NHTSA Form 1205 Underage DDP Screener High School

Respondent Criteria

• 9 groups of 14-20 year olds

• (1) 14-15 (in high school) all female group

• (1) 14-15 (in high school) all male group

• (1) 14-15 (in high school) mixed gender group

• (1) 16-18 (in high school) all female group

• (1) 16-18 (in high school) all male group

• (1) 16-18 (in high school) mixed gender group

• (1) 18-20 (post high school, attending or not attending college) all female group

• (1) 18-20 (post high school, attending or not attending college) all male group

• (1) 18-20 (post high school, attending or not attending college) mixed gender group

• For 16-20 year olds - Have a valid driver’s license & drive at least occasionally

• Should not completely object to drinking alcohol.

The following screener recruits high school, 14-18 year olds

OMB Control No. 2127-0682

Expiration Date 02/28/2015

Screener for High School Students (14-18 year olds)

INTRODUCTION: Hello, my name is _________ from ________________market research firm. We are conducting a survey today among 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?

REFERRED PROSPECT INTRODUCTION: Hello, my name is _________ from ______________, a market research firm. I’m calling today because ____________ has agreed to participate in a market research interview. The discussion would take place with __________ and four of his/her peers. He/she provided your child’s name as peer who might like to participate. This is not an attempt to sell anything. We are interested in your child’s opinions. If your child qualifies, is this something you might allow them to participate in? [IF YES, CONTINUE; OTHERWISE TERMINATE]

Would you spare a few minutes to answer some questions first? All your answers will be kept confidential.

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

IF REFERRED PEER, SKIP TO Q3 TO VERIFY CHILD AGE.

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]

	14 years	15 years	16 years	17 years	18 years	Older than 18 years
Male
Female
	CONTINUE					TERMINATE

MUST BE 14-18 YEARS TO CONTINUE.

IF 14-17 YEAR OLDS, CONTINUE WITH Q4. IF 18 YEAR OLD, ASK TO SPEAK DIRECTLY WITH 18 YEAR OLD. REPEAT INTRODUCTION AND SKIP TO Q6.

4. 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.

5. Now I am going to read a list of brief statements and I’d like you to tell me how well each statement describes your XX year old son/daughter. 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
My child enjoys meeting and talking to new people
My child is open about expressing his/her opinions in a group setting.
My child generally likes to spend his/her free time alone.

TERMINATE IF RESPONDENT SELECTS ANY SHADED BOXES.

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

( ) unsure/prefer not to answer

RECRUIT FAIR REPRESENTATION OF HOUSEHOLD INCOME LEVELS

[FOR PARENTS] Which of the following best describes our child?

[FOR 18+] Which of the following best describes you?

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 REPRESENTATION 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

E ( ) Banking or Financial Services CONTINUE

F ( ) An energy, oil or fuel provider CONTINUE

TERMINATE IF YES TO A-D. CONTINUE IF ANSWER E-F.

[IF SPEAKING WITH 18 YEAR OLD, SKIP INTRO AND GO TO Q9]

PARENT INTRO TO INVITE FOR INITIAL RESPONDENT:

We are planning to hold a discussion with high school students to discuss decisions they make and hear their opinions.

PARENT INTRO TO INVITE FOR PEER REFERRAL

As mentioned, we are planning to hold a discussion with ________and some of his/her other high school peers. We want to discuss decisions they make and hear their opinions.

TOPIC DISCLOSURE – ALL PARENTS OF UNDERAGE PARTICIPANTS

This research project is being conducted by the National Highway Traffic Safety Administration (NHTSA). They are trying to understand the factors that impact teens’ decisions about drinking and driving. The research will not attempt to impact your child’s decisions or opinions, but we want to hear their opinions about what it is like to be a teen and what influences their decision-making. The organization will use the learning from this research to craft public service messaging with intent to discourage underage drinking and driving. We will not be telling this to any of the teens participating in the research prior to the discussion because we do not want to influence their opinions. However, the organization felt it was important that parents know the topic ahead of time. The discussion would last 90 minutes, would take place on (DATE) and your child would be paid $x for their time.

Now, I’d like to ask your XX age son/daughter a few questions and see if he/she is interested in participating. Would that be okay? Remember, we’d rather not have your child know the nature or purpose of the discussion until they find out during the discussion.

Could I speak with him/her? [IF PARENT WANTS TO LISTEN, INDICATE THAT WE’D RATHER THEY NOT SO THAT CHILD WILL FEEL COMFORTABLE BEING COMPLETELY HONEST. IF PARENT INSISTS, PLEASE MAKE NOTE OF THAT ON THE SCREENER AND REQUEST THAT CHILD BE ALLOWED TO ANSWER ON HIS/HER OWN.]

TO ALL 14-17 TEENS:

Hi my name is __________ . I was just speaking with your [mom/dad] about market research discussions that we’re putting together with teens your age about lifestyle influences and decisions. If you might be interested in participating in this kind of discussion, I’d like to ask you a few quick questions about yourself. Can I ask you a few questions? [UNLESS PARENT HAS OPTED TO LISTEN:] Please be assured that we will not be sharing your answers to these questions with your parents and everything you say is confidential.

9. Which of the following best describes your student status? (CHECK ALL THAT APPLY)

( ) In high school, finishing 9^th grade

( ) In high school, finishing 10^th grade

( ) In high school, finishing 11^th grade

( ) In high school, finishing 12^th grade

( ) Graduated high school TERMINATE

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

( ) Yes CONTINUE TO Q11

( ) No SKIP TO Q12

9. 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 SKIP TO Q10

MUST CURRENTLY BE IN HIGH SCHOOL. 14-15 YEAR OLDS SKIP TO Q18

9. (FOR 16+) Do you currently have a valid driver’s license?

( ) Yes CONTINUE

( ) No TERMINATE

MUST HAVE A VALID DRIVER’S LICENSE TO CONTINUE

9. (FOR 16+) Is your driver’s license a restricted license? (If needed: This may mean that you have restrictions on the ages of your passenger or the hours you can drive.)

( ) Yes

( ) No

FOR LOS ANGELES: ALLOW A MAXIMUM OF 2 RESPONDENTS WITH RESTRICTED LICENSES PER GROUP

9. (FOR 16+) Do you currently own a car, truck, or motorcycle, or have access to someone else’s vehicle that you are permitted to drive at least occasionally?

( ) Yes CONTINUE

( ) No TERMINATE

9. (FOR 16+) Which of the following statements describes your driving habits in a typical week? (READ)

A ( ) I’m a “weekday driver.” I drive mostly on weekdays, like when I commute to/from school. CONTINUE

B ( ) I’m a “weekend driver.” I spend the most time behind the wheel on weekends (Friday- Sunday). CONTINUE

C ( ) I’m a “road warrior.” I drive more than 100 miles in a typical week, whether for school, work or leisure. CONTINUE

D ( ) I’m a “moderate driver.” I drive most days, but I log fewer than 100 miles in a typical week. CONTINUE

E ( ) I’m a “driveway dweller.” I drive very little. TERMINATE

F ( ) None of these statements describe my driving behavior. TERMINATE

MUST ANSWER A-D TO CONTINUE; TERMINATE IF ANSWER E-F.

9. Where you live, do you have easy access to public transport such as buses or a subway system?

( ) Yes CONTINUE TO Q 17

( ) No SKIP TO Q18

[ASK IF YES IN Q16]

9. How often do you take public transport?

( ) Daily TERMINATE

( ) On the weekends TERMINATE

( ) During the week but not on the weekends

( ) Occasionally

( ) Hardly ever

9. Which of the following social activities, if any, have you engaged in over the past month? (READ)

( ) Dining out with friends

( ) Attending concerts or theater productions

( ) Attending house parties

( ) Hanging out with groups of friends in my home or theirs

( ) Going bowling

MUST ANSWER YES TO AT LEAST 2 OF THE ABOVE LIST TO CONTINUE

9. Now I am going to read a list of brief statements and I’d like you to tell me how much you agree or disagree with each statement. Please use a 1-7 scale where 1 means you ‘disagree completely’ and 7 means you ‘agree completely.’ Choose any number between 1 and 7 for each statement I read. Please remember as you answer these questions, that your answers are confidential and will not be shared beyond this survey. We’d like you to be as honest as possible. (READ FIRST QUESTION). How much do you agree or disagree with that statement on that scale from 1 to 7. Again, 1 is disagree completely and 7 is agree completely. [RECORD RESPONSE WITH “X” IN APPROPRIATE BOX & CONTINUE UNTIL ALL STATEMENTS ARE RATED]

	1	2	3	4	5	6	7
a. Many of my friends drink alcohol when we are in social situations.
b. Several of my peers smoke cigarettes when we’re in social situations
c. No one should drink alcohol until they are of legal drinking age.
d. I think texting and driving is wrong under all circumstances
e. I would get a ride home with a friend who has had an alcoholic drink as long as they aren’t buzzed or drunk.
f. Several of my peers smoke marijuana when we’re in social situations
e. If it’s in a safe setting, drinking is fine.

TERMINATE IF RESPONDENT SELECTS ANY SHADED BOXES.

9. During the last 12 months, how often did you usually have any kind of drink containing alcohol? By a drink we mean half an ounce of absolute alcohol (e.g. a 12 ounce can or glass of beer or cooler, a 5 ounce glass of wine, or a drink containing 1 shot of liquor). Choose only one.

( ) Every day

( ) At least once a week

( ) 2 to 3 times a month

( ) once a month

( ) 3 to 11 times in the past year

( ) 1 or 2 times in the past year

( ) I did not drink any alcohol in the past year, but I did drink in the past TERMINATE

( ) I never drank any alcohol in my life TERMINATE

TRY TO RECRUIT RANGE OF FREQUENCY

9. During the last 12 months, how many alcoholic drinks did you have on a typical day when you drank alcohol?

( ) 7 or more drinks TERMINATE
( ) 5 to 6 drinks TERMINATE
( ) 3 to 4 drinks CONTINUE
( ) 2 drinks CONTINUE
( ) 1 drink CONTINUE

TERMINATE IF ANSWER “5 TO 6 DRINKS” OR MORE. OTHERWISE, CONTINUE.

9. During the last 12 months, how often did you have 5 or more (males) or 4 or more (females) drinks containing any kind of alcohol in within a two-hour period? [That would be the equivalent of at least 5 (4) 12-ounce cans or bottles of beer, 5 (4) five ounce glasses of wine, 5 (4) drinks each containing one shot of liquor or spirits - to be provided by interviewer if asked.] Choose only one:

( ) Every day TERMINATE

( ) At least once a week TERMINATE

( ) 2 to 3 days a month TERMINATE

( ) One day a month TERMINATE

( ) 3 to 11 days in the past year CONTINUE

( ) 1 or 2 days in the past year CONTINUE

IF ANSWER ONE DAY A MONTH OR MORE OFTEN, TERMINATE. OTHERWISE CONTINUE.

9. 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.

9. I’d 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 it’s 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)

INVITATION TO RECRUIT PEERS (FOR INITIAL RESPONDENT IN EACH GROUP)

Thank you for helping with this survey. I would like to invite you to a research discussion. We are interested in holding a discussion to speak with you and five of your peers who are the same age and also [HIGH SCHOOL STUDENTS]. If you agree to participate, you will provide a list of five people your age, and I would call to ask them to attend. The discussion would be held on MM/DD/YY at XX:XX, and the session will last approximately 90 minutes. You and each participant will receive $75 cash incentive for your participation. Your participation is strictly voluntary.

[IF UNDER 18]: I will talk to your mom/dad about the date/time, but would you be interested in joining us?

( ) Yes CONTINUE & ASK TO SPEAK WITH PARENT/GUARDIAN; SKIP TO PARENT INVITATION

( ) No TERMINATE

[IF 18]: Would you be interested in joining us?

( ) Yes

( ) No TERMINATE

REFERRED INVITATION

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. __________ (referrer) and 4 other participants close to your age are also invited to participate. The session will last approximately 90 minutes. You will receive $75 cash incentive for your participation. Your participation is strictly voluntary.

[IF UNDER 18]: I will talk to your mom/dad about the date/time, but would you be interested in joining us?

( ) Yes CONTINUE & ASK TO SPEAK WITH PARENT/GUARDIAN ; SKIP TO PARENT INVITATION

( ) No TERMINATE & TRY ANOTHER PEER IDENTIFIED BY ORIGINAL RESPONDENT.

[IF 18]: Would you be interested in joining us?

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.

PARENT INVITATION FOR RESPONDENTS UNDER 18

Your child has indicated that HE/SHE is interested in participating in our discussion. The discussion would take place on MM/DD/YY at XX:XX and will last approximately 90 minutes. To show our appreciation, we would offer your child $75 to participate. This would be paid after participating in the discussion. Would you allow your child to participate?

( ) Yes

( ) No TERMINATE

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