Form NHTSA Form 1203 NHTSA Form 1203 Parent Screener

Respondent Criteria

• 6 groups of parents with children aged 16-18

• 3 groups of parents who identify as more tolerant In regard to their child drinking alcohol (18 respondents total)

• 3 groups of parents who identify as non-tolerant in regard to their child drinking alcohol (18 respondents total)

MUST NOT BE RELATED TO TEENAGE RESPONDENTS

OMB Control No. 2127-0682

Expiration Date 02/28/2015

INTRODUCTION: Hello, my name is _________ from ________________market research firm. We are calling different households in your area and would like to hear your opinions. This is not an attempt to sell you anything. All your answers will be kept confidential. Would you spare a few minutes to answer some questions?

This collection of information is voluntary and will be used for formative purposes only so that we may develop and evaluate programs designed to reduce the number of traffic-related injuries and deaths. 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 2127-0682. Public reporting for this collection of information is estimated to be approximately 10 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

1. Could we begin now?

( ) Yes

( ) No TERMINATE OR SCHEDULE CALLBACK

2. How many children who will be in grades 9-12 this fall currently live in your household?

None ( ) TERMINATE

1 –2 ( )

3 or more ( )

3. What are the age and gender of each of the high school-age children that are currently living in your home? [RECORD AGE OF EACH CHILD IN APPROPRIATE BOX]

	Less than 16 years	16 years	17 years	18 years	Older than 18 years
Male
Female
	TERMINATE	CONTINUE			TERMINATE

MUST BE 16-18 YEARS TO CONTINUE.

Are you the parent or guardian of the XX year old male/female that lives in your household?

( ) Yes CONTINUE

( ) No

IF NO, ASK TO SPEAK TO PARENT/GUARDIAN. IF NOT AVAILABLE, SCHEDULE CALL BACK OR THANK AND TERMINATE.

4. Have you ever participated in a market research study such as a focus group or interview?

( ) Yes CONTINUE WITH Q5

( ) No SKIP TO Q6

5. Approximately when was the last time you participated in a market research study?
   [DO NOT READ LIST]

( ) Within the past six months TERMINATE

( ) Longer than six months ago CONTINUE

6. 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

RECRUIT FAIR REPRESENTATION OF HOUSEHOLD INCOME

7. Are you of Hispanic or Latino descent?

Yes

No

7. Select one or more of following that best describes your race? [ACCEPT MULTIPLE RESPONSES]

American Indian or Alaska Native

Asian

Black or African American

Native Hawaiian or Other Pacific Islander

White

RECRUIT FAIR REPRESENATION OF RACE/ETHNICITY

9. Do you or does anyone in your immediate family work for any of the following companies or industries? [READ LIST. MARK ALL THAT APPLY.]

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

B ( ) A media company such as radio, newspaper, television, etc TERMINATE

C ( ) A company that sells, manufactures, or distributes any alcoholic beverages, excluding grocery and convenience stores TERMINATE

D ( ) Law enforcement TERMINATE

TOPIC DISCLOSURE – ALL PARENTS OF UNDERAGE PARTICIPANTS

This is a research project is looking to study the discussions parents have with their children concerning drinking. The discussion would last 90 minutes, would take place on (DATE) and you would be paid $75 for their time.

9. Does your child have a valid driver’s license?

( ) Yes CONTINUE

( ) No TERMINATE

MUST HAVE A VALID DRIVER’S LICENSE TO CONTINUE

9. Is his/her driver’s license a restricted license? (If needed: This may mean that they have restrictions on the ages of their passenger or the hours they can drive.)

( ) Yes

( ) No

FOR Los Angeles: ALLOW A MAXIMUM OF 2 RESPONDENTS THAT HAVE CHILDREN WITH RESTRICTED LICENSES PER GROUP

9. Do you currently own a car, truck, or motorcycle that you permit your child to drive occasionally, or does your child own a car, truck, or motorcycle?

( ) Yes CONTINUE

( ) No TERMINATE

13. I am going to read a few statements. After I read each one, would you please tell me whether or not it describes you or your attitudes completely, somewhat, or not at all?

	Describes completely	Describes somewhat	Describes not at all
I let my teenager stay out past midnight on the weekends	TOLERANT	NOT-TOLERANT	NOT-TOLERANT
I believe trying alcohol is an inevitable part of being a teenager	TOLERANT	NOT-TOLERANT	NOT-TOLERANT
I think my teenager has consumed alcohol without adult supervision at some point	TOLERANT NOT-TOLERANT	NOT-TOLERANT	NOT-TOLERANT
I enforce strict consequences for underage drinking	NOT-TOLERANT	NOT-TOLERANT	TOLERANT

RECRUIT FOR 2 GROUPS – TOLERANT AND NOT TOLERANT

TOLERANTS SHOULD HAVE AT LEAST 2 ANSWERS THAT SOLELY APPLY TO THAT CATEGORY.

14. I am going to read a few statements. After I read each one, would you please tell me whether or not it describes you completely, somewhat, or not at all? [RECORD RESPONSE WITH “X” IN APPROPRIATE BOX]

	Describes completely	Describes somewhat	Describes not at all
I enjoy meeting and talking to new people
I am open about expressing my opinion, even when it is different than my friends
I usually spend all of my free time by myself

TERMINATE IF RESPONDENT SELECTS ANY SHADED BOXES

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.

15. Id 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 its 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)

Thank you for helping with this survey. I would like to invite you to a research discussion to be held on MM/DD/YY at XX:XX. The session will last approximately 90 minutes. You will receive $75 cash incentive for your participation. Your participation is strictly voluntary.

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.

FINAL INSTRUCTION: Thank you very much for agreeing to participate. Please arrive to the facility a few minutes early. If you should need to cancel for any reason, please contact X at XXX-XXX-XXXX.

END OF SCREENER GUIDE

NHTSA Form 1203 Page 8