown the following screen (Q1). Others will skip to Q1_2.}
Screenshot – Online Survey Question Q1
192
{Note to reviewers: Only respondents who selected “no” for Q1,“are you planning to stop drinking regular soft
drinks (non-diet) or other sugary drinks?,” will be shown the following screen (Q1_1). Others will skip to Q1_2.}
Screenshot - Online Survey Question Q1_1
193
Screenshot – Online Survey Question Q1_2
194
Screenshot - Online Survey Question Q1_3
195
Screenshot – Online Survey Question Q2
196
Screenshot – Online Survey Question Q3
197
Screenshot – Online Survey Question Q3_1
198
Screenshot – Online Survey Question Q3_2
199
Screenshot – Online Survey Question Q4
200
Screenshot – Online Survey Question 4_1
201
Screenshot – Online Survey Question Q4_2
202
{Note to reviewers: All respondents will be asked Q5. However, respondents who had selected “no” for screener
QS11, “did you drink any regular soft drinks (non-diet) or other sugary drinks?,” will not be shown the item in Q5
that asks “how interested are you in cutting back on regular soft drinks (non-diet) or other sugary drinks.”}
Screenshot – Online Survey Question Q5
203
{Note to reviewers: There is no Q6}
Screenshot – Online Survey Question Q7
204
Screenshot – Online Survey Question Q8
205
Screenshot – Online Survey Question Q9
206
Screenshot – Online Survey Question Q10
207
{Note to reviewers: At this point, some respondents will be shown a set of ads (TV, radio and/or print) that
correspond to a discrete campaign (randomly chosen). Others will be shown randomly chosen individual ads that
do not correspond to a discrete campaign. After each ad is shown, they will be asked Q12-Q19.}
Screenshot: Initial Screen for Ad Evaluations
208
{Note to reviewers: The screen below is a sample of the screen respondents will see when viewing each ad. The
questions they will be asked for each ad will be the same, regardless of the ad they see.}
Screenshot: Sample Screen of Ad Presentation
209
Screenshot: Ad Survey Question Introduction Page
210
Screenshot – Online Survey Question Q12
211
Screenshot – Online Survey Question Q13
212
Screenshot – Online Survey Question Q14
213
Screenshot – Online Survey Question Q15
214
Screenshot – Online Survey Question Q16
215
Screenshot – Online Survey Question Q17
216
Screenshot – Online Survey Question Q18
217
{Note to reviewers: Only respondents who selected “somewhat agree” or “strongly agree” on Q18 for the item
“This ad grabbed my attention,” will be shown the question below (Q19). Others will skip to next ad or, if
appropriate, will be shown Q20.}
Screenshot – Online Survey Question Q19
218
Screenshot: Transition Page before Each Ad
219
{Note to reviewers: Q20 below will only be shown if respondents have evaluated individual ads that together
comprise a campaign.}
Screenshot – Online Survey Question Q20
220
{Note to reviewers: At this point, respondents who were being shown individual
ads corresponding to a discrete campaign, will begin seeing a set of randomly
chosen individual ads (TV, radio, and/or print) that do not correspond to a
campaign. Those who were already being shown individual ads not
corresponding to a campaign, will continue to be shown individual spots. After
each ad is shown, they will be asked Q22-29 (which are the same as Q12-Q19,
presented above). Respondents will then see the questions that follow.}
221
{Note to reviewers: Only respondents who selected “yes” for screener QS11, “did you drink any regular soft drinks
(non-diet) or other sugary drinks?,” will be shown the following screen (Q30). Others will skip to Q30_2.}
Screenshot – Online Survey Question Q30
222
{Note to reviewers: Only respondents who selected “no” for Q30, “are you planning to stop drinking regular soft
drinks (non-diet) or other sugary drinks?,” will be shown the following screen (Q30_1). Others will skip to Q30_2.}
Screenshot – Online Survey Question Q30_1
223
Screenshot – Online Survey Question Q30_2
224
Screenshot – Online Survey Question Q30_3
225
Screenshot – Online Survey Question Q31
226
{Note to reviewers: Only respondents who selected “yes” for screener QS11, “did you drink any regular soft drinks
(non-diet) or other sugary drinks?,” will be shown the following screen (Q32). Those who responded “no” to QS11
on the screener will skip to Q32_1.}
Screenshot – Online Survey Question Q32
227
Screenshot – Online Survey Question Q32_1
228
Screenshot – Online Survey Question Q32_2
229
{Note to reviewers: There is no Q33}
Screenshot – Online Survey Question Q34
230
Screenshot – Online Survey Question Q35
231
Screenshot – Online Survey Question Q36
232
Screenshot – Online Survey Question Q37
233
Screenshot: Initial Screen for Classification Questions
234
Screenshot – Online Survey Question C1
235
Screenshot – Online Survey Question C2
236
Screenshot – Online Survey Question C3
237
Screenshot – Online Survey Question C4
238
Screenshot – Online Survey Question C5
239
Screenshot – Online Survey Question C6
240
Screenshot – Online Survey Question C7
241
Screenshot – Survey End Page
242
Form Approved
OMB No. 0920-0572
Expiration Date: 2/28/2015
Attachment 2j: Online Survey for Healthy Living
for African American Audiences
Community Health Media Center – Testing Educational Campaign
Materials with African American and Hispanic Audiences
Introduction
SHOW: About this online survey: Thank you for answering these questions. You are qualified to
participate in this online survey, which is being conducted on behalf of the Centers for Disease
Control and Prevention, sometimes referred to as CDC, in Atlanta. The online survey will take
about 22 minutes to complete. In this online survey, you are going to be shown sample
advertisements and asked to share your honest opinions about them.
Your responses will be entered into a database and will only be seen by researchers associated
with this online survey. Your answers will be kept secure to the extent permitted by law. There will
be no risk to you. You may stop at any time. You will receive your gift, as it is explained in your
online survey invitation, after completing the online survey.
If you have any questions about this online survey or about your rights as an online survey
participant, please email them to StudyInfo@fhi360.org.
By clicking 'Next,' I am agreeing to the above project description.
Public Reporting Burden Statement
Public reporting burden of this collection of information is estimated to average 22 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).
243
[BACKGROUND HEALTH BEHAVIORS AND ATTITUDES]
[Contemplation and Behavioral Intentions]
Pre-Post Questions
[CHECK S11. IF S11=1 (YES), ASK Q1. OTHERS SKIP TO Q1_2]
Q1.
Are you planning to stop drinking regular soft drinks (non-diet) or other sugary drinks within
the next 30 days? SINGLE RESPONSE, DO NOT ROTATE.
1
2
Yes…………………………………………………………... Continue
No……………………………………………………………. Continue
[IF Q1=1 SKIP TO Q1_2. IF Q1=2 CONTINUE TO Q1_1]
Q1_1. Are you planning to cut back on regular soft drinks (non-diet) or other sugary drinks within
the next 30 days? SINGLE RESPONSE, DO NOT ROTATE.
1
2
Yes………………………………………………………….. Continue
No……………………………………………………………. Continue
Q1_2. Are you planning to be more physically active within the next 30 days? SINGLE
RESPONSE, DO NOT ROTATE.
1
2
Yes………………………………………………………….. Continue
No……………………………………………………………. Continue
Q1_3. Are you planning to eat healthier meals and snacks within the next 30 days? SINGLE
RESPONSE, DO NOT ROTATE.
1
2
Q2.
Yes………………………………………………………….
No………………………………………………………..….
Continue
Continue
Are you planning to do something about your weight within the next 30 days? SINGLE
RESPONSE, ROTATE 1-3.
1
2
3
4
Yes, I plan to try to lose weight………………………….
Yes, I plan to try to gain weight………………………….
Yes, I plan to try to maintain my current weight……….
No, I have no plans to do anything about my weight….
Continue
Continue
Continue
Continue
244
Q3.
During the past 12 months, did you try to cut back on regular soft drinks (non-diet) or
other sugary drinks? SINGLE RESPONSE, DO NOT ROTATE.
1
2
Yes…………………………………………………………..
No……………………………………………………………
Continue
Continue
Q3_1. During the past 12 months, did you try to be more physically active? SINGLE
RESPONSE, DO NOT ROTATE.
1
2
Yes…………………………………………………………..
No……………………………………………………………
Continue
Continue
Q3_2. During the past 12 months, did you try to eat healthier meals and snacks? SINGLE
RESPONSE, DO NOT ROTATE.
1
2
Q4.
Yes………………………………………………………….. Continue
No………………………………………………………….... Continue
In the past year, have you tried to do any of the following? MULTIPLE RESPONSE, DO
NOT ROTATE.
1
2
3
Lose weight…………………………………………………. Continue
Gain weight……………………………………………...…. Continue
Maintain your current weight……………………………... Continue
Q4_1. Compared to a year ago, do you weigh…? SINGLE RESPONSE, DO NOT ROTATE.
1
2
3
Less……………………………………….………………..
More………………………………………………………...
About the same…………………………………………….
Continue
Continue
Continue
Q4_2. And compared to a year ago, would you say that you are…? SINGLE RESPONSE, DO
NOT ROTATE.
1
2
3
More healthy……………………………………………….
Less healthy………………………………………………..
About the same ……………………………………………
Continue
Continue
Continue
245
Q5.
Overall, on a scale from 1 to 5, where 1 is not at all interested and 5 is extremely
interested, how interested are you in…? SINGLE RESPONSE GRID FORMAT,
RANDOMIZE LIST.
[CHECK S11. IF S11=1 (YES), INSERT A. INSERT B AND C FOR ALL PERSONS]
1
2
3
4
5
A
B
C
Not at all interested………………………………………
A little interested.…………………………………………
Somewhat interested……….……………………………
Very interested……………………………………………
Extremely interested ………………………………….…
Continue
Continue
Continue
Continue
Continue
Cutting back on regular soft drinks (non-diet) or other sugary drinks
Being more physically active
Eating healthier meals and snacks
[THERE IS NO Q6.]
Q7.
Thinking about the next six months, how likely are you to…? Please use a scale from 1 to
5, where 1 is not at all likely and 5 is extremely likely. SINGLE RESPONSE GRID
FORMAT, ROTATE A-C AND D-F.
1
2
3
4
5
A
B
C
D
E
F
G
Not at all likely……………………………………………
Somewhat unlikely..……………………………………..
Neither likely nor unlikely..………………………………
Somewhat likely..…………………………………………
Extremely likely ………………………………………….
Continue
Continue
Continue
Continue
Continue
Look for more information on the health benefits of cutting back on regular soft
drinks (non-diet) or other sugary drinks
Look for more information on the health benefits of being more physically active
Look for more information on the health benefits of eating healthier meals and
snacks
Talk to a friend about the health benefits of cutting back on regular soft drinks
(non-diet) or other sugary drinks
Talk to a friend about the health benefits of being more physically active
Talk to a friend about the health benefits of eating healthier meals and snacks
Participate in community efforts to reduce obesity
246
[Self-Efficacy Questions]
Q8.
On a scale from 1 to 5, where 1 indicates that you strongly disagree and 5 indicates that
you strongly agree, please indicate how much you agree or disagree with each of these
statements. SINGLE RESPONSE GRID FORMAT, RANDOMIZE LIST.
1
2
3
4
5
Strongly disagree………………………………………….
Somewhat disagree………………………………………..
Neither agree nor disagree……………………………….
Somewhat agree……………………………………………
Strongly agree………………………………………………
Continue
Continue
Continue
Continue
Continue
A I feel as though I can make a difference regarding my risk for being overweight or
obese
B I am confident that I can protect myself from being overweight or obese
C There are many things I can do to protect myself from being overweight or obese
D Generally speaking, it is possible to reduce one’s risk for being overweight or obese
[Behavioral Beliefs]
Q9.
On a scale from 1 to 5, where 1 indicates that you strongly disagree and 5 indicates that
you strongly agree, please indicate how much you agree or disagree with each of these
statements. SINGLE RESPONSE GRID FORMAT, RANDOMIZE LIST.
1
2
3
4
5
Strongly disagree………………………………………….
Somewhat disagree………………………………………..
Neither agree nor disagree……………………………….
Somewhat agree……………………………………………
Strongly agree………………………………………………
Continue
Continue
Continue
Continue
Continue
Eliminating regular soft drinks (non-diet) and other sugary drinks during meals every day
would…
A
…make me feel that I was doing something good for my health
B
…make eating meals less enjoyable for me
C
…help me prevent weight gain
D
…make life more stressful for me
E
…help me save money
F
…make it easier for me to drink milk or water at mealtimes
G
…help me lose weight
H
…help me maintain a healthy weight
Q9_1. On a scale from 1 to 5, where 1 indicates that you strongly disagree and 5 indicates that
you strongly agree, please indicate how much you agree or disagree with each of these
statements. SINGLE RESPONSE GRID FORMAT, RANDOMIZE LIST.
1
2
3
Strongly disagree………………………………………….
Somewhat disagree………………………………………..
Neither agree nor disagree……………………………….
Continue
Continue
Continue
247
4
5
Somewhat agree…………………………………………… Continue
Strongly agree……………………………………………… Continue
Being more physically active several times per week would…
A
…make me feel that I was doing something good for my health
B
…give me more energy and stamina
C
…help me prevent weight gain
D
…make life more stressful for me
E
…help me save money
F
… make me feel more comfortable with the way I look
G
…help me lose weight
H
…help me maintain a healthy weight
Q9_2. On a scale from 1 to 5, where 1 indicates that you strongly disagree and 5 indicates that
you strongly agree, please indicate how much you agree or disagree with each of these
statements. SINGLE RESPONSE GRID FORMAT, RANDOMIZE LIST.
1
2
3
4
5
Strongly disagree………………………………………….
Somewhat disagree………………………………………..
Neither agree nor disagree……………………………….
Somewhat agree……………………………………………
Strongly agree………………………………………………
Continue
Continue
Continue
Continue
Continue
Eating healthier meals and snacks several times per week would…
A
…make me feel that I was doing something good for my health
B
… give me more energy and stamina
C
…help me prevent weight gain
D
…make life more stressful for me
E
…help me save money
F
… make me feel more comfortable with the way I look
G
…help me lose weight
H
…help me maintain a healthy weight
[Community Attitudes]
Q10.
1
2
3
Which of the following statements best describes how you think the problem of obesity
should be solved in your community? SINGLE RESPONSE, ROTATE 1-2.
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
248
CAMPAIGN EVALUATIONS
MOST RESPONDENTS WILL FIRST SEE A SET OF ADS THAT CORRESPOND TO A
DISCRETE CAMPAIGN (RANDOMLY CHOSEN). AFTER EACH AD SHOWN, ASK Q12-Q19.
AFTER THE ENTIRE CAMPAIGN IS SHOWN, ASK Q20.
Q11.
CAMPAIGNSHOWN – CODE, DO NOT DISPLAY, FIRST
SHOW: Now we would like to show you a few different health-related ads, including a television,
print, and/or radio ad, and then ask you to evaluate each ad. Even if an ad is from another
community or city, please rate it as if it were an ad from your local community. Also, please note
that the video quality of these ads may vary – please rate them based on the content of the ads,
not on the quality of the video.
Please make sure the volume on your computer is turned up, so that you may both see and/or hear
the TV and radio ads.
Please click “Next” to continue.
NOTE: WHEN THE TV ADS ARE PRESENTED, PLEASE SHOW THE FOLLOWING MESSAGE
ABOVE THE SCREEN: This ad is a TV ad. Please be patient while the video loads; also note that
the video may stop to buffer from time to time. We do not expect buffering to continue for more
than 30 seconds. If you find that it is buffering too long, you can suspend the survey at any time
and return to this point in the survey simply by clicking on the original survey link.
And remember: even if an ad is from another community or city, please rate it as if it were an ad
from your local community.
NOTE: WHEN THE RADIO ADS ARE PRESENTED, PLEASE SHOW THE FOLLOWING
MESSAGE ABOVE THE SCREEN: This ad is a radio ad. Please be patient while the audio
loads; also note that the audio may stop to buffer from time to time. We do not expect buffering to
continue for more than 30 seconds. If you find that it is buffering too long, you can suspend the
survey at any time and return to this point in the survey simply by clicking on the original survey
link.
And remember: even if an ad is from another community or city, please rate it as if it were an ad
from your local community.
249
Questions for Each Ad
SHOW: Please answer the following questions about the ad you just viewed.
Q12.
If you saw or heard this message, would it get your attention? SINGLE RESPONSE, DO
NOT ROTATE.
1
2
Yes………………………………………………………….. Continue
No……………………………………………………………. Continue
Q13.
Why or why not? OPEN ENDED…………………………………………….. Continue
Q14.
Is this message believable? SINGLE RESPONSE, DO NOT ROTATE.
1
2
Yes………………………………………………………….. Continue
No……………………………………………………………. Continue
Q15.
Why or why not? OPEN ENDED…………………………………………….. Continue
Q16.
Did you think this ad would be effective to motivate you or someone else to…? SINGLE
RESPONSE GRID FORMAT, RANDOMIZE LIST.
Please use a scale from 1 to 5, where 1 is not at all effective and 5 is extremely effective.
1
2
3
4
5
A
B
C
Q17.
Not at all effective…………………………………………
Somewhat ineffective.……………………………………
Neither effective nor ineffective…………………………
Somewhat effective………………………………………
Extremely effective ……………………………………….
Continue
Continue
Continue
Continue
Continue
Cut back on regular soft drinks (non-diet) or other sugary drinks
Be more physically active
Eat healthier meals and snacks
Who would you say this ad is trying to reach? Please check all that apply. MULTIPLE
RESPONSE, DO NOT ROTATE.
1
2
3
You……………………………………..…………………..
People like you………………………………..………….
Someone else……………………………………..……..
Continue
Continue
Continue
250
Q18.
On a scale from 1 to 5, where 1 indicates that you strongly disagree, and 5 indicates that
you strongly agree, please indicate how much you agree or disagree with each of the
following statements about this advertisement. SINGLE RESPONSE GRID FORMAT,
RANDOMIZE LIST.
1
2
3
4
5
A
B
C
D
E
F
G
H
I
J
K
Strongly disagree………………………………………….
Somewhat disagree………………………………………..
Neither agree nor disagree……………………………….
Somewhat agree……………………………………………
Strongly agree………………………………………………
Continue
Continue
Continue
Continue
Continue
Overall, I liked this ad
I am interested in this ad’s topic
I trust the information in this ad
This ad was confusing
This ad was convincing
This ad said something important to me
This ad grabbed my attention
I learned something new from this ad
I can do what this ad suggests
This ad was easy to understand
I would notice this ad if I saw/heard it
IF RESPONSE 4 OR 5 TO Q18G, ASK Q19. OTHERS SKIP TO INSTRUCTIONS
BEFORE Q20.
Q19. You mentioned that this ad grabbed your attention. What makes it stand out? OPEN
ENDED…………………………………. Continue
BEFORE THE NEXT AD IS EVALUATED, UNTIL THE LAST AD, SHOW: Now you will see
another ad to evaluate. Once again, even if an ad is from another community or city, please rate it
as if it were an ad from your local community. Please note that we would like your reaction to each
ad individually – we will not ask you to compare one ad to any other.
[ONLY ASK Q20 ONCE A WHOLE “CAMPAIGN” IS EVALUATED]
251
Campaign Summary Evaluation
Q20.
Considering the impact of these ads together, please indicate how much you agree or
disagree with each statement. SINGLE RESPONSE GRID FORMAT, RANDOMIZE LIST.
1
2
3
4
5
A
B
C
D
E
F
G
H
I
J
K
L
Strongly disagree………………………………………….
Somewhat disagree………………………………………..
Neither agree nor disagree……………………………….
Somewhat agree……………………………………………
Strongly agree………………………………………………
Continue
Continue
Continue
Continue
Continue
I trust the information in this set of ads.
This set of ads was convincing.
This set of ads grabbed my attention.
This set of ads told me something I didn’t already know.
THERE IS NO E
The message about the health benefits of being more physically active in this set
of ads was persuasive.
The message about the health benefits of eating healthier meals and snacks in
this set of ads was persuasive.
This set of ads gave me good reasons to cut back on regular soft drinks (non-diet)
or other sugary drinks.
This set of ads gave me good reasons to stop drinking regular soft drinks (nondiet) or other sugary drinks.
This set of ads gave me good reasons to be more physically active.
This set of ads gave me good reasons to eat healthier meals and snacks.
This set of ads gave me good reasons to try to lose weight.
252
INDIVIDUAL SPOT EVALUATIONS
EACH RESPONDENT WILL SEE A SET OF RANDOMLY CHOSEN INDIVIDUAL ADS. AFTER
EACH AD SHOWN, ASK Q22-Q29.
Q21.
ADS SHOWN – CODE, DO NOT DISPLAY, ADS SHOWN
SHOW: We would now like to show you a few more ads and then gather your reactions to them. If
you are watching a television or radio ad, please make sure the volume on your computer is turned
up, so that you may both see and hear the video or audio.
Once again, even if an ad is from another community or city, please rate it as if it were an ad from
your local community, and please rate the ads based on their content, not on the quality of the
video. Please note that we would like your reaction to each ad individually – we are not interested
in comparing any of the ads to one another.
Please click “Next” to continue.
NOTE: WHEN THE TV ADS ARE PRESENTED, PLEASE SHOW THE FOLLOWING MESSAGE
ABOVE THE SCREEN: This ad is a TV ad. Please be patient while the video loads; also note that
the video may stop to buffer from time to time. We do not expect buffering to continue for more
than 30 seconds. If you find that it is buffering too long, you can suspend the survey at any time
and return to this point in the survey simply by clicking on the original survey link.
And remember: even if an ad is from another community or city, please rate it as if it were an ad
from your local community.
NOTE: WHEN THE RADIO ADS ARE PRESENTED, PLEASE SHOW THE FOLLOWING
MESSAGE ABOVE THE SCREEN: This ad is a radio ad. Please be patient while the audio
loads; also note that the audio may stop to buffer from time to time. We do not expect buffering to
continue for more than 30 seconds. If you find that it is buffering too long, you can suspend the
survey at any time and return to this point in the survey simply by clicking on the original survey
link.
And remember: even if an ad is from another community or city, please rate it as if it were an ad
from your local community.
253
Questions for Each Ad
SHOW: Please answer the following questions about the ad you just viewed.
Q22.
If you saw or heard this message, would it get your attention? SINGLE RESPONSE, DO
NOT ROTATE
1
2
Yes……………………………………………………..……
No…………………………………………………….……..
Continue
Continue
Q23.
Why or why not? OPEN ENDED……………………………………..……..
Continue
Q24.
Is this message believable? SINGLE RESPONSE, DO NOT ROTATE
1
2
Yes………………………………………………………….
No…………………………………………………………...
Continue
Continue
Q25.
Why or why not? OPEN ENDED……………………………………………
Continue
Q26.
Did you think this ad would be effective to motivate you or someone else to…?
Please use a scale from 1 to 5, where 1 is not at all effective and 5 is extremely effective.
SINGLE RESPONSE GRID FORMAT, RANDOMIZE LIST.
1
2
3
4
5
Not at all effective…………………………………………
Somewhat ineffective.……………………………………
Neither effective nor ineffective…………………………
Somewhat effective………………………………………
Extremely effective ……………………………………….
Continue
Continue
Continue
Continue
Continue
A Cut back on regular soft drinks (non-diet) or other sugary drinks
B Be more physically active
C Eat healthier meals and snacks
Q27.
Who would you say this ad is trying to reach? Please check all that apply. SINGLE
RESPONSE, DO NOT ROTATE
1
2
3
You………………………………………………...………..
People like you…………………………………………….
Someone else……………………………………………...
Continue
Continue
Continue
254
Q28.
On a scale from 1 to 5, where 1 indicates that you strongly disagree, and 5 indicates that
you strongly agree, please indicate how much you agree or disagree with each of the
following statements about this advertisement. SINGLE RESPONSE GRID FORMAT,
RANDOMIZE LIST.
1
2
3
4
5
A
B
C
D
E
F
G
H
I
J
K
Strongly disagree…………………………………………..
Somewhat disagree………………………………………..
Neither agree nor disagree……………………………….
Somewhat agree……………………………………………
Strongly agree………………………………………………
Continue
Continue
Continue
Continue
Continue
Overall, I liked this ad
I am interested in this ad’s topic
I trust the information in this ad
This ad was confusing
This ad was convincing
This ad said something important to me
This ad grabbed my attention
I learned something new from this ad
I can do what this ad suggests
This ad was easy to understand
I would notice this ad if I saw/heard it
IF RESPONSE 4 OR 5 TO Q28G, ASK Q29. OTHERS SKIP TO INSTRUCTIONS AFTER
Q29.
Q29.
You mentioned that this ad grabbed your attention. What makes it stand out? OPEN
ENDED………………………………………………………………………… Continue
BEFORE THE NEXT AD IS EVALUATED, UNTIL THE LAST AD, SHOW: Now you will see
another ad to evaluate. Once again, even if an ad is from another community or city, please rate it
as if it were an ad from your local community. Please note that we would like your reaction to each
ad individually – we are not interested in comparing any of the ads to one another.
255
Summary Evaluation
Q29_1. Considering the impact of these ads together, please indicate how much you agree or
disagree with each statement. SINGLE RESPONSE GRID FORMAT, RANDOMIZE LIST.
1
2
3
4
5
A
B
C
D
E
F
G
H
I
J
K
L
Strongly disagree………………………………………….
Somewhat disagree………………………………………..
Neither agree nor disagree……………………………….
Somewhat agree……………………………………………
Strongly agree………………………………………………
Continue
Continue
Continue
Continue
Continue
I trust the information in this set of ads.
This set of ads was convincing.
This set of ads grabbed my attention.
This set of ads told me something I didn’t already know.
THERE IS NO E
The message about the health benefits of being more physically active in this set
of ads was persuasive.
The message about the health benefits of eating healthier meals and snacks in
this set of ads was persuasive.
This set of ads gave me good reasons to cut back on regular soft drinks (non-diet)
or other sugary drinks.
This set of ads gave me good reasons to stop drinking regular soft drinks (nondiet) or other sugary drinks.
This set of ads gave me good reasons to be more physically active.
This set of ads gave me good reasons to eat healthier meals and snacks.
This set of ads gave me good reasons to try to lose weight.
256
Pre-Post Questions
[Behavioral Intentions]
[CHECK S11. IF S11=1 (YES), ASK Q30. OTHERS SKIP TO Q30_2]
Q30.
Are you planning to stop drinking regular soft drinks (non-diet) or other sugary drinks within
the next 30 days? SINGLE RESPONSE, DO NOT ROTATE.
1
2
Yes………………………………………………………..
No………………………………………………………….
Continue
Continue
[IF Q30=1 SKIP TO Q30_2. IF Q30=2 CONTINUE TO Q30_1]
Q30_1. Are you planning to cut back on regular soft drinks (non-diet) or other sugary drinks within
the next 30 days? SINGLE RESPONSE, DO NOT ROTATE.
1
2
Yes………………………………………………………….
No…………………………………………………………...
Continue
Continue
Q30_2. Are you planning to be more physically active within the next 30 days? SINGLE
RESPONSE, DO NOT ROTATE.
1
2
Yes………………………………………………………….
No………………………………………………………..….
Continue
Continue
Q30_3. Are you planning to eat healthier meals and snacks within the next 30 days? SINGLE
RESPONSE, DO NOT ROTATE.
1
2
Q31.
Yes………………………………………………………….
No…………………………………………………………...
Continue
Continue
Are you planning to do something about your weight within the next 30 days? SINGLE
RESPONSE, ROTATE 1-3.
1
2
3
4
Yes, I plan to try to lose weight………………………….
Yes, I plan to try to gain weight…………………………
Yes, I plan to try to maintain my current weight……….
No, I have no plans to do anything about my weight..….
Continue
Continue
Continue
Continue
[CHECK S11. IF S11=1 (YES), ASK Q32. OTHERS SKIP TO INSTRUCTIONS BEFORE
Q32_1]
257
Q32.
Overall, on a scale from 1 to 5, where 1 is not at all interested and 5 is extremely
interested, how interested are you in cutting back on regular soft drinks (non-diet) or other
sugary drinks? SINGLE RESPONSE, DO NOT ROTATE.
1
2
3
4
5
Not at all interested………………………………………
A little interested.…………………………………………
Somewhat interested……….……………………………
Very interested……………………………………………
Extremely interested ………………………………….…
Continue
Continue
Continue
Continue
Continue
Q32_1 Overall, on a scale from 1 to 5, where 1 is not at all interested and 5 is extremely
interested, how interested are you in trying to be more physically active? SINGLE
RESPONSE, DO NOT ROTATE.
1
2
3
4
5
Not at all interested………………………………………
A little interested.…………………………………………
Somewhat interested……….……………………………
Very interested……………………………………………
Extremely interested ………………………………….…
Continue
Continue
Continue
Continue
Continue
Q32_2 Overall, on a scale from 1 to 5, where 1 is not at all interested and 5 is extremely interested,
how interested are you in trying to eat healthier meals and snacks? SINGLE RESPONSE,
DO NOT ROTATE.
1
2
3
4
5
Not at all interested………………………………………
A little interested.…………………………………………
Somewhat interested…….………………………………
Very interested……………………………………………
Extremely interested ………………………………….…
Continue
Continue
Continue
Continue
Continue
[THERE IS NO Q33]
258
Q34.
Thinking about the next six months, how likely are you to…? Please use a scale from 1 to
5, where 1 is not at all likely and 5 is extremely likely. SINGLE RESPONSE GRID
FORMAT ROTATE A-C AND D-F.
1
2
3
4
5
A
B
C
D
E
F
G
Not at all likely………………………………………….…
Somewhat unlikely..………………………………………
Neither likely nor unlikely.…..………………………….…
Somewhat likely..…………..………………………….…..
Extremely likely ………….………………………………..
Continue
Continue
Continue
Continue
Continue
Look for more information on the health benefits of cutting back on regular soft
drinks (non-diet) or other sugary drinks
Look for more information on the health benefits of being more physically active
Look for more information on the health benefits of eating healthier meals and
snacks
Talk to a friend about the health benefits of cutting back on regular soft drinks
(non-diet) or other sugary drinks
Talk to a friend about the health benefits of being more physically active
Talk to a friend about the health benefits of eating healthier meals and snacks
Participate in community efforts to reduce obesity
[Self-Efficacy Questions]
Q35.
On a scale from 1 to 5, where 1 indicates that you strongly disagree and 5 indicates that
you strongly agree, please indicate how much you agree or disagree with each of these
statements. SINGLE RESPONSE GRID FORMAT, RANDOMIZE LIST.
Continue
1
Strongly disagree………………………………..……….
2
Somewhat disagree……………………………….……..
Continue
3
Neither agree nor disagree………………………..…….
Continue
4
Somewhat agree…………………………………….…… Continue
5
Strongly agree……………………………………….……
Continue
A I feel as though I can make a difference regarding my risk for being overweight or
obese
B I am confident that I can protect myself from being overweight or obese
C There are many things I can do to protect myself from being overweight or obese
D Generally speaking, it is possible to reduce one’s risk for being overweight or obese
259
Q36.
On a scale from 1 to 5, where 1 indicates that you strongly disagree and 5 indicates that
you strongly agree, please indicate how much you agree or disagree with each of these
statements. SINGLE RESPONSE GRID FORMAT, RANDOMIZE LIST.
1
2
3
4
5
Strongly disagree…………………………………………
Somewhat disagree………………………………………
Neither agree nor disagree……………………………...
Somewhat agree……………………………………….…
Strongly agree………………………………………….…
Continue
Continue
Continue
Continue
Continue
Eliminating regular soft drinks (non-diet) and other sugary drinks during meals every day
would…
A
…make me feel that I was doing something good for my health
B
…make eating meals less enjoyable for me
C
…help me prevent weight gain
D
…make life more stressful for me
E
…help me save money
F
…make it easier for me to drink milk or water at mealtimes
G
…help me lose weight
H
…help me maintain a healthy weight
Q36_1. On a scale from 1 to 5, where 1 indicates that you strongly disagree and 5 indicates that
you strongly agree, please indicate how much you agree or disagree with each of these
statements.
SINGLE RESPONSE GRID FORMAT, RANDOMIZE LIST.
1
2
3
4
5
Strongly disagree………………………………………...
Somewhat disagree……………………………………...
Neither agree nor disagree………………………………
Somewhat agree……………………………………….…
Strongly agree…………………………………………..…
Continue
Continue
Continue
Continue
Continue
Being more physically active several times per week would…
A
…make me feel that I was doing something good for my health
B
…give me more energy and stamina
C
…help me prevent weight gain
D
…make life more stressful for me
E
…help me save money
F
… make me feel more comfortable with the way I look
G
…help me lose weight
H
…help me maintain a healthy weight
260
Q36_2. On a scale from 1 to 5, where 1 indicates that you strongly disagree and 5 indicates that
you strongly agree, please indicate how much you agree or disagree with each of these
statements. SINGLE RESPONSE GRID FORMAT, RANDOMIZE LIST.
1
2
3
4
5
Strongly disagree…………………………………………
Somewhat disagree………………………………………
Neither agree nor disagree……………………………...
Somewhat agree……………………………………….…
Strongly agree………………………………………….…
Continue
Continue
Continue
Continue
Continue
Eating healthier meals and snacks several times per week would…
A
…make me feel that I was doing something good for my health
B
…give me more energy and stamina
C
…help me prevent weight gain
D
…make life more stressful for me
E
…help me save money
F
… make me feel more comfortable with the way I look
G
…help me lose weight
H
…help me maintain a healthy weight
[Community Attitudes]
Q37.
Which of the following statements best describes how you think the problem of obesity
should be solved in your community? SINGLE RESPONSE, ROTATE 1-2.
1 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
2 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
3 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
261
CLASSIFICATION
SHOW: You’re almost done! These last few questions are for classification purposes only and will
be used for analyzing the results of the survey in total. They will not be identified with you
personally.
C1.
Has a healthcare professional ever told you that you are overweight or at risk for being
overweight? SINGLE RESPONSE, DO NOT ROTATE
1
2
3
C2.
Yes……………………………………………………………....
No………………………………………………………………..
Don’t know / not sure ………………………………………....
Continue
Continue
Continue
What is your current occupational status? Are you…? Please select the option that best
applies to you. SINGLE RESPONSE, DO NOT ROTATE.
1
2
3
4
5
6
7
8
10
C4.
Continue
Continue
Continue
Has anyone else in your household been identified by a health care professional as being
overweight or at risk for being overweight? SINGLE RESPONSE DO NOT ROTATE
1
2
3
C3.
Yes…………………………………………………….…………
No……………………………………………………....………..
Don’t know / not sure ……………………………………........
Employed full time…………………………………………….
Employed part time……………………………………………
Unemployed…………………………………………………....
Homemaker………………………………………………. …...
Student ……………………………………………………..…..
Retired ………………………………………………..…….......
Disabled …………………………………………………..…….
Other (Please specify: _________)………………….……….
Prefer not to answer……..…………………………………..…
Continue
Continue
Continue
Continue
Continue
Continue
Continue
Continue
Continue
What is your marital status? SINGLE RESPONSE, ROTATE 1-6.
1
2
3
4
5
6
8
Married ………………………………………………………..…
Unmarried living with a partner……………………………..…
Divorced …………………………………………..……………
Widowed ………………………………………….……………
Separated…………………………………………..…………..
Single, never been married ………………………..…………
Prefer not to answer……..……………………………..……...
Continue
Continue
Continue
Continue
Continue
Continue
Continue
262
C5.
How many children (under age 18) live in your household?
1
2
C6.
What is your household’s total income from all sources before taxes? SINGLE
RESPONSE, DO NOT ROTATE
1
2
3
4
5
6
7
8
9
C7.
Enter number: [Numeric Response] …………………………….. Continue
Prefer not to answer [Check Box]……..………………………….. Continue
Under $20,000……..…………………………….………………….
$20,000 to $29,999 .…………………………….……………….....
$30,000 to $39,999 .…………………………….………………….
$40,000 to $49,999 .…………………………….……………….....
$50,000 to $74,999 .…………………………….………………….
$75,000 to $99,999 .…………………………….………………….
$100,000 to $199,999 .…………………………….………… …....
$200,000 or more.……………………..………….………………...
Prefer not to answer.…………………………….………………….
Continue
Continue
Continue
Continue
Continue
Continue
Continue
Continue
Continue
In the following list of items, please indicate which devices you currently use or own.
MULTIPLE RESPONSE, ROTATE LIST.
1
2
3
4
5
6
A desktop computer………………………………………………… Continue
A laptop computer…………………………………………………... Continue
A smartphone, such as an iPhone, BlackBerry, Android, Windows phone, etc.
…………………………………………………………….………….. Continue
A tablet, such as an iPad, Kindle Fire, Nook Color, Motorola Xoom, etc.
………………………………………………………………………… Continue
An iPod or other mp3 player …………………………………….… Continue
None of these – EXCLUSIVE - ANCHOR
SHOW: That is the last question. Thank you for your time. Please click “OK” to confirm
your participation.
263
Attachment 2k: Screen Captures of Online Survey for Healthy Living for African American Audiences
Community Health Media Center – Testing Educational Campaign
Materials with African American and Hispanic Audiences
Screenshot – Online Survey Start Screen
264
{Note to reviewers: Only respondents who selected “yes” for screener QS11,“did you drink any regular soft drinks
(non-diet) or other sugary drinks,?” will be shown the following screen (Q1). Others will skip to Q1_2.}
Screenshot – Online Survey Question Q1
265
{Note to reviewers: Only respondents who selected “no” for Q1,“are you planning to stop drinking regular soft
drinks (non-diet) or other sugary drinks?,” will be shown the following screen (Q1_1). Others will skip to Q1_2.}
Screenshot - Online Survey Question Q1_1
266
Screenshot – Online Survey Question Q1_2
267
Screenshot - Online Survey Question Q1_3
268
Screenshot – Online Survey Question Q2
269
Screenshot – Online Survey Question Q3
270
Screenshot – Online Survey Question Q3_1
271
Screenshot – Online Survey Question Q3_2
272
Screenshot – Online Survey Question Q4
273
Screenshot – Online Survey Question 4_1
274
Screenshot – Online Survey Question Q4_2
275
{Note to reviewers: All respondents will be asked Q5. However, respondents who had selected “no” for screener
QS11, “did you drink any regular soft drinks (non-diet) or other sugary drinks?,” will not be shown the item in Q5
that asks “how interested are you in cutting back on regular soft drinks (non-diet) or other sugary drinks.”}
Screenshot – Online Survey Question Q5
276
{Note to reviewers: There is no Q6}
Screenshot – Online Survey Question Q7
277
Screenshot – Online Survey Question Q8
278
Screenshot – Online Survey Question Q9
279
Screenshot – Online Survey Question Q9_1
280
Screenshot – Online Survey Question 9_2
281
Screenshot – Online Survey Question Q10
282
{Note to reviewers: At this point, some respondents will be shown a set of ads (TV, radio and/or print) that
correspond to a discrete campaign (randomly chosen). Others will be shown randomly chosen individual ads that
do not correspond to a discrete campaign. After each ad is shown, they will be asked Q12-Q19.}
Screenshot: Initial Screen for Ad Evaluations
283
{Note to reviewers: The screen below is a sample of the screen respondents will see when viewing each ad. The
questions they will be asked for each ad will be the same, regardless of the ad they see.}
Screenshot: Sample Screen of Ad Presentation
284
Screenshot: Ad Survey Question Introduction Page
285
Screenshot – Online Survey Question Q12
286
Screenshot – Online Survey Question Q13
287
Screenshot – Online Survey Question Q14
288
Screenshot – Online Survey Question Q15
289
Screenshot – Online Survey Question Q16
290
Screenshot – Online Survey Question Q17
291
Screenshot – Online Survey Question Q18
292
{Note to reviewers: Only respondents who selected “somewhat agree” or “strongly agree” on Q18 for the item
“This ad grabbed my attention,” will be shown the question below (Q19). Others will skip to next ad or, if
appropriate, will be shown Q20.}
Screenshot – Online Survey Question Q19
293
Screenshot: Transition Page before Each Ad
294
{Note to reviewers: Q20 below will only be shown if respondents have evaluated individual ads that together
comprise a campaign.}
Screenshot – Online Survey Question Q20
295
{Note to reviewers: At this point, respondents who were being shown individual
ads corresponding to a discrete campaign, will begin seeing a set of randomly
chosen individual ads (TV, radio, and/or print) that do not correspond to a
campaign. Those who were already being shown individual ads not
corresponding to a campaign, will continue to be shown individual spots. After
each ad is shown, they will be asked Q22-29 (which are the same as Q12-Q19,
presented above). Respondents will then see the questions that follow.}
296
{Note to reviewers: Only respondents who selected “yes” for screener QS11, “did you drink any regular soft drinks
(non-diet) or other sugary drinks?,” will be shown the following screen (Q30). Others will skip to Q30_2.}
Screenshot – Online Survey Question Q30
297
{Note to reviewers: Only respondents who selected “no” for Q30, “are you planning to stop drinking regular soft
drinks (non-diet) or other sugary drinks?,” will be shown the following screen (Q30_1). Others will skip to Q30_2.}
Screenshot – Online Survey Question Q30_1
298
Screenshot – Online Survey Question Q30_2
299
Screenshot – Online Survey Question Q30_3
300
Screenshot – Online Survey Question Q31
301
{Note to reviewers: Only respondents who selected “yes” for screener QS11, “did you drink any regular soft drinks
(non-diet) or other sugary drinks?,” will be shown the following screen (Q32). Those who responded “no” to QS11
on the screener will skip to Q32_1.}
Screenshot – Online Survey Question Q32
302
Screenshot – Online Survey Question Q32_1
303
Screenshot – Online Survey Question Q32_2
304
{Note to reviewers: There is no Q33}
Screenshot – Online Survey Question Q34
305
Screenshot – Online Survey Question Q35
306
Screenshot – Online Survey Question Q36
307
Screenshot – Online Survey Question Q36_1
308
Screenshot – Online Survey Question Q36_2
309
Screenshot – Online Survey Question Q37
310
Screenshot: Initial Screen for Classification Questions
311
Screenshot – Online Survey Question C1
312
Screenshot – Online Survey Question C2
313
Screenshot – Online Survey Question C3
314
Screenshot – Online Survey Question C4
315
Screenshot – Online Survey Question C5
316
Screenshot – Online Survey Question C6
317
Screenshot – Online Survey Question C7
318
Screenshot – Survey End Page
319
File Type | application/pdf |
File Title | Microsoft Word - Attachment 2 Cover Sheet |
Author | tlehman |
File Modified | 2014-12-12 |
File Created | 2014-12-11 |