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pdfRTI/FDA Tobacco Focus Groups
Screening Questionnaire
Name:
Address:
City:
State:
Telephone:
Zip:
Email:
Hello, this is _____________ from [FACILITY NAME], a local market research firm.
May I please speak to_____________?
(Hello, this is _____________ from [FACILITY NAME], a local market research
firm.) We are working with RTI International, a nonprofit research organization, and
the Food and Drug Administration (FDA) on a research study about tobacco
products and would like to include your opinions. I want to assure you that we are
not from a tobacco company or a company that sells quit-smoking aids.
We are holding a group discussion on [DATE] with 7 other people like yourself. The
discussion group starts at [TIME] and will last about 90 minutes. For study
purposes, the group discussion will be audio and video recorded, and FDA project
team members may observe the discussion. If you participate, you will receive $XX
for your time and opinions. First, however, I need to ask you a few questions to see
if you qualify for the study.
Record Gender—Do not ask:
Male
Female
1. Which of the following categories best describes your age? (Read list. Recruit
per group. Recruit a mix to show per group.)
18–24
Recruit for 18–24 Group
25–29
Recruit for 25–34 Group
30–34
Recruit for 25–34 Group
35–39
Recruit for 35+ Group
40–49
Recruit for 35+ Group
50–59
Recruit for 35+ Group
60 and over
Recruit for 35+ Group
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2. Have you smoked more than 100 cigarettes, cigarillos, or little cigars in your
lifetime?
Yes
Continue.
No
Continue if recruiting for 18–24 Groups, otherwise:
If male, go to Question 8.
If female, thank the respondent and terminate.
3. Do you currently smoke cigarettes, cigarillos, or little cigars…? (Read list.)
Every day
Continue.
Some days
Go to Question 5.
Not at all (FORMER)
If recruiting for Former Smokers Groups, go to
Question 7; otherwise, thank the respondent and
terminate.
4. [Smokers/Every day only.] On average, how many cigarettes, cigarillos, or
little cigars do you smoke a day? Would you say…? (Read list.)
Fewer than 10 (LIGHT) Go to Question 8 if recruiting 18–24 light smokers.
10 or more (CURRENT) Continue. [For Light User Group only, thank the
respondent and terminate.]
5. [Smokers/Some days only.] On how many of the past 30 days did you smoke
a cigarette, cigarillo, or little cigar? Would you say…? (Read list.)
Fewer than 20 (LIGHT) Go to Question 8 if recruiting 18–24 light smokers.
20 to 30 (CURRENT)
Continue. [For Light User Group only, thank the
respondent and terminate.]
6. [Smokers/Some days only.] On average, when you smoked during the past
30 days, about how many cigarettes, cigarillos, or little cigars did you smoke a
day? Would you say…? (Read list.)
Fewer than 10 (LIGHT) Go to Question 8 if recruiting 18–24 light smokers.
10 or more (CURRENT) Continue. [For Light User Group only, thank the
respondent and terminate.]
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7. How long has it been since you quit smoking cigarettes, cigarillos, or little
cigars? Would you say…? (Read list. Recruit at least 6 Recent Quitters per
group.)
Less than 6 months ago Continue to recruit (Recent Quitters) for Former
Groups.
6 to 12 months ago
Continue to recruit (Recent Former Users) for
Former Groups.
1 to 2 years ago
Continue to recruit (Recent Former Users) for
Former Groups.
More than 2 years ago
Thank the respondent and terminate.
8. Do you currently use chewing tobacco, snuff, or dip, such as Copenhagen, Skoal,
Grizzly, or Redman? (If yes, recruit for Smokeless Tobacco User Group and/or
at least 2 per each remaining male group).
Yes
Continue.
No
If smoker, continue; otherwise, thank the
respondent and terminate.
9. In the past 5 years, have you or any member of your household worked for any
of the following? If yes to any, thank the respondent and terminate.
A tobacco or cigarette company
A public health or community organization involved in communicating the
dangers of smoking or the benefits of quitting
A marketing, advertising, or public relations agency or department
The U.S. Food and Drug Administration (FDA)
The National Institutes of Health (NIH)
The Centers for Disease Control and Prevention (CDC)
The Substance Abuse and Mental Health Services Administration
(SAMHSA)
The Centers for Medicare & Medicaid Services (CMS)
10. Have you or any member of your household ever lobbied on behalf of the
tobacco industry?
Yes
Thank the respondent and terminate.
No
Continue.
11. Have you or any member of your household personally represented or worked
on behalf of a tobacco company in connection with a tobacco lawsuit?
Yes
Thank the respondent and terminate.
No
Continue.
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12. Have you participated in any paid market research in the past 6 months?
Yes
Thank the respondent and terminate.
No
Continue.
13. For study purposes, if you participate, the discussion group will be recorded.
The interviewer will not ask any sensitive questions. Are your okay with us
recording your group discussion?
Yes
Continue.
No
Thank the respondent and terminate.
14. What is the highest level of education that you have completed? (Read list.
Recruit a mix to show per group. No more than two postgraduates per group.)
Less than high school
Go to Question 16.
High school graduate or GED
Go to Question 16.
Some college or 2-year degree
Continue.
College degree
Continue.
Postgraduate degree
Continue.
15. Are you currently enrolled in college either part time or full time? (Recruit for
College Student Groups and/or mix to show per remaining groups.)
Yes
No
16. Are you of Hispanic or Latino origin? (Recruit for Hispanic Group and/or at
least 1 to show in each remaining group.)
Yes
No
17. What is your race? (Read list. Recruit AA for AA Groups and/or a mix to show
per remaining groups.)
White
Black or African American
Asian
Native Hawaiian or other Pacific Islander
American Indian or Alaskan Native
[DON’T READ] Hispanic
[DON’T READ] Other
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18. Finally, during the focus group discussion, you will be asked to review written
materials and offer your opinions; therefore, I need to ask whether you have a
medical or nonmedical condition that hinders your ability to read and/or
understand written materials in English?
Yes
Thank the respondent and terminate.
No
Continue.
Great! You qualify for our study. The discussion group will be held on [DATE] at
[TIME] and will last about 90 minutes. For your time and opinions, you will receive a
$XX cash honorarium.
19. Would you like to participate in the group discussion at [TIME] on [DATE]?
Yes
Continue.
No
Thank the respondent and terminate.
Great! May I please have your mailing or e-mail address to send you a confirmation
letter with directions? [Verify address and phone number.]
Thank you. That’s all the questions I have today. Please try to arrive at least
15 minutes prior to the group. If you have any questions or find that you are unable
to attend, please call [facility’s phone number] as soon as possible. Thank you again
for your time. We look forward to seeing you at [TIME] on [DATE].
Read if necessary:
If you have any questions about the study, you may contact Katherine Kosa of RTI
at 1-800-334-8571, extension 23901. If you have concerns about how participants
are being treated in the study, you may contact RTI’s Office of Research Protection
toll-free at 1-866-214-2043.
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File Type | application/pdf |
File Title | Microsoft Word - Doc03_Attachment A Final Screener.doc |
Author | Christopher.Colburn |
File Modified | 2011-12-23 |
File Created | 2011-12-23 |