Appendix I_rev screen instru

Appendix I
Screener Instrument

OMB # 0925-0538
Expiration Date: 11/30/2008

Health Information National
Trends Survey 2007
(HINTS 2007)
ENGLISH INTERVIEW –
SCREENING INSTRUMENT
December 2007

NATIONAL CANCER INSTITUTE (NCI)
The Privacy Act requires us to tell you that we are authorized to collect this information by
Section 411.285a, 42 USC. You do not have to provide the information requested. However, the
information you provide will help the National Cancer Institute’s ongoing efforts to promote
good health and prevent disease. There are no penalties should you choose not to participate in
this study.
Public reporting burden for this collection of information is estimated to average 5 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: NIH, Project Clearance Branch, 6705
Rockledge Drive, MSC 7974, Bethesda, MD 20892-7974, ATTN: PRA (0925-0538). Do not
return the completed form to this address.

TABLE OF CONTENTS

Screener ....................................................................................................

1

Initial Contact ...............................................................................................
Birthday Method of Respondent Selection ....................................................
Household Enumeration ...............................................................................
Additional Phone Questions..........................................................................
Extended Interview Introduction....................................................................
End Statements............................................................................................

1
1
4
5
6
7

HINTS 2007, Screening CATI Study Instrument, National Cancer Institute (NCI)

Page i

SCREENER

INITIAL CONTACT
SC-01.

Hello, this is {INTERVIEWER NAME} and I'm calling for the U.S. Department of Health
and Human Services for a national study on people’s needs for health information.
OR
Hello, this is {INTERVIEWER NAME} and I’m calling for the U.S. Department of Health
and Human Services for a national health study.
Am I speaking to someone who lives in this household and is at least 18 years old?
YES.........................................................................
NO ..........................................................................
ANSWERING MACHINE..........................................
THERE ARE NO ADULTS .......................................

SC-02.

Is this phone number for . . .
home use, ...............................................................
home and business use, or ......................................
business use only? ..................................................

SC-03.

1
2 (SC-03)
3 (End Statement 1)
4 (End Statement 3)

1 (SC-04)
2 (SC-04)
3 (End Statement 2)

May I speak with a household member who is at least 18 years old?
[IF NEEDED: Household members include people who think of this household as their
primary place of residence. It includes persons who usually stay in the household but are
temporarily away on business, vacation, in a hospital, or living at school in a dorm,
fraternity or sorority.]
AVAILABLE.............................................................
NOT AVAILABLE.....................................................
THERE ARE NONE .................................................

1 (SC-01)
2 (Code result as callback)
3 (End Statement 3)

BIRTHDAY METHOD OF RESPONDENT SELECTION
I have some questions to see who in your household may be eligible to participate in this study.
SC-04.

Including yourself, how many people aged 18 or older currently live in this household?
[IF NEEDED: Include people who usually stay in this household, but are temporarily away
on business, vacation, or in the hospital. Do not include persons who are away on full-time
active military duty with the armed forces, students living away from home in their own
apartment, or any other family member who may be in a nursing home or other institution.]
|__|__|

[0 to 25]

HINTS 2007, Screening CATI Study Instrument, National Cancer Institute (NCI)

Page 1

BOX SC-1
IF THERE IS ONLY 1 ADULT IN THE HH, CONTINUE.
IF THERE ARE 2 ADULTS IN HH, RUN SELECTION ALGORITHM. IF SCREENER
RESPONDENT IS SELECTED, CONTINUE. IF NON-SCREENER RESPONDENT
SELECTED, GO TO SC-08.
IF THERE ARE 3 ADULTS IN HH, RUN SELECTION ALGORITHM. IF SCREENER
RESPONDENT IS SELECTED, CONTINUE. IF OLDER HH MEMBER IS SELECTED, GO TO
SC-09. IF YOUNGER HH MEMBER IS SELCTED, GO TO SC-10.
IF THERE ARE MORE THAN 3 ADULTS IN HH AND SCREENER RESPONDENT IS
SELECTED, CONTINUE. OTHERWISE, GO TO SC-11.

SC-05.

May I please have your first name?
[IF NEEDED: I only need something to refer to you. Could you please give me your initials
or something else that would allow me to identify you?.]
[ENTER NAME]
_______________________

SC-06.

IF NOT OBVIOUS, ASK: [Are you male or female?]
MALE ......................................................................
FEMALE..................................................................

SC-07.

1
2

May I please have your age?
|__|__| .....................................................................

SC-08.

[1 to 20 characters]

[18 to 130] (SC-19)

The computer has randomly determined that the other adult in this household should
participate in the rest of the interview. I would like to get the first name of this person so I
can ask him or her to participate in the study. May I please have the first name of the other
adult?
[IF NEEDED: I only need something to refer to (him/her). Could you please give me
(his/her) initials or something else that would allow me to identify (him/her)?]
_______________________

HINTS 2007, Screening CATI Study Instrument, National Cancer Institute (NCI)

[1 to 20 characters]
(SC-13)

Page 2

SC-09.

The computer has randomly determined that one of the adults in the household other than
yourself should participate in the rest of the interview. To help us select this person, may I
please have the first name of the older of these two adults?
[IF NEEDED: I only need something to refer to (him/her). Could you please give me
(his/her) initials or something else that would allow me to identify (him/her)?]
[ENTER NAME]
[IF R DOESN'T KNOW WHO IS OLDEST, RECORD A DK RESPONSE.]
_______________________

SC-10.

[1 to 20 characters]
(SC-13)

The computer has randomly determined that one of the adults in the household other than
yourself should participate in the rest of the interview. To help us select this person, may I
please have the first name of the younger of these two adults?
[IF NEEDED: I only need something to refer to (him/her). Could you please give me
(his/her) initials or something else that would allow me to identify (him/her)?]
[ENTER NAME]
[IF R DOESN'T KNOW WHO IS YOUNGEST, RECORD A DK RESPONSE.]
_______________________

SC-11.

The computer has randomly determined that one of the {NUMBER} adults other than
yourself should participate in the rest of the interview. To help us select this person, do
you know who has had the most recent birthday among these adults?
YES.........................................................................
NO ..........................................................................

SC-12.

[1 to 20 characters]
(SC-13)

1 (SC-12)
2 (SC-15)

Other than yourself then, may I please have the first name of the adult who has
most recent birthday?

had the

[IF NEEDED: I only need something to refer to (him/her). Could you please give me
(his/her) initials or something else that would allow me to identify (him/her)?]
_______________________

SC-13.

[1 to 20 characters]

Is {NAME/this person} male or female?
MALE ......................................................................
FEMALE..................................................................

HINTS 2007, Screening CATI Study Instrument, National Cancer Institute (NCI)

1
2

Page 3

SC-14.

May I please have {NAME/this person}’s age?
|__|__|__| ................................................................

[18 to 130] (SC-19)

HOUSEHOLD ENUMERATION
SC-15.

So that the computer can choose someone to interview, may I please have the first names
and ages of the {NUMBER} adults currently living in this household. Please do not include
yourself.
[IF NEEDED: Include people who usually stay in this household, but are temporarily away
on business, vacation, or in the hospital. Do not include persons who are away on full-time
active military duty with the armed forces, students living away from home in their own
apartment, or any other family member who may be in a nursing home or other institution.]
[IF NEEDED: I only need something to refer to (him/her). Could you please give me
(his/her) initials or something else that would allow me to identify (him/her)?]
_______________________

SC-16.

May I please have {NAME/this person}’s age?
|__|__|__| ................................................................

SC-17.

[18 to 130]

[CODE GENDER. IF NOT OBVIOUS, ASK:
Is {NAME/this person} male or female?]
MALE ......................................................................
FEMALE..................................................................

SC-18.

[1 to 25 characters]

1
2

We have listed {NUMBER} household member{s} other than yourself who {is/are} 18 or
older.
Have we missed anyone else 18 or older who usually lives here but is temporarily away?
For example, away on business, vacation, in a hospital, or living away at school in a dorm,
fraternity, or sorority?
NO ONE WAS MISSED ...........................................
SOMEONE WAS MISSED .......................................

1
2

BOX SC-2
COMPUTER RANDOMLY SELECTS RESPONDENT.
CONTINUE.

HINTS 2007, Screening CATI Study Instrument, National Cancer Institute (NCI)

Page 4

ADDITIONAL PHONE QUESTIONS
SC-19.

Because we are conducting this study by phone, and people with more telephone
numbers have more chances of being in the study, I have some questions about the
telephone numbers in your household.
Besides the number I called, do you have other telephone numbers in your household not
including cell phones?
YES.........................................................................
NO ..........................................................................

SC-20.

1
2 (SC-24)

Including computer and fax phone numbers, how many of these additional phone numbers
are for home use?
[IF NEEDED: Do not include cell phones.].
|__|__| .....................................................................
REFUSED ...............................................................
DON'T KNOW..........................................................

[0 to 19]
-7 (BOX SC-6)
-8 (BOX SC-6)

BOX SC-3
IF SC-20=0, GO TO BOX SC-6.
IF SC-20=1, CONTINUE.
OTHERWISE, GO TO SC-22.

SC-21.

Is this additional phone number used for a computer or fax machine?
YES.........................................................................
NO ..........................................................................

SC-22.

1 (SC-23)
2 (BOX SC-6)

Of these {NUMBER} additional home use phone numbers, how many are used for a
computer or fax machine?
|__|__| .....................................................................
REFUSED ...............................................................
DON'T KNOW..........................................................

[0 to 19]
-7 (BOX SC-6)
-8 (BOX SC-6)

BOX SC-4
IF SC-22=0, GO TO BOX SC-6.
IF SC-22=1, CONTINUE.
OTHERWISE, GO TO SC-25.
SC-23.

Some households have telephone numbers that are used both for talking and for
computer or fax. Is this number ever answered for talking?
YES.........................................................................
NO ..........................................................................

HINTS 2007, Screening CATI Study Instrument, National Cancer Institute (NCI)

1 (SC-26)
2 (BOX SC-6)

Page 5

SC-24.

Do you have any additional phone numbers for computers or fax machines?
YES.........................................................................
NO ..........................................................................

SC-25.

1
2 (BOX SC-6)

Some households have telephone numbers that are used both for talking and for
computer or fax. How many of these {NUMBER} computer or fax numbers are ever
answered for talking?
|__|__| .....................................................................
REFUSED ...............................................................
DON'T KNOW..........................................................

[0 to 19]
-7 (BOX SC-6)
-8 (BOX SC-6)

BOX SC-5
IF SC-25=0, GO TO BOX SC-6.
IF SC-25=1, CONTINUE.
OTHERWISE, GO TO SC-27.
SC-26.

Is this computer or fax number answered for …
personal calls,..........................................................
business calls, or .....................................................
both?.......................................................................

SC-27.

1 (BOX SC-6)
2 (BOX SC-6)
3 (BOX SC-6)

Of these {NUMBER} phone numbers that are answered, how many are answered for nonbusiness related calls?
|__|__| .....................................................................

[0 to 19]

BOX SC-6
IF SCREENER RESPONDENT = SELECTED
RESPONDENT, GO TO SC-29.
OTHERWISE CONTINUE.

EXTENDED INTERVIEW INTRODUCTION
SC-28.

May I speak to {SELECTED RESPONDENT}?
My name is {INTERVIEWER NAME}, and I'm calling for the U.S. Department of Health
and Human Services for a national study on people’s needs for health information. You
have been selected for the study and we need your participation.
OR
My name is {INTERVIEWER NAME} and I’m calling for the U.S. Department of Health and
Human Services for a national health study. You have been selected for the study and we
need your participation.
AVAILABLE.............................................................
NOT AVAILABLE ....................................................

HINTS 2007, Screening CATI Study Instrument, National Cancer Institute (NCI)

1
2 (Code result callback)
Page 6

SC-29.

The interview will take about 25-30 minutes depending on your answers, but your
participation is voluntary and you can refuse to answer any questions or withdraw from the
study at any time. All information obtained will be kept confidential to the extent the law
allows. If you want, we can do part of the interview and finish it at another time.

SC-30.

Because these questions are very important, I need to ask [again] what is your age,
please?
|__|__|__| ................................................................
DK...........................................................................
RF...........................................................................

SC-31.

Are you . . .
less than 18 years old, .............................................
between 18 and 34, .................................................
35 to 39...................................................................
40 to 44, or ..............................................................
45 or older? .............................................................

SC-32.

[18 to 130]
(SC-31)
( SC-31)

1 (End Statement 3)
2
3
4
5

[ASK IF NOT OBVIOUS: Are you male or female?]
MALE ......................................................................
FEMALE..................................................................

1 (HC-01)
2 (HC-01)

END STATEMENTS
END STATEMENT 1.

[PLEASE READ THE FOLLOWING MESSAGE INTO THE ANSWERING MACHINE.]
This is {INTERVIEWER NAME} calling for the U.S. Department of Health and Human
Services for a national study on people’s needs for health information. It is very important
that we speak with you. We will call back within the next day or two, or you can call us at
1-888-314-1133. Thank you.
OR
This is {INTERVIEWER NAME} calling for the U.S. Department of Health and Human
Services for a national health study. It is very important that we speak with you. We will
call back within the next day or two, or you can call us at 1-888-314-1133. Thank you.

END STATEMENT 2.

Thank you, but we are only interviewing in private residences. Good-bye.

END STATEMENT 3.

These are all the questions I have for you at this time. Thank you very much for your
cooperation. Good-bye.

HINTS 2007, Screening CATI Study Instrument, National Cancer Institute (NCI)

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