Attachment 2 - Fem Attachment 2 - Female Screener

ATTACHMENT 2: Female Recruit/Screener

OMB No. 0930-0196

Expiration Date: 08/31/2010

Public Burden Statement: 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.  The OMB control number for this project is 0930-0196. Public reporting burden for this collection of information is estimated to average 3 minutes per respondent per year, as no time is necessary for reviewing instructions, searching existing data sources, gathering and maintaining data, nor completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to SAMHSA Reports Clearance Officer, 1 Choke Cherry Road, Room 7-1044, Rockville, Maryland, 20857.

SAMSHA Underage Alcohol Use Prevention Campaign

FEMALE Recruit/Screener

Sample Selection

• Participants should be recruited for 1 of 12 telephone focus groups.

• A total of 6 participants should be recruited for each group.

• The objective is to obtain participants who are parents of a 9-15 year old child.

• Participants should be recruited from a cross-section of the country.

• Participants with multiple children can only be recruited for one qualifying group.

• Only one participant per household.

Introduction

• Hello, my name is ____________ and I am calling from the Gallup Organization. We are interested in talking to parents to understand their thoughts about issues relating to their children.

• The purpose of these groups is to gather insights to help the U.S. Government develop an education program for parents. This is a unique opportunity to make a valuable contribution to your community and the Nation.

• The groups will be conducted over the telephone so you don’t have to go anywhere. We are also offering a $ 30 gift card to say “thank you” for participating in the discussion.

Interviewer:

1. May I ask you a few questions to see if you qualify for our focus groups?

1. YES (Continue)

2. NO (Thank and terminate)

2. Gender:

1. Male (Switch to Male Recruit/Screener)

2. Female (Continue)

3. Are you the mother or primary caregiver of a child between the age of 9 and 15?

1. YES, mother (Continue)

2. YES, primary caregiver, if selected ask, what is your relation to the child_____________________

3. NO (Thank and terminate)

4. Have you ever attended a group discussion for market research purposes?

Yes ( ) go to item (b) below

No ( ) go to (Continue)

4b.How many group discussions have you attended in the past 12 months?

RECORD #_______________

IF MORE THAN 3, THANK AND TERMINATE

 

5. On a scale of 1 to 6 where “1” is “Very Uncomfortable” and “6” is “Very Comfortable,” how comfortable do you feel expressing your opinion in a group with 4 or 5 other people?

VERY UNCOMFORTABLE VERY COMFORTABLE

1 2 3 4 5 6

MUST ANSWER 4, 5, OR 6 on the scale. If below 4, THANK AND TERMINATE.

6. Are you of Hispanic origin?

1. Yes( ) (RECRUIT TWO FOCUS GROUPS IN THIS CATEGORY)

2. No ( )

7. Would you say your race is? (Tell me all that apply.) (RECRUIT A MIX FOR GROUP 4)

1. American Indian/Alaska Native

2. Asian

3. Black/African American (TWO FOCUS GROUPS IN THIS CATEGORY)

4. Native Hawaiian or Other Pacific Islander

5. White (ONE FOCUS GROUP IN THIS CATEGORY)

8. Are you or your child’s other parent in the military currently, or did either one of you serve in the last 8 years?

3. YES (ONE FOCUS GROUP IN THIS CATEGORY)

2. NO

9. We are looking for a specialized group of parents with children of a certain age. Do you have a child living in your household that’s between the age of_______?

GROUP 1—AA Females (9-11)

1. 9-11 (ONE FOCUS GROUP IN THIS CATEGORY IF 7c SELECTED)

GROUP 2—HISPANIC Females (9-11)

(ONE FOCUS GROUP IN THIS CATEGORY IF Q6=1)

1. YES (Continue)

2. NO

GROUP 3—WHITE Females (12-13)

2. 12-13 (ONE FOCUS GROUP IN THIS CATEGORY IF 7e SELECTED)

GROUP 4—MILITARY Females (12-13)

(ONE FOCUS GROUP IN THIS CATEGORY IF Q8=1 SELECTED).

1. YES (Continue)

2. NO

GROUP 5—AA Females (14-15)

3. 14-15 (ONE FOCUS GROUP IN THIS CATEGORY IF 7c SELECTED)

GROUP 6—HISPANIC Females (14-15)

(ONE FOCUS GROUP IN THIS CATEGORY IF Q6=1)

1. YES (Continue)

2. NO

RECRUITER NOTE: If NO to ALL questions 9a-4c, THANK AND TERMINATE

Recruiter Grid:

	African American	White	Hispanic	Military
Mothers
9–11	Group 1		Group 2
12–13		Group 3			Group 4
14–15	Group 5		Group 6

CLOSE [Dates are tentative until approval is received to proceed.]

Our group will be held on DATE at TIME. Will you be able to participate?

DATE TIME

IF GROUP 1 participant READ: Monday, April xx, 2010 8:00-9:00pm EDT

7:00-8:00pm CDT

6:00-7:00pm MDT

5:00-6:00pm PDT

IF GROUP 2 participant READ: Wednesday, April xx, 2010 8:00-9:00pm EDT

7:00-8:00pm CDT

6:00-7:00pm MDT

5:00-6:00pm PDT

IF GROUP 3 participant READ: Thursday, April xx, 2010 8:00-9:00pm EDT

7:00-8:00pm CDT

6:00-7:00pm MDT

5:00-6:00pm PDT

IF GROUP 4 participant READ: Saturday, April xx, 2010 1:00-2:00pm EDT

12:00-1:00pm CDT

11:00-12:00pm MDT

10:00-11:00pm PDT

IF GROUP 5 participant READ: Monday, April xx, 2010 8:00-9:00pm EDT

7:00-8:00pm CDT

6:00-7:00pm MDT

5:00-6:00pm PDT

IF GROUP 6 participant READ: Wednesday, April xx, 2010 8:00-9:00pm EDT

7:00-8:00pm CDT

6:00-7:00pm MDT

5:00-6:00pm PDT

If YES to participating, READ and collect the following information

READ: As part of the requirement for the group, we will be mailing you a packet with materials you will need to participate. In addition we will send a $30 gift card when the group is completed to thank you for giving us your time.

9. What is your mailing address?

­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­

ADRRESS LINE 1:_______________________________________

ADDRESS LINE 2:_______________________________________

CITY, STATE, ZIP:_______________________________________

10. What is your telephone number that we can reach you to verify you received the packet?

Telephone #: ___________________________

11. Do you have email address we can also use to contact you? If YES, record address below.

EMAIL:_______________________________________________

INTERVIEWER: Thanks for agreeing to participate I just have a few additional demographic questions.

D1. Age: (RECRUIT A MIX)

1. Below 40

2. 40-55

3. 55-65

4. 65+

D2. Would you say you live in a/an __________community? (RECRUIT A MIX)

1. Urban

2. Suburban

3. Rural

D3. Annual household income? (RECRUIT A MIX)

01 Under $25,000

02 $25,000 to $34,999

03 $35,000 to $49,999

04 $50,000 to $74,999

05 $75,000 to $99,999

06 $100,000 to $149,999

07 $150,000 and over

Final Notes

• Participants must join the focus group from a quiet room with a telephone.

• A $30 gift card will be mailed to participants when the group is completed.

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