letters etc.

Attachment 4
1) RDD
Advance Letter
Screener Refusal Conversion Letter
Extended Interview Refusal Conversion
Letter
Permission Refusal Conversion Letter
„
„
„

„

2) Area Probability Sample
Advance Letter
Screener Refusal Conversion Letter
Extended Interview Refusal Conversion
Letter
„
„
„

3) Telephone Introduction and
Consent/Assent Scripts for Adults and
Adolescents

RDD Advance Letter
Dear Current Resident,
Your household has been selected for this year’s California Health Survey. This
important telephone survey is your opportunity to have your voice heard on health
issues.
This survey helps California learn about the health of its people and the problems
they have getting health care. The results may help the people and families in your
community.
Your household is very special because you are part of a scientific sample
representing many other households like yours. We do this survey every two years.
Since 2001, more than 100,000 Californians have talked to us about many
different health topics.
We will be calling sometime in the next two weeks and one adult in your household
will be selected for the interview. If you have teenagers (ages 12-17), we will ask to
interview one with permission from a parent. Participation is voluntary. All
answers are confidential and used only for this survey.
Please take a moment to take our call. We are not selling anything or asking for
money. If we call at an inconvenient time, you can suggest a better time for us to
call back. To thank you in advance for taking our call and hearing about this
survey, we are enclosing a $2 bill. This small gift is for you to keep whether or not
you decide to participate (this money is not from State or local taxes).
Thank you for your help.
Sincerely,

Dr. E. Richard Brown
Director, UCLA Center for Health Policy Research
Note:

If you have questions about the California Health Survey, you can call tollfree 1-888-941-2950 or visit our website at www.californiahealthsurvey.org

Major funders of this survey include the California Department of Health Services and the National
Cancer Institute.
Relevant to Privacy Act Information, the legislative authority for this survey is 42 USC 285.

www.healthpolicy.ucla.edu
10960 Wilshire Boulevard, Suite 1550 Los Angeles, CA 90024 PH: 310 794.0909 FAX: 310 794.2686

Screener Refusal Letter
Dear Current Resident,
Your household has been selected for this year’s California Health
Survey. This telephone survey is an important opportunity to have your
voice heard on health care issues.
We do this survey every two years. This research helps California learn
about the health of its people and the problems they have getting health
care. The results may be used to help the people and families in your
community.
We recently called your home, but it was not a good time for anyone to
speak with us. We know your time is valuable. However, we encourage
you to take just a few minutes to talk to our interviewer when we call
again.
Your household is part of a scientific sample representing many other
households like yours. Please take a moment to take our call. If we
happen to call at an inconvenient time, you can suggest a time that is
better for you.
If you have any questions, you may call toll free at 1-888-941-2950.
Sincerely,

Dr. E. Richard Brown
Director, UCLA Center for Health Policy Research
Note:

If you want to read more about this survey, you can visit our
website at www.californiahealthsurvey.ucla.edu.

Major funders of this survey include the California Department of Health Services
and the National Cancer Institute.

Relevant to Privacy Act Information, the legislative authority for this survey is 42 USC 285.

www.healthpolicy.ucla.edu
10960 Wilshire Boulevard, Suite 1550 Los Angeles, CA 90024 PH: 310 794.0909 FAX: 310 794.2686

Extended Interview Refusal Letter
Dear Current Resident,
We recently talked on the telephone with someone in your home who has
been selected to be part of the California Health Survey. I do not know
that person’s name because this is a confidential survey and names
cannot be released.
The person we talked to chose not to do the interview or not to finish it.
We respect that decision since the interview is voluntary. However, I
kindly ask him or her to please reconsider.
You are part of a scientific sample representing many others like
yourself. You are important in making a complete picture of the people
of California. The results may be used to improve health care and help
your community.
One of our interviewers from Westat, the survey firm making the
telephone calls, will call again. I want to give the selected person one
more opportunity to be part of this important survey. If necessary, our
interviewer can make an appointment for a more convenient time.
Please take a moment to talk with us. If you have any questions, you
may call toll free at 1-888-941-2950.
Sincerely,

Dr. E. Richard Brown
Director, UCLA Center for Health Policy Research
Note:

If you want to read more about this survey, you can visit our
website at www.californiahealthsurvey.ucla.edu.

Major funders of this survey include the California Department of Health Services
and the National Cancer Institute.
Relevant to Privacy Act Information, the legislative authority for this survey is 42 USC 285.

www.healthpolicy.ucla.edu
10960 Wilshire Boulevard, Suite 1550 Los Angeles, CA 90024 PH: 310 794.0909 FAX: 310 794.2686

Permission Refusal Letter
Dear Parent or Guardian,
We recently did a telephone interview with an adult in your household. I
want to thank that person for his or her time. We also selected one
teenager between age 12 and 17 to be interviewed. However, the parent
or guardian did not give us permission to interview their teenager. We
respect that decision and will not speak with anyone under 18 years old
without permission.
I want to ask the parent or guardian to please reconsider. Our survey
results may help to improve the health of young people in your
community. Your teenager is important. She or he is part of a scientific
sample representing many other similar young people.
One of our interviewers from Westat, the survey firm making the
telephone calls, will call again. We will again ask for permission to
interview the selected teenager. This voluntary interview only takes
about 15 minutes. We can make an appointment for a convenient time
to do it.
If we still cannot get permission, or the selected teenager does not want
to do it, tell the interviewer when we call. We will not call or write again.
If you have any questions, you may call toll-free at 1-888-941-2950.
Yours truly,

Dr. E. Richard Brown
Director, UCLA Center for Health Policy Research

Note:

If you want to read more about this survey, you can visit our
website at www.californiahealthsurvey.ucla.edu.

Major funders of this survey include the California Department of Health Services
and the National Cancer Institute.

Relevant to Privacy Act Information, the legislative authority for this survey is 42 USC 285.

www.healthpolicy.ucla.edu
10960 Wilshire Boulevard, Suite 1550 Los Angeles, CA 90024 PH: 310 794.0909 FAX: 310 794.2686

Advance Letters for Area Probability Sample Households without Matched Telephone
Numbers

Dear Current Resident,
Your household has been selected for this year’s California Health Survey. This important
telephone survey is your opportunity to have your voice heard on health issues.
This survey helps California learn about the health of its people and the problems they
have getting health care. The results may help the people and families in your community.
Your household is very special because you are part of a scientific sample representing
many other households like yours. We do this survey every two years. Since 2001, more
than 100,000 Californians have talked to us about many different health topics.
One adult in your household will be selected for the interview. Participation is voluntary.
All answers are confidential and used only for this survey.
Westat, a social science research firm, will conduct the interview. An interviewer with a
Westat badge will visit your household sometime between (date) and (date), 2007. A few
initial questions will determine if someone in your household is eligible for an interview. If
you would like to set an appointment or complete the interview by telephone before we visit,
you can contact Westat at their toll-free number, 1-888-941-2950, and give your telephone
number and the time that is convenient for you.
Please take a moment to talk to us. We are not selling anything or asking for money. If we
happen to visit at an inconvenient time, you can suggest a time that is better for you.
To thank you in advance for talking to us about this survey, we are enclosing a $2 bill.
This small gift is for you to keep whether or not you decide to participate (this money is not
from state or local taxes). If you participate in the interview, we will give you an additional
$25 for your time.
Thank you for your help.
Sincerely,

Dr. E. Richard Brown
Director, UCLA Center for Health Policy Research
Note:

If you have questions about the California Health Survey, you can call toll-free 1888-941-2950 or visit our website at www.californiahealthsurvey.org

Major funders of this survey include the California Department of Health Services and the National Cancer
Institute.
Relevant to Privacy Act Information, the legislative authority for this survey is 42 USC 285.

www.healthpolicy.ucla.edu
10960 Wilshire Boulevard, Suite 1550 Los Angeles, CA 90024 PH: 310 794.0909 FAX: 310 794.2686

Initial In-Person Refusal Conversion Letter

Dear Current Resident,
Your household has been selected for this year’s California Health Survey. This
telephone survey is an important opportunity to have your voice heard on
health care issues.
We do this survey every two years. This research helps California learn about
the health of its people and the problems they have getting health care. The
results may be used to help the people and families in your community.
We recently called your home, but it was not a good time for anyone to speak
with us. We know your time is valuable. However, we encourage you to take
just a few minutes to talk to our interviewer when we contact you again. Your
household is part of a scientific sample representing many other households
like yours.
Westat, a social science research firm, is conducting this study. In the next
week or two, an interviewer from Westat will visit your household to try to
reach you. If we happen to stop by at an inconvenient time, please suggest a
time that is better for you. If you would like to set an appointment before we
call, you can contact Westat at their toll-free number, 1-888-941-2950, and
give your telephone number and the time that is convenient for you.
Please take a moment to talk to us. To thank you for participating in the
interview, we are offering to pay $25 for your time. If we happen to visit at an
inconvenient time, you can suggest a time that is better for you.
If you have any questions, you may call toll free at 1-888-941-2950.
Sincerely,

Dr. E. Richard Brown
Director, UCLA Center for Health Policy Research
Note: If you want to read more about this survey, you can visit our website at
www.californiahealthsurvey.ucla.edu.
Major funders of this survey include the California Department of Health Services and the
National Cancer Institute.
Relevant to Privacy Act Information, the legislative authority for this survey is 42 USC 285.

www.healthpolicy.ucla.edu
10960 Wilshire Boulevard, Suite 1550 Los Angeles, CA 90024 PH: 310 794.0909 FAX: 310 794.2686

In-Person Extended Interview Refusal Conversion Letter

Dear Current Resident,
We recently talked on the telephone with someone in your home who has been
selected to be part of the California Health Survey. I do not know that person’s
name because this is a confidential survey and names cannot be released.
The person we talked to chose not to do the interview or not to finish it. We
respect that decision since the interview is voluntary. However, I kindly ask
him or her to please reconsider.
You are part of a scientific sample representing many others like yourself. You
are important in making a complete picture of the people of California. The
results may be used to improve health care and help your community.
Westat, a social science research firm, is conducting this study. In the next
week or two, an interviewer from Westat will visit your household to try to
reach you. I want to give the selected person one more opportunity to be part
of this important survey. If we happen to stop by at an inconvenient time,
please suggest a time that is better for you. If you would like to set an
appointment before we call, you can contact Westat at their toll-free number, 11-888-941-2950, and give your telephone number and the time that is
convenient for you.
Please take a moment to talk to us. To thank you for participating in the
interview, we are offering to pay $25 for your time. If we happen to visit at an
inconvenient time, you can suggest a time that is better for you.
Please take a moment to talk with us. If you have any questions, you may call
toll free at 1-888-941-2950.
Sincerely,

Dr. E. Richard Brown
Director, UCLA Center for Health Policy Research
Note: If you want to read more about this survey, you can visit our website at
www.californiahealthsurvey.ucla.edu.
Major funders of this survey include the California Department of Health Services and the
National Cancer Institute.
Relevant to Privacy Act Information, the legislative authority for this survey is 42 USC 285.

www.healthpolicy.ucla.edu
10960 Wilshire Boulevard, Suite 1550 Los Angeles, CA 90024 PH: 310 794.0909 FAX: 310 794.2686

Consent Scripts for the California Health Interview Survey
1) Introductory RDD screener script
"Hello, my name is {interviewer name}. I am calling for the University of California at Los Angeles. We
are doing a scientific study about health in California. "
1) "Are you a member of this household and at least 18 years old?"
1. YES................................................ [CONTINUE WITH 3]
2. NO.................................................. [CONTINUE WITH 2]
2) "May I please speak with a household member who is at least 18 years old?"
1. AVAILABLE.................................... [BEGIN SCREENER SCRIPT AGAIN]
2. UNAVAILABLE............................... [END CALL, THANK, AND SET APPOINTMENT]
3. NONE………………………………. .[THANK AND END]
3) "Is this telephone number used for business use only?"
1. YES................................................ [THANK AND END]
2. NO.................................................. [CONTINUE]
I have a few questions to see if someone in your household qualifies for this study. This will only take a
few minutes.
4) "Including yourself, how many adults AGE 18 AND OLDER, currently live in this household?"
_____ NUMBER OF ADULTS
1. MORE THAN ONE...... [USE MODIFIED LAST-BIRTHDAY SELECTION METHOD;
IF SCREENER RESPONDENT = ADULT EXTENDED INTERVIEW RESPONDENT, PROCEED.
OTHERWISE, GO TO SECONDARY SCREENER SCRIPT]
2. NO............................... [CONTINUE]
"You do qualify for this study."
[IF NO, ASK: "are you the parent or guardian of a child age 12-17 living in this household?"]
[IF YES, CONTINUE WITH ADOLESCENT SELECTION PROTOCOL.]
[IF NO, GO TO ADULT EXTENDED INTERVIEW CONSENT SCRIPT.]

2) Introductory cell phone only screener script
"Hello, my name is {INTERVIEWER NAME}. I am calling for the University of California. We are doing a
scientific study about health in California. Your telephone number was randomly drawn to be in the
California Health Survey. If you are currently driving a car or doing any activity that requires your full
attention, I need to call you back at a later time." [PROGRAMMING NOTE: IF TRUE, END CALL
IMMEDIATELY AND SET APPOINTMENT].
1) "Are you at least 18 years old?"
1. YES................................................ [CONTINUE WITH 3]
2. NO.................................................. [CONTINUE WITH 2]

1

2) "May I please speak with a household member who is at least 18 years old?"
1. AVAILABLE.................................... [BEGIN SCREENER SCRIPT AGAIN]
2. UNAVAILABLE............................... [END CALL, THANK, AND SET APPOINTMENT]
3. NONE………………………………. . [GO TO CLOSE1]
3) "Is this telephone number also used for business purposes?"
1. YES................................................ [GO TO CLOSE2]
2. NO.................................................. [CONTINUE]
For this part of the study, we are trying to reach people who use cellular service for their primary
telephone. It will take about 2 minutes to see if you qualify for the study. We will send you $5 to thank
you for answering these questions.
4) "Do you have any regular, landline telephone numbers in your home?"
1. YES................................................... [GO TO CLOSE2]
2. NO..................................................... [CONTINUE]
5) "Including yourself, how many adults AGE 18 AND OLDER, currently live in this household?"
_____ NUMBER OF ADULTS
6) "Do any of the adults share this cell phone number?"
1. YES............................. [IF SCREENER RESPONDENT = ADULT EXTENDED INTERVIEW
RESPONDENT, PROCEED. OTHERWISE, USE MODIFIED LAST-BIRTHDAY SELECTION METHOD
AND GO TO SECONDARY SCREENER SCRIPT]
2. NO............................... [CONTINUE]
"You do qualify for the study."
[PROGRAMMING NOTE: GO TO ADULT EXTENDED INTERVIEW CONSENT SCRIPT]

3) Introductory In-person screener script
"Hello, my name is {interviewer name}. I am here on behalf of the University of California at Los Angeles.
We are doing a scientific study about health in California. "
1) "Are you a member of this household and at least 18 years old?"
1. YES................................................ [CONTINUE WITH 3]
2. NO.................................................. [CONTINUE WITH 2]
2) "May I please speak with a household member who is at least 18 years old?"
1. AVAILABLE.................................... [BEGIN SCREENER SCRIPT AGAIN]
2. UNAVAILABLE............................... [END CALL, THANK, AND SET APPOINTMENT]
3. NONE………………………………. .[THANK AND END]
I have a few questions to see if someone in your household qualifies for this study. This will only take a
few minutes.
3) "Including yourself, how many adults AGE 18 AND OLDER, currently live in this household?"
_____ NUMBER OF ADULTS
1. MORE THAN ONE...... [USE MODIFIED LAST-BIRTHDAY SELECTION METHOD;
IF SCREENER RESPONDENT = ADULT EXTENDED INTERVIEW RESPONDENT, PROCEED.
OTHERWISE, GO TO SECONDARY SCREENER SCRIPT]
2. NO............................... [CONTINUE]
"You do qualify for this study."
2

Verbal Consent and Assent Telephone Scripts for the California Health Interview Survey
1) Consent script for adult extended interview
"{Again}, I am {calling for/or here on behalf of) the University of California at Los Angeles. We are doing a
scientific research study about health that may help improve services in your community. Your
{telephone number/address} was randomly drawn to be in the California Health Survey."
"The interview takes about 30 minutes on average, but may be as short as 20 minutes. There are
questions about your health, diet and exercise, sexual behaviors, and healthcare and insurance.
[PROGRAMMING NOTE: FOR CELL PHONE RESPONDENTS SAY, "We will send you $25 to thank you
for your help with this survey."] [FOR IN-PERSON INTERVIEWS, SAY, "We will give you $25 to thank
you for your help with this survey."]
"This interview is voluntary and confidential. Your answers will be used only for this survey. You can skip
any question, and you can stop at any time."
"Do you have any questions about this?"
[PROGRAMMING NOTE: ANSWER QUESTIONS AND PROCEED.]
"The University has very strict safeguards to protect your confidentiality. We have obtained a certificate
from the National Institutes of Health to protect your privacy. If you want, I can give you the name and
toll-free telephone number of the persons at UCLA in charge of the study. Would you like this information
now or can we begin the interview?"
[PROGRAMMING NOTES: IF REQUESTS INFORMATION ABOUT PRIVACY SAFEGUARDS: Your
name, address, and telephone number will be erased after the study is completed. The survey data will
be kept in a secure data center, and your answers will only be used to produce total numbers. No
personal information will be released.
IF REQUESTS INFORMATION ABOUT NIH CERTIFICATE OF CONFIDENTIALITY:
With a Certificate of Confidentiality, the researchers cannot be forced to disclose information that may
identify you, even by a court subpoena, in any federal, state, or local civil, criminal, administrative,
legislative, or other proceedings. The researchers will use the Certificate to resist any demands for
information that would identify you, except for those from personnel of the United States Government for
information that would be used for auditing or evaluation of Federally- funded projects.
A Certificate of Confidentiality does not prevent you or a member of your family from voluntarily releasing
information about yourself or your involvement in this research. If you give an insurer, employer, or other
person your written consent to receive research information, then the researchers may not use the
Certificate to withhold that information."]
[PROGRAMMING NOTES:
IF REQUESTED:
1. WANTS STUDY INFORMATION: Please contact Dr. E. Richard Brown if you have any questions
about the study. Dr. Brown can be reached toll-free at 1-866-275-2447.
2. WANTS INFORMATION ABOUT RIGHTS OF RESEARCH SUBJECTS OR THE NIH
CERTIFICATION FOR PROTECTION OF PERSONAL INFORMATION: Please contact the Office for the
Protection of Research Subjects at (310) 825-8714.]
3. BOTH: Provide both contact numbers.
4. BEGIN INTERVIEW – THANK AND CONTINUE
5. DON'T BEGIN INTERVIEW: Ask, "If another time is more convenient, we can schedule at a better
time."]

3

[FOR IN-PERSON INTERVIEWERS, "You may conduct the interview with a cell phone that I
will provide to you or on your household's landline phone, if you have one. Which do you
prefer?"]
[IN-PERSON INTERVIEWERS WILL SCHEDULE CALL WITH REMOTE TELEPHONE
INTERVIEWERS AND RETURN AFTER CALL IS COMPLETED TO THANK
RESPONDENTS AND PAY $25 CASH INCENTIVE.]
2) Permission script read to the adult respondent or screener respondent:
"{Adolescent’s first name} has {also} been selected for the study. Are you the parent or legal
guardian who can give permission for us to speak with {adolescent’s first name}?"
1. YES................................................ [PROCEED]
2. NO.................................................. [THANK AND END]
"Because this interview is voluntary, I will need to ask {adolescent’s first name} if {he/she} is willing to
do it. However, I need to obtain your consent to talk to {adolescent’s first name} because {he/she} is
under the age of 18."
"I will ask questions about health and health behaviors, such as food, exercise, tobacco, alcohol and
drug use. There are also questions about fighting and violence and sexual behavior. Children and
teens have heard about many of these health issues in the classroom."
"All the information is strictly confidential and will not be released to anyone. {Adolescent’s first
name} can skip any question and can stop the interview at any time. The answers will be used only
for this survey. The interview takes about 15 to 20 minutes."
"Also, we believe that young people tend to feel more comfortable doing the interview when their
parents are not in the same room listening. Do you have any questions?"
[PROGRAMMING NOTE: ANSWER QUESTIONS AND PROCEED.]
"May I have your permission to speak with and interview {adolescent’s first name}?"
"If you’d like more information, I can give you the name and toll-free telephone number of the persons
at UCLA in charge of the survey.”
[PROGRAMMING NOTES:
IF REQUESTED:
1. WANTS STUDY INFORMATION: Please contact Dr. E. Richard Brown if you have any questions
about the study. Dr. Brown can be reached toll-free at 1-866-275-2447.
2. WANTS INFORMATION ABOUT RIGHTS OF RESEARCH SUBJECTS OR THE NIH
CERTIFICATION FOR PROTECTION OF PERSONAL INFORMATION: Please contact the Office for
the Protection of Research Subjects at (310) 825-8714.]
3. BOTH: Provide both contact numbers.
4. READ VERBAL ASSENT SCRIPT TO ADOLESCENT
5. DON'T BEGIN INTERVIEW: Ask "If another time is more convenient, we can schedule at a better
time."]

3) Assent script read to the selected adolescent respondent:
"Hello, my name is {interviewer name}. I am calling for the University of California at Los Angeles.
We are doing a scientific study about health that may help improve services in your community."
"You were selected by chance for this scientific survey. It is completely voluntary, and the information
you give will be kept confidential. Your answers will be used only for this survey. No names are used
when we summarize what we learn."

4

"I'm going to ask questions about diet and exercise and about tobacco, alcohol, and drugs even if you
don’t use any of these. There are also some questions about fighting and violence and sexual
behavior."
"The interview takes about 15 to 20 minutes. You can skip any questions and stop at any time. Do
you have any questions?"
[ANSWER QUESTIONS AND PROCEED.]
"The University has very strict safeguards to protect your confidentiality. We have obtained a
certificate from the National Institutes of Health to protect your privacy. If you want, I can give you the
name and toll-free telephone number of the persons at UCLA in charge of the study. Would you like
this information now or can we begin the interview?"
[PROGRAMMING NOTES: IF REQUESTS INFORMATION ABOUT PRIVACY SAFEGUARDS:
Your name, address, and telephone number will be erased after the study is completed. The survey
results will be kept in a secure data center, and your answers will only be used to produce total
numbers.
[IF REQUESTS INFORMATION ABOUT NIH CERTIFICATE OF CONFIDENTIALITY:
With a Certificate of Confidentiality, the researchers cannot be forced to disclose information that may
identify you, even by a court subpoena, in any federal, state, or local civil, criminal, administrative,
legislative, or other proceedings. The researchers will use the Certificate to resist any demands for
information that would identify you, except for those from personnel of the United States Government
for information that would be used for auditing or evaluation of Federally- funded projects.
A Certificate of Confidentiality does not prevent you or a member of your family from voluntarily
releasing information about yourself or your involvement in this research. If you give an insurer,
employer, or other person your written consent to receive research information, then the researchers
may not use the Certificate to withhold that information."]
[PROGRAMMING NOTES: IF REQUESTED:
1. WANTS STUDY INFORMATION: Please contact Dr. E. Richard Brown if you have any questions
about the study. Dr. Brown can be reached toll-free at 1-866-275-2447.
2. WANTS INFORMATION ABOUT RIGHTS OF RESEARCH SUBJECTS OR THE NIH
CERTIFICATION FOR PROTECTION OF PERSONAL INFORMATION: Please contact the Office for
the Protection of Research Subjects at (310) 825-8714.]
3. BOTH: Provide both contact numbers.
4. BEGIN INTERVIEW – THANK AND CONTINUE
5. DON'T BEGIN INTERVIEW: Ask, "If another time is more convenient, we can schedule at a better
time."]
"Are you in a private enough place so you can answer these questions freely?"

5