Form Attachment 3 Attachment 3 Screener Interviews for Selected Women to Participate in

ATTACHMENT 3

Focus Group Screener

Form Approved

OMB Control No._______

Expiration Date________

FOCUS GROUP SCREENER

Selected Women

Criteria for females:

• Mothers of children ages 5 or under, or pregnant

• College education

• Regular news readership

• Not “a great deal” of environmental knowledge

NOTES TO FACILITY

• Please do not call people who have done a focus group in the last 6 months.

• Please do not call people who have ever done 5 or more focus groups.

• 6-9 participants per group.

Hello. My name is _____ of _______, a local marketing research firm. We are recruiting participants for a research study about environmental issues and would very much like to include your opinions. Participants in this study will receive $75. Let me assure you that this is a legitimate research study. I am not trying to sell anything. I have just a couple of questions to see if you qualify for the study.

1. RECORD GENDER

( ) Female – CONTINUE

( ) Male – [ASK TO SPEAK TO FEMALE HEAD OF HOUSEHOLD, IF NO FEMALE IN HH, THANK & TERMINATE]

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: Carol E. Walker, CDC Acting Reports Clearance Officer, 1600 Clifton Road, MS-D74, Atlanta, GA 30333.

2. What is the last year of school or college have completed?

( ) Less than High School – THANK & TERMINATE

( ) High School grad – THANK & TERMINATE

( ) Some college – THANK & TERMINATE

( ) 4-year college graduate – CONTINUE

( ) Graduate school – CONTINUE

( ) Refused – THANK & TERMINATE

3. Are you the mother of a child between the ages of 0 and 5, or are you currently pregnant?

( ) Yes– CONTINUE

( ) No – THANK & TERMINATE

4. During an average week, how often do you read national newspapers, such as the Wall Street Journal, the New York Times, the Washington Post, the Chicago Tribune, or the Los Angeles Times, either in print or the online version?

( ) 3 or more times per week – CONTINUE

( ) 0-2 time per week– CONTINUE

( ) Refused -– THANK & TERMINATE

5. Now let me ask you about news programs on television or radio. Do you regularly, that is, almost every day, watch or listen to television or radio news on the major networks, a cable channel like CNN, or a public television or radio station like PBS or NPR?

( ) Yes – CONTINUE

( ) No – CONTINUE

( ) Refused -– THANK & TERMINATE

6. Do you regularly, that is, almost every week, read a national news magazine such as Time, Newsweek, the US News and World Report, or the Economist?

( ) Yes – CONTINUE

( ) No – CONTINUE

( ) Refused -– THANK & TERMINATE

STOP.

IF Q4=3+ times per week OR Q5=yes OR Q6=yes, CONTINUE.

ELSE THANK AND TERMINATE.

7. Do you regularly, that is, almost every week, visit parenting websites or read parenting magazines?

( ) Yes – CONTINUE

( ) No – THANK & TERMINATE

( ) Refused -– THANK & TERMINATE

8. How much knowledge would you say you have about environmental issues, including climate change, chemical exposures, and clean energy? Would you say a great deal, some, a little, not a lot?

( ) A great deal – THANK & TERMINATE

( ) Some – CONTINUE

( ) A little – CONTINUE

( ) Not a lot – CONTINUE

( ) Refused -– THANK & TERMINATE

9. How often do you talk with other moms who have kids around the same age as yours about parenting issues? Would you say…

( ) Every day – CONTINUE

( ) A couple of times a week– CONTINUE

( ) Once a week– CONTINUE

( ) Once a month– CONTINUE

( ) Less than once a month– CONTINUE

( ) Refused -– THANK & TERMINATE

10. I will read you a list of activities that people sometimes do. For each activity, please tell me whether you have done that activity in the past year?

During the past year have you…	YES	NO
Written to or called any politician at state, local or national level?	□	□
Attended a public meeting on town or school affairs?	□	□
Served on a committee for a local organization?	□	□
Served as an officer of a club or organization?	□	□
Worked for a political party?	□	□
Attended a political rally, speech, or organized protest of any kind?	□	□
Written a letter to the editor of a newspaper or magazine, or called a radio show or TV show to express an opinion?	□	□
Posted your opinions online, either on a blog or a social networking site like Facebook?	□	□
Made a speech?	□	□

STOP.

IF 2 OR FEWER “yes” IN Q10, RECRUIT.

ELSE THANK AND TERMINATE.

11. Please stop me when I mention the group that includes your age. [RECRUIT A MIX]

( ) 18 – 24– CONTINUE

( ) 25 – 29– CONTINUE

( ) 30 – 34 – CONTINUE

( ) 35 – 39– CONTINUE

( ) 40 – 44– CONTINUE

( ) 45 – 49– CONTINUE

( ) 50 and older – THANK & TERMINATE

( ) Refused – THANK & TERMINATE

12. What is your race? [RECRUIT AT LEAST 2 NOT WHITE]

( ) American Indian or Alaska Native– CONTINUE

( ) Asian– CONTINUE

( ) Black or African American – CONTINUE

( ) Hispanic or Latino – CONTINUE

( ) Native Hawaiian or Other Pacific Islander – CONTINUE

( ) White – CONTINUE

( ) Refused – THANK & TERMINATE

13. Are you currently employed? [RECRUIT AT LEAST 3 EMPLOYED]

( ) Yes

( ) No

14. Finally, do you or anyone in your household work or volunteer for any of the following:

		Yes	No
	An advertising agency, marketing or marketing research firm	□	□
	A for-profit or not-for profit environmental organization	□	□
	A federal, state or local government agency that focuses on environmental issues	□	□
	A for-profit or not-for-profit organization that is part of the chemical industry	□	□

If “yes” to any of the above, THANK AND TERMINATE

READ THE FOLLOWING:

I’d like to invite you to take part in a research study that takes the form of a group discussion. The discussion will be held on _______and will last about 2 hours. No one will try to sell you anything in this discussion and no one will contact you for any sales purpose as a result of your participation in this study. We are only interested in your opinions. After taking part in this study, you will receive $75 as a token of appreciation.

GIVE RESPONDENT DIRECTIONS TO FACILITY. We will call you the day before to remind you about this discussion. We will be counting on your attendance since we will only be inviting about eight people. So that we can be sure to start and end on time, please plan to arrive at our office fifteen minutes before the beginning of the group. We are counting on your participation, so please be sure to contact us as soon as possible if something arises and you find you can’t attend.

May I please get your:

Name: _________________________________________________________________________

Address: ________________________________ City:_________________ Zip: _____________

Home Phone: ___________________________ Work Phone: _____________________________

9