Parent Screener--Main: Baseline & Follow-up Replenishments

The Real Cost Campaign Outcomes Evaluation Study: Cohort 3 (Outcomes Study)

Attachment 2. Parent Guardian Online Screener ExPECTT 3_FU2_10-2024

Parent Screener--Main: Baseline & Follow-up Replenishments

OMB: 0910-0915

Document [docx]

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Expectt 3: baseline and
follow-up Replenishments
WEB Screener Specifications for Programming

OMB No: 0910-0915 Expiration Date: 06/30/2026

Paperwork Reduction Act Statement: According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a valid OMB control number. The public reporting burden for this collection of information has been estimated to average 5 minutes per response. Send comments regarding this burden estimate or any other aspects of this collection of information, including suggestions for reducing burden to PRAStaff@fda.hhs.gov.

ExPECTT 3 Baseline and Follow-up Replenishments Web Screening Application Specifications

Document Format:

Each question is represented by a table (see template below) and each web screen is separated by a *** line.

Table Template:

VARIABLE NAME
ASK	Universe Receiving Question
Question Text Yes No
NEXT	Logic to next items.
NOTES	Explanation and text of any NOTESs that respondents might receive on this screen.

LANG
ASK	ALL
Thank you for your interest in the Health and Media Study being conducted for the U.S. Food and Drug Administration (FDA). Would you like to complete this in English or Spanish? [SPANISH TEXT OF SAME TEXT ABOVE] 1 English/Inglés 2 Spanish/Español
NEXT	IF LANG = SPANISH, SHOW SCREENER IN SPANISH AND GO TO SCNR_ASSENT IF LANG = ENGLISH, SHOW SCREENER IN ENGLISH AND GO TO SCNR_ASSENT
NOTES	NA

SCNR_ASSENT
ASK	ALL
The U.S. Food and Drug Administration (FDA) is conducting the Health and Media Study across the United States. Your address was randomly chosen along with approximately [FILL APPROXIMATE # OF SCREENERS] other addresses nationwide. We ask that an adult member of your household (18 or older) answer these questions to determine if any household members are selected to complete the study. If anyone is selected, they will be provided with a unique link to begin an online survey. If they complete the survey before [END DATE] they will receive $25 [IF TODAY IS BEFORE EARLY BIRD DATE] and a bonus $5 if they complete it on or before [EARLY BIRD DATE]. (Note that parental permission is required before anyone under the age of 18 can participate.) Also, please understand that federal law keeps your answers confidential, your participation is voluntary, and you can refuse to answer any question. If you have questions about the study, call the project helpline at 1-866-800-9177. If you have questions about your rights as a study participant, call Advarra’s institutional review board (IRB) toll-free at 877-992-4724. Please indicate whether you are willing to answer a few questions to see if you or another household member are eligible to participate in the study. 1. Yes, I am willing to answer questions 2. No, I do not want to participate
NEXT	IF SCNR_ASSENT = 1 (YES), GO TO SR_AGE IF SCNR_ASSENT = 2 (NO), GO TO THANK_YOU
NOTES	IF SCNR_ASSENT = 2 (NO), THEN FINAL RESULT CODE SHOULD BE ESTABLISHED TO REFLECT HOUSEHOLD REFUSAL IN SCREENER

SR_AGE2
ASK	ALL
[LINK] FAQ [/LINK] [PHONE ICON] [LINK] 866-800-9177 [/LINK] How old are you? _____ [RANGE: 1-99]
NEXT	IF SR AGE2 > 17, THEN SR_RESIDE
HARD CHECK	IF SR_AGE < 18, DISPLAY: “A household member aged 18 years or older is needed to complete this survey. Please provide the letter and log-in information you received at this address to a household member that is 18 years or older, and ask them to complete this survey.”
NOTES	IF SR_AGE2 < 18, THEN INTERIM RESULT CODE SHOULD BE ESTABLISHED TO REFLECT HOUSEHOLD INFORMANT AGE INELIGIBLE.

SR_RESIDE
ASK	ALL
[LINK] FAQ [/LINK] [PHONE ICON] [LINK] 866-800-9177 [/LINK] Do you live at: [FILL ADDRESS]? 1 Yes 2 No
NEXT	IF SR RESIDE = YES, THEN OCCUPANCYALL1
HARD CHECKNOTES	IF SR_RESIDE = 2, DISPLAY: “A person aged 18 years or older that lives in this address is needed to complete this survey. Please provide the letter and log-in information you received at this address to a household member that is 18 years or older, and ask them to complete this survey.”
NOTES	IF SR_RESIDE = 2 (NO), THEN INTERIM RESULT CODE SHOULD BE ESTABLISHED TO REFLECT HOUSEHOLD INFORMANT RESIDENCE INELIGIBLE.

BLOCK START: HHROSTER
OCCUPANCYALL1
ASK	IF SR RESIDE = YES
[LINK] FAQ [/LINK] [PHONE ICON] [LINK] 866-800-9177 [/LINK] The first few questions are about people who live or stay in this home. Please do not include anyone who is living somewhere else for more than 2 months, such as a college student living away, someone in the Armed Forces on deployment, or anyone who is visiting temporarily. Including you, how many total people live or stay at this address? _______ # of people at the address (including yourself) (RANGE 0-20)
NEXT	IF OCCUPANCYALL1 = 0, THEN OCCUPANCYALL_CONFIRM IF OCCUPANCYALL1 > 0, THEN OCCUPANCY1
NOTES	NA

OCCUPANCYALL_CONFIRM
ASK	IF OCCUPANCYALL1 = 0
[LINK] FAQ [/LINK] [PHONE ICON] [LINK] 866-800-9177 [/LINK] You indicated no one lives or stays at [ADDRESS FILL]. Is that correct? Yes No
NEXT	IF OCCUPANCYALL_CONFIRM = Yes, GO TO THANK_YOU IF OCCUPANCYALL_CONFIRM = No, GO TO OCCUPANCYALL2
NOTES

OCCUPANCYALL2
ASK	IF OCCUPANCYALL_CONFIRM = 2
[LINK] FAQ [/LINK] [PHONE ICON] [LINK] 866-800-9177 [/LINK] The first few questions are about people who live or stay in this home. Please do not include anyone who is living somewhere else for more than 2 months, such as a college student living away, someone in the Armed Forces on deployment, or anyone who is visiting temporarily. Including you, how many total people live or stay at this address? _______ # of people at the address (including yourself) (RANGE 0-20)
NEXT	IF OCCUPANCYALL2 = 0, THEN THANK_YOU IF OCCUPANCYALL2 > 0, THEN OCCUPANCY1
HARD CHECK
NOTES	CREATE VARIABLE OCCUPANCYALL IF OCCUPANCYALL1 > 0, THEN OCCUPANCYALL = OCCUPANCYALL1 IF OCCUPANCYALL2 > 0, THEN OCCUPANCYALL = OCCUPANCYALL2 IF OCCUPANCYALL2 = 0 OR OCCUPANCYALL_CONFIRM = 1, THEN OCCUPANCYALL = 0

OCCUPANCY1
ASK	IF OCCUPANCYALL > 0
[LINK] FAQ [/LINK] [PHONE ICON] [LINK] 866-800-9177 [/LINK] Including you, how many of these people are adults 18 years old or older who live or stay at this address? _______ # of people 18 years old or older (including yourself) (RANGE 0-20)
NEXT	IF OCCUPANCY1 = 0, THEN OCCUPANCY_CONFIRM IF OCCUPANCY1 > 0, THEN ADULTS1A
NOTES	NA

OCCUPANCY_CONFIRM
ASK	IF OCCUPANCY1 = 0
[LINK] FAQ [/LINK] [PHONE ICON] [LINK] 866-800-9177 [/LINK] You indicated no adult age 18 years old or older lives or stays at [ADDRESS FILL]. Is that correct? Yes No
NEXT	IF OCCUPANCY_CONFIRM = 1, GO TO THANK_YOU IF OCCUPANCY_CONFIRM = 2, GO TO OCCUPANCY2
NOTES

OCCUPANCY2
ASK	IF OCCUPANCY_CONFIRM = 2
[LINK] FAQ [/LINK] [PHONE ICON] [LINK] 866-800-9177 [/LINK] Including you, how many of these people are adults 18 years old or older who live or stay at this address? _______ # of people 18 years old or older (including yourself) (RANGE 0-20)
NEXT	IF OCCUPANCY2 = 0, THEN THANK_YOU IF OCCUPANCY2 > 0, THEN ADULTS1A
HARD CHECK
NOTES	CREATE VARIABLE OCCUPANCY IF OCCUPANCY1 > 0, THEN OCCUPANCY = OCCUPANCY1 IF OCCUPANCY2 > 0, THEN OCCUPANCY = OCCUPANCY2 IF OCCUPANCY2 = 0 OR OCCUPANCY_CONFIRM = 1, THEN OCCUPANCY = 0

ADULTS1A
ASK	IF OCCUPANCY > 0
[LINK] FAQ [/LINK] [PHONE ICON] [LINK] 866-800-9177 [/LINK] Including you, how many adults living or staying in this home are age 18-20? _______ # of adults between 18 and 20 years old [RANGE 0-20]
NEXT	ADULTS1B
HARD CHECK	IF ADULTS1A = 0 & SR_AGE2 = 18-20, DISPLAY: “You previously indicated that you were aged 18-20. Please check your response.”
NOTES	If respondent provides an age in SR_AGE2 between 18-20 and indicates there were zero 18-20 year olds in the household in ADULTS1A, even after the hard check, we will not consider the respondent to be eligible to take the survey themselves and ask them to roster others in the household.

ADULTS1B
ASK	IF OCCUPANCY > 0
[LINK] FAQ [/LINK] [PHONE ICON] [LINK] 866-800-9177 [/LINK] Including you, how many adults living or staying in this home are age 21-24? _______ # of adults between 21 and 24 years old [RANGE 0-20]
NEXT	ADULTS2
NOTES	NA

ADULTS2
ASK	IF OCCUPANCY > 0
[LINK] FAQ [/LINK] [PHONE ICON] [LINK] 866-800-9177 [/LINK] Including you, how many adults living or staying in this home are age 25-34? _______ # of adults between 25 and 34 years old [RANGE 0-20]
NEXT	ADULTS3
NOTES	NA

ADULTS3
ASK	IF OCCUPANCY > 0
[LINK] FAQ [/LINK] [PHONE ICON] [LINK] 866-800-9177 [/LINK] Including you, how many adults living or staying in this home are age 35-54? _______ # of adults between 35 and 54 years old [RANGE 0-20]
NEXT	ADULTS4
NOTES	NA

ADULTS4
ASK	IF OCCUPANCY > 0
[LINK] FAQ [/LINK] [PHONE ICON] [LINK] 866-800-9177 [/LINK] Including you, how many adults living or staying in this home are age 55-64? _______ # of adults between 55 and 64 years old [RANGE 0-20]
NEXT	ADULTS5
NOTES	NA

ADULTS5
ASK	IF OCCUPANCY > 0
[LINK] FAQ [/LINK] [PHONE ICON] [LINK] 866-800-9177 [/LINK] Including you, how many adults living or staying in this home are age 65 or older? _______ # of adults 65 years or older [RANGE 0-20]
NEXT	CHILDRENHH
NOTES	NA

CHILDRENHH
ASK	ALL
[LINK] FAQ [/LINK] [PHONE ICON] [LINK] 866-800-9177 [/LINK] How many total children age 17 or younger live or stay in this home? ____ total number of children [RANGE 0-20]
NEXT	HH_CHKPNT
NOTES	NA

HH_CHKPNT
ASK	ALL
[LINK] FAQ [/LINK] [PHONE ICON] [LINK] 866-800-9177 [/LINK] You reported that there were [HHnum] people in this household: [adult_num] adults and [child_num] children. Is this correct? Yes No
FILL	HH_num = OCCUPANCYALL adult_num = OCCUPANCY HH_num = CHILDRENHH
NEXT	IF HH_CHKPNT = 1 (YES), AND CHILDRENHH = 0 GO TO VERIFY ROSTER DATA IF HH_CHKPNT = 1 (YES), AND CHILDRENHH > 0 GO TO CHILDREN1 IF HH_CHKPNT = 2 (NO) REPEAT BLOCK HHROSTER
NOTES	NA
BLOCK END: HHROSTER

CHILDREN1
ASK	IF CHILDRENHH>0
[LINK] FAQ [/LINK] [PHONE ICON] [LINK] 866-800-9177 [/LINK] How many children living or staying in this home are age 0-5? _______ # of children between 0 and 5 years old [RANGE 0-20]
NEXT	CHILDREN2
NOTES	NA

CHILDREN2
ASK	IF CHILDRENHH>0
[LINK] FAQ [/LINK] [PHONE ICON] [LINK] 866-800-9177 [/LINK] How many children living or staying in this home are age 6-10? _______ # of children between 6 and 10 years old [RANGE 0-20]
NEXT	CHILDREN3
NOTES	NA

CHILDREN3
ASK	IF CHILDRENHH>0
[LINK] FAQ [/LINK] [PHONE ICON] [LINK] 866-800-9177 [/LINK] How many children living or staying in this home are age 11-17? _______ # of children between 11 and 17 years old [RANGE 0-20]
NEXT	EDUCATION1
NOTES	NA

VERIFY ROSTER DATA
ASK
[LINK] FAQ [/LINK] [PHONE ICON] [LINK] 866-800-9177 [/LINK] Let’s confirm the people who live here. These are the people listed as living in this household. [ADULT_NUM1A] adults 18-20 years old [ADULT_NUM1B] adults 21-24 years old [ADULT_NUM2] adults 25-34 years old [ADULT_NUM3] adults 35-54 years old [ADULT_NUM4] adults 55-64 years old [ADULT_NUM5] adults 65 or older [CHILD_NUM1] children 0-5 years old [CHILD_NUM2] children 6-10 years old [CHILD_NUM3] children 11-17 years old EACH AGE GROUP HAS AN EDIT FUNCTION BUTTON AND PARTICIPANTS CAN EDIT AND SAVE NEW VALUES FOR EACH AGE GROUP If this information is correct and there are no other household members, please click the Submit button. [SUBMIT]

NEXT	IF VERIFY ROSTER DATA = SUBMIT, THEN EDUCATION1 ~~IF VERIFY ROSTER DATA = Add Member+, THEN PERSON # AGE~~
FILL	ADULT_NUM1A = ADULTS1A ADULT_NUM1B = ADULTS1B ADULT_NUM2 = ADULTS2 ADULT_NUM3 = ADULTS3 ADULT_NUM4 = ADULTS4 ADULT_NUM5 = ADULTS5 CHILD_NUM1 = CHILDREN1 CHILD_NUM2 = CHILDREN2 CHILD_NUM3 = CHILDREN3
NOTES	IF EDIT FUNCTION SELECTED, THEN EDIT ROSTER OPTION VALUES OF EACH VARIABLE USED IN THE FILLS SHOULD BE UPDATED IF RESPONDENT CHANGE THEM IN THIS SCREEN. IF PNTA IS SELECTED IN ANY AGE RANGE, THE FILL SHOULD DISPLAY BLANK.

EDUCATION1
ASK	ALL
[LINK] FAQ [/LINK] [PHONE ICON] [LINK] 866-800-9177 [/LINK] We’d like to know about the highest level of education of the adults 18 years or older in your household. Including you, how many adults 18 years old and older living or staying in this home have an Associates, Bachelor’s, graduate or professional degree? _______ # of adults (including yourself) (RANGE 0-20)
NEXT	EDUCATION2
NOTES	Provide a check if the # of adults is greater than the total number of adults

EDUCATION2
ASK	ALL
[LINK] FAQ [/LINK] [PHONE ICON] [LINK] 866-800-9177 [/LINK] We’d like to know about the highest level of education of the adults 18 years or older in your household. Including you, how many adults 18 years old and older living or staying in this home attended some college but do not have a degree? _______ # of adults (including yourself) (RANGE 0-20)
NEXT	EDUCATION3
NOTES	Provide a check if the # of adults is greater than the total number of adults

EDUCATION3
ASK	ALL
[LINK] FAQ [/LINK] [PHONE ICON] [LINK] 866-800-9177 [/LINK] We’d like to know about the highest level of education of the adults 18 years or older in your household. Including you, how many adults 18 years old and older living or staying in this home have a high school diploma or GED or less (did not attend college)? _______ # of adults (including yourself) (RANGE 0-20)
NEXT	RACE
NOTES	Provide a check if the # of adults is greater than the total number of adults. Add up all adults reported in education questions. This number should = the total number of adults in the HH.

RACE_REV

ASK

ALL

[LINK] FAQ [/LINK] [PHONE ICON] [LINK] 866-800-9177 [/LINK]

The next question is about anyone living or staying in this home.

What is the race and/or ethnicity of anyone living or staying in this home? Select all that apply and enter additional details in the spaces below.


American Indian or Alaska Native ______Enter, for example, Navajo Nation, Blackfeet Tribe of the Blackfeet Indian Reservation of Montana, Native Village of Barrow Inupiat Traditional Government, Nome Eskimo Community, Aztec, Maya, etc.
� Asian � Chinese � Asian Indian � Filipino � Vietnamese Korean � Japanese ______Enter, for example, Pakistani, Hmong, Afghan, etc.
� Black or African American � African American � Jamaican � Haitian � Nigerian � Ethiopian � Somali ______Enter, for example, Trinidadian and Tobagonian, Ghanaian, Congolese, etc.
� Mexican � Puerto Rican � Salvadoran � Cuban � Dominican � Guatemalan ______Enter, for example, Colombian, Honduran, Spaniard, etc.
� Middle Eastern or North African  Lebanese  Iranian  Egyptian   Syrian  Iraqi  Israeli  ______ Enter, for example, Moroccan, Yemeni, Kurdish, etc.
� Native Hawaiian or Other Pacific Islander � Native Hawaiian � Samoan � Chamorro  � Tongan � Fijian � Marshallese  _ _____ Enter, for example, Chuukese, Palauan, Tahitian, etc.
� White  English  German  Irish   Italian  Polish  Scottish  ______ Enter, for example, French, Swedish, Norwegian, etc.

NEXT

HOME LANG

NOTES

HOME LANG
ASK	ALL
[LINK] FAQ [/LINK] [PHONE ICON] [LINK] 866-800-9177 [/LINK] Which best describes the language spoken in your home? English only Mostly English Mostly Spanish Mostly another language Spanish only
NEXT	INCOME
NOTES	NA

INCOME
ASK	ALL
[LINK] FAQ [/LINK] [PHONE ICON] [LINK] 866-800-9177 [/LINK] Which of the following categories best describes the total income of your household from all sources in the past year? Less than $10,000 $10,000 to under $30,000 $30,000 to under $50,000 $50,000 to under $70,000 $70,000 to under $110,000 $110,000 or more
NEXT	HOME
NOTES	NA

HOME
ASK	ALL
[LINK] FAQ [/LINK] [PHONE ICON] [LINK] 866-800-9177 [/LINK] These next questions are about your home. Is this home…. Owned by you or someone in your household Rented Occupied without payment of rent
NEXT	INTERNET
NOTES	NA

INTERNET
ASK	ALL
[LINK] FAQ [/LINK] [PHONE ICON] [LINK] 866-800-9177 [/LINK] At this house, apartment, or mobile home, do you or any member of your household have access to the Internet? Yes, by paying a cell phone company or Internet service provider Yes, without paying a cell phone company or Internet service provider No access to the Internet at this household
NEXT	BENEFITS
NOTES	NA

BENEFITS
ASK	ALL
[LINK] FAQ [/LINK] [PHONE ICON] [LINK] 866-800-9177 [/LINK] In the past 12 months, did you or any member of this household receive benefits from the Food Stamp Program or SNAP (the Supplemental Nutrition Assistance Program)? Do NOT include WIC, the School Lunch Program, or assistance from food banks. Yes No
NEXT	SMOKING
NOTES	NA

SMOKING
ASK	ALL
[LINK] FAQ [/LINK] [PHONE ICON] [LINK] 866-800-9177 [/LINK] The next question is about cigarette smoking. Do any of the adults (18 or older) living or staying in this home currently smoke cigarettes? Yes No
NEXT	IF CHILDREN3 = 0 AND ADULTS1A = 0, GO TO THANK_YOU IF ADULTS1A > 0, GO TO NAME2 IF ADULTS1A = 0 AND CHILDREN3 > 0, GO TO NAME
NOTES	NA

NAME2
ASK	IF ADULTS1A > 0 & (HH MEMBERS are 18-20 YEARS OLD)
[LINK] FAQ [/LINK] [PHONE ICON] [LINK] 866-800-9177 [/LINK] Can you please tell us the name or nickname and current age of the [FILL1] 18-20 years old, [FILL IF RESPONDENT IS 18-20: including yourself]? NAME1: AGE1: [FILL IF RESPONDENT IS 18-20: [ ] This is me] NAME2: AGE2: [ ] This is me NAME3: AGE3: [ ] This is me NAME4: AGE4: [ ] This is me NAME5: AGE5: [ ] This is me
FILL	If ADULTS1A = 1, FILL1: “person who is” If ADULTS1A > 1, FILL1: “[ADULTS1A] people who are”
NEXT	IF SR_AGE2 = 18-20, THEN ELIGIBLE IF SR_AGE2 > 20 & CHILDREN3 > 0, THEN NAME IF SR_AGE2 > 20 & CHILDREN3 = 0, THEN ADULTR1

ELIGIBLE
ASK	IF NUMSELECTED = 1_INF
[LINK] FAQ [/LINK] [PHONE ICON] [LINK] 866-800-9177 [/LINK] Congratulations! You are eligible to participate in the study. You can start the survey now, or you can begin at another time that is convenient for you. We will email you a unique link to access the survey online. You can use this link to start the survey at another time or to reenter the survey after beginning it. As a reminder, we will provide everyone who participates by [DATE] with a $25 gift card. Please provide your name and email address, even if you plan to complete the survey today. Name Email address Confirm email address [NEXT]
NEXT	CONFIRM_COMPLETE
NOTES	PROGRAMMER: Add email validation to check correct format of email address “Please enter a valid email address.”. Add validation to confirm that both emails match: “The addresses you entered do not match. Please review your responses.”.

CONFIRM_COMPLETE
ASK	AFTER SELECTING NEXT IN ELIGIBLE
[LINK] FAQ [/LINK] [PHONE ICON] [LINK] 866-800-9177 [/LINK] Thank you for providing your contact information. You can either begin the survey now or use the link we will email to access the survey at a later date. [START SURVEY]
NEXT	GO TO SURVEY CONSENT
NOTES	Programmer: Respondent should be marked as a screener complete once they get to this item

NAME
ASK	IF CHILDREN3 > 0 (HH MEMBERS are 11-17 YEARS OLD)

[LINK] FAQ [/LINK] [PHONE ICON] [LINK] 866-800-9177 [/LINK] Can you please tell us the name or nickname and current age of the [CHILD_NUM3] child(ren) who is/are 11-17 years old? [DISPLAY NAME AND AGE FIELDS FOR THE TOTAL NUMBER OF ELIGIBLE CHILDREN (VALUE OF CHILDREN3)] NAME1: AGE1: [NAME2: AGE2:] [NAME3: AGE3:] [NAME4: AGE4:] [NAME5: AGE5:]
NEXT	IF NUMSELECTED = 0, GO TO THANK_YOU ELSE GO TO RESPONDENT_SELECTION
FILL	CHILD_NUM3 = CHILDREN3
NOTES	SELECT HH MEMBERS BASED ON NUMBER OF 11-17 YEAR OLDS AND 18-20 YEAR OLDS UPDATE VARIABLE NUMSELECTED IF ONE 11-17 YEAR OLD AND NO 18-20 YEAR OLDS, SELECT THAT PERSON AND NUMSELECTED=1_MINOR. IF TWO 11-17 YEAR OLDS AND NO 18-20 YEAR OLDS, SELECT BOTH AND NUMSELECTED=2_MINOR. IF MORE THAN TWO 11-17 YEAR OLDS, RANDOMLY SELECT TWO OUT OF THE TOTAL AND NUMSELECTED =2_MINOR. IF ONE 11-17 YEAR OLD AND ONE OR MORE 18-20 YEAR OLDS (18-20 YO NOT TAKING SCREENER), SELECT THE 11-17 YEAR OLD AND ONE 18-20 YEAR OLD AND NUMSELECTED = 2_MIX. IF ONE OR MORE 11-17 YEAR OLD AND ONE OR MORE 18-20 YEAR OLDS (18-20 YO IS TAKING SCREENER), SELECT THE 18-20 YEAR OLD AND NUMSELECTED = 1_INF. IF ONE 18-20 YEAR OLD AND NO 11-17 YEAR OLDS, SELECT THE 18-20 YEAR OLD AND NUMSELECTED = 1_ADULT. IF TWO OR MORE 18-20 YEAR OLD AND NO 11-17 YEAR OLDS, SELECT TWO 18-20 YEAR OLD AND NUMSELECTED = 2_ADULT. IF TWO OR MORE 11-17 YEAR OLDS AND ONE OR MORE 18-20 YEAR OLDS, SELECT TWO 11-17 YEAR OLDS AND NUMSELECTED = 2_MINOR. ELSE NUMSELECTED=0. Values: 1_INF (INFORMANT WAS SELECTED) 1_MINOR (1 11-17 YO WAS SELECTED) 1_ADULT (1 18-20 YO WAS SELECTED) 2_MINOR (2 11-17 YO WERE SELECTED) 2_MIX (1 MINOR AND 1 ADULT WERE SELECTED) 2_ADULT (2 18-20 YO WERE SELECTED) CREATE VARIABLE NAME1 AND AGE1 TO STORE NAME AND AGE OF FIRST PERSON SELECTED. IF NUMSELECTED = 2_MIX OR 2_MINOR, CREATE VARIABLE NAME2 AND AGE2 TO STORE NAME AND AGE OF SECOND CHILDREN SELECTED. CREATE VARIABLE R1_MINOR (If first respondents R is minor or not) IF AGE1 < 18 THEN R1_MINOR = 1 IF AGE1 => 18, THEN R1_MINOR = 0 CREATE VARIABLE R2_MINOR (If second selected respondent is minors or not) IF AGE2 < 18 THEN R2_MINOR = 1 IF AGE2 => 18, THEN R2_MINOR = 0 IF ONLY 1 CHILD IS SELECTED, THEN R2_MINOR = MISSING CREATE VARIABLE TOTAL_MINORS R1_MINOR + R2_MINOR = TOTAL_MINORS (Can take values of 0, 1, 2)

RESPONDENT SELECTION
ASK	IF NUMSELECTED != 0 AND NUMSELECTED != 1_INF
[LINK] FAQ [/LINK] [PHONE ICON] [LINK] 866-800-9177 [/LINK] Congratulations! The following [FILL1] been selected to participate in the study. NAME1 and AGE1 [IF NUMSELECTED = 2_MIX OR 2_MINOR OR 2_ADULT DISPLAY: NAME2 and AGE2] [NEXT]

NEXT	IF R1_MINOR = 0 AND (R2_MINOR = 0 OR R2_MINOR = MISSING), THEN ADULTR1 – ADCONTACT1 IF R1_MINOR = 1 AND (R2_MINOR =1 OR R2_MINOR = MISSING), THEN YOUTHR1
FILL	If NUMSELECTED in (1_MINOR, 1_ADULT), FILL1: “person from this household has” If NUMSELECTED in (2_MINOR, 2_MIX, 2_ADULT), FILL1: “people from this household have”
NOTES	NA

ADULTR1 – ADCONTACT1
ASK	IF R1_MINOR = 0 AND (R2_MINOR = 0 OR R2_MINOR = MISSING)
[LINK] FAQ [/LINK] [PHONE ICON] [LINK] 866-800-9177 [/LINK] We would like to contact [Name1] [FILL IF NUMBER of 18-20 selected = 2: and Name 2] directly to invite them to complete the survey. Can you please provide their name[s] and phone number[s] and email address[es]? As a reminder, we will provide everyone who participates by [DATE] with a $25 gift card. Yes No – I do not wish to provide their information
NEXT	IF YES - ADCONTACT3 IF NO – ADCONTACT2
FILL	Display name and ages of participants that are over 18
NOTES	NA

ADULTR2 – ADCONTACT2
ASK	IF ADULTR1- CONTACT1=NO
[LINK] FAQ [/LINK] [PHONE ICON] [LINK] 866-800-9177 [/LINK] Participation in this study is important and we would like to invite NAME1 [and NAME2] to take part. We will send a letter to your house with more details. Can you also please invite NAME1 and NAME2 to call us at 866-800-9177? Thank you.

NEXT	Go to THANK YOU
NOTES	Set status as selected adult, no contact info

ADULTR1 – ADCONTACT3
ASK	IF ADULTR1 CONTACT=YES
[LINK] FAQ [/LINK] [PHONE ICON] [LINK] 866-800-9177 [/LINK] Thank you. Please fill in the information below. [NAME1, AGE1] Name Phone Number Email [NAME2, AGE2] Name Phone Number Email We will contact this person to participate in the study. Thank you for your help.

NEXT	IF R1_MINOR = 0 OR R2_MINOR = 0, THEN THANK YOU IF R1_MINOR = 1 OR R2_MINOR = 1, THEN YOUTHR1

NOTES	Display NAME2 AND AGE2 FIELDS IF THERE ARE 2 ADULTS SELECTED.

YOUTHR1
ASK	R1_MINOR = 1 OR R2_MINOR = 1
[LINK] FAQ [/LINK] [PHONE ICON] [LINK] 866-800-9177 [/LINK] Because the [TOTAL_MINORS = 1 AND NUMSELECTED != 2_MIX, DISPLAY: “person”, IF TOTAL_MINORS = 2, DISPLAY: ‘”people”, IF TOTAL_MINORS = 1 AND NUM_SELECTED = 2_MIX, DISPLAY: “the other person] selected to participate in the Health and Media Study [IF TOTAL_MINORS = 1, DISPLAY: “is”, IF TOTAL_MINORS= 2, DISPLAY: “are”] younger than 18 years old, a parent or guardian must first provide permission. INTERVIEW A: [NAME1] [AGE1] (YOUTHR1A) Are you the parent or guardian of [NAME1]? Parent Guardian Not the parent or guardian [IF TOTAL_MINORS = 2] INTERVIEW B: [NAME2] [AGE2] {YOUTHR1B) Are you the parent or guardian of [NAME2]? Parent Guardian I am not the parent or guardian of this youth
FILL1
NEXT	IF TOTAL_MINORS = 1 AND YOUTHR1a = 1 or 2, GO TO YOUTHR3_SR_IS_PARENT IF TOTAL_MINORS = 1 AND YOUTHR1a = 3, THEN GO TO YOUTHR2_SR_NOT_PARENT IF TOTAL_MINORS = 2 AND YOUTHR1a = 1 or 2 AND YOUTHR1b = 1 or 2, GO TO YOUTHR3_SR_IS_PARENT IF TOTAL_MINORS = 2 AND YOUTHR1a = 1 or 2 AND YOUTHR1b = 3, GO TO YOUTHR2_CONTACT4 IF TOTAL_MINORS = 2 AND YOUTHR1a = 3 AND YOUTHR1b = 1 or 2, GO TO YOUTHR2_CONTACT4 IF TOTAL_MINORS = 2 AND YOUTHR1a = 3 AND YOUTHR1b = 3, GO TO YOUTHR2_SR NOT PARENT
NOTES	NA

YOUTHR2 – SR NOT PARENT
ASK	IF (TOTAL_MINORS = 1AND YOUTHR1a = 3) OR (TOTAL_MINORS = 2 AND YOUTHR1a = 3 AND YOUTHR1b = 3)
[LINK] FAQ [/LINK] [PHONE ICON] [LINK] 866-800-9177 [/LINK] Before [NAME1] [IF TOTAL_MINORS = 2 DISPLAY: and [NAME2]]can begin the survey a parent or guardian must first provide permission. Is [NAME1]’s [IF TOTAL_MINORS = 2 DISPLAY: o [NAME2]’s] parent or guardian available right now to provide permission in this survey? Yes No
NEXT	YOUTHR2 – SR NOT PARENT = 2, THEN YOUTHR2 - CONTACT YOUTHR2 – SR NOT PARENT = 1, THEN YOUTHR2 – PASS1
NOTES	NA

YOUTHR2 – PASS1
ASK	IF YOUTHR2=YES
[LINK] FAQ [/LINK] [PHONE ICON] [LINK] 866-800-9177 [/LINK] Please pass your device to the parent or guardian of [NAME1] [IF TOTAL_MINORS = 2 DISPLAY: or [NAME 2]] and press Next when they are ready. Next

NEXT	YOUTHR2 – PASS2

NOTES	NA

YOUTHR2 – PASS2
ASK	IF YOUTHR2 – PASS1 = NEXT
[LINK] FAQ [/LINK] [PHONE ICON] [LINK] 866-800-9177 [/LINK] Hello. The U.S. Food and Drug Administration (FDA) is conducting the Health and Media Study across the United States. Your address was randomly chosen along with approximately [FILL APPROXIMATE # OF SCREENERS] other addresses nationwide. Please understand that federal law keeps your answers confidential, your participation is voluntary, and you can refuse to answer any question. If you have questions about the study, call the project helpline at 1-866-800-9177. If you have questions about your rights as a study participant, call Advarra’s institutional review board (IRB) toll-free at 877-992-4724. Based on the people in this household, we have selected the following person / people to participate in the study. NAME 1 AGE 1 NAME 2 AGE 2 (YOUTHR2_PASS2A) Are you the parent or guardian of NAME 1 AGE 1? Yes No (YOUTHR2_PASS2B) Are you the parent or guardian or NAME 2 AGE 2? Yes No

NEXT	Go to parental permission (YOUTHR3 – SR IS PARENT) Need to repeat the logic above IF TOTAL_MINORS = 1 AND YOUTHR2-PASS2A = YES, THEN YOUTHR3 – SR IS PARENT IF TOTAL_MINORS = 1 AND YOUTHR2-PASS2A = NO, THEN YOUTHR2 CONTACT1 IF TOTAL_MINORS = 2 AND YOUTHR2-PASS2A = YES AND YOUTHR2-PASS2B = YES, THEN YOUTHR3 – SR IS PARENT IF TOTAL_MINORS = 2 AND YOUTHR2-PASS2A = YES AND YOUTHR2-PASS2B = NO, THEN YOUTHR2 – CONTACT4 IF TOTAL_MINORS = 2 AND YOUTHR2-PASS2A = NO AND YOUTHR2-PASS2B = YES, THEN YOUTHR2 – CONTACT4 IF TOTAL_MINORS = 2 AND YOUTHR2-PASS2A = NO AND YOUTHR2-PASS2 = NO, THEN YOUTHR2 – CONTACT

NOTES	NA

YOUTHR2 – CONTACT1
ASK	IF (TOTAL_MINORS = 1 AND YOUTHR2_PASS2A = NO) OR (TOTAL_MINORS = 2 AND YOUTHR2_PASS2A = NO AND YOUTHR2_PASS2B = NO)
[LINK] FAQ [/LINK] [PHONE ICON] [LINK] 866-800-9177 [/LINK] We would like to contact the parent or guardian of [Name1] or [Name2] to get permission for the survey. Can you please provide their name and phone number and email address? As a reminder, we will provide everyone who participates by [DATE] with a $25 gift card. Yes No – I do not wish to provide their information

NEXT	IF YOUTHR2_CONTACT1 = YES, GO TO YOUTHR2_CONTACT3 IF YOUTHR2_CONTACT1 = NO, GO TO YOUTHR2_CONTACT2

NOTES	NA

YOUTHR2 – CONTACT2
ASK	IF YOUTHR2- CONTACT1=NO
[LINK] FAQ [/LINK] [PHONE ICON] [LINK] 866-800-9177 [/LINK] Participation in this study is important and we would like to invite [NAME1] [IF TOTAL_MINORS = 2 DISPLAY: and [NAME2]] to take part. We will send a letter to your house with more details. Can you also please invite the parent or guardian of [NAME1] [IF TOTAL_MINORS = 2 DISPLAY: and [NAME2]] to call us at 866-800-9177? Thank you.

NEXT	Go to THANK YOU

NOTES	Set status as selected youth no parental permission no contact info

YOUTHR2 – CONTACT3
ASK	IF YOUTHR2 CONTACT1=YES
[LINK] FAQ [/LINK] [PHONE ICON] [LINK] 866-800-9177 [/LINK] Thank you. Please fill in the information below. [PROGRAMMER: STRING VARIABLES, TWO ENTRY FIELDS, LABELED AS FIRST NAME AND LAST NAME. TWENTY CHARACTER EACH] First Name: Last Name: [PROGRAMMER: APPLY PHONE NUMBER MASK, INCLUDING AREA CODE. 10 DIGITS THAT DON’T NEED NAVIGATING BETWEEN FIELDS. LABEL AS PHONE NUMBER] Phone Number: [PROGRAMMER: APPLY EMAIL FORMATTING. LABEL AS EMAIL ADDRESS] Email Address: We will contact this person to provide permission for [NAME1] [IF TOTAL_MINORS = 2 DISPLAY: and [NAME2]] to participate in the study. Thank you for your help.
NEXT	THANK YOU
NOTES	NA

YOUTHR2 – CONTACT4
ASK	IF TOTAL_MINORS = 2 AND ((YOUTHR2_PASS2A = NO AND YOUTHR2_PASS2B = YES) OR (YOUTHR2_PASS2B = NO AND YOUTHR2_PASS2A = YES)
[LINK] FAQ [/LINK] [PHONE ICON] [LINK] 866-800-9177 [/LINK] Thank you. We would like to contact the parents or guardians of both selected participants. Please enter the contact information for the other parent or guardian below. [PROGRAMMER: STRING VARIABLES, TWO ENTRY FIELDS, LABELED AS FIRST NAME AND LAST NAME. TWENTY CHARACTER EACH] First Name: Last Name: [PROGRAMMER: APPLY PHONE NUMBER MASK, INCLUDING AREA CODE. 10 DIGITS THAT DON’T NEED NAVIGATING BETWEEN FIELDS. LABEL AS PHONE NUMBER] Phone Number: [PROGRAMMER: APPLY EMAIL FORMATTING. LABEL AS EMAIL ADDRESS] Email Address: We will contact this person to provide permission for [NAME_NOT_GUARDIAN] to participate in the study. Thank you for your help. In the meantime, we would like to get your permission for [NAME_GUARDIAN] to participate.
FILLS	IF YOUTHR2_PASS2A = 3 AND YOUTHR2_PASS2B = 1 OR 2, THEN NAME_NOT_GUARDIAN = NAME1 AND NAME_GUARDIAN = NAME2 IF YOUTHR2_PASS2B = 3 AND YOUTHR2_PASS2A = 1 OR 2, THEN NAME_NOT_GUARDIAN = NAME2 AND NAME_GUARDIAN = NAME1
NEXT	YOUTHR3 – SR IS PARENT

NOTES	NA

YOUTHR3 – SR IS PARENT
ASK	IF NUM_CONSENT = 1 OR NUM_CONSENT = 2
[LINK] FAQ [/LINK] [PHONE ICON] [LINK] 866-800-9177 [/LINK] Before [CHILDNAME1] age [CONSENTAGE1] [IF NUM_CONSENT = 2 DISPLAY: and [CHILDNAME2] age [CONSENTAGE2] can participate in this study, which asks about tobacco, alcohol, and drug use or non-use and other health related issues, we need to get your permission. [NEXT]

NEXT	IF CHILD1=NO AND ONLY ONE CHILD SELECTED, GO TO THANK YOU. IF CHILD1=NO AND CHILD2=NO, GO TO THANK YOU. IF CHILD1=NO AND CHILD 2=YES, FOLLOW PATH FOR ONE CHILD AND REFER TO THE CHILD WHO HAS PERMISSION. IF CHILD1=YES AND CHILD 2=NO, FOLLOW PATH FOR ONE CHILD AND REFER TO THE CHILD WHO HAS PERMISSION. IF YES TO BOTH CHILDREN CONTINUE TO YOUTHR3 – SR IS PARENT2

NOTES	NA

YOUTHR3 – SR IS PARENT2
ASK	IF NUM_CONSENT = 1 AND COLLECTED_CONSENT = 1 IF NUM_CONSENT = 2 AND COLLECTED_CONSENT in (11, 10, 01)
[LINK] FAQ [/LINK] [PHONE ICON] [LINK] 866-800-9177 [/LINK] Thank you. Your child can start the interview now, or he/she can begin at another time that is convenient for them. We will email you and your child a unique link for them to access the survey online. You can use this link to start the survey at another time, or to reenter the survey after beginning it. Please provide the(se) email address(es), even if your child plans to complete the survey today. [DISPLAY IF COLLECTED_CONSENT = 1 OR 11 OR 10] [CHILD1EMAIL] CONSENTNAME1 (Age CONSENTAGE1)’s email address [DISPLAY IF COLLECTED_CONSENT = 01 OR 11] [CHILD2EMAIL] CONSENTNAME2 (Age CONSENTAGE2)’s email address

NEXT	IF NUM_CONSENT = 1 AND COLLECTED_CONSENT = 1, GO TO YOUTHR3_PASS5 IF NUM_CONSENT = 2 AND COLLECTED_CONSENT = 11, GO TO YOUTHR3_PASS5_CHILD2 IF NUM_CONSENT = 2 AND COLLECTED_CONSENT = 10 OR 01, GO TO YOUTHR3_PASS5

NOTES	CHILD1EMAIL AND CHILD2EMAIL require email formatting.

YOUTHR3 – PASS5
ASK	NUM_CONSENT = 1 AND COLLECTED_CONSENT = 1 OR NUM_CONSENT = 2 AND COLLECTED_CONSENT = 10 OR 01
[LINK] FAQ [/LINK] [PHONE ICON] [LINK] 866-800-9177 [/LINK] Thank you. Is your child [CONSENTED1CHILD] available to complete the survey now? The survey should take about 30 minutes to complete. Yes – please pass this device to your child and allow them to complete the study in private. Please press Next when they are ready. No

NEXT	If YOUTHR3_PASS5=Yes go to YOUTH SURVEY LINK (BASELINE FOR YOUTH) IF YOUTHR3_PASS5=No go to THANK_YOU

NOTES	IF COLLECTED_CONSENT = 1 OR 10, FILL CONSENTED1CHILD : “CONSENTNAME1 AGE1” IF COLLECTED_CONSENT = 01, FILL CONSENTED1CHILD “CONSENTNAME2 AGE2” IF YOUTHR3_PASS5=Yes, END OF SCREENER, LAUNCH BASELINE, AND ASSIGN RESULT CODE

YOUTHR3 – PASS5_CHILD2
ASK	IF COLLECTED_CONSENT = 11
[LINK] FAQ [/LINK] [PHONE ICON] [LINK] 866-800-9177 [/LINK] Thank you. We would like one of your children to complete the survey today, if possible. Is CONSENTNAME1 CONSENTAGE1 or CONSENTNAME2 CONSENTAGE2 available to complete the survey now? The survey should take about 30 minutes to complete. Yes, CONSENTNAME1 CONSENTAGE1 is available now Yes, CONSENTNAME2 CONSENTAGE2 is available now No neither child is available now

NEXT	If YOUTHR3_PASS5_CHILD2=1 OR 2, GO TO YOUTHR3_ PASS6_CHILD2 IF YOUTHR3_PASS5_CHILD2=3 go to LINKS

NOTES	NA

YOUTHR3 – PASS6_CHILD2
ASK	YOUTHR3 – PASS5_CHILD2 = 1 OR 2
[LINK] FAQ [/LINK] [PHONE ICON] [LINK] 866-800-9177 [/LINK] Please pass this device to [FILL1] and allow them to complete the study in private. Please press Next when they are ready. We will email a survey link to [FILL2] within the next [X] days to complete the survey at their convenience. As a reminder, we will provide everyone who participates by [DATE] with a $25 gift card.
	FILL 1: IF YOUTHR3_PASS5_CHILD2 = 1, FILL1 = CONSENTNAME1 CONSENTAGE1 IF YOUTHR3_PASS5_CHILD2 = 2, FILL1 = CONSENTNAME2 CONSENTAGE2 FILL2: IF YOUTHR3_PASS5_CHILD2 = 1, FILL2 = CONSENTNAME2 CONSENTAGE2 IF YOUTHR3_PASS5_CHILD2 = 2, FILL2 = CONSENTNAME1 CONSENTAGE1
NEXT	Launch Baseline instrument END OF SCREENER, LAUNCH BASELINE, ASSIGN RESULT CODE

NOTES	NA







NOTES

LINKS
ASK	YOUTHR3 – PASS5_CHILD2=3
[LINK] FAQ [/LINK] [PHONE ICON] [LINK] 866-800-9177 [/LINK] We will email a survey link to [FILL1] within the next [X] days to complete the survey at their convenience. As a reminder, we will provide everyone who participates by [DATE] with a $25 gift card. Thank you.
	FILL1: ~~IF COLLECTED_CONSENT = 1, FILL CONSENTNAME1 CONSENTAGE1~~ IF COLLECTED_CONSENT = 11, FILL “CONSENTNAME1 CONSENTAGE1 and CONSENTNAME2 CONSENTAGE2”
NEXT	THANK YOU

NOTES	NA

THANK YOU
ASK	IF SCNR_ASSENT = 2 OR OCCUPANCYALL_CONFIRM = 1 OR OCCUPANCYALL2 = 0 OR OCCUPANCY_CONFIRM = 1 OR OCCUPANCY2 = 0 OR CHILDREN3 = 0 OR NUMSELECTED = 0 OR (NUM_CONSENT = 1 AND COLLECTED_CONSENT = 0) OR (NUM_CONSENT = 2 AND COLLECTED_CONSENT = 00) OR YOUTHR2_CONTACT3 = NEXT OR YOUTHR2_CONTACT2 = NEXT OR YOUTHR3_PASS5 = 2 OR LINKS = NEXT
[LINK] FAQ [/LINK] [PHONE ICON] [LINK] 800-848-4079 [/LINK] SCNR_ASSENT = 2 OR (NUM_CONSENT = 1 AND COLLECTED_CONSENT = 0) OR (NUM_CONSENT = 2 AND COLLECTED_CONSENT = 00) OR YOUTHR2_CONTACT2 = NEXT OR YOUTHR2_CONTACT3 = NEXT] Thank you for your time. [ OCCUPANCYALL_CONFIRM = 1 OR OCCUPANCYALL2 = 0 OR OCCUPANCY_CONFIRM = 1 OR OCCUPANCY2 = 0] Thank you for your time. This household is not eligible to participate in this study. [NUMSELECTED = 0 OR CHILDREN3 = 0] No one in your household has been selected for an interview. Thank you for your time. [IF YOUTHR3_PASS5= 2 OR LINKS = NEXT] Thank you. We will email an invitation for your child/children to participate at a convenient time. We will send the email to the email addresses that you have provided. Please check for that email.

NEXT	NA
NOTES	NA

File Type	application/vnd.openxmlformats-officedocument.wordprocessingml.document
Author	MacMonegle (She/Her), Anna
File Modified	0000-00-00
File Created	2024-10-28