Pre/Post Intervention Survey

Teen Safe Driving Measurement Research

Pre/Post Intervention Survey Questions

Qualified Respondents

- Parents of 15 to 18 year old teenage drivers

Test Markets Quotas

Pilot Market #1 900 screened, 400 participants

Pilot Market #2 900 screened, 400 participants

Name:	__________________________________________________________________
Address:	__________________________________________________________________
City:	________________________________ State:____________ Zip:_____________
Telephone:	(_______)_________________________________________________________

ASK TO SPEAK TO PERSON LISTED BASED ON RDD STANDARDS;
IF NOT AVAILABLE, MAKE APPOINTMENT TO CALLBACK

	Date	Time
Call Back 1	_____/_____/_____	____:____ am/pm
Call Back 2	_____/_____/_____	____:____ am/pm
Call Back 3	_____/_____/_____	____:____ am/pm

Main Introduction

Hello, my name is _______________ calling from ICR, a national research firm based in Pennsylvania. Today, we are conducting a brief study on behalf of the Centers for Disease Control and Prevention. The CDC is interested in the opinions of people from your area on issues that may affect you and your family. In particular, we would like to ask you some questions about teen driving. The interview will only take about eight minutes of your time and we are not selling anything.

If at any time and for any reason you would prefer not to answer any questions, please feel free not to. If at any time you would like to stop participating, please tell me. You will not be penalized in any way for deciding to stop participation at any time.

Public reporting burden for this collection of information is estimated to average 15 minutes for the pre/post intervention survey questions 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 Reports Clearance Officer; 1600 Clifton Road, MS D-74, Atlanta, GA 30333, ATTN: PRA (0920------).

(IF 1 TEEN DRIVER [YES IN Q.C1 OR 1 IN Q.C2])

You mentioned that you have one teenage driver between the ages of 15 and 18.

(IF MORE THAN 1 CHILD DRIVER [2+ IN Q.C2])

You mentioned that you have (INSERT #) teenage drivers between the ages of 15 and 18. For this survey, I’d like you to think about the (randomize: oldest/youngest) teenage driver in this age range.

1a. First, how old is this child?

____________ (ENTER 15-18)

RR Refused

1b. And is this child male or female?

1 Male

2 Female

R Refused

1c. Does this child have his or her learner’s permit or driver’s license?

1 Learner’s permit (SKIP TO Q.2)

2 Driver’s license (ASK Q.1d)

R Refused (SKIP TO Q.2)

1d. What type of driver’s license does your child have – an intermediate or provisional license or a full license?

1 Intermediate/provisional

2 Full

D Don’t know

R Refused

2. Which of the following is your biggest worry as it relates to your teenager?

(ROTATE 1-5; ALWAYS ASK 6 LAST)

1 Crime and violence

2 Drugs

3 Alcohol

4 Driving

5 Smoking

6 Teen sex

D (DO NOT READ) Don’t know

R (DO NOT READ) Refused

3. And which is your second biggest worry as it relates to your teenager?

(ROTATE 1-5; ALWAYS ASK 6 LAST)

(DO NOT LIST ITEM MENTIONED IN Q.2)

1 Crime and violence

2 Drugs

3 Alcohol

4 Driving

5 Smoking

6 Teen sex

D (DO NOT READ) Don’t know

R (DO NOT READ) Refused

4. How often do you talk to your teenager about (INSERT ITEM)?

1 At least once per month

2 Once every 3 months

3 Once every 6 months

4 Once a year

5 Less than once a year, or

6 You’ve never discussed this with your child

D (DO NOT READ) Don’t know

R (DO NOT READ) Refused

(ROTATE A-E; ALWAYS ASK F LAST)

a. Crime and violence

b. Drugs

c. Alcohol

d. Driving

e. Smoking

f. Teen sex

5. As far as you know, which of the following is the number one cause of teen deaths in this country? Is it …

(ROTATE)

1 Crime and violence

2 Drugs

3 Alcohol

4 Motor vehicle crashes

D (DO NOT READ) Don’t know

R (DO NOT READ) Refused

Now let’s focus on you for a second. I’d like to ask you a few questions about your driving habits.

6. When you personally are driving your vehicle, do you sometimes (INSERT ITEM)?

1 Yes

2 No

D Don’t know

R Refused

a. Talk on your cell phone

b. Exceed the speeding limit

c. Drive without wearing your seatbelt

d. Eat food while driving

e. Adjust the stereo, CD player, or portable media player

f. Use a PDA or other wireless handheld device

7. In the past 12 months, have you talked to this child about (INSERT ITEM)?

1 Yes

2 No

D Don’t know

R Refused

a. Using a cell phone while driving

b. Drinking and driving

c. The importance of wearing seatbelts

d. Limiting the number of passengers in a vehicle

e. Obeying traffic laws and speeding limits

f. Eating while driving

g. Adjusting the stereo, CD player, or portable media player while driving

h. Using a PDA or text messaging while driving

8. Do you allow your child to drive in the evenings unsupervised by an adult after 10 PM?

1 Yes

2 No

D Don’t know

R Refused

Next, I am going to read you a series of statements about driving. After I read each statement, I want you to tell me if you strongly agree, somewhat agree, somewhat disagree or strongly disagree with each statement. The first statement is …

9. (INSERT STATEMENT)

(READ AS NECESSARY: Do you …)

4 Strongly agree

3 Somewhat agree

2 Somewhat disagree, or

1 Strongly disagree

D (DO NOT READ) Don’t know

R (DO NOT READ) Refused

(ROTATE)

a. Elderly people are more likely than teens to have a car crash

b. Among teen drivers, driver inexperience results in more crashes than drinking and driving

c. Parents have a strong influence on their teenager’s driving habits

d. Teens are more likely to be in a crash if driving with multiple teen passengers

DEMOGRAPHICS

These last few questions are for demographic purposes and are being asked to help us better understand your responses. Your answers are completely confidential and your name will not be associated with your responses.

10. Is your total annual household income from all sources, and before taxes…?

(READ LIST; ENTER ONE RESPONSE)

01 Less than $10,000

02 $10,000 but less than $15,000

03 $15,000 but less than $20,000

04 $20,000 but less than $25,000

05 $25,000 but less than $30,000

06 $30,000 but less than $40,000

07 $40,000 but less than $50,000

08 $50,000 but less than $75,000, or

09 $75,000 but less than $100,000

10 $100,000 or more

DD (DO NOT READ) Don’t know

RR (DO NOT READ) Refused

11. Which one of the following best describes your background? Are you…?

(READ LIST; ENTER ONE RESPONSE)

1 White

2 Black or African American

3 Hispanic or Latino

4 Asian

5 American Indian or Alaska Native

6 Native Hawaiian or Pacific Islander

7 (VOLUNTEERED) Other (SPECIFY) ________________

R (DO NOT READ) Refused

12. (CODE FROM SAMPLE: Area)

1 Urban

2 Rural

Those are all the questions I have. Thank you for your time.

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