Generic Real Time Food Recall Survey Instrument 8-24-10 (2)

OMB No. 0910-xxxx

Expiration Date: xx/xx/20xx

PUBLIC Disclosure Burden Statement

Public reporting burden for this collection of information is estimated to average 10 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:

Department of Health and Human Services
Food and Drug Administration
CFSAN/PRB Comments/HFS-24
5100 Paint Branch Parkway
College Park, MD 20740-3835.

[“Real Time” Survey of Consumer Knowledge, Perception,

and Reported Behavior Concerning

[Pathogen] Outbreak and [Food product] Recall]

[Screener and Questionnaire]

Thank you for responding to the invitation to participate in this survey on a recent [pathogen] outbreak and [food product] recall.

Please answer a few questions to see if you are eligible to participate in the study. Please be assured that all of your answers are kept confidential and no personal identifying information is retained with your answers. If any part of the survey makes you uncomfortable, please feel free to stop at any time.

S1. Are you at least 18 years old?

• YES

• NO [“You must be at least 18 years old to participate in this study. Thank you very much for your interest in our research.”] [eliminate]

S2. Have you shopped for groceries for yourself or others in the last month?

• Yes

• No [“We are looking for participants who have shopped for groceries in the past month. Thank you very much for your interest in our research.”] [eliminate]

S3. Do you or does someone from your immediate family work for any of the following:

• Market Research Firm [“We are recruiting individuals with certain characteristics. Thank you very much for your interest in our research.”] [eliminate]

• The Food and Drug Administration,

U.S. Department of Agriculture,

• or State or local food agency [“We are recruiting individuals with certain characteristics. Thank you very much for your interest in our research.”]

[eliminate]

• Food Industry or Food Retailer [“We are recruiting individuals with certain characteristics. Thank you very much for your interest in our research.”] [eliminate]

We are interested in what you have heard about the current [pathogen] problem in [food product]. We are interested in [food product] that you would buy at a store or have at a food establishment away from home. This survey will take about 10 minutes to complete. Please allow enough time to complete the entire survey in one sitting. All responses will be kept confidential.

[Knowledge/Information Seeking]

1. Have you heard or read anything in the last week about health risks related to eating raw [food product]?

0. No

1. Yes

98. DON’T KNOW

1a. Have you heard or read anything in the last week about a [food product] recall? That is, have you heard or read anything in the last week about returning [food product] to the store, or that some [food product] are potentially contaminated with disease-causing organisms?

0. No

1. Yes

98. DON’T KNOW

2. Have you seen anything on television in the last week about a [food product] recall?

0. No

1. Yes

98. DON’T KNOW

3. Have you seen anything in the newspaper in the last week about a [food product] recall?

0. No

1. Yes

98. DON’T KNOW

4. Have you seen anything on the internet in the last week about a [food product] recall?

0. No

1. Yes

98. DON’T KNOW

4a. Have you heard anything on the radio in the last week about a tomato recall?

0. No

1. Yes

98. DON’T KNOW

[If Q1 thru Q4a=0, skip to Q12]

5. Do you remember what you heard or read about raw [food product]?

Did you hear . . .?

5a. Do not eat any [food product]

5b. Do not eat certain types of [food product]

5c. Do not eat certain brands of [food product]

5d. Cook [food product] well before eating

5e. Return [food product] to the food store

5f. Discard [food product]

5g. Other ___________ [specify]

0. No

1. Yes

98. DON’T KNOW

[6a for 1^st wave only] [If Q5a thru Q5g=0, skip to Q7]

6a to 6g. How likely are you to follow that advice [insert item from list above]? Would you say . . .?

1. not very likely,

2. somewhat likely, or

3. very likely?

8. DON’T KNOW

7. Did you go to any of the following sources for information about the [food product] recall? [y/n for each source]

7a. The Centers for Disease Control, or CDC, website

7b. The Food and Drug Administration, or FDA, website

7c. The U.S. Department of Agriculture, or USDA, website

7d. The Foodsafety.gov website

7e. News websites

7f. Food company websites

7g. The Centers for Disease Control, or CDC, 1-800 number

7h. The Food and Drug Administration, or FDA, 1-800 number

7i. Your State department of health

7j. Newspapers or television

7k. Blog articles, podcasts, or other social media sources

0. No

1. Yes

98. DON’T KNOW

8. How informed would you say you are about the current [food product] recall, if one means you are not at all informed and ten means you are very well informed?

1. Not at all informed

10. Very well informed

98. DON’T KNOW

9. On the same 10-point scale, how informed would you say you are about….

a. The causes of [pathogen] contamination in the current [food product] recall

b. What the government is doing to find the source of the [pathogen] problem for the [food product] recall]

c. What manufacturers/retailers are doing to find the source of the [pathogen] problem for the [food product] recall]

d. The number of U.S. States involved in the [food product] recall.

e. Whether the State where you live is involved in the [food product] recall.

f. What the government is doing to make sure the [food product] recall doesn’t happen again

g. Ways to protect yourself from [food product] contaminated with [pathogen]

1. Not at all informed

10. Very well informed

98. DON’T KNOW

10. Using a 10-point scale, how informed about the current [food product] recall would you say are the grocery stores or markets where you usually purchase food?

1. Not at all informed

10. Very well informed

98. DON’T KNOW

11. Using a 10-point scale, how safe do you think it is currently to eat [food product] associated with the [food product] recall?

1. Not at all safe

10. Very safe

98. DON’T KNOW

[Behavior]

12. In the past year, have you eaten raw [food product]?

0. No

1. Yes

98. DON’T KNOW

13. In the past month, did you eat any raw [food product]?

0. No

1. Yes

98. DON’T KNOW

14. Have you eaten any raw [food product] this week?

0. No

1. Yes

98. DON’T KNOW

15. Do you currently have any raw [food product] in your home?

0. No

1. Yes

98. DON’T KNOW

16. Would you say that raw [food product] is a regular part of your daily food intake?

0. No

1. Yes

98. DON’T KNOW

17. Weekly food intake?

0. No

1. Yes

98. DON’T KNOW

18. Monthly food intake?

0. No

1. Yes

98. DON’T KNOW

[If Q1 thru Q4a=0, skip to Q24]

19. Since hearing about the recall, have you changed how much raw [food product] you eat?

Are you eating [select one best answer]

1. more raw [food product].

2. the same amount of raw [food product].

3. less raw [food product].

4. no raw [food product] at all since hearing about the recall.

5. only raw [food product] that is not part of the recall.

8. DON’T KNOW

19a. If you selected “no raw [food product] at all,” which of the following is true?

I have not eaten raw [food product] because . . .

19.a.1. no particular reason

19.a.2. I have not had a taste for [food product]

19.a.3. I have not had the opportunity

19.a.4. I want to avoid becoming ill

19.a.5. I want to follow the health advisory

19.a.6. [food product] is unavailable for purchase

[If Q19=4, skip to Q20]

19b. Since hearing about the recall, have you changed how often you eat [food product]?

Have you eaten[food product] [select one best answer]

1. more often.

2. as often as usual.

3. less often.

8. DON’T KNOW

20. Once you hear that the [food product]available in stores and restaurants are no longer part of the problem that caused the [pathogen] outbreak, how soon will you resume eating [food product]?

1. I have not stopped eating raw [food product]

2. Immediately or as soon as I have an occasion to eat it

3. I plan to wait awhile.

4. I do not intend to eat raw [food product] again.

21. If you were unable to eat raw [food product] for three months, do you have other foods to choose from that could easily take its place?

0. No

1. Yes

98. DON’T KNOW

22. On a 10-point scale, how difficult would it be for you and your family to limit how much you eat of raw [food product]? Would you say…

1. not at all difficult

10. very difficult

98. DON’T KNOW

23. Does what you know about the [food product] recall make you more or less likely to eat at restaurants, or does it have no impact?

1. More likely

2. Less likely

3. No impact

[Perception]

24. On a scale from strongly disagree to strongly agree, please indicate your response about the following

24a. I want to prevent foodborne illnesses (or getting sick from food)

1. Strongly disagree

10. Strongly agree

98. DON’T KNOW

24b. I want the ability to protect myself from foodborne illnesses (or getting sick from food)

1. Strongly disagree

10. Strongly agree

98. DON’T KNOW

24c. I really don’t care about foodborne illnesses (getting sick from food)

1. Strongly disagree

10. Strongly agree

98. DON’T KNOW

[If Q1 thru Q4a=0, skip to Q32]

25. In terms of protecting your health, how important do you think it is to follow the

[food product] recall recommendations?

1. Not at all important

10. Very important

98. DON’T KNOW

26. Do you believe you have the information you need to keep yourself and your family safe from [pathogen] associated with the [food product] recall?

0. No

1. Yes

98. DON’T KNOW

27. How believable to you is the information about [pathogen] outbreak from raw [food product]?

1. not at all believable

10. Completely believable

98. DON’T KNOW

28. How worried are you about becoming infected or getting ill from [food product] or [pathogen]?

Not at all worried

Not too worried

Somewhat worried

Very worried

98. DON’T KNOW

29. How angry are you that [food product] was contaminated with [pathogen]?

Not at all angry

Not too angry

Somewhat angry

Very angry

98. DON’T KNOW

30. Using a 10-point scale, how likely do you think it is that you or members of your family would get sick from eating raw [food product] associated with the current [food product] recall?

1. Not at all likely

10. Very likely

98. DON’T KNOW

31. How likely is it that you or members of your family would have serious long-term

health problems from eating raw [food product] associated with the current [food product] recall? Would you say…

1. Not at all likely

10. Very likely

98. DON’T KNOW

32. Would you now like to have more information about the current [food product] recall advisory?

0. No

1. Yes (provide link to advisory)

98. DON’T KNOW

[Demographics.]

33. How many total people, including yourself, live in your household? (Range = 1-97)

(Include foster children, roommates or housemates, and people staying with you last night who have no permanent place to stay. This includes people living with you most of the time while working, even if they have another place to live. Do not include college students living away while attending college, people in a correctional facility, nursing home or psychiatric hospital last night, armed forces personnel living somewhere else, people who live or stay at another place most of the time.

_____NUMBER

98. DON’T KNOW

[If Q33 <2, skip to Q37]

How many of these people in your household are . . .

34. Children younger than five years old?

_____ (Range = 0 to 20)

98. DON’T KNOW

35. Children between 5 and 18 years?

______ (Range = 0 to 20)

98. DON’T KNOW

36. Adults 60 years of age or older?

_______ (Range = 0 to 20)

98. DON’T KNOW

37. Are you or is anyone in your household pregnant?

1. YES, I am pregnant.

2. Yes, someone in my household is pregnant

3. NO

8. DON’T KNOW

38. Please read the following list of health conditions and indicate if you have been told by a doctor that you have any of them: liver disease, currently receiving chemotherapy or radiation therapy, HIV, AIDS, organ transplant, or weakened immune system.

1. Yes, I have at least one of the conditions listed.

2. No, I do not have any of the conditions listed.

8. DON’T KNOW

39. Please select one of the following. Are you:

0. Male

1. Female

40. What is your age in years? [Open ended]

_______

41. What is the highest level of education that you have completed?

1. Less than high school

2. High school graduate or GED

3. Technical/vocational school

4. Community college

5. Some college (1-3 years

towards Bachelor’s degree)

6. College (Bachelor’s degree)

7. Advanced degree (post graduate degree)

42. Are you of Hispanic or Latino origin?

0. No

1. Yes

43. What is your race? You may choose one or more categories. Are you?

1. White

2. Black or African American

3. Asian

4. Native Hawaiian or other Pacific Islander

5. American Indian or Alaska Native

6. Other

44. Please provide any comments you wish. [Open-ended]

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