NHTSA Form 1142 CPS GM Comm Checks Recruitment Screener

Focus Group Studies Under Generic Clearance - Recruitment Screener

OMB Control No. 2127-0667

Expiration Date 10/31/2010

Recruitment Screener

Parent & Caretaker Focus Groups to Develop

New Child Passenger Safety Public Service Advertising Campaign

Generic Clearance OMB Control No: 2127-0667: Focus Groups for Traffic and Motor Vehicle Safety Programs and Activities

PHONE SCREENING INTERVIEW GUIDE

NOTE TO RECRUITER: If a child answers the phone say, “May I speak with a parent or adult who lives in the household?”

Hello, this is __________________, from (NAME OF FOCUS GROUP COMPANY), calling on behalf of the U.S. Department of Transportation. We are conducting a study of American’s opinions about motor vehicle safety. I would like to ask you a few questions to determine if you are eligible for the study. (INTERVIEWER NOTE: If necessary, read:) A federal agency may not conduct or sponsor, and a person is not required to respond to, nor shall a person be subject to a penalty for failure to comply with a collection of information subject to the requirements of the Paperwork Reduction Act unless that collection of information displays a current valid OMB Control Number. The OMB Control Number for this information collection is 2127-0667. Public reporting for this collection of information is estimated to be approximately 10 minutes per response, including the time for reviewing instructions, completing and reviewing the collection of information. All responses to this collection of information are voluntary. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to: Information Collection Clearance Officer, National Highway Traffic Safety Administration, 1200 New Jersey Ave, S.E., Washington, DC, 20590

Could we begin now?

1. NOTE TO RECRUITER: RECORD SEX. (RECRUIT MIX, OK TO SKEW FEMALE)

( ) Female

( ) Male

2. Do you, or does anyone in your immediate family, work in any of the following industries or professions? NOTE TO RECRUITER: IF YES TO ANY ANSWER, TERMINATE

( ) Marketing or marketing research (TERMINATE)

( ) Advertising or public relations (TERMINATE)

( ) News media, including newspaper, television, radio or publishing

(TERMINATE)

( ) Any company that manufactures, distributes, or sells automobiles or automobile parts (TERMINATE)

( ) Any company that manufactures, distributes, or sells car seats (TERMINATE)

3. In the past 6 months, have you participated in a group discussion or interview regarding a product or service?

( ) Yes (TERMINATE)

( ) No (CONTINUE)

4. Which of the following groups does your age fall into? (READ LIST)

( ) Under 18 (TERMINATE)

( ) 18 – 24 (CONTINUE)

( ) 25 – 34 (CONTINUE)

( ) 35 – 44 (CONTINUE)

( ) 45 – 54 (CONTINUE)

( ) 55 – 64 (CONTINUE)

( ) 65+ (CONTINUE)

( ) Refused (TERMINATE)

5. Are you the parent or guardian of any children age 12 or younger living in your household?

( ) Yes (CONTINUE)

( ) No (SKIP TO Q7)

6. What are the ages of your children under age 13 who currently live with you?

NOTE TO RECRUITER: WRITE IN AGES

	Age
Child 1	_____
Child 2	_____
Child 3	_____
Child 4	_____
Child 5	_____

NOTE TO RECRUITER: VERIFY ONE CHILD IS BETWEEN AGES 0-12. IF YES, SKIP TO Q9. IF NO, CONTINUE TO Q7.

NOTE TO RECRUITER: RECRUIT 18 PARENTS/CARETAKERS OF CHILDREN AGES 0-3, 18 PARENTS/CARETAKERS OF CHILDREN AGES 4-7, AND 18 PARENTS/CARETAKERS AGES 8-12

7. Do you look after children for family or friends for three or more days per week regularly?

( ) Yes

( ) No (TERMINATE)

8. How old is this child/children that you look after?

	Age
Child 1	_____
Child 2	_____
Child 3	_____
Child 4	_____
Child 5	_____

NOTE TO RECRUITER: ONE CHILD MUST BE BETWEEN AGES 0-12 TO CONTINUE; IF 13 OR OLDER, TERMINATE

9. Do you drive a car, truck, SUV, or van on a regular basis?

( ) Yes (CONTINUE)

( ) No (TERMINATE)

NOTE TO RECRUITER: READ THE FOLLOWING:

For the rest of the survey, I will use the term car. When I use this term, please also think about vans, trucks, and SUVs.

10. On average, how often does your child under age 13 travel with you in your car?

( ) 3 days per week or more (CONTINUE)

( ) Less than 3 days per week (TERMINATE)

11. Thinking about the car that you personally drive, which of the following do you do regularly, that is, more often than not? Do you regularly…

NOTE TO RECRUITER: READ LIST, CHECK ALL THAT APPLY

	YES	NO
Lock your doors when you leave your car	( )	( )
Wear the lap and/or shoulder strap of your safety belt	( )	( )
Ask others riding in your car to buckle their seatbelt	( )	( )
Take your car in for tune-ups	( )	( )
Use a safety restraint like a car seat or a safety belt for your child(ren)	( )	( )

NOTE TO RECRUITER: MUST ANSWER YES TO “E” IN Q11 TO CONTINUE. OTHERWISE, TERMINATE.

12. You mentioned you use car safety restraints for your child. As I reference the age of your child, please tell me which of the following type of car safety restraint you use for that child when they ride in your car.

NOTE TO RECRUITER: REFERENCE CHILD’S AGE, READ LIST OF SAFETY RESTRAINTS, CHECK ONE

	Child 1 Age ___	Child 2 Age ___	Child 3 Age ___	Child 4 Age ___	Child 5 Age ___
Rear-facing car seat	( )	( )	( )	( )	( )
Forward-facing car seat	( )	( )	( )	( )	( )
Booster seat	( )	( )	( )	( )	( )
Adult seat belt	( )	( )	( )	( )	( )
No car seat or seat belt	( )	( )	( )	( )	( )
Don’t know	( )	( )	( )	( )	( )

NOTE TO RECRUITER: TERMINATE IF RESPOND “NO CAR SEAT/SEAT BELT” OR “DON’T KNOW” FOR ALL CHILDREN 0-12

13. It is important in our research to speak with people of different backgrounds and cultures. Which of the following best represents your ethnic background or race? NOTE TO RECRUITER: READ LIST

( ) Caucasian

( ) African-American or Black

( ) Hispanic or Latino

( ) Asian

( ) Alaskan Native or American Indian

( ) Native Hawaiian or Other Pacific Islander

( ) Other (SPECIFY)________________

( ) Refused

13. Which of the following bests describes your household income? NOTE TO RECRUITER: READ LIST

( ) Lower than $30,000 annually

( ) $30,000 to 49,999

( ) $50,000 to 74,999

( ) $75,000 to 99,999

( ) $100,000 to 149,999

( ) $150,000 +

( ) Refused

(RECRUIT A MIX)

13. What was the last grade of school that you’ve completed? NOTE TO RECRUITER: READ LIST

( ) 8^th grade or less (TERMINATE)

( ) 9^th grade through 11^th grade

( ) Completed high school

( ) Some college/Trade School/Associate’s Degree

( ) Completed college

( ) Post Graduate

( ) Refused

(RECRUIT A MIX; SKEW TOWARDS COMPLETED HIGH SCHOOL OR HIGHER)

NOTE TO RECRUITER: The next question is an articulation question. What the respondent says is not important; rather, judge his/her ability and willingness to comment with a specific point-of-view.

13. If you could go on an all expense paid vacation for two weeks anywhere in the world, where would you go and why?

____ Articulate

____ Not articulate (TERMINATE)

INVITATION

Thank you for helping us with this survey. We have been asked to conduct interviews with people like you to give us ideas related to child safety in the car. We would like to invite you to a research interview to be held on MM/DD/YY at XX:XX. The session will last approximately 90 minutes. We understand the demand on your schedule; therefore, you will receive $75 for your participation. Your participation is strictly voluntary.

May we count on you to join us?

( ) Yes (CONTINUE)

( ) No (TERMINATE)

We will be giving you a reminder call the day before the session. Is this the best number to reach you? Is there a preferred time for us to call you?

ALTERNATIVE PHONE, IF NECESSARY: ____________________________

PREFFERED TIME, IF APPLICABLE: _________________________________

If, for any reason, you are unable to attend, please call us at XXX-XXX-XXXX.

Thank you, and we look forward to seeing you soon.

END OF SCREENER GUIDE

NHTSA Form 1142 Page 9