Healthy School Environment

Attachment A

OMB Control # 0584-0524

Expiration Date: 04/30/2013

OMB BURDEN STATEMENT:  According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number.  The valid OMB control number for this information collection is 0584-0524.  The time to complete this information collection is estimated as part of the 10 minutes for the screener, including the time for reviewing instructions and completing the information.

USDA/FNS

Mini Group Screening Questionnaire – Middle School Students

Formative Round (December 2010): Baltimore, MD; Cleveland, OH; Riverside, CA

Evaluative Round (May 2011): Atlanta, GA; Des Moines, IA; Dallas, TX

RESEARCH CONTACT: Kristy Grulikowski at 404-995-4552 or [email protected]

SPECS:

• Two, 60-minute mini focus groups with middle school (grades 6-8) students, per location.

• Recruit 12 for 6 to show (seat) at each group.

• All students must be actively involved in school clubs, sports teams, student government or other school activities (see Q8).

• 5 of the 8 students must be in a low income household (see Q10).

• All students should attend a middle school that offers the National School Lunch Program (we will provide facility with a list of eligible local schools for recruitment).

• All students may not attend a middle school that has won a HUSSC (HealthierUS School Challenge) award (we will provide facility with a list of local schools that are not eligible for recruitment).

• There will be a focus group for parents on the same date/location. Those parents WILL NOT be the parents of the children selected for these sessions.

• Each child must be able to speak English.

• All respondents must be outgoing, responsive, articulate, willing and able to read and react to written materials, and must be willing to speak openly in a group.

FORMATIVE: PLEASE RECRUIT RESPONDENTS AS FOLLOWS:

	GROUP	DATE*	TIME	LOCATION
[ ]	Group 1: middle school students (girls)	TBD	TBD	Baltimore, MD
[ ]	Group 2: middle school students (boys)	TBD	TBD	Baltimore, MD
[ ]	Group 3: middle school students (boys)	TBD	TBD	Cleveland, OH
[ ]	Group 4: middle school students (girls)	TBD	TBD	Cleveland, OH
[ ]	Group 5: middle school students (girls)	TBD	TBD	Riverside, CA
[ ]	Group 6: middle school students (boys)	TBD	TBD	Riverside, CA

EVALUATIVE: PLEASE RECRUIT RESPONDENTS AS FOLLOWS:

	GROUP	DATE*	TIME	LOCATION
[ ]	Group 1: middle school students (boys)	TBD	TBD	Atlanta, GA
[ ]	Group 2: middle school students (girls)	TBD	TBD	Atlanta, GA
[ ]	Group 3: middle school students (girls)	TBD	TBD	Des Moines, IA
[ ]	Group 4: middle school students (boys)	TBD	TBD	Des Moines, IA
[ ]	Group 5: middle school students (boys)	TBD	TBD	Dallas, TX
[ ]	Group 6: middle school students (girls)	TBD	TBD	Dallas, TX

ASK TO SPEAK TO THE HEAD OF THE HOUSEHOLD.

INTRODUCTION: Hello, my name is __________ from __________. We are conducting a study about nutrition on behalf of the United States Department of Agriculture, Food and Nutrition Service, that will help America’s youth, and I’d like to ask you a few questions. I’m not trying to sell you anything. We would like to invite a number of middle school students in your area to participate in a focus group to help us understand more about what they think about nutrition and health.

May I speak to the male or female head of household? This should only take a few minutes. ONCE ADULT ON PHONE, REPEAT INTRODUCTION AND READ OMB STATEMENT (see top of screener).

1. Do you, or does anyone in your household, work for a radio station, television station, newspaper, market research company, advertising or public relations company?

Yes……	[ ]	Terminate
No……..	[ ]	Continue

2. Do you or does anyone in your household work in any of the following industries? [Record each “yes” response.]

	Yes
Healthcare/Medical……………………………	[ ]	Terminate if “YES” to any
Nutrition/Food Service………………………..	[ ]
Fitness…………………………………………	[ ]
Food Manufacturing…………………………..	[ ]
School Food Service…………………………..	[ ]
Food/Nutrition Assistance Programs………….	[ ]

3. Do you have any children that are in middle school living at home with you?

Yes………………….	[ ]	Continue
No…………………..	[ ]	Terminate

4. What is/are the age(s), grade(s) and gender(s) of the middle school child/ren currently living at home with you. (RECORD INFORMATION IN COLUMNS OF TABLE BELOW)

TERMINATE IF NO CHILD LIVING IN HOUSEHOLD CURRENTLY ATTENDS MIDDLE SCHOOL.

	Gender	Age	Grade	Name of School
1
2
3
4

RECRUIT MIX OF AGE/GRADES

ALL PARTICIPANTS MUST BE 11-13 YEARS OF AGE

DO NOT RECRUIT MORE THAN ONE CHILD PER FAMILY

RECRUIT NO MORE THAN TWO CHILDREN FROM THE SAME SCHOOL

FORMATIVE PHASE

RECRUIT BOYS FOR GROUPS: 2,3,6

RECRUIT GIRLS FOR GROUPS: 1,4,5

EVALUATIVE PHASE

RECRUIT BOYS FOR GROUPS: 1,4,5

RECRUIT GIRLS FOR GROUPS: 2,3,6

5. [IDENTIFY CHILD TO RECRUIT AND ASK THE FOLLOWING]

Do you think your child in X grade would like to participate in a focus group discussion?

Yes	[ ]	Continue
No	[ ]	Terminate

6. Has this child ever participated in a focus group or been paid to be part of a discussion group?
   
   

Yes	[ ]	Continue
No	[ ]	Skip to Q8

7. How recently did he/she/they participate in a focus group?
   
   

Less than 6 months ago	[ ]	Terminate
6 months ago or longer	[ ]	Continue

8. Does this child participate in any of the following activities:

	Yes	No
School clubs (e.g., science, chess, community service, foreign language, etc.)……….............	[ ]	[ ]	Continue if “YES” to any
Sports teams……………………………….....	[ ]	[ ]
Dance/Cheerleading/Gymnastics…………….	[ ]	[ ]
Student government…………………………..	[ ]	[ ]
Honor society…………………………………	[ ]	[ ]
Theater/Drama………………………………..	[ ]	[ ]
School band/orchestra/chorus………………..	[ ]	[ ]

9. Including yourself, how many people currently live in your household?

__________ [Record answer]

10. What is your total annual household income? [Do not read list]

Less than $19,000…………	1	Record number below
$19,000 - $25,000…………	2	Record number below
$25,001 - $32,000…………	3	Record number below
$32,001 - $38,000…………	4	Record number below
$38,001 - $45,000…………	5	Record number below
$45,001 - $51,000…………	6	Record number below
$51,001 - $58,000…………	7	Record number below
$58,001 - $64,000…………	8	Record number below
More than $64,000………..	[ ]	Terminate
Don’t know/Refused ……...	[ ]	Terminate

Answer to question 9: ____________ Answer to question 10: _______________

Accept respondent if he/she falls into one of the following categories:

___ Has 2 people in household (Q9), and answer to Q10 is 1 or 2.

___ Has 3 people in household (Q9), and answer to Q10 is 1, 2, or 3

___ Has 4 people in household (Q9), and answer to Q10 is 1, 2, 3, or 4

___ Has 5 people in household (Q9), and answer to Q10 is 1, 2, 3, 4, or 5.

___ Has 6 people in household (Q9), and answer to Q10 is 1, 2, 3, 4, 5, or 6.

___ Has 7 people in household (Q9), and answer to Q10 is 1, 2, 3, 4, 5, 6, or 7.

___ Has 8+ people in household (Q9), and answer to Q10 is 1, 2, 3, 4, 5, 6, 7, or 8.

[INTERVIEWER, RECORD WHICH CATEGORY RESPONDENT FALLS INTO]

11. Is your middle school child of Hispanic or Latino origin?

No………………….	[   ]	Continue
Yes …….…….……	[   ]	Continue

12. Which of the following best describes your middle school child’s race?   (READ LIST. ACCEPT MULTIPLE ANSWERS.)

American Indian or Alaska Native………...	[   ]	Terminate only if response is inarticulate
Asian ….…….…………………………….	[   ]
Black or African American …….………	[   ]
Native Hawaiian or Other Pacific Islander..	[   ]
White………………………………………	[   ]	Recruit no more than 3*

* TO THE EXTENT POSSIBLE, THE GROUP SHOULD BE A MIX OF RACES/ETHNICITIES.

AFTER THE PARENT HAS QUALIFIED THE CHILD ACCORDING TO ALL OF THE PRECEDING QUESTIONS, ASK TO SPEAK TO THE BOY OR GIRL WHO FITS THE SPECS. INFORM THE PARENT THAT HE/SHE MAY STAY ON THE LINE.

AFTER CHILD HAS COME TO THE PHONE, THE RECRUITER MUST PERSONALLY ASK THE CHILD THESE QUESTIONS.

Hello, my name is ______ and I’m glad to talk to you. I’d like to ask you a few questions. There are no right or wrong answers, just tell me what you think.

13. What is your name? RECORD FULL NAME ____________________________

14. What grade are you in? [ ] 6 [ ] 7 [ ] 8

CHILD MUST BE IN GRADE 6, 7 OR 8. IF NOT, TERMINATE.

The following question will be asked to ascertain if the respondent is articulate, outgoing and comfortable conversing. Outgoing and articulate respondents are critical to the success of the groups.

15. What is your favorite character (TV, book, movie, etc.)? Why is (INSERT CHARACTER) your favorite?

RECORD CHARACTER NAME: ________________________________________________

REASONS:

EACH CHILD MUST BE ABLE TO GIVE ANSWERS IN COMPLETE SENTENCES AND FULLY DESCRIBE WHY THE CHARACTER IS HIS/HER FAVORITE; OTHERWISE, TERMINATE.

16. Now, I’m going to read you some sentences. Please tell me if you think it is True, Not True, or You Don’t Know… READ ALL ANSWERS FOR EACH

	True	Not true	Don’t know
I like to tell other people what I think, even it is different from what other people think		TERMINATE	TERMINATE
I like meeting and talking to new people		TERMINATE	TERMINATE
I like being in groups of people		TERMINATE	TERMINATE

RESPONDENT MUST ANSWER “TRUE” FOR ALL THREE STATEMENTS.

17. I would like to invite you to come to a group and talk with other middle schoolers your age. I think you’ll have fun helping us with this project. Would you like to participate?

Yes	[ ]	Continue
No	[ ]	Terminate

IF THE CHILD QUALIFIES ON ALL OF THE SCREENING QUESTIONS, TELL HIM/HER THAT HE/SHE HAS BEEN INVITED TO ATTEND A FOCUS GROUP DISCUSSION WITH OTHER KIDS HIS/HER AGE.

AGAIN…DO NOT RECRUIT A CHILD WHO DOES NOT WANT TO PARTICIPATE EVEN IF PARENT SAYS, “YES, HE/SHE WOULD LIKE TO.”

ASK THE CHILD TO GIVE THE PHONE BACK TO THE PARENT AND TELL THE PARENT THAT THEIR CHILD HAS QUALIFIED TO ATTEND A FOCUS GROUP SESSION WITH OTHER CHILDREN HIS/HER AGE.

We would like to invite your child to participate in a group discussion that will be held at our facility on (DATE) at (TIME). The group will last approximately 60 minutes. To help cover costs such as transportation to the focus group site, you will be given $50 at the end of the group session. Would you be willing to participate?

Yes……………( ) SCHEDULE No……………..( ) TERMINATE

I will call you to remind you of this appointment. However, if for some reason your child is unable to attend, please call me at (TELEPHONE NUMBER) so that I can find a replacement for him/her.

Please note that the parents of all participants will be asked to sign a confidentiality agreement and parental consent form prior to participating in the group. Thank you for agreeing to be part of our study. We look forward to meeting you. Goodbye.

Respondent’s name: ___________________________________________

Address: ____________________________________________________

Telephone # (Home): __________________ (Work) _________________

Recruited by: _________________________________________________