Attachment 6: Chil Attachment 6: Child Screener

ATTACHMENT 6

Child Recruit/Screener

OMB No. 0930-0196

Expiration Date: 09/30/2013

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 15 minutes hours per respondent per year, including time for responding to questions, reviewing message concepts provided, and sharing reactions and ideas within the group. 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 8-1099, Rockville, Maryland, 20857.

SAMSHA Underage Drinking Prevention National Media Campaign

CHILD INTERVIEW Recruit

NAME OF CHILD: ________________________________________

NAME OF PARENT: _______________________________________

PHONE: ________________________________

E-MAIL: _________________________________

Sample Selection

• Participants should be recruited for 1 of 24 interviews.

• The objective is to obtain four interviewees per age group for a total of four interviews. Please recruit one extra boy and one extra girl per age group.

• Participants should be recruited from a cross section of race/ethnicity, socioeconomic status, and rural/urban/suburban groups.

• Only one participant per household.

ASK TO SPEAK TO PARENT/GUARDIAN OF CHILD IN HOUSEHOLD WHO IS CURRENTLY BETWEEN THE AGES OF 9 AND 15

INTRODUCTION

Hello, my name is ____________ and I am calling from Gallup. We are interested in talking to young people between the ages of 9 and 15 to understand their thoughts about some important issues relating to their health and safety.

The purpose of these groups is to help the U.S. Government develop an underage drinking prevention education program for parents. We’ve talked with many parents already, and they’ve told us they need messages that work for their children. This is a unique opportunity to make a valuable contribution to your community and the Nation. If you have a few minutes, we would like to talk to you and see whether you’ll give us permission to invite your child to participate. We also have a few questions to ask your child after we talk with you. We are offering a $50 gift card for you and a $25 gift card for the child as a way to say thank you for participating.

GENERAL QUESTIONS

I have some general questions for you that should take just a few minutes. For my records, may I please have your name? [RECORD PARENT’S NAME ABOVE]

1. First of all, what is the preferred language spoken in your household?

______________________________________ [TERMINATE IF NOT ENGLISH]

2. This project will involve the opinions of your child. How many, if any, sons or daughters do you have who are between the ages of 9 and 15, and are currently living with you at home?

NUMBER: _________ [TERMINATE IF NONE]

3. ASK OF ALL: When consumer interviews are conducted, it is sometimes important for us to talk with people who have already participated in a previous consumer interviews because they have experience talking about certain topics. Other times, it is important that we speak to people who have not participated in any focus groups or interviews.

When, if ever, was the last time your (CHILD OR CHILDREN AGES 9-15) participated in a consumer interview or a group discussion, with us or with any other company? [ASK FOR EACH CHILD WITHIN RANGE]

[DO NOT READ LIST]

• Within past 6 months [ ] [ ] [ ] — [TERMINATE]

• More than 6 months ago [ ] [ ] [ ] — [CONTINUE]

• Never [ ] [ ] [ ] — [SKIP TO Q. 7]

[NOTE: NO PREVIOUS PARTICIPATION FOR CHILD WITHIN PAST 6 MONTHS.]

4. ASK OF ALL: I am going to read you several age categories. Please stop me when I reach the one in which your child/children current age falls: [RECORD RECRUIT’S NAME ABOVE]

• 9-11What is the first name of this child? ________________(RECRUIT FOR SESSION AS NEEDED)

• 12-13 What is the first name of this child?_______________ (RECRUIT FOR SESSION AS NEEDED)

• 13-15 What is the first name of this child?_______________ (RECRUIT FOR SESSION AS NEEDED)

5. ASK OF ALL:

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

01 Urban

02 Suburban

03 Rural

B. Annual household income? (RECRUIT A MIX)

01 Less than $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 or more

NOTE: PLEASE DETERMINE AT THIS TIME WHICH CHILD WILL BE THE FOCUS OF THE SCREENING, AND REFER TO THAT CHILD BY NAME FROM THIS POINT ONWARD.

SELECTED CHILD SPECIFIC QUESTIONS - PARENT

1. Which of the following best describes [INSERT CHILD’S NAME FROM Q 4] ethnic background? [READ LIST AND RECORD]

01 Hispanic

02 Latino

2. What is [INSERT CHILD’S NAME FROM Q 4] race? (Mark all that apply)

1. American Indian or Alaska Native

2. Asian

3. Black or African American

4. Native Hawaiian or Other Pacific Islander

5. White

3. I am going to read you a list of topics. Please tell me how often, if at all, you and [INSERT CHILD’S FIRST NAME] talk about them.

01 School/grades

02 Drugs

03 Sex

04 Alcohol

05 Peer pressure

06 Bullying

4. Thinking about a scale of 1 to 6, where “1” is “Very Uncomfortable” and “6” is “Very Comfortable,” how comfortable do you feel about someone interviewing [INSERT CHILD’S NAME] about the consequences of underage drinking?

VERY UNCOMFORTABLE VERY COMFORTABLE

1 2 3 4 5 6

MUST ANSWER 5 OR 6

5. Thinking about a scale of 1 to 6 where “1” is “Very Uncomfortable” and “6” is “Very Comfortable,” how comfortable do you feel [INSERT CHILD’S NAME] would be in expressing his/her opinions in an interview?

VERY UNCOMFORTABLE VERY COMFORTABLE

1 2 3 4 5 6

MUST ANSWER 5 OR 6

At this point, I would like to talk with [INSERT CHILD’S NAME] and ask (him or her) a few questions.

SELECTED CHILD SPECIFIC QUESTIONS – CHILD

RECRUITER: PLEASE ASK THE FOLLOWING QUESTIONS TO DETERMINE HOW TALKATIVE AND ARTICULATE THE CHILD IS. IT IS CRITICAL THAT WE SPEAK WITH YOUNG PEOPLE WHO ARE COMFORTABLE EXPRESSING THEMSELVES WITH SOMEONE THEY ARE MEETING FOR THE FIRST TIME. PLEASE USE YOUR BEST JUDGMENT HERE AND RECRUIT ONLY YOUNG PEOPLE THAT ARE THOUGHTFUL AND FREELY EXPRESS THEMSELVES IN A MANNER THAT IS RELEVANT TO THE TOPIC BEING DISCUSSED.

WHEN CHILD IS ON THE PHONE, PLEASE INTRODUCE YOURSELF AND SAY:

Hi! I was talking with your (INSERT PARENT RELATIONSHIP) about some different kinds of things parents talk about with kids your age. Now I'd like to ask you a few questions. There are no right or wrong answers to my questions. These are just some questions about things you and your parents talk about. So, please be very honest in your answers. If you are ready, let's begin.

1. How old are you?

2. What grade are you in?

3. What kind of activities do you do outside of school?

NOTE: WE ARE LOOKING FOR ARTICULATE CHILDREN. PLEASE USE YOUR JUDGMENT IN CONSIDERING THE CHILD'S ANSWERS. IF THE CHILD CANNOT ANSWER THE QUESTION, OR HAS DIFFICULTY COMMUNICATING, PLEASE TERMINATE.

4. If something is bothering you at school, how comfortable are you talking to your

(INSERT PARENT RELATIONSHIP/S) about it?

5. Now, I'd like you to think about something different for a few moments. What would you

like to do when you grow up?

6. Can you tell me what would be interesting or fun about that?

THANK THE CHILD AND ASK TO SPEAK TO PARENT AGAIN.

PARTICIPATION DECISION

IF THE CHILD CANNOT OR DOES NOT ANSWER THE QUESTIONS, OR HAD DIFFICULTY, PLEASE PROVIDE THE FOLLOWING INFORMATION TO THE PARENT/GUARDIAN.

Thank you for taking the time to talk with me today and for giving me the opportunity to talk to (INSERT CHILD’S NAME). (INSERT CHILD’S NAME) does not meet the criteria necessary to participate in this interview. The information you and your child provided will not be used for any purpose. Thank you again for you time. [TERMINATE]

CHILDREN SELECTED TO PARTICIPATE—PLEASE READ THE FOLLOWING INFORMATION TO THE PARENT/GUARDIAN.

We would like to invite [INSERT CHILD’S NAME] to participate in an interview that will take place at our location/facility.

The discussion will last approximately 45 minutes and will be held on (day, date, time).

Your child's opinion is very important to us and to thank (him or her) for participating and to compensate you for your time, we would like to give [him/her] a $25 gift card and you a $50 gift card at the end of the session.

Total: 24 interviews

	Raleigh	Cleveland
9-11	4 Interviews GROUP 1	4 Interviews GROUP 4
12-13	4 Interviews GROUP 2	4 Interviews GROUP 5
14-15	4 Interviews GROUP 3	4 interviews GROUP 6

The interviews will be held on DATE at TIME at LOCATION. Will you be able to participate?

DATE TIME LOCATION

IF GROUP 1 participant READ: TBD TBD TBD

IF GROUP 2 participant READ: TBD TBD TBD

IF GROUP 3 participant READ: TBD TBD TBD

IF GROUP 4 participant READ: TBD TBD TBD

IF GROUP 5 participant READ: TBD TBD TBD

IF GROUP 6 participant READ: TBD TBD TBD

ADVISE PARENT OF THE FOLLOWING:

• The Parent or guardian will be required to sign a facility consent form allowing his or her child's participation.

• Ideally, the parent will stay at the facility while the child participates in the discussion. However, if the parent leaves, he or she must be reachable by cell phone.

• Please ask the respondent to arrive 10-15 minutes ahead of time.

• Explain that participants who arrive after their scheduled time will not receive gift cards.

• Give the participant the location information and directions.