Screener

Appendix B - screener questions.doc

Data to Support Drug Product Communications as Used by the FDA

Screener

OMB: 0910-0695

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Appendix B: Screener for Pretest 1-4

Thank you for your interest in the study. Please answer the following questions to determine if you are eligible to participate.




Programming Notes. [THESE WILL NOT APPEAR ON THE SCREEN]. When the quota has been met, go to ineligibility statement.


What is your age? ____


If <60, skip to ineligibility statement.


How many years of education have you had?

    • Less than high school

    • Completed high school

    • Some college

    • Associate’s degree (2-year)

    • Bachelor’s degree (4-year)

    • Some postgraduate work

    • Postgraduate degree (M.A., Ph.D., M.D., J.D., etc.)


Quota: 50% of sample completed high school or less than high school; 50% completed some college or higher.




What is your sex?

  • Male

  • Female


Quota: 50% male/50% female

Are you Hispanic or Latino?

  • No

  • Yes


No Quota


What is your race? You may select one or more races.

  • American Indian or Alaska Native

  • Asian

  • Black or African American

  • Native Hawaiian or other Pacific Islander

  • White

  • Some other race


Do you work for a pharmaceutical company, an advertising agency, or a market research company?

  • No

  • Yes


[ALLOW MULTIPLE RESPONSES]

Quota: At least 10% of sample African American.







If yes, skip to ineligibility statement.



Ineligibility statement: Thank you completing these questions. You are not eligible for this study.




File Typeapplication/msword
AuthorSullivan, Helen W
Last Modified ByMizrachi, Ila
File Modified2015-10-07
File Created2015-10-07

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