Form 5.1 Survey

OMB #: 0925-0593

Expiration Date: 07/31/ 2013

Low-Intensity Invitation to High-Intensity Conversion Script, Phase II

Recruitment Strategy Substudy

Event Name(s):

Two-Tiered Recruitment Strategy

Instrument Name(s) and Versions:

Low Intensity Invitation to High-Intensity Conversion Script (HI,LI) – 1.0

Recruitment Groups:

High and Low Intensity

Low to High Conversion Script (HI,LI) – 1.0

TABLE OF CONTENTS

Outbound Calling Script 3

Inbound calling script 10

Pregnancy probability Group Script 12

Low to High Conversion Script (HI,LI) – 1.0

PROGRAMMER INSTRUCTION:

IF PARTICIPANT IS BEING CALLED, GO TO THE OUTBOUND CALLING SCRIPT (OUT_ANSWER).

IF PARTICIPANT IS CALLING IN RESPONSE TO THE “NCS MAILING”, GO TO THE INBOUND CALLING SCRIPT (IN_INTRO).

OUTBOUND CALLING SCRIPT

OUT100. (OUT_ANSWER)

INTERVIEWER CHECK: DID SOMEONE ANSWER THE PHONE?

YES 1(OUT_SPEAK)

NO 2 (CODE CASE.

TRY CALLING AT ANOTHER TIME.)

ANSWERING MACHINE 3 (OUT_ANSMC)

OTHER/SPECIFY -2(OUT_ANSWER_OTH)

OUT101 (OUT_ANSWER_OTH) ___________________________

INTERVIEWER INSTRUCTION: CODE CASE AND FOLLOW UP AS APPROPRIATE.

OUT200. (OUT_SPEAK)

Hello, may I speak with [PARTICIPANT NAME]?

PERSON AVAILABLE 1(OUT_AVAIL)

PERSON NOT AVAILABLE 2 (OUT_UNAVAIL)

REFUSED -1(OUT_UNAVAIL)

DON’T KNOW -2(OUT_UNAVAIL)

OUT300. (OUT_AVAIL)

My name is [INTERVIEWER’S NAME] and I am calling from [LOCAL STUDY AFFILIATE] about the National Children’s Study.

I’d like to thank you again for taking part in the National Children’s Study and for recently answering some questions.

I’m calling today to tell you that we are starting the next part of the Study. Do you have a few minutes to talk with me?

YES 1(OUT_INTRO)

NO 2 (OUT_TALK)

REFUSED -1(OUT_TALK)

DON’T KNOW -2(OUT_TALK)

OUT301. (OUT_INTRO)

The next part of the Study includes visits by our staff with you, if you are pregnant or trying to get pregnant.

Staff would come to your home a few times a year, and ask you more detailed questions about your health, [IF PREGNANT: your pregnancy], home, work, and neighborhood. If you do not want to meet at your home, you could come to our office, or we could meet with you at another place that you choose. During the first visit, we would give you some more details about this part of the Study and see if you are interested and willing to take part in the visits. At future visits, we may ask you to consider giving us a blood sample or samples, such as water or soil from your home. The visits are important to the Study because the information will help us learn about how the environment influences children’s health, development, and quality of life.

Our staff will visit with you at a time that is good for you and your household. The first visit should take about an hour. Your taking part in the visits will be very helpful to the Study, but it is, of course, your choice. Even if you choose not to be in this part of the Study, you can continue being in the Study just as you have been. We really appreciate you taking part in the Study.

If you are interested in considering this part of the Study, I would like to schedule a visit with you for one of our staff to talk about the Study, to get your permission, in writing, for you to take part in the visits, and to have you answer some more detailed questions.

Would you like to schedule a visit?

YES 1(OUT_YES)

NO 2(OUT_NO)

REFUSED -1(OUT_NO)

DON’T KNOW -2(OUT_NO)

[For UCLA: Would you like to schedule a visit?]

YES 1(OUT_YES)

NO 2(OUT_NO)

REFUSED -1(OUT_NO)

DON’T KNOW -2(OUT_NO)

OUT301A. (OUT_YES)

Great. We really appreciate that you are willing to take the time to learn more about this part of the Study. Before we schedule the visit, I just have a few questions.

[For UCLA: We will have a staff member call you back to schedule the visit]

PROGRAMMER INSTRUCTION: CHECK RESPONDENT’S PPG STATUS.

GO TO PPG SCRIPT (PPG_CONFIRM).

OUT301B. (OUT_NO)

That’s fine. I understand. As I said before, we so appreciate you taking part in the Study. Even if you choose not to take part in the visits, you can, of course, continue being in the Study just like you have been. We will contact you in a few months and ask you some questions just like those that you answered before. Thank you again. Goodbye.

INTERVIEWER INSTRUCTION: END CALL AND CODE CASE.

OUT302. (OUT_TALK)

Is there a better time when we could talk?

YES 1(OUT_SCHEDULE)

NO 2(OUT_REF)

REFUSED -1(OUT_REF)

DON’T KNOW -2(OUT_REF)

OUT302A. (OUT_SCHEDULE)

OUT302A1. (R_BEST_TTC_1) What would be a better time for you?

INTERVIEWER INSTRUCTION: ENTER IN HOUR AND MINUTE VALUES AND/OR DAY(S) OF WEEK; AND SELECT AM OR PM

|___|___| : |___|___| _____________________________

H H M M (DAY_WEEK_2)

REFUSED -1

DON’T KNOW -2

OUT302A2. (R_BEST_TTC_2)

AM 1

PM 2

REFUSED -1

DON’T KNOW -2

OUT302A3. (R_BEST_TTC_3)

AFTER TIME REPORTED 1

BEFORE TIME REPORTED 2

REFUSED -1

DON’T KNOW -2

Thank you. I will try again later.

INTERVIEWER INSTRUCTION: END CALL AND CODE CASE.

OUT302B. (OUT_REF)

INTERVIEWER INSTRUCTION: USE REFUSAL CONVERSION TECHNIQUES IF PARTICIPANT HAS PARTICULAR CONCERNS.

That’s fine. I understand. As I said before, we so appreciate you taking part in the Study. Even if you choose not to take part in the visits, you can, of course, continue being in the Study just like you have been. We will contact you in a few months and ask you some questions just like those that you answered before. Thank you again. Goodbye.

INTERVIEWER INSTRUCTION: END CALL AND CODE CASE.

OUT400. (OUT_UNAVAIL)

Is [PARTICIPANT PHONE NUMBER] the best number to reach her?

YES 1(OUT_CALLBK)

NO 2(OUT_NEXTPH)

REFUSED -1(OUT_NEXTPH)

DON’T KNOW -2(OUT_NEXTPH)

OUT401. (OUT_CALLBK)

OUT401A. (BEST_TTC_1) What would be a good time to reach her?

INTERVIEWER INSTRUCTION: ENTER IN HOUR AND MINUTE VALUES AND/OR DAY(S) OF WEEK; AND SELECT AM OR PM

|___|___| : |___|___| _____________________

H H M M (DAY_WEEK_1)

REFUSED -1

DON’T KNOW -2

OUT401B. (BEST_TTC_2)

AM 1

PM 2

REFUSED -1

DON’T KNOW -2

OUT401C. (BEST_TTC_3)

AFTER TIME REPORTED 1

BEFORE TIME REPORTED 2

REFUSED -1

DON’T KNOW -2

Thank you. I will try again later.

INTERVIEWER INSTRUCTION: END CALL AND CODE CASE.

OUT402. (OUT_NEXTPH)

What would be the best number to reach her?

INTERVIEWER INSTRUCTION: RECORD BEST NUMBER TO REACH PARTICIPANT.

___ ___ ___ - ___ ___ ___ - ___ ___ ___ ___

PHONE NUMBER

Thank you. I will try that number.

REFUSED -1

DON’T KNOW -2

INTERVIEWER INSTRUCTION: END CALL AND CODE CASE.

OUT500. (OUT_ANSMC)

Hello, this message is for [PARTICIPANT’S NAME]. This is [INTERVIEWER’S NAME] calling from [LOCAL STUDY AFFILIATE] about the National Children’s Study. We will call back again within the next day or so, or you may call us, toll-free, at [TOLL-FREE NUMBER]. Thank you.

INTERVIEWER INSTRUCTION: CODE CASE. TRY CALLING AT ANOTHER TIME.

INBOUND CALLING SCRIPT

IN100. (IN_INTRO)

Thank you for calling us. I’d like to take a couple of minutes to tell you about the next part of the Study.

The next part of the Study includes visits by our staff with you, if you are pregnant or trying to get pregnant.

Staff would come to your home a few times a year, and ask you more detailed questions about your health, [IF PREGNANT: your pregnancy], home, work, and neighborhood. If you do not want to meet at your home, you could come to our office, or we could meet with you at another place that you choose. During the first visit, we would give you some more details about this part of the Study and see if you are interested and willing to take part in the visits. At future visits, we may ask you to consider giving us a blood sample or samples, such as water or soil, from your home. The visits are important to the Study because the information will help us learn about how the environment influences children’s health, development, and quality of life.

Our staff will visit with you at a time that is good for you and your household. The first visit should take about one hour. Your taking part in the visits will be very helpful to the Study, but it is, of course, your choice. Even if you choose not to take part in the visits, you can continue being in the Study just like you have been. We really appreciate you taking part in the Study.

If you are interested in the visit part of the Study, I would like to schedule a visit with you for one of our staff to talk about the Study, to get your permission, in writing, for you to take part in the visits, and to have you answer some more detailed questions.

Would you like to schedule a visit now?

YES 1(IN_YES)

NO 2(IN _NO)

REFUSED -1(IN _NO)

DON’T KNOW -2(IN _NO)

[For UCLA: Would you like to schedule a visit?]

YES 1(IN_YES)

NO 2(IN _NO)

REFUSED -1(IN _NO)

DON’T KNOW -2(IN _NO)

IN101. (IN_YES)

Great. We really appreciate that you are willing to take the time to learn more about the visit part of the Study. Before we schedule the visit, I just have a few questions.

[For UCLA: We will have a staff member call you back to schedule a visit.]

INTERVIEWER INSTRUCTION: IF NECESSARY, ASK THE RESPONDENT FOR HER NAME, ADDRESS, AND REFERENCE NUMBER (FOUND ON THE WOO LETTER) IN ORDER TO LOCATE INFORMATION ON THE RESPONDENT’S PPG STATUS. SELECT RESPONDENT.

PROGRAMMER INSTRUCTION: ALLOW CATI TO IDENTIFY PARTICIPANT SO MOST RECENT OF (PPG_FIRST) OR (PPG_STATUS) CAN BE DISPLAYED.

GO TO PPG SCRIPT (PPG_CONFIRM).

IN102. (IN_NO)

That’s fine. I understand. As I said before, we so appreciate you taking part in the Study. Even if you choose not to take part in the visits, you can continue being in the Study just like you have been. We will contact you in a few months and ask you some questions just like those that you answered before. Thank you again. Goodbye.

INTERVIEWER INSTRUCTION: END CALL AND CODE CASE.

PREGNANCY PROBABILITY GROUP (PPG) SCRIPT

PPG001. (PPG_CONFIRM)

IF RESPONDENT IS KNOWN TO BE PREGNANT, ADD [Just to confirm,] Are you pregnant now?

YES………………………………………………………………………1

NO, NO ADDITIONAL INFORMATION………………………………2

NO, RECENTLY GAVE BIRTH……………………………………… 3

NO, RECENT PREGNANCY LOSS………………………………… 4

NO, RECENT PREGNANCY LOSS AND CURRENTLY TRYING

TO BECOME PREGNANT…………………………………… 5

REFUSED…………………………………………………………… -1 (FOLLOWUP_4)

DON’T KNOW…………………………………………………………-2 (FOLLOWUP_4)

PROGRAMMER INSTRUCTION: USE PPG MATRIX BELOW TO DETERMINE SKIP PATTERN:

MOST RECENT OF EITHER (PPG FIRST ) FROM PREGNANCY SCREENER INSTRUMENT (HI,LI) V1.1 OR (PPG_STATUS) FROM PREGNANCY PROBABILITY GROUP FOLLOW-UP INSTRUMENT V 1.1	RESPONSE IN PPG001:
	YES (PPG_CONFIRM=1)	NO, NO ADD’L INFO (PPG_CONFIRM=2)	NO, RECENT BIRTH (PPG_CONFIRM-=3)	NO, RECENT LOSS (PPG_CONFIRM=4)	NO, RECENT LOSS AND TRYING (PPG_CONFIRM=5)
(PPG_FIRST) or (PPG_STATUS)=1	(APPT_1) (PPG_STATUS=1)	(FOLLOWUP_3)*	(APPT_2) (PPG_STATUS =4)	(FOLLOWUP_1)*	(FOLLOWUP_2) (PPG_STATUS =2)
(PPG_FIRST) or (PPG_STATUS) =2	(APPT_2) (PPG_STATUS=1)	(APPT_1) (PPG_STATUS =2)	(APPT_2) (PPG_STATUS =4)	(FOLLOWUP_1)*	(FOLLOWUP_2) (PPG_STATUS =2)

*(PPG_STATUS) will depend on responses to follow up questions.

PPG001A. (APPT_1)

PROGRAMMER INSTRUCTION: [NO CHANGE IN (PPG STATUS)]

Good. I’d like to go ahead and schedule a visit with you to talk about the next part of the Study.

When would be a good time for you?

INTERVIEWER INSTRUCTION: SET AN APPOINTMENT.

Thank you again for taking part in the Study. A member of our staff will be visiting with you on [SCHEDULED APPOINTMENT DATE AND TIME] at [HOME, OUR OFFICE, OTHER PLACE]. If you have any questions at all, please call our toll-free number, [TOLL-FREE NUMBER]. Thank you again. Goodbye.

INTERVIEWER INSTRUCTION: END CALL. CODE CASE.

PROGRAMMER INSTRUCTION: (PPG_STATUS).

USE (PPG_STATUS) FROM (FOLLOWUP_1) OR (FOLLOWUP_3)

ELSE, SET (PPG_STATUS) TO MATCH MOST RECENT OF (PPG_FIRST) OR (PPG_STATUS).

PPG001B. (APPT_2)

PROGRAMMER INSTRUCTION: (PPG_STATUS).

USE (PPG_STATUS) FROM (FOLLOWUP_1) OR (FOLLOWUP_3)

ELSE, Select the most recent date of (PPG_FIRST) OR (PPG_STATUS) =1 OR 2 => (PPG_STATUS) =4.

IF PREGNANCY NOTIFICATION (PPG_CONFIRM=1), THEN (PPG_STATUS) =2 => (PPG_STATUS) =1)]

[Congratulations.] I’d like to go ahead and schedule a visit with you to talk about the next part of the Study.

When would be a good time for you?

INTERVIEWER INSTRUCTION: SET AN APPOINTMENT.

Thank you again for taking part in the Study. A member of our staff will be visiting with you on [SCHEDULED APPOINTMENT DATE AND TIME] at [HOME, OUR OFFICE, OTHER PLACE]. If you have any questions at all, please call our toll-free number, [TOLL-FREE NUMBER]. Thank you again. Goodbye.

INTERVIEWER INSTRUCTION: END CALL. CODE CASE.

PPG001C. (FOLLOWUP_1)

INTERVIEWER INSTRUCTION: YOU MAY SAY [I’m sorry to hear you’ve lost your baby – I know this can be a hard time.] IF SOCIAL CUES INDICATE IT IS APPROPRIATE.

Thank you for taking the time to answer these questions today. However, at this time, we are only making visits to women who are pregnant or who are trying to get pregnant. Based on what I thought I heard you say, I understand that you are not pregnant or trying to get pregnant at this time. Is this correct?

YES (NOT PREGNANT, NOT TRYING)……… 1(PREGTRY_1)

NO (SP IS TRYING) 2(PROGRAMMER INSTRUCTION )

NO (SP IS PREGNANT) 3(PROGRAMMER INSTRUCTION )

REFUSED -1(PREGTRY_1)

DON’T KNOW -2(PREGTRY_1)

PROGRAMMER INSTRUCTION: (PPG_STATUS)

IF (FOLLOWUP_1) =2, SET (PPG_STATUS) = 2. GO TO (APPT_1).

IF (FOLLOWUP_1) = 3, SET (PPG_STATUS) = 1. GO TO (APPT_2).

PPG001D. (PREGTRY_1) Thank you. Because you are not pregnant or trying to get pregnant, we won’t ask you to take part in the visit part of the Study at this time. But, we will contact you again in a few months to ask you some questions just like those that you answered before. Thank you again. Goodbye.

INTERVIEWER INSTRUCTION: END CALL AND CODE CASE. SEND CASE BACK TO PPG FOLLOW UP FOR 6 MONTHS;

PROGRAMMER INSTRUCTION: (PPG_STATUS) SET (PPG_STATUS) =3.

PPG001E. (FOLLOWUP_2)

PROGRAMMER INSTRUCTIONS: ( PPG_STATUS)

IF [RECENT PREGNANCY LOSS AND TRYING TO BECOME PREGNANT (PPG_CONFIRM)=5], (MOST RECENT OF (PPG_FIRST) OR (PPG_STATUS) WAS =1 OR 2 => (PPG_STATUS) =2)]

INTERVIEWER INSTRUCTION: YOU MAY SAY [I’m sorry to hear you’ve lost your baby – I know this can be a hard time.] IF SOCIAL CUES INDICATE IT IS APPROPRIATE.

Because you are trying to get pregnant, I’d like to go ahead and schedule a visit to talk with you about the next part of the Study.

When would be a good time for you?

INTERVIEWER INSTRUCTION: SET AN APPOINTMENT.

Thank you again for taking part in the Study. A member of our staff will be visiting with you on [SCHEDULED APPOINTMENT DATE AND TIME] at [HOME, OUR OFFICE, OTHER PLACE]. If you have any questions at all, please call our toll-free number, [TOLL-FREE NUMBER]. Thank you again. Goodbye.

INTERVIEWER INSTRUCTION: END CALL. CODE CASE.

PPG500. (FOLLOWUP_3)

Thank you for taking the time to answer these questions today. However, at this time, we are only making visits to women who are pregnant or who are trying to get pregnant. Based on what I think I heard you say, I understand that you are not pregnant or trying to get pregnant at this time. Is this correct?

YES (NOT PREGNANT, NOT TRYING)……… 1(PREGTRY_2)

NO (SP IS TRYING) 2(PROGRAMMER INSTRUCTION)

NO (SP IS PREGNANT) 3(PROGRAMMER INSTRUCTION)

REFUSED -1(PREGTRY_2)

DON’T KNOW -2(PREGTRY_2)

PROGRAMMER INSTRUCTION: (PPG_STATUS) IF (FOLLOWUP_3) =2, SET (PPG_STATUS) = 2. GO TO (APPT_1).

IF (FOLLOWUP_3) = 3, SET (PPG_STATUS) = 1. GO TO (APPT_2).

PPG500A. (PREGTRY_2)

Thank you. Because you are not pregnant or trying to get pregnant at this time, we won’t ask you to take part in the visit part of the Study at this time. But, we will contact you again in a few months to ask you some questions just like those that you answered before. Thank you again. Goodbye.

INTERVIEWER INSTRUCTION: END CALL AND CODE CASE.

PROGRAMMER INSTRUCTION: (PPG_STATUS).

SET (PPG_STATUS) =3.

PPG001F (FOLLOWUP_4)

PROGRAMMER INSTRUCTION: [NO CHANGE IN (PPG STATUS)]

INTERVIEWER INSTRUCTION: USE REFUSAL CONVERSION TECHNIQUES IF PARTICIPANT HAS PARTICULAR CONCERNS.

That’s fine. I understand. As I said before, we so appreciate you taking part in the Study. We will contact you in a few months and ask you some questions just like those that you answered before. Thank you again. Goodbye.

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: NIH, Project Clearance Branch, 6705 Rockledge Drive, MSC 7974, Bethesda, MD 20892-7974, ATTN: PRA (0925-0593*). Do not return the completed form to this address.