Form Approved
OMB No. 0920-0910
Exp. Date 01/31/2024
Emerging Tobacco Products Communication Initiative
Survey Questionnaire Eligibility Screener
Public reporting burden of this collection of information is estimated to average 2 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 (0920-0910).
Thank you for your interest in this study. Please answer the following questions to determine if you are eligible to participate.
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Programming Notes. [THESE WILL NOT APPEAR ON SCREEN]. |
[Open-ended]
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If S1 < 18, skip to ineligibility statement. |
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Quota of 200 teachers
Quota of 200 administrators and guidance counselors |
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If S2 = “school staff” or “other” selections AND S3 = “not a coach,” skip to ineligibility statement.
If S2 = “school staff” or “other” AND S3= “Yes”, skip to S6.
Quota of 200 who identify as coaches (regardless of whether they also identify as educators).
Quota of 100 who identify as “sports/athletic coach”
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If 50% or higher, skip to S6.
If less than 50%, continue to S5. |
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If S3 = “not a coach” and S5 = “no”, skip to ineligibility statement. |
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If S6 = “middle school,” continue. (Quota of 300.)
If S6 = “high school,” continue. (Quota of 300.)
If S6 = “elementary school” or “other,” skip to ineligibility statement. |
[Drop down menu]
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If “outside U.S.”, skip to ineligibility statement.
Minimum quota of 120 per U.S. Census region (Northeast, South, Midwest, West). |
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Minimum quota of 120 per category.
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Minimum quota of 150 per category. |
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Minimum quota of 120 Hispanic/Latino participants.
Permit overlap for ethnicity and race categories (S10 and S11). For example, if we enroll an African-American Hispanic participant, this person would count toward both the race and ethnicity quotas.
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Minimum quota of 120 non-White participants.
Permit overlap for ethnicity and race categories (S10 and S11). For example, if we enroll an African-American Hispanic participant, this person would count toward both the race and ethnicity quotas.
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Minimum quota of 240 male participants.
Minimum quota of 240 female participants.
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Eligibility statement: Thank you for completing these questions. You are eligible for this study and will now be taken to the consent form and survey. Ineligibility statement: Thank you for completing these questions. You are not eligible for this study. |
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
Author | Gore, Kailen |
File Modified | 0000-00-00 |
File Created | 2024-09-25 |