Form 1 Recruitment Screener for Focus Groups

Form Approved

OMB No. 0920-0919

Exp. Date 01/31/2015

Recruitment Screener for Focus Groups

CDC Message Testing and Materials Development regarding

Risk of Alcohol Use During Pregnancy

Summary of Focus Groups by Type and Location

All participants will be between 18 and 44 years old. There will be a mix of participants with respect to age within groups. There will be a mix of participants with respect to race/ethnicity within or across group, as discussed with the recruitment firm.

Baltimore, Maryland

Group 1: Women 18-30 years old, had a baby in the past year

Group 2: Women 31-44 years old, had a baby in the past year

Group 3: Women 18-30 years old, trying to get pregnant

Group 4: Women 31-44 years old, trying to get pregnant

Atlanta, Georgia

Group 5: Women 18-30 years old, had a baby in the past year

Group 6: Women 31-44 years old, had a baby in the past year

Group 7: Women 18-30 years old, trying to get pregnant

Group 8: Women 31-44 years old, trying to get pregnant

INTRODUCTION

[ASK TO SPEAK TO FEMALE IN THE HOUSEHOLD AGE 18 OR OLDER. RECRUIT 10 PER GROUP (FOR 6-8 TO SHOW)]

ANSWERING MACHINE MESSAGE SCRIPT:

Hello, my name is [RECRUITER FIRST AND LAST NAME]. I'm calling from [RECRUITMENT FIRM]. We would like to talk to you to see if you are interested in participating in a discussion group for a study to get your opinion on some materials on health and alcohol use for the Centers for Disease Control and Prevention (CDC). You will receive a payment of $75 for your participation. If you are interested, please call [PHONE NUMBER] at your convenience.

[IF RESPONDENT IS AVAILABLE, INTRODUCE SELF AND GIVE REASON FOR CALLING:]

Hello, I’m [RECRUITER FIRST AND LAST NAME] and I'm calling from [RECRUITMENT FIRM]. We are an independent consumer research organization. We are not selling or promoting any product or service. I am calling you because we are conducting discussion groups to better understand women’s views on health and alcohol use. We would like to hear your opinion. The discussion groups last 2 hours. My questions today will only take a couple of minutes.

Does this sound like something you would be interested in?

Yes No  TERMINATE

Great. Let’s find out if you qualify. I have a few questions to ask you. Bear with me; as I said, this should only take a few minutes. At some point, I may end the questions if I find out that you do not meet the requirements for the group. This has nothing to do with you; we simply want to include a variety of people in each discussion group.

Is it OK if I ask you a few questions?

Yes No  TERMINATE

Before we begin, I’d like to let you know that all information you provide will be private. Your help is voluntary, and you do not have to answer every question. If you would rather not answer a question, let me know and you can skip it. You can stop at any time.

1. Do you, or does any member of your household or immediate family, work for …?

A market research company or marketing firm?

An advertising agency or public relations firm?

TV, radio, newspapers or magazines?

A company related to health care?

Work as a doctor, nurse, pharmacist or nutritionist?

[IF YES TO ANY  TERMINATE]

2. Now I am going to give you a few age ranges. Please stop me when I reach the group you are in.

18 to 30 years [GROUPS 1, 3, 5, 7]

31 to 44 years [GROUPS 2, 4, 5, 8]

45 years old or older  TERMINATE

3. Have you given birth in the past 12 months? [GROUPS 1,2, 5,6]

Yes KEEP AND PLACE INTO GROUPS 1, 2, 5, 6 No  ASK QUESTION 4 TO SCREEN FOR GROUPS 3, 4, 7, 8

4. Are you currently trying to get pregnant? [GROUPS 3, 4, 7, 8 ]

Yes KEEP AND PLACE INTO GROUPS 3, 4, 7, 8 No  TERMINATE FOR GROUPS 3, 4, 7, 8

5. Are you able to conceive?

Yes No  TERMINATE

6. Are you currently pregnant?

No Yes  TERMINATE

7. Have you had any alcohol in the past 90 days?

Yes No [ASK 7A]

[IF NO]: 7a. Was this for religious reasons?

Yes No  TERMINATE

8. What is the highest grade or level of school that you have completed?

8^th grade or less

Some high school, but did not graduate

High school graduate or GED

Some college or 2 year degree

4 year college degree

Master’s degree  TERMINATE

Doctoral or other postgraduate degree  TERMINATE

[NO ANSWER]  TERMINATE

[PLEASE RECRUIT AT LEAST 1 PERSON PER GROUP WITH LESS THAN A HIGH SCHOOL DIPLOMA OR GED]

INCOME

9. What was your total household income last year? You do not need to give me an exact number. I will read you some possibilities, and you may tell me which one is closest to the total that everyone in your household brought in last year:

[Read responses aloud]

Under $25,000

$25,000 to $34,999

$35,000 to $49,999

$50,000 to $74,999

$75,000 or more

[PLEASE RECRUIT SO EACH GROUP WILL HAVE PARTICIPANTS FROM ALL RANGES]

10. Are you of Hispanic or Latino origin?

Yes No

11. How would you describe your race? [PLEASE SELECT ALL THAT APPLY]

American Indian or Alaskan Native

Asian

Black or African-American

Native Hawaiian or Other Pacific Islander

White

[PLEASE RECRUIT A RACIAL/ETHNIC MIX]

TERMINATION SCRIPT

Thank you for answering all of my questions. We are recruiting people from different backgrounds and unfortunately, we have already recruited several individuals with similar characteristics as yours. Again, thank you for the time.

INVITATION SCRIPT (USE IF INDIVIDUAL MEETS RECRUITING CRITERIA)

Thank you for answering all of my questions so far.

12. The group discussions will take place on [INSERT SCHEDULE] Are you able to attend on one of these days and times? Which ones?

Yes No  TERMINATE

13. During the group, you will be asked to read several materials and share your opinion. Would you feel comfortable reading the materials and discussing them with others?

Yes No  TERMINATE

Great. As I said, the group discussion will take about 2 hours of your time. No one will try to sell you anything. No one will call on you as a result of your participation. You will receive a payment of $75 for your participation. This is an important project, and we hope you will be part of it.

14. Do you agree to participate in one of the discussion groups?

Yes No  TERMINATE. Thank you for speaking with me.

CONTINUATION SCRIPT (USE FOR INDIVIDUALS WHO QUALIFY AND AGREE TO PARTICIPATE)

Let me just mention a couple of more things:

1. If you use glasses for reading or watching TV, please be sure to bring them with you, since you will be asked to read several things.

2. We cannot provide babysitting services, so it will not be possible for you to bring any children with you.

3. If someone comes with you to the discussion group, they will not be able to join in the group. They will need to wait for you outside the room.

4. Only one person from the same family will be able to participate in the discussion groups.

We can only invite a limited number of people to be in the groups. May we schedule you for one of the groups?

We will call you a few days before the group to remind you of the date and time. If you will not be able to participate, please call [NAME AND NUMBER] to let us know as soon as possible, so we can ask someone else. We need to have a certain number of people for each group.

NAME: _______________________________________________________

ADDRESS: _________________________________________________

CITY: _________________________________________________

ZIP CODE: _________________________________________________

PHONE: (DAY) _____________________________________

(EVE) _____________________________________

(EMAIL) _____________________________________

SCHEDULED FOR: ______________________________________________

Recruiter: ____________________________ Date: _______________

The public reporting burden of 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 - CDC/ATSDR Reports Clearance Officer; 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333 ATTN: PRA (0920-0919)