NHTSA Form 1152 Impaired Driving Prevention-Screener

Focus Group Studies Under Generic Clearance - Recruitment Screener

OMB Control No. 2127-0667

Expiration Date 10-31-2013

Recruitment Screener

Focus Groups to Develop Impaired Driving Prevention Public Service Advertising Campaign

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

NOTE TO RECRUITER: Ask to speak to anyone age 21 to 34 (note: age range is critical). If none available, terminate.

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 Hispanic’s opinions about driving laws and behaviors. 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 6 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

I would like to ask you a few questions to determine if you are eligible for the study.

IF A CHILD ANSWERS THE PHONE: May I speak with a parent or adult who lives in the household?

Could we begin now?

( ) Yes

( ) No TERMINATE OR SCHEDULE CALLBACK

1. RECORD SEX:

( ) FEMALE

( ) MALE

RECRUIT MEN FOR GROUPS 1-2 AND WOMEN FOR GROUPS 3-4

2. Into which of the following ranges does your age fall? (READ)

( ) Under 21 TERMINATE

( ) 21 - 27 QUALIFY

( ) 28 - 34 QUALIFY

( ) 35-44 TERMINATE

( ) Above 45 TERMINATE

RECRUIT A MIX OF AGES 21 TO 34

3. Have you participated in a focus group discussion or one-on-one research interview in the past year, either in your home/office or at another location?

( ) Yes SKIP TO Q3b

( ) No SKIP TO Q3c

3b. What was the topic of that discussion or interview? _________________________________

TERMINATE IF TOPIC WAS RELATED TO 1) ALCHOHOLIC BEVERAGES OR DRINKING, OR 2) A SOCIAL OR PUBLIC HEALTH ISSUE. IF ANY QUESTIONS, CONSULT WITH CLIENT.

3c. Have you, or anyone else in your household, worked in the past year for:

A. ( ) A manufacturer, distributor, seller or marketer of alcoholic beverages, excluding

grocery and convenience stores

B. ( ) A market research, advertising, marketing, or public relations firm or department within a company

C. ( ) An energy, oil or fuel provider

D. ( ) An Internet or traditional business selling pre-recorded CDs, DVDs or home electronics

TERMINATE IF “A” OR “B” IS CHECKED.

4. Do you currently own a car, truck, or motorcycle, or have access to someone else’s vehicle that you are permitted to drive?

( ) Yes

( ) No TERMINATE

5. Which of the following statements describes your driving habits in a typical week? (READ)

( ) I’m a “weekday driver.” I drive mostly on weekdays, like when I commute to/from work or school.

( ) I’m a “weekend driver.” I spend the most time behind the wheel on weekends (Friday- Sunday).

( ) I’m a “road warrior.” I drive more than 100 miles in a typical week, whether for business or leisure.

( ) I’m a “moderate driver.” I drive most days, but I log fewer than 100 miles in a typical week.

( ) I’m a “driveway dweller.” I drive very little. My vehicle spends more time in its parking spot than on the road TERMINATE

( ) None of these statements describe my driving behavior. TERMINATE

RECRUIT A MIX

6. Which of the following activities, if any, have you engaged in over the last three weeks? (READ)

(a) Dining out with friends ( )

(b) Attending concerts or theater productions ( )

(c) Attending house parties ( )

(d) Going out for drinks after work ( ) MUST CHECK TWO OR

(e) Entertaining friends in my home ( ) MORE TO CONTINUE.

(f) Going to bars, sports bars or taverns ( )

(g) Going to beer or wine tasting events ( )

(h) Going to nightclubs or lounges ( )

(i) Going bowling ( )

(j) Playing pool or billiards ( )

(k) Attending professional sporting events ( )

(l) Going to casinos, or other gaming establishments ( )

7. Which of the following best describes your drinking habits when it comes to alcoholic beverages? (READ)

( ) I never drink. TERMINATE

( ) I’m an infrequent drinker; I rarely drink except for on an occasional holiday or

special occasion. TERMINATE

( ) I drink in social situations 1- 2 times per week, and I generally drink 1 to 2 drinks each time CONTINUE

( ) I drink in social situations 1- 2 times per week, and I generally drink 3 or more drinks each time CONTINUE

( ) I drink in social situations 3 or more times in a week, and I generally drink 1 to 2 drinks each time CONTINUE

( ) I drink in social situations 3 or more times in a week, and I generally drink 3 or more drinks each time CONTINUE

8. What is your current employment status? (READ)

( ) Employed full time

( ) Employed part time

( ) Retired TERMINATE

( ) Full-time student MAX ONE PER GROUP

( ) Stay-at-home parent

( ) Temporarily unemployed

[ASK IF EMPLOYED FULL- OR PART-TIME IN Q8]

8a. What is your occupation? _____________________________

RECRUIT A VARIED MIX OF WHITE COLLAR AND BLUE COLLAR OCCUPATIONS ACROSS GROUPS.

9. I am going to read a series of statements that may or may not reflect your opinions or your lifestyle. For each, please tell me if you 1) Agree Strongly, 2) Agree Somewhat, 3) Neither Agree nor Disagree, 4) Disagree Somewhat, or 5) Disagree Strongly.

1 2 3 4 5

(A) I consider myself to be a daring and adventurous person( ) ( ) ( ) ( ) ( )

(B) I hate all advertising ( ) ( ) ( ) ( ) ( )

(C) I have an active social life ( ) ( ) ( ) ( ) ( )

(D) I usually drive faster than the speed limit ( ) ( ) ( ) ( ) ( )

(E) I’ve known most of my friends for 5 or more years ( ) ( ) ( ) ( ) ( )

(F) It’s ok to drive home if you’ve had a few drinks,

as long as you’re not drunk ( ) ( ) ( ) ( ) ( )

MUST SPECIFY 3 OR 4 OR 5 FOR B TO CONTINUE

MUST SPECIFY 1 OR 2 OR 3 FOR F TO CONTINUE

10. Which of the following best describes your level of formal education? (READ)

Less than high school ( ) TERMINATE

Graduated from high school ( )

Received GED ( )

Attended college, but have not graduated ( )

Completed a vocational school program ( )

Graduated from a two-year college ( )

Graduated from a four-year college or university ( )

Attended or completed graduate school ( )

Currently attending college or vocational school ( )

RECRUIT A MIX

12. Which of the following ranges includes your annual household income? (READ)

( ) Under $20,000 TERMINATE

( ) $20,000 - $29,999

( ) $30,000 - 49,999

( ) $50,000 – 79,999

( ) $80,000 - 99,999

( ) $100,000 and over

13. In what city or town do you live?

­­­­­­­_________________________________

RESPONDENT SHOULD NOT LIVE IN AN URBAN CENTER THAT HAS EXTREMELY EASY ACCESS TO PUBLIC TRANSPORTATION OR TAXIS. PLEASE AIM TO RECRUIT AS MANY RESPONDENTS FROM DIFFERENT LOCALITIES IN THE REGION AS POSSIBLE.

THE NEXT QUESTION IS AN ARTICULATION QUESTION. WHAT THE RESPONDENT SAYS IS NOT IMPORTANT; RATHER, JUDGE HIS ABILITY AND WILLINGNESS TO COMMENT WITH A SPECIFIC POINT-OF-VIEW.

14. I’d like to finish by asking you a question that is a complete departure from the type of questions I’ve been asking you to this point. There are no right or wrong answers and it’s an opportunity to use your imagination:

If you had the opportunity to spend one hour with a famous person – either from the past or present – who would that person be?

Why did you pick this person? Please be as specific as possible.

____ Articulate

____ Not articulate (TERMINATE)

INVITATION

Thank you for helping us with this survey. We would like to invite you to a research discussion to be held on MM/DD/YY at XX:XX. The session will last approximately 2 hours. We understand the demand on your schedule; therefore, you will receive $75 cash incentive for your participation. Your participation is strictly voluntary.

May we count on you to join us?

( ) Yes (CONTINUE)

( ) No (TERMINATE)

ADVISE INVITEES THAT IF THEY REQUIRE EYEGLASSES TO BE

SURE TO BRING THEM TO THE INTERVIEW

NOTE TO INTERVIEWER: Do not schedule anyone who is reluctant about the time, hesitant about participating in a discussion, talks too low or speaks unclearly.

END OF SCREENER GUIDE

NHTSA Form 1152 Page 10